[This corrects the article DOI: 10.3389/fimmu.2025.1679750.].

BACKGROUND:The transfusion of uncross-matched O-type red blood cells(URBCs)is the global standard of care for emergency resuscitation in trauma.However,its application in China remains limited due to concerns over safety and resource availability.This study aimed to evaluate the clinical efficacy and safety of URBCs in patients with severe pelvic fractures. METHODS:In this multicenter,retrospective cohort study(2019-2023),patients with severe pelvic fractures(Abbreviated Injury Scale[AIS]≥3)transfused within 24 h of admission were stratified into the URBC and non-URBC groups.Propensity score overlap weighting(PSOW)was used to address confounding factors.The primary outcome was 30-day in-hospital mortality.Secondary outcomes included length of stay(LOS),24-hour blood product consumption,and in-hospital complications. RESULTS:A total of 526 patients were included(URBC group,n=57;non-URBC group,n=469).After PSOW adjustment,there was no significant difference in 30-day mortality(21.4%vs.21.3%,P=0.989)between the URBC and non-URBC groups.However,the URBC group received significantly lower volumes of plasma,platelets,and cryoprecipitate within the first 24 h(all P<0.05).No clinically significant acute hemolytic transfusion reactions were observed during the study period.Furthermore,subgroup analysis of non-O-type blood recipients(57.1%)showed no significant differences in mortality compared with their O-type counterparts,and no acute hemolytic transfusion reactions were observed. CONCLUSION:Early administration of URBCs for severe pelvic fractures is safe.While not associated with increased mortality or hemolytic transfusion reactions,early use of URBCs was linked to a significant reduction in coagulation-related blood product consumption.This study provides evidence supporting the implementation of URBC within resource-constrained trauma setting to improve resuscitation efficiency.

Mitophagy has emerged as a key regulator in lung injury, presenting new avenues for therapeutic intervention. Lung injury, often caused by infections, trauma, or inhalation of toxic gases, disrupts lung tissue integrity and function, frequently leading to pulmonary fibrosis. Mitophagy serves a dual purpose: it removes damaged mitochondria, reducing oxidative stress and preventing cell death, thereby offering protection in acute lung injury. However, excessive mitophagy can deplete mitochondria, impair energy metabolism, and aggravate tissue damage. Throughout the progression of lung injury, mitophagy finely tunes inflammation, immune responses, and cell survival, helping to modulate cytokine storms and delay fibrosis. Additionally, it influences metabolic reprogramming and intercellular communication, affecting critical cell types such as alveolar epithelial cells, macrophages, and fibroblasts, which are essential for tissue repair and regeneration. Although the precise molecular mechanisms remain under investigation, mitophagy is increasingly recognized as a promising therapeutic target for lung injury and fibrosis. The future challenge lies in achieving a precise balance in the regulation of mitophagy to maximize its protective effects while minimizing potential harm, thereby opening new pathways for innovative therapeutic strategies.

BackgroundIdiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease characterized by excessive fibroblast activation and extracellular matrix deposition, leading to severe tissue remodeling and poor prognosis. While current treatments offer limited efficacy. Emerging evidence suggests cuproptosis, a novel form of copper-dependent cell death, as a potential mechanism influencing fibroblast survival and fibrogenesis.MethodsBulk RNA sequencing (RNA-seq), single-cell RNA sequencing (scRNA-seq), and spatial transcriptomics were utilized to analyze gene expression profiles from IPF patient samples and healthy controls. Differentially expressed genes related to copper regulation and cell death pathways were identified using machine learning algorithms. Immune infiltration was assessed using CIBERSORT, and cell-cell interactions were explored using the CellChat algorithm. Gene set variation analysis (GSVA) and gene set enrichment analysis (GSEA) were employed to explore the role of nicotinamide phosphoribosyltransferase (NAMPT) in cuproptosis and fibrosis-related pathways.ResultsTranscriptomic analysis identified NAMPT as a key hub gene in IPF, with strong positive correlation to cuproptosis. Spatial transcriptomics revealed elevated cuproptosis activity in NAMPT+ fibroblasts localized in fibrotic lesions. Additionally, NAMPT+ fibroblasts exhibited increased crosstalk with M2 macrophages through the C3-ITGB2 complement pathway, implicating NAMPT in promoting fibroblast activation and shaping a pro-fibrotic immune microenvironment.ConclusionThis study identifies NAMPT as a critical regulator of cuproptosis in IPF fibroblasts and highlights its dual role in fibroblast activation and immune modulation. Targeting NAMPT offers a promising therapeutic strategy for modulating fibroblast behavior, reducing fibrosis, and disrupting the pro-fibrotic cell communication network in IPF.

Glucose metabolism is the core process by which cells obtain energy, providing adenosine triphosphate and metabolic intermediates through glycolysis and the tricarboxylic acid cycle and supporting cell proliferation, migration, and functional maintenance. It not only fuels cells but also cranks out nicotinamide adenine dinucleotide phosphate (NADPH) via the pentose phosphate pathway. This NADPH is crucial for fending off oxidative stress, keeping immune responses in check, and playing a role in cell signaling. During the process of wound healing, glucose metabolism plays a crucial role in each stage. In the early stage, cells rely on glycolysis to generate energy for proliferation and migration; during the inflammatory phase, immune cells generate reactive oxygen species through glucose metabolism to eliminate pathogens; and during the proliferation and remodeling phase, glucose metabolism supports the generation of the extracellular matrix and tissue repair. However, in chronic wounds, abnormal glucose metabolism increases oxidative stress and inflammatory responses, significantly delaying wound healing. Understanding how abnormal glucose metabolism affects the wound microenvironment and cell function can help researchers develop new therapeutic strategies. Therefore, this review breaks down how glucose metabolism works at each stage of wound healing. We are highlighting its potential as something we can target therapeutically, and hoping to spark some fresh ideas and avenues for research and clinical use down the road.

BACKGROUND:Internal iliac artery embolization (IIAE) is a critical hemostatic intervention for controlling hemorrhage in patients with hemodynamically unstable pelvic fractures (HUPF). However, the optimal technique-nonselective versus selective embolization-and the choice of embolic materials remain debated. This study compares the efficacy, safety, and clinical outcomes of nonselective embolization (NSE) and selective embolization (SE) techniques in patients with HUPF. A secondary analysis examined the impact of different embolic materials on patient outcomes. METHODS:This multicenter retrospective study included patients aged 16 and older with HUPF who underwent IIAE. Patients were categorized into NSE or SE groups. Key outcomes included 24-h red blood cell (RBC) transfusion volume, duration of angioembolization (AE), complications, mortality, and infection rates. Propensity score overlap weighting (PSOW) was used for comparisons, with validation via propensity score matching (PSM). Subgroup analyses also employed PSOW to assess outcomes based on embolic materials. RESULTS:A total of 296 patients with HUPF met the inclusion criteria, with 214 undergoing NSE and 82 receiving SE. After PSOW, near-perfect comparability between the two groups was achieved (SMDs = 0). The NSE group had significantly lower 24-h RBC transfusion volumes (2.00 vs. 4.00 units, MD, -2 units; 95% CI, -2.0 to 0; and p = 0.018) and shorter AE duration (65 vs. 80 min, MD, -15 min; 95% CI, -20 to -5.16; and p < 0.001). NSE group also required less 24-h plasma transfusion. Although the NSE group showed higher rates of deep vein thrombosis and urinary tract infection in PSOW analysis, subsequent PSM analysis revealed no significant differences between groups. Similarly, both groups showed comparable rates of other complications, hospital costs, and mortality rates. Subgroup analysis showed that the gelatin sponge (GS) group had higher 24-h RBC transfusion volumes and longer AE durations, though these were not statistically significant. Notably, the GS group had significantly higher rates of pulmonary infections and incision/pin tract infections. CONCLUSION:Nonselective embolization appeared to be associated with reduced RBC transfusion needs and provide faster hemorrhage control, though this did not translate to a survival benefit. The evidence regarding NSE's effect on specific complication risks was inconclusive. Subgroup analysis showed coils were associated with fewer complications than GS. Further prospective studies are needed to clarify the optimal technique and materials.

Despite advancements in trauma care, uncontrolled hemorrhage and trauma-induced coagulopathy (TIC) remain the leading causes of preventable deaths after trauma. Understanding the genetic underpinnings and molecular mechanisms of TIC is crucial for developing effective diagnostic and therapeutic strategies. This study employed a comprehensive bioinformatics approach to elucidate the genetic landscape associated with TIC. Gene expression data from 20 samples, comprising 10 controls and 10 severe trauma patients with TIC, were analyzed. This approach included principal component analysis, differential gene expression analysis using DESeq2, Gene Set Enrichment Analysis (GSEA), weighted gene co-expression network analysis (WGCNA), and machine learning (ML) algorithms (support vector machine-recursive feature elimination, least absolute shrinkage and selection operator, and random forest) for feature gene identification. Functional analysis of genes and immunoinfiltration analysis were also conducted. A total of 1014 differentially expressed genes (DEGs) were identified, indicating significant genetic alterations in TIC. GSEA confirmed the involvement of critical pathways, and WGCNA identified 35 relevant gene modules. The integration of ML algorithms highlighted nine key feature genes (TFPI, MMP9, ABCG5, TPSAB1, TK1, IGKV3D.11, SAMSN1, TIMP3, and GZMB). Immunoinfiltration analysis revealed distinct immune cell compositions in TIC samples. The multifactor regulation network provided insights into complex gene regulatory mechanisms. This study presents a detailed genetic and molecular profile of TIC. Integrating various bioinformatics tools and ML algorithms has enabled the identification of potential biomarkers and therapeutic targets. These findings could significantly contribute to improving the diagnostic accuracy and treatment efficacy for patients with TIC, potentially reducing the mortality rates associated with trauma.

Background:Patients affected by heat stroke (HS) develop myocardial injury at an early stage and exhibit a significantly higher risk of death than those without myocardial injury. Methods:We used WGCNA and myocardial tissue transcriptome sequencing to identify candidate DEGs associated with HS-induced myocardial injury. Immune infiltration and functional enrichment analyses were performed to investigate the correlation between candidate DEGs and immune cell populations and their biological functions. Protein-protein interaction (PPI) network analysis was used to identify hub genes. Clinical validation was performed through ELISA of blood samples from patients with HS, followed by construction of a hub gene-based prognostic nomogram. Additionally, the L1000FWD platform was used to screen potential small-molecule therapeutic drugs. Finally, we established HS mice models and cellular models to validate the therapeutic efficacy and underlying mechanisms of the selected compounds. Results:Thirteen candidate DEGs were identified in the HS myocardial tissues. Immune infiltration analysis showed significant positive correlations between these DEGs and macrophages, NK cells, and dendritic cells. Functional enrichment analysis indicated that the candidate DEGs were predominantly enriched in the MAPK signaling pathway. PPI network analysis identified JUN as a key hub gene in HS-induced myocardial injury. Clinical validation showed that c-Jun levels were significantly elevated in patients with than in those without HS myocardial injury (p < 0.001) with an area under the curve (AUC) of 0.781 that indicated diagnostic accuracy. A prognostic nomogram based on c-Jun achieved an AUC of 0.906 for predicting patient outcomes. Furthermore, the L1000FWD platform identified ZG-10 as a potential therapeutic drug. In vivo and in vitro experiments showed that ZG-10 improved cardiac function in HS mouse models, alleviated c-Jun-mediated inflammatory responses and apoptosis in myocardial tissues, and inhibited the JNK/p38 MAPK pathway to downregulate c-Jun expression. Conclusions:This study has systematically elucidated the central role of c-Jun in HS-induced myocardial injury. We have provided a novel biomarker for early diagnosis and prognostic evaluation of HS-induced myocardial injury. Additionally, we have identified ZG-10 as a potential therapeutic drug for HS-induced myocardial injury, which is a new treatment strategy for this condition.

Introduction:Amputation among children and adolescents, with its substantial physical, psychological, and economic impacts, remains a significant global health issue. Objectives:This study uses data from the Global Burden of Disease (GBD) to examine trends in amputation burden among youth aged 0-19 from 1990 to 2021. Methods:This study utilized the 2021 GBD dataset, focusing on the incidence, prevalence, and years lived with disabilities (YLDs) associated with amputations. We applied pinpoint regression and age-period-cohort models to explore trends across the socio-demographic index (SDI) regions, GBD regions, and sex groups from 1990 to 2021, while also forecasting the burden of amputations up to 2040. Results:We found a global decline in the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized YLDs rate (ASYR) for children and adolescents. Specifically, the ASIR decreased from 207.3 per 100,000 people in 1990 to 141.5 per 100,000 in 2021, while the ASPR declined from 2,119.6 to 1,437.8 per 100,000 people. Over the same period, YLDs dropped from 30.7 per 100,000 to 18.3 per 100,000. High-SDI countries experienced the greatest declines, reflecting improvements in healthcare and rehabilitation services. In contrast, low-SDI regions and conflict-affected countries like Afghanistan and Syria saw increments in the incidence and prevalence rates. The highest incidence was observed among males aged 15-19 years, with a relative risk of 1.28 compared with the other age groups. Projections indicate that although global incidence rates may continue declining until 2040, disparities in high-risk areas will persist without targeted interventions. Conclusion:This study highlights a global decline in the burden of amputations among children and adolescents but reveals significant disparities based on SDI regions, sex, and age. Targeted public health strategies and resource allocation are, needed to address these inequalities, improve trauma care, and enhance rehabilitation services, especially in high-risk areas.

BackgroundHemodynamically unstable pelvic fractures (HUPF) in skeletally immature children and adolescents carry significant mortality. While internal iliac artery embolization (IIAE) is a cornerstone of management for HUPF in adults, data on its application and outcomes in this truly pediatric population, particularly in China, are scarce. This study aimed to evaluate the feasibility, safety, and clinical outcomes of IIAE for HUPF in this specific, vulnerable group.MethodsThis multicenter, retrospective case series included patients aged 15 years or younger who presented with HUPF and underwent IIAE at three major Chinese trauma centers between 2019 and 2023. Key outcomes included immediate hemorrhage control, in-hospital mortality, and long-term complications.ResultsA total of seven patients underwent IIAE. The cohort demonstrated severe trauma, with a median Pelvic Abbreviated Injury Scale (AIS) of 5 and a median Injury Severity Score (ISS) of 36. Of the six patients who underwent contrast-enhanced computed tomography (CECT), active arterial extravasation was identified in four. However, subsequent angiography confirmed life-threatening arterial injuries in all seven patients, including the two with negative CECT scans. Immediate and sustained hemodynamic stability was achieved in six patients (85.7%). The single mortality occurred in a patient with refractory hemorrhagic shock who required a massive transfusion of 28.5 units of red blood cells, whereas the median for the six survivors was 4 units. At a median follow-up of 22 months, all survivors were ambulatory and no major procedure-related ischemic complications were observed.ConclusionIIAE is a feasible and effective life-saving intervention for HUPF in skeletally immature patients. A negative CECT scan does not rule out significant arterial injury, underscoring the vital role of prompt angiography. We recommend a low threshold for early intervention, with consideration of non-selective embolization as a primary damage control tactic in these critically injured children.

Pulmonary fibrosis (PF) remains a clinically intractable condition with limited therapies. Ferroptosis has emerged as a critical driver of PF. The previous study demonstrates that increased secretion of tissue plasminogen activator from ferroptotic airway epithelial cells contributes to PF progression in a paracrine manner. Herein, the indispensable role of signal transducer and activator of transduction 6 (STAT6) is further elucidated in maintaining airway epithelial homeostasis during PF and uncovers a novel mechanism by which STAT6 regulates mitophagy to modulate ferroptosis. Specifically, mitophagy is induced during PF along with STAT6 activation, and deficiency of STAT6 significantly alleviates epithelial ferroptosis and PF. Mechanistically, STAT6 directly binds to the parkin RBR E3 ubiquitin protein ligase (PRKN) promoter region at the site (-990 to -976), inhibiting PRKN transcription and thereby impairing mitophagy. Consistently, lentivirus-mediated PRKN interference in both wild-type and STAT6 knockout mice aggravates ferroptosis and PF. Furthermore, virtual screening identifies rifabutin as a potential STAT6 inhibitor, that exhibits therapeutic effects against PF both in vivo and in vitro. Collectively, these findings reveal an unreported mechanism by which STAT6 promotes PF by inhibiting PRKN-mediated mitophagy in the airway epithelium. Rifabutin is further identified and validated as a promising STAT6 inhibitor to alleviate PF, offering new insights into therapy development.

Purpose Internal iliac artery ligation (IIAL) has been used as a damage control procedure to treat hemodynamically unstable pelvic fracture for many years. However, there is ongoing debate regarding the effectiveness and safety of this hemostatic method. Therefore, we performed a systematic literature review to assess the efficacy and safety of IIAL for pelvic fracture hemostasis. Methods Three major databases, PubMed, Embase, and Google Scholar, were searched to screen eligible original studies published in English journals. Two reviewers independently read the titles, abstracts, and full texts of all literature. Articles were included if they reported the use and effects of IIAL. Results A total of 171 articles were initially identified, with 22 fully meeting the inclusion criteria. Among the analyzed cases, up to 66.7% of patients had associated abdominal and pelvic organ injuries, with the urethra being the most frequently injured organ, followed by the bowel. The outcomes of IIAL for achieving hemostasis in pelvic fractures were found to be satisfactory, with an effective rate of 80%. Hemorrhagic shock was the leading cause of death, followed by craniocerebral injury. Notably, no reports of ischemic complications involving the pelvic organs due to IIAL were found. Conclusion IIAL has a good effect in treating hemodynamically unstable pelvic fracture without the risk of pelvic organ ischemia. This procedure should be considered a priority for hemodynamically unstable pelvic fracture patients with abdominal organ injuries.

BackgroundThis study explored the epidemiological trends in pelvic fracture (PF) in China from 1992 to 2021, analyze their relationships with age–period–cohort (APC) factors, and predict the trends of PF from 2022 to 2046.MethodsIncidence and years lived with disabilities (YLDs) of PF among sexes in China from 1992 to 2021 were obtained through the 2021 Global Burden of Disease (GBD) database. Trends in the incidence and YLDs were described, and a joinpoint regression model was used. The APC model was used to explore the effects of age, period, and cohort on the incidence and YLDs. Nordpred forecasted the incidence and YLDs in China from 2022 to 2046.ResultsIn 2021, there were an estimated 0.63 million incidence cases and 0.33 million of YLDs, respectively. The number and age-standardized rate (ASR) of incidence and YLDs were both gradually increased. The average annual percent change (AAPC) in incidence and YLDs for men were 0.26% and −0.17%, respectively. For women, the AAPC values for incidence and YLDs were −0.03% and −0.57% (p < 0. 001), respectively. The relative risk (RR) of PF increases with age, with the lowest risk in those aged 10–14 years for incidence and aged 1–4 for YLDs and the highest risk in those aged >95 years for incidence and aged 90–94 years for YLDs. The period effect showed a totally increase in the risk across the general, male, and female populations. Cohort effects indicated a totally significant decline for both incidence and YLDs. The predicted incidence and YLDs of PF in China from 2022 to 2046 showed an initial rise, followed by a decline, with 2029 and 2034 being the turning point for incidence and YLDs, respectively.ConclusionThe characteristics of pelvic fracture incidence and YLDs in China are complex. Thus, primary prevention measures must be strengthened. Raising awareness about osteoporosis prevention, enhancing public health education, and promoting good dietary and hygiene habits are appropriate preventive measures for PF in China.

Abstract Background This study assessed the global trends and burden of severe chest injury, including rib fractures, lung contusions, and heart injuries from 1990 to 2019. Herein, we predicted the burden patterns and temporal trends of severe chest injuries to provide epidemiological evidence globally and in China. Methods In our analysis, the age-standardized incidence rate (ASIR), prevalence rate (ASPR), and years lived with disability rate (ASYR) of severe chest injury were analyzed by gender, age, sociodemographic index, and geographical region between 1990 and 2019 using data from the Global Burden of Disease study 2019. Trends were depicted by calculating the estimated annual percentage changes (EAPCs). The impact of age, period, and cohort factors was assessed using an Age-Period-Cohort model. Autoregressive integrated moving average (ARIMA) model was employed to predict severe chest injury trends from 2020 to 2050. Results In 2019, the global number of severe chest injury cases reached 7.95 million, with the highest incidence rate observed in Central Europe (209.61). Afghanistan had the highest ASIRs at 277.52, while North Korea had the lowest ASIRs at 41.02. From 1990 to 2019, the Syrian Arab Republic saw significant increases in ASIR, ASPR, and ASYR, with EAPCs of 10.4%, 9.31%, and 10.3%, respectively. Burundi experienced a decrease in ASIR with an EAPC of − 6.85% (95% confidence interval [CI] − 11.11, − 2.37), while Liberia’s ASPR and ASYR declined with EAPCs of − 3.22% (95% CI − 4.73, − 1.69) and − 5.67% (95% CI − 8.00, − 3.28), respectively. Falls and road injuries remained the most common causes. The relative risk of severe chest injury by age, period, and cohort demonstrated a complex effect globally and in China. The ARIMA model forecasted a steady increase in global numbers from 2020 to 2050, while in China, it forecasted an increase in incidence, a decrease in ASIR and ASYR, and an increase in ASPR. Conclusions This study provides a groundbreaking analysis of global severe chest injury, shedding light on its measures and impact. These findings highlight the need for timely, specialized care and addressing regional disparities to mitigate the severe chest injury burden.

Purpose:Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease. PANoptosis, a unique inflammatory programmed cell death, it manifests as the simultaneous activation of signaling markers for pyroptosis, apoptosis, and necroptosis. However, research on the role of PANoptosis in the development of IPF is currently limited. This study was aimed to explore the role of PANoptosis in IPF. Methods:In this study, we first identified PANDEGs using the GEO database. Exploring potential biological functions and immune cell infiltration abundance through GO/KEGG enrichment analysis and Immune infiltration analysis. Through machine learning and experimental validation, we identified four diagnostic genes and four prognostic genes associated with PANoptosis, leading to the development of a diagnostic and prognostic model for IPF. Our single-cell analysis further explored the role of these PANoptosis prognostic genes. Additionally, the L1000FWD application was used to identify small molecule drugs, based on the four PANoptosis prognostic genes, and confirmed their efficacy through molecular docking. Results:104 PANoptosis differentially expressed genes were identified from IPF and normal tissues. Enrichment analysis indicated that these genes were associated with immune-inflammatory response pathway. We developed a diagnostic and prognostic models based on PANoptosis related genes. The diagnostic model included AKT1, PDCD4, PSMA2, and PPP3CB. Conversely, the prognostic model included TNFRSF12A, DAPK2, UACA, and DSP. External dataset validation and qPCR showed the reliability of most of the conclusions. Additionally, potential therapeutic drugs, including Metergoline, Candesartan, and Selumetinib, were identified based on four prognostic genes. Molecular docking shows that these drugs have good binding ability with their targets. Conclusion:Importantly, our findings provide scientific evidence for the diagnosis and prognostic biomarkers of IPF patients, as well as small molecule therapeutic drugs.

创伤外科的病历书写与传统外科存在区别.创伤外科病历记录了创伤救治的医疗全过程,反映创伤技术水平及救治效果.目前,创伤外科病历书写大多沿用传统外科各专业的书写模式,不能反映创伤患者整体损伤情况及诊断治疗经过,导致创伤外科病历质量参差不齐,妨碍创伤救治与学术交流.创伤评估有其特殊性,传统体格检查方法并不完全适用于创伤患者.此外,随着诊疗技术的进步,临床评估过程中也可以避免采用一些导致疼痛、延误抢救,甚至造成损伤的查体方法和诊疗操作.随着创伤救治理论技术和学科发展,创伤外科病历的书写有待进一步规范和统一.笔者通过分析创伤外科病历书写的特殊性,梳理和总结目前病历书写中存在的问题并提出改进建议,为规范创伤外科病历书写、提升创伤救治综合实力提供参考.

ObjectivePneumonia is a common pulmonary complication of flail chest, causing high morbidity and mortality rates in affected patients. The existing methods for identifying pneumonia have low accuracy, and their use may delay antimicrobial therapy. However, machine learning can be combined with electronic medical record systems to identify information and assist in quick clinical decision-making. Our study aimed to develop a novel machine-learning model to predict pneumonia risk in flail chest patients. MethodsFrom January 2011 to December 2021, the electronic medical records of 169 adult patients with flail chest at a tertiary teaching hospital in an urban level I Trauma Centre in Chongqing were retrospectively analysed. Then, the patients were randomly divided into training and test sets at a ratio of 7:3. Using the Fisher score, the best subset of variables was chosen. The performance of the seven models was evaluated by computing the area under the receiver operating characteristic curve (AUC). The output of the XGBoost model was shown using the Shapley Additive exPlanation (SHAP) method. ResultsOf 802 multiple rib fracture patients, 169 flail chest patients were eventually included, and 86 (50.80%) were diagnosed with pneumonia. The XGBoost model performed the best among all seven machine-learning models. The AUC of the XGBoost model was 0.895 (sensitivity: 84.3%; specificity: 80.0%).Pneumonia in flail chest patients was associated with several features: systolic blood pressure, pH value, blood transfusion, and ISS. ConclusionOur study demonstrated that the XGBoost model with 32 variables had high reliability in assessing risk indicators of pneumonia in flail chest patients. The SHAP method can identify vital pneumonia risk factors, making the XGBoost model's output clinically meaningful.

Flail chest is a severe chest trauma that is commonly associated with lung contusion, resulting in acute respiratory distress syndrome and respiratory failure, which brings challenges in clinical management. It has become a clinical consensus that surgical treatment of flail chest can rapidly restore thoracic stability, eliminate paradoxical breathing, and maintain stability of respiratory and circulatory functions. However, non-surgical interventions continue to be crucial in further improving the prognosis of patients with flail chest, such as pain management and respiratory management. In this study, the authors review the research progress in pain control and respiratory management during comprehensive treatment of patients with flail chest for better understanding of pain management and lung injury care, which may provide references for clinical treatment and further improvement of clinical prognosis and quality of life for patients with flail chest.

Rib fracture is the most common injury in chest trauma. Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injury such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, unable to retain a full-time job. In the past two decades, surgery for rib fractures has achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. Before the year of 2018, there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad, focusing on the guidance of the overall treatment decisions and plans; another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures. The Chinese Society of Traumatology, Chinese Medical Association, and the Chinese College of Trauma Surgeons, Chinese Medical Doctor Association organized experts from cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics and other disciplines to participate together, following the principle of evidence-based medicine and in line with the scientific nature and practicality, formulated the Chinese consensus for surgical treatment of traumatic rib fractures (STTRF 2021). This expert consensus put forward some clear, applicable, and graded recommendations from seven aspects: preoperative imaging evaluation, surgical indications, timing of surgery, surgical methods, rib fracture sites for surgical fixation, internal fixation method and material selection, treatment of combined injuries in rib fractures, in order to provide guidance and reference for surgical treatment of traumatic rib fractures.