The China Mortality Prediction Model in Trauma, which is based on the International Classification of Disease Disorders (ICD)-10-CM lexicon (CMPMIT-ICD-10),is a new trauma scoring system. Our objective was to compare the prognostic performance of the CMPMIT-ICD10 with that of the Acute Physiology and Chronic Health Evaluation II (APACHEII), Sequential Organ Failure Assessment (SOFA), Injury Severity Score (ISS), and Abbreviated Injury Scale (AIS) for in-hospital mortality in patients with traumatic hemorrhagic shock(THS).This retrospective observational cohort study was conducted at a tertiary teaching hospital from May 1, 2013, to May 31, 2023.The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, and associations with outcomes of theCMPMIT-ICD-10, APACHE II, SOFA, ISS, and AIS scores for the prediction of in-hospital death were assessed. A total of 420 patients with THS were included. Forty-one (9.8%) patients died during hospitalization. For the prediction of in-hospital death, the CMPMIT-ICD-10 (0.8757) and APACHE II(0.8709) had greater AUCs compared with the AIS (0.6243), SOFA (0.7669), and ISS (0.6601). With the best cut-off value of 59.5, the CMPMIT-ICD10 had a highest sensitivity (85.4%) and good specificity(79.9%) and overall accuracy (80.4%). The CMPMIT-ICD10 (OR 1.057, 95% CI 1.028-1.087, p < 0.001) and APACHE II (OR 1.125, 95% CI 1.045-1.211, p = 0.002) were independently associated with in-hospital death. Comparable to the APACHE II but significantly better than the SOFA, ISS, and AIS, the CMPMIT-ICD-10 performed well in predicting the short-term mortality of patients with THS. These findings suggest that the CMPMIT-ICD-10 may have superior utility for predicting short-term death in THS patients.

Purpose Severe trauma is a major cause of death and disability. Among its complications, multiple organ dysfunction syndrome (MODS) is a key late-stage condition, which is closely associated with post-traumatic cytokine storm. At present, there is a lack of reliable models for effective prediction of MODS, and the understanding of the dynamic changes of post-traumatic cytokines remains limited. This study is primarily designed to develop a predictive model for post-traumatic MODS, with a secondary aim of characterizing the features of the post-traumatic cytokine storm. Methods This is a study protocol. A prospective, multicenter, observational longitudinal study was designed. A total of 600 patients with severe trauma who have an injury severity score > 15 will be enrolled. Serum samples will be collected at 4 time points: within 8 h, 24 h, 72 h, and 168 h after injury. The temporal changes of key cytokines including interleukin-18, interferon-γ–inducible protein 10, monocyte chemoattractant protein-1, eosinophil chemotactic protein, monocyte chemoattractant protein-4, C-X-C motif chemokine ligand 12, macrophage inflammatory protein-3α, interleukin-1 receptor antagonist, cystatin C and myeloid-related protein 8/myeloid-related protein 14 will be quantitatively analyzed. The primary outcome of the study is the occurrence of MODS. Based on this, a combined multi-factor prediction model will be established and verified, and the characteristics of post-traumatic cytokine storm will be systematically described. Discussion This multicenter prospective study will provide robust evidence for the development and validation of a cytokine-based model for early prediction of MODS after severe trauma and further clarify the temporal evolution of post-traumatic cytokine storm.

Severe trauma continues to rank among the leading causes of mortality and permanent disability globally, posing an intractable public health challenge that mandates prompt sophisticated and multidisciplinary intervention. Notably, the “Chinese model” has evolved into a transformative paradigm designed to optimize the efficiency of prehospital and in-hospital trauma rescue systems. This review presents a comprehensive analysis of paradigm-shifting advances in the management of severe trauma. We systematically scrutinize the latest clinical and translational evidence underpinning life-saving resuscitation strategies, with a particular focus on the paradigm shift from aggressive crystalloid-based resuscitation to hemostatic damage control resuscitation Furthermore, we delve into innovations in core damage control techniques encompassing hemorrhage control, decompression of compartment syndromes, skeletal stabilization, and surgical source control of contamination. We also evaluate the revolutionary impact of information technology and artificial intelligence on streamlining trauma care workflows, from prehospital triage to postdischarge follow-up. Additionally, through a cross-country comparison of trauma system configurations, we address the pivotal role of standardized quality control metrics and centralized trauma registries in mitigating regional disparities in trauma care outcomes. By synthesizing these cutting-edge developments, this review endeavors to explore future directions for the construction of a more resilient and intelligent high-performance trauma care system. Looking ahead, the integration of advanced technologies, personalized medicine, and cross-border collaboration holds promise for further enhancing trauma care efficiency and equity, ensuring that trauma systems evolve to meet the challenges of increasingly complex and dynamic healthcare environments.

Objective This qualitative study aimed to explore the self-management dilemmas faced by patients with diabetes in Chinese primary care and collect suggestions for improvement.Design Qualitative methods are used in this study. Thematic analysis was used to analyse the transcripts.Setting Four primary care communities in Beijing. The interviews were conducted between April and August 2025.Participants This qualitative study used face-to-face, semi-structured interviews with 32 patients with type 2 diabetes. Data collection continued until information saturation was reached.Results Four core themes and multiple subthemes were identified. The first theme, ‘Inadequate Disease Cognition and Health Literacy’, showed that patients had a limited understanding of diabetes, often delaying diagnosis and only learning about complications after they appeared. Misconceptions about diet and a lack of medication management knowledge were also common. The second theme, ‘Suboptimal Daily Management’, highlighted that physical activity was unstructured, glucose monitoring was irregular and emergency response capabilities were poor. The third theme, ‘Fragmented Healthcare Resources and Inadequate Family Support’, revealed systemic barriers such as limited primary care competencies, homogeneous health education formats that failed to meet patients’ needs and insufficient family support. The fourth theme, ‘Limitations in Self-Management Decision-Making’, demonstrated that patients’ decision-making processes were predominantly experience-driven, relying on personal or communal anecdotes rather than scientific medical evidence.Conclusions The self-management challenges among Chinese patients with diabetes in primary care are a complex interplay of inadequate individual cognition, suboptimal daily practices and fragmented support systems. The study suggests that future interventions should focus on enhancing general practitioner training, developing culturally sensitive health education and rebuilding family and community support networks to sustainably resolve these management dilemmas.

Background and Objectives:In response to the characteristics of frequent data interactions between pre-hospital emergency care and multi-departmental in-hospital systems, along with complex transmission pathways, we established a dynamic assessment methodology covering the entire data lifecycle and analyzed the status of data security risks within China's trauma care system. This study aims to develop a security risk assessment index for trauma data security (TDSI). Methods:Evaluation indicators were established through qualitative interviews, literature reviews, and Delphi expert consultations. The weight for indicators was determined using the analytic hierarchy process (AHP). National surveillance employing a multi-stage random cluster sampling method was conducted at 80 trauma centers in 31 provincial-level administrative units in China in 2023. The Delphi expert consultation recruited administrators, clinicians, and data specialists from trauma centers across various regions of China. Twenty experts from various regions of China were recruited for the Delphi study. Results:The response rate for the final survey was 95%. The TDSI system consisted of three dimensions and 36 indicators. The weight was 0.388 for trauma care data management from the clinical department, 0.342 for information security technologies from the IT department, and 0.270 for data security policies from the management department. The overall TDSI across all trauma centers was 60.27, varying from 25.7 to 82.1 across trauma centers. The northern region had the highest TDSI (66.32). Conclusions:This study developed a TDSI using a modified Delphi method. This index system is a scoring framework that focuses on clinical, management, and IT capabilities that determine the prioritization of data security enhancements for trauma centers.

Sepsis causes high mortality and resource strain, with neutrophil-derived reactive oxygen species (ROS) contributing to excessive inflammation. The secretory protein FAM19A4 modulates ROS release, but its role in sepsis is unclear. In this study, we find elevated FAM19A4 levels in septic patients and cecal ligation and puncture (CLP) mice, which correlate with increased mortality. Fam19a4 -/ - mice subjected to CLP show significantly improved survival and attenuated multiorgan injury without impaired peritoneal bacterial clearance or altered circulating neutrophil counts. FAM19A4 deficiency reduces the cell counts of neutrophils (Ly6G +) and macrophages (F4/80 +) in the lungs and liver, diminishes systemic ROS production tracked by bioluminescence, and decreases neutrophil extracellular trap (NET) formation in serum and lung tissue. In vitro, FAM19A4 enhances neutrophil phagocytosis and ROS generation but does not affect lipopolysaccharide-induced chemotaxis. Mechanistically, FAM19A4 drives neutrophil ROS release specifically through p38 MAPK signaling activation, as revealed by bulk RNA sequencing, western blot analysis, and treatment with p38 inhibitor SB203580. These results indicate that FAM19A4 is upregulated during sepsis and exacerbates outcomes by enhancing neutrophil ROS production via p38 MAPK, representing a promising therapeutic target for this condition.

OBJECTIVE:To explore the feasibility of establishing a temporary trauma team led by trauma experts in primary hospitals for disaster medical rescue. METHODS:In the coal mine flooding accident in Xiaoyi City, Shanxi Province on December 15, 2021, according to the local emergency plan and the characteristics of the accident, the trauma experts trained the medical staff from the local primary hospital on advanced trauma life support (ATLS) and damage control surgery (DCS) in the short time interval between the occurrence of the mine disaster and the admission of medical staff to the disaster scene. A temporary trauma team composed of trauma experts, ATLS team, and DCS team was formed to provide early diagnosis and treatment for survivors before and in the hospital. RESULTS:The miners were found on the 36th hour of the disaster. All 22 miners were male, and 2 died underground. Another 20 people were rescued 39－43 hours after the disaster, with a median age of 48 years (34-57 years). All the survivors suffered from hypothermia, dehydration, maceration of feet and other injuries. There were 18 cases of acute inhalation tracheobronchitis, 14 cases of electrolyte acid-base disturbance, 6 cases of trunk contusion, 1 case of psoas major hematoma, and 1 case of lower extremity hematoma. Deep vein thrombosis was in 4 cases. The ATLS team focused on injury assessment, rewarming and rehydration within 50－60 minutes before admission, and completed auxiliary examinations within 2 hours after admission to clarify the diagnosis. The DCS team evaluated 6 patients with mechanical blunt trunk injury and excluded the indication of emergency surgery. The trauma experts conducted the whole process of supervision and quality control of disaster rescue. The positive rate of capillary refill test in the all survivors at the third hour of admission was significantly lower than that immediately after being rescued (75.0% vs. 15.0%, P=0.000 3), and they were discharged 4－7 days after admission. CONCLUSION:Under the leadership of trauma experts and relying on the medical staff of primary hospitals, it is feasible to establish and train a temporary trauma team with ATLS and DCS functions to participate in the medical rescue of disasters, which is in line with the current national conditions of China.

BACKGROUND:Unsupervised traumatic brain injury (TBI) lesion detection aims to identify and segment abnormal regions, such as cerebral edema and hemorrhages, using only healthy training data. Recent advancements in generative models have achieved success in unsupervised anomaly detection by transforming abnormal patterns into normal counterparts. However, current mask-free image generators often fail to maintain semantic consistency of anatomical structures during the restoration process. This limitation negatively impacts residual-based anomaly detection, particularly in cases where structural deformations occur due to the mass effect of TBI lesions. PURPOSE:This study aims to develop a semantic-consistent, unsupervised TBI lesion detection and segmentation method that minimizes false positives by preserving normal tissue consistency during the image generation process while addressing mass effect-related tissue deformations. METHODS:We propose the semantic-consistent diffusion model (SCDM) for unsupervised TBI lesion detection, focusing on the localization and segmentation of various lesion types from noncontrast CT scans of TBI patients. Leveraging the high-quality image generation capabilities of unconditioned diffusion models (DM), we introduce a normal tissue retainment (NTR) regularization to ensure that normal tissues remain unaltered throughout the iterative denoising process. Furthermore, we address normal tissue compression and deformation caused by the mass effect of TBI lesions through diffeomorphic registration, reducing erroneous activations in residual images and final lesion maps. RESULTS:Extensive experiments were conducted on three publicly available brain lesion datasets and one internal dataset. These datasets comprised 75, 51, 92, and 56 CT scans, respectively. Thirty seven CT scans without TBI lesions were used for training and validation, while the remaining scans were used for testing. The proposed method achieved average DSC of 0.56, 0.51, 0.47, and 0.52 and AUPRC of 0.57, 0.48, 0.53, and 0.50 on the BCIHM, BHSD, Seg-CQ500, and internal datasets, respectively, surpassing state-of-the-art unsupervised methods for TBI lesion detection and segmentation. An ablation study validated the effectiveness of the proposed NTR regularization and diffeomorphic registration-based mass effect simulation. CONCLUSIONS:The results suggest that the proposed SCDM enables effective TBI lesion detection and segmentation across diverse TBI CT scans. It significantly reduces false positives by addressing inconsistencies in normal tissue during the iterative image restoration process and mitigating mass effect-induced tissue deformations.

BACKGROUND:Malignant arrhythmia induced by traumatic hemorrhage is a leading cause of early mortality in hemorrhagic shock. Understanding the mechanisms driving these arrhythmias and identifying therapeutic targets are critical for improving early survival in patients with traumatic hemorrhagic shock. METHODS:Peripheral blood samples from patients with hemorrhagic shock were collected and analyzed for peptidylarginine deiminase 2 (PAD2) protein levels using ELISA. Pad2 knockout mice ( Pad2 -/- , Pad2 KO) were generated, and the hemorrhagic shock model was constructed via femoral artery cannulation and bloodletting. Cardiomyocytes were isolated and contractility and calcium content were measured by confocal microscopy. PAD2 subcellular localization was assessed through immunofluorescence and Western blotting. Proteins interacting with PAD2 in cardiomyocytes were identified using co-immunoprecipitation followed by mass spectrometry (CoIP-MS). The effect of PAD2 on sarcoplasmic reticulum calcium-ATPase 2a (SERCA2a) activity and citrullination was evaluated through enzyme activity assays and protein citrullination detection. AAV9-PAD2 was injected into mice via tail vein to induce in vivo overexpression of PAD2 in the myocardium. The effects of PAD2 enzymatic activity mutations and a PAD2-specific inhibitor on survival rate and arrhythmia following hemorrhagic shock were assessed through intraperitoneal injection. RESULTS:PAD2 protein levels were significantly elevated in the peripheral blood of patients with hemorrhagic shock. Pad2 knockout improved calcium homeostasis in the sarcoplasmic reticulum of cardiomyocytes and alleviated post-shock arrhythmia in mice. Following hypoxia, PAD2 exhibited increased colocalization with the sarcoplasmic reticulum. During hypoxia, PAD2 inhibited SERCA2a activity through citrullination. AAV9-mediated overexpression of PAD2 in cardiomyocytes worsened both survival rates and the incidence of ventricular arrhythmia following hemorrhagic shock in mice. Conversely, PAD2 enzymatic activity mutations and a PAD2-specific inhibitor improved survival rates and reduced arrhythmia after hemorrhagic shock. CONCLUSION:During myocardial hypoxia occurs in hemorrhagic shock, PAD2 reduces SERCA2a enzyme activity by citrullination, disrupting myocardial calcium homeostasis. Peptidylarginine deiminase 2 gene deficiency or inhibition improves ventricular arrhythmias and increases survival following hemorrhagic shock. LEVEL OF EVIDENCE:Original Research-basic sciences research; not applicable.

OBJECTIVES:To explore data security risks associated with trauma medical data within hospitals in China, identify and explore the potential underlying factors contributing to these risks and collect suggestions from different stakeholders. DESIGN:This is a qualitative study involving two types of hospital personnel. Data analysis was performed using thematic analysis. SETTING:The study was conducted in 21 tertiary hospitals from 12 provinces in China, distributed across the eastern, central and western regions of the country. The interviews were conducted between April and August 2022. PARTICIPANTS:A total of 27 respondents (7 department heads and 20 doctors) were interviewed through stratified purposive sampling. RESULTS:Data security risks associated with trauma medical data might arise from trauma physicians' inadequate management of trauma data, the absence of trauma data administrators and data management systems and the lack of security measures for trauma databases. Feasible suggestions included training trauma physicians, establishing a trauma data administrator and a trauma data management system and improving basic data security protection measures. CONCLUSIONS:Determining the risks of trauma medical data security and providing tailored suggestions contribute to the development of healthcare data governance in China. This research establishes a foundation for addressing the current risks related to trauma medical data security and could contribute to efforts to improve the overall capacity of trauma data management in China.

Aptamers represent a distinct category of short nucleotide sequences or peptide molecules characterized by their ability to bind to specific targets with high precision. These molecules are predominantly synthesized through SELEX (Systematic Evolution of Ligands by Exponential Enrichment) technology. Recent findings indicate that aptamers may have significant applications in regenerative medicine, particularly in the domain of tissue repair. In comparison to other bioactive agents, aptamers exhibit superior specificity and affinity, are more readily accessible, and can be chemically modified, thereby presenting a promising avenue for the functionalization of tissue engineering materials in tissue repair applications. This review delineates the properties of aptamers and examines the methodologies and advancements related to aptamer-functionalized hydrogels, nanoparticles, and electrospun materials. It categorizes the four primary functions of aptamers in tissue repair, namely regeneration, delivery systems, anti-inflammatory actions, and pro-coagulation effects. Furthermore, the review explores the utilization of aptamer-functionalized tissue engineering materials in the repair of bone, nerve, and vascular tissues, highlighting the mechanisms by which aptamers facilitate tissue growth and repair through regenerative properties and their role in transporting substances that promote repair. Lastly, the review addresses the future prospects and challenges associated with the application of aptamers in tissue repair, offering novel insights and directions for further research and application in this domain.

Severe hemorrhage and its associated complications represent the primary causes of mortality among trauma patients. Consequently, the development of hemostatic materials that exhibit rapid and effective hemostatic properties, alongside favorable biocompatibility, anti-infective characteristics, and anti-inflammatory capabilities, is of paramount importance. Drawing inspiration from the structure of shark skin, this research introduces chitosan/gelatin microspheres characterized by a wrinkled morphology, which facilitate hemostasis through the mechanisms of physical adsorption and coagulation inherent to their structure. Furthermore, a thrombin receptor-activating peptide (TRAP6) was incorporated into the microspheres via polydopamine (PDA) surface modification, enhancing the aggregation of activated platelets and red blood cells at the site of injury, thereby improving the hemostatic efficacy of the microspheres. Our findings further demonstrate that these chitosan/gelatin microspheres promote the healing of infected wounds, showcasing significant hemostatic, antibacterial, and anti-inflammatory properties, as well as the capacity to mitigate oxidative stress. Thus, the chitosan/gelatin microspheres developed in this study hold considerable promise for widespread application in hemostasis and the management of various infected wounds.

BACKGROUND:The lack of a stable, easy-to-operate animal model for severe trauma has hindered the research progress. The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma, providing a reliable research tool. METHODS:Male C57BL/6J mice (aged 8-10 weeks and weighting approximately 20 g) were used to establish the severe trauma model. Under anesthesia, a midshaft femoral fracture was created and packed with sterile cotton. A midline incision was made from the inguinal region to the sternum, exposing the abdominal organs for 30 min. The right femoral artery was cannulated to induce controlled blood loss at 30%, 35%, 40%, and 50% of the total blood volume. Survival rates were monitored for 24 h post-induction. In the mice that experienced 30% blood loss, the mean arterial pressure, body temperature, blood gas parameters, peripheral blood inflammatory markers, and major organ pathological changes were assessed. RESULTS:Mice with femoral fractures, soft tissue injuries, abdominal organ exposure, and 30% blood loss exhibited stable survival rates. Increased blood loss significantly reduced survival rates. Mean arterial pressure decreased initially, recovering within 0-15 min and returning to baseline by 50 min. Similarly, the body temperature decreased initially and gradually recovered to baseline within 50 min. Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury. Distant organs, including intestines, lungs, liver, spleen and kidneys, displayed varying degrees of injury. CONCLUSION:The established mouse model replicates the pathophysiological responses to severe trauma, indicating stability and reproducibility, which could be an useful tool for further trauma research.

PURPOSE:Early mortality in major trauma has decreased, but MODS remains a leading cause of poor outcomes, driven by trauma-induced cytokine storms that exacerbate injuries and organ damage. METHODS:This prospective cohort study included 79 major trauma patients (ISS >15) treated in the National Center for Trauma Medicine, Peking University People's Hospital, from September 1, 2021, to July 31, 2023. Patients (1) with ISS >15 (according to AIS 2015), (2) aged 15-80 years, (3) admitted within 6 h of injury, (4) having no prior treatment before admission, were included. Exclusion criteria were (1) GCS score <9 or AIS score ≥3 for TBI, (2) confirmed infection, infectious disease, or high infection risk, (3) pregnancy, (4) severe primary diseases affecting survival, (5) recent use of immunosuppressive or cytotoxic drugs within the past 6 months, (6) psychiatric patients, (7) participation in other clinical trials within the past 30 days, (8) patients with incomplete data or missing blood samples. Admission serum inflammatory cytokines and pathophysiological data were analyzed to develop machine learning models predicting MODS within 7 days. LR, DR, RF, SVM, NB, and XGBoost were evaluated based on the area under the AUROC. The SHAP method was used to interpret results. RESULTS:This study enrolled 79 patients with major trauma, and the median (Q1, Q3) age was 51 (35, 59) years (52 males, 65.8%). The inflammatory cytokine data were collected for all participants. Among these patients, 35 (44.3%) developed MODS, and 44 (55.7%) did not. Additionally, 2 patients (2.5%) from the MODS group succumbed. The logistic regression model showed strong performance in predicting MODS. Ten key cytokines, IL-18, Eotaxin, MCP-4, IP-10, CXCL12, MIP-3α, MCP-1, IL-1RA, Cystatin C, and MRP8/14 were identified as critical to the trauma-induced cytokine storm and MODS development. Early elevation of these cytokines achieved high predictive accuracy, with an AUROC of 0.887 (95% CI 0.813-0.976). CONCLUSION:Trauma-induced cytokine storms are strongly associated with MODS. Early identification of inflammatory cytokine changes enables better prediction and timely interventions to improve outcomes.

Osteoporotic (OP) fractures remain a tough clinical challenge owing to their impaired healing outcome, which requires novel biomaterials with osteogenicity for effective healing. Metallic zinc (Zn) is attracting increasing attention for biodegradable intramedullary nails (IMNs) for OP fracture healing thanks to their comprehensive mechanical properties, biosafety, and bioactivity. However, the multiple biofunctions required for OP fracture healing have not been fully met by Zn. Herein, a zoledronate (ZA)-mediated calcium-zinc silicate (Ca(Zn)Si) metal-organic/inorganic hybrid coating was fabricated on Zn-based IMN by coordination chemistry driven via interactions between ZA and Ca2+/Zn2+ as well as in-situ directional growth of Ca(Zn)Si phase. The ZA&Ca(Zn)Si hybrid coating exhibited a homogeneous micro/nanostructure with a granular morphology, which prevented premature fracture failure of IMN in rat femur by ameliorating corrosion mode and decreasing degradation rate of the Zn matrix. More importantly, this hybrid coating enabled sustained release of Zn2+/Ca2+/Si4+ and ZA in the long term, achieving a remarkable effect on vascularized bone regeneration. The coated IMN enhanced angiogenesis–osteogenesis coupling through autocrine and paracrine effects between endothelial cells and bone marrow mesenchymal stem cells. Osteoclastogenesis was repressed by Zn2+ and ZA. This approach offers a new strategy for surface-engineering of biodegradable metals for bone fracture healing.

This study developed novel porphyrinized carbon quantum dots (pCQDs) with unique physical bactericidal properties, visual tracking capabilities, and broad-spectrum antibacterial effects to combat resistant pathogens. The positively charged surface of pCQDs facilitates electrostatic interactions with bacterial membranes, leading to membrane disruption and effective physical bactericidal action, while significantly reduce the risk of resistance development. Additionally, pCQDs emit red fluorescence during antibacterial activity, allowing real-time visualization of bacterial damage. In vitro assays confirmed that pCQDs exhibit robust bactericidal effects against both Gram-positive and Gram-negative bacteria. In a Balb/c mouse MRSA wound model, pCQDs reduced wound area to 36.6 % on day 8, outperforming the control (60.8 %) and vancomycin (56.6 %) groups, demonstrating superior early-stage antibacterial efficacy. Meanwhile, pCQDs exhibited excellent biosafety both in vitro and in vivo. Transcriptomic analysis further revealed that pCQDs induced metabolic dysregulation in MRSA by physically interfering membrane transporters, leading to disruption of organic acid and amino acid metabolism, inhibition of cell wall biosynthesis, and energy collapse. Concurrently, in E.coli, pCQDs disrupted ion metabolism and impaired respiratory chain activity and signal transduction pathways, resulting in energy depletion and cell death. In summary, pCQDs represent a safe and effective antibacterial strategy, offering new possibilities for the innovative application of antibacterial materials in infection treatment.

BackgroundThis study aimed to establish the reference range of the neutrophil-to-lymphocyte absolute ratio (NLR) in healthy individuals, explore the association between NLR and post-trauma nosocomial infections, and evaluate the effectiveness of NLR in predicting clinical outcomes of post-trauma infections.MethodsA retrospective analysis was conducted based on medical records of acute trauma patients from the China National Center for Trauma Medical and health examination data from Chengdu First People’s Hospital, Sichuan Province. The reference range of NLR was established, and multivariate logistic regression analysis was performed to identify risk factors for infection, with subgroup analysis conducted by age. The predictive value of NLR for post-trauma infections was assessed using the area under the receiver operating characteristic curve (AUC).ResultsA total of 175,019 individuals were included, comprising 165,504 healthy individuals (753 minors [0.45%, <18 years] and 164,751 adults [99.55%]) and 9,515 acute trauma patients (8,602 in the control group [90.40%] and 913 with post-trauma infections [9.60%]). The 2.5th-97.5th percentile range for NLR was 0.69-3.48 in minors and 0.86-3.83 in adults. NLR was identified as an independent risk factor for post-trauma infections, with an odds ratio (OR) of 1.43 (95% CI: 1.18-1.73). Additionally, NLR showed a positive correlation with common inflammatory markers, CRP (r = 0.37 [0.32-0.42], weak correlation) and PCT (r = 0.52 [0.45-0.58], moderate correlation). Receiver operating characteristic (ROC) analysis demonstrated that NLR had an AUC of 0.71 (95% CI: 0.69-0.73, P < 0.0001) for predicting infections, with a diagnostic cutoff value of 4, sensitivity of 60.28% (95% CI: 59.24-61.31), and specificity of 72.85% (95% CI: 69.71-75.77). No significant differences in NLR values were observed between groups with pulmonary infections, urinary tract infections, combined pulmonary and urinary infections, and soft tissue infections (P > 0.05). However, NLR values were significantly higher in patients with fungal infections compared to those without (P = 0.03).ConclusionThe current 2.5th-97.5th percentile range of NLR is 0.69-3.48 in minors and 0.86-3.83 in adults. With increasing age, the reference range widens, and females tend to have a slightly broader range than males. NLR is an independent risk factor for post-trauma infections, showing higher predictive value in patients over 60 years of age. Although NLR cannot differentiate infection sites or pathogen types, elevated NLR values may provide a reference for identifying fungal infections.

Background: Peripheral nerve injury is a challenging orthopedic issue in clinical management that often leads to limb dysfunction or even disability in severe cases. A thorough exploration of the repair process of peripheral nerve injury and the underlying mechanism contributes to formulate more effective therapeutic strategies. Methods: In the present study, we established a sciatic nerve transection injury model in Sprague-Dawley (SD) rats. A 12-week compensatory repair of sciatic nerve transection injury using a chitin cannula for small gap anastomosis was then performed via sleeve jointing the proximal common peroneal nerve to the distal tibial nerve and common peroneal nerve, with a 2 mm interval. Compensatory repair via small gap amplification was observed via gross observation of nerve specimen, osmic acid staining, and electrophysiological stimulation of sciatic nerve branches of the tibial and common peroneal nerve. Rat limbs were observed, and the functional recovery of effector muscles of the gastrocnemius and tibialis anterior muscles was assessed through weighing the muscle wet weight, Hematoxylin and Eosin (H&E) staining, and muscle strength detection. H&E staining, Masson staining, and toluidine blue staining were performed to observe the morphological changes of the dorsal root ganglion. Positive expressions of key proteins involved in the Phosphatase and tensin homologue deleted on chromosome ten (PTEN)-protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling pathway, including PTEN, AKT, mTOR, Toll-like receptor 4 (TLR4), and Caspase9 in the dorsal root ganglion during compensatory repair of sciatic nerve after injury via small gap amplification, were detected by immunohistochemical staining. Results: It is found that the compensatory repair of sciatic nerve transection injury using a chitin cannula for small gap anastomosis via sleeve jointing effectively restored the continuity, number of myelinated nerve fibers, and nerve conduction velocity. It promoted toe abduction recovery, improved muscle fiber morphology and increased the wet weight and muscle strength of the gastrocnemius muscle and tibialis anterior muscle. Moreover, it increased the number of neurons and nerve fibers, and improved their morphology. Downregulated PTEN, TLR4, and Caspase9 in the dorsal root ganglia and upregulated AKT and mTOR were observed after small gap amplification than those of the transection injury group, which were closer to those of the control group. Conclusions: Compensatory repair of sciatic nerve transection injury using a chitin cannula for small gap anastomosis via sleeve jointing can restore the morphology and function of the sciatic nerve, effector muscles, and corresponding dorsal root ganglia by activating the PTEN-AKT/mTOR signaling pathway in the dorsal root ganglia. Our findings provide novel therapeutic targets for peripheral nerve injuries.