Abstract:Trauma-induced sepsis,a life-threatening syndrome characterized by organ dysfunction resulting from a dysregulated host response to infection,is frequently precipitated by severe trauma or burns.In post-traumatic sepsis,patients experience a"second hit"that further exacerbates immune dysregulation.The immune system un-dergoes continuous dynamic changes,with the potential coexistence of excessive inflammatory responses and immuno-suppression.This immune imbalance poses a significant challenge for precise therapeutic interventions.In recent years,rapid developments have been witnessed in multi-omics technologies and systems medicine,which have ena-bled more accurate identification of biomarkers and molecular targets,facilitating immune phenotyping of sepsis pa-tients,paving the way for personalized diagnostic and therapeutic approaches,and bringing new opportunities for sep-sis research.This review summarizes the latest research progress in the pathogenesis of trauma-induced sepsis with a particular focus on immune dysregulation mechanisms and explores the potential of individualized immunotherapy in promoting novel strategies for sepsis diagnosis and treatment.Furthermore,we discuss how the emerging field of pre-cision medicine,based on sepsis immunology,offers new hope for improving outcomes in sepsis management.By in-tegrating cutting-edge research findings with clinical perspectives,this review aims to provide a comprehensive over-view of the current state and future directions in trauma-induced sepsis research and management.

Abstract:Objective To investigate the effects of different cold compress regimens on postoperative limb swelling and pain in patients undergoing knee arthroscopy for tibial meniscus injuries.Methods This prospective study analyzed data from 62 patients who underwent knee arthroscopy at the Department of Traumatology and Ortho-paedics,First Affiliated Hospital of Harbin Medical University,between Aug.2023 and Mar.2024.Participants(27 males,35 females;mean age 48.3 years,range 21-69 years)sustained tibial meniscus injuries via road traffic accidents(n=33),falls(n=12),or other mechanisms(n=17).Using a random number table,patients were allo-cated to either the control group or the experimental group(n=31 for each).The control group received intermit-tent ice pack therapy(30 min per session,3 times daily),with functional exercises performed out of cold compress-ing.The experimental group received near-continuous ice pack therapy,interrupted only for scheduled functional exercises;the ice packs were replaced after warming to room temperature.For both groups,the cold compress ther-apy was initiated 6 h postoperatively and continued for 3 d.The VAS scores for pain and knee swelling(measured 2 cm above the patella's superior pole,5 cm below the patellar midpoint,and at the patella's inferior pole)were assessed before and 24,48,and 72 h post-cold compress initiation.The knee flexion range of motion(ROM)was also evaluated at 1 week postoperatively.Results No significant differences were observed between the two groups for baseline data(pre-cold compress)of VAS scores,knee swelling or mean knee ROM(all P＞0.05).After near-continuous cold compressing,the experimental group showed significantly less pain and swelling(perimeter at 2 cm above the patella's superior pole/the patella's inferior pole/5 cm below the patellar midpoint)at 24 h(VAS score:3.1±0.8 vs.3.9±0.6;perimeter:cm,2.68±0.16/2.89±0.18/1.54±0.18 vs.2.91±0.22/3.09±0.23/1.84±0.17,all P＜0.05),48 h(VAS score:2.1±0.5 vs.2.6±0.6;perimeter:cm,2.00±0.20/2.21±0.17/1.12±0.19 vs.2.33±0.19/2.52±0.21/1.41±0.18,all P＜0.05),and 72 h(VAS score:1.2±0.6 vs.1.8±0.5;perimeter:cm,1.47±0.14/1.67±0.13/0.97±0.11 vs.1.73±0.23/1.97±0.20/1.13±0.16,all P＜0.05)after therapy initiation.Furthermore,the knee flexion ROM was significantly larger in the experimental group at 1 week after cold compress(134.4°±8.3° vs.128.4°±8.9°,P＜0.05).Conclusion Near-continuous cold com-press is significantly more effective than intermittent therapy in reducing postoperative pain and knee joint swelling,improving knee flexion ROM,and enhancing overall rehabilitation outcomes following arthroscopic meniscal surgery.

Abstract:Objective To observe the therapeutic effect of 3％and 7.5％(w/v)hypertonic saline on pul-monary edema in rats with blast injuries complicated by hemorrhagic shock.Methods A total of 200 healthy Spra-gue-Dawley rats[10 weeks old,body weight:(200.0±20.0)g]were randomly divided into five groups(n=40per group):sham group,blast injury complicated by hemorrhagic shock group,Lactated Ringer's solution(LR)resus-citation group,3％hypertonic saline+LR resuscitation group,and 7.5％hypertonic saline+LR resuscitation group.This composite injury model was established first by using a blast shock wave and a thermal radiation system to in-duce blast injuries,and then by controlled hemorrhage via withdrawing 40％of the total blood volume to induce hem-orrhagic shock.At the end stage of shock,resuscitation was performed in three groups:LR alone as a base,and combined infusion of LR+3％or 7.5％hypertonic saline,respectively.Lung vascular permeability,pulmonary water content,organ function,and rat survival rate were measured to evaluate the therapeutic effects of hypertonic saline on pulmonary edema.Results The blast injury combined with hemorrhagic shock model was successfully established,and the model rats exhibited typical signs of shock,along with significantly increased vascular permeability in the lung,kidney,brain,and intestine(all P＜0.001 compared with sham group),accompanied by organ dysfunction.Ar-terial blood gas analysis indicated acidosis and hypoxia,with significantly decreased mean arterial pressure,heart rate,and tissue perfusion(all P＜0.001 compared with sham group).The LR resuscitation alone reduced Evans blue(EB)content in various tissues,and improved certain blood gas parameters and tissue perfusion,specifically in terms of increasing perfusion in the kidney and intestine(P＜0.05 compared with the blast injury complicated by hemorrhagic shock group),while liver perfusion,organ function,and water content in the lung and brain showed no significant improvement(all P＞0.05).Based on LR resuscitation,the combined infusion of 3％and 7.5％hyper-tonic saline significantly improved vascular permeability and organ function(P＜0.05 compared with the LR resusci-tation group).Although differences were observed between the two different concentrations,i.e.,permeability,phys-iological parameters,and tissue perfusion,there were no statistically significant differences in final survival rate and organ functional improvement(both P＞0.05).Conclusion Hypertonic saline can significantly alleviate pulmonary edema and vascular leakage in rats with blast injuries complicated by hemorrhagic shock,which also improves the or-gan function.Although no statistically significant differences were found between 3％and 7.5％hypertonic saline in terms of survival rate and organ protection,3％hypertonic saline is more recommended considering the safety and clinical application,which warrants further investigation.

Abstract:Objective To investigate the surgical methods and clinical efficacy of a two-step method com-bined with pelvic unlocking reduction frame for minimally invasive treatment of Tile C3 pelvic fractures.Methods The retrospective data of 26 patients with Tile C3 pelvic fractures treated with the two-step method were collected from our trauma center from Jul.2017 to Jul.2023.Among the 26 cases,there were 11 males and 15 females aged 18-57(mean 37.7)years,with the time from injury to surgery being 4-27(mean 10.2)d.There were 6 cases of C3.1,4 cases of C3.2,and 16 cases of C3.3.All patients were treated with the two-step method for closed reduction and minimal internal fixation.The first step involves manual traction of the relatively stable or minor displaced side of the pelvis for initial reduction,temporarily fixed with a 7.3 mm hollow screw or fixation pin as a reference.The significantly vertically displaced side is reduced by using the reduction frame and stabilized with sacroiliac screws.In the second step,using the reduced and stabilized side as a reference,the temporarily fixed side is readjusted for optimal reduction to ultimately complete the bilateral pelvic fixation.The anterior ring is fixed according to the injury condition using Infix,anterior column screws,or pubic symphysis plates.Surgical time,blood loss,fluoroscopy re-sults,and postoperative complications were recorded.Follow-up included fracture healing time,reduction quality e-valuated using the Matta criteria,and clinical efficacy assessed by Majeed scoring.Results All the 26 cases expe-rienced successful surgeries,with intraoperative fluoroscopy results showing good screw placement.The average sur-gical time was 90-270(mean 161.2)min,and the average intraoperative blood loss was 30-150(mean 76.1)mL.Matta reduction criteria revealed 16 excellent,7 good,and 3 acceptable results,with a satisfactory rate of 88.5％.Three cases experienced symptoms of lateral femoral cutaneous nerve injury,whose symptoms were relieved after re-moval of the Infix;one case with Infix fixation developed superficial subcutaneous infection,which was improved af-ter debridement;no other surgical-related complications occurred.Follow-up for 1-3 years showed that all fractures healed,with a healing time of 3-5(mean 3.7)months,and no complications such as loss of reduction or failure of internal fixation.The Majeed clinical efficacy scores showed 18 excellent and 8 good results,yielding a total satisfac-tory rate of 100％.Conclusion The two-step pelvic unlocking reduction frame technique can effectively achieve closed reduction of Tile C3 pelvic fractures,characterized by its simplicity,minimal damage,and good outcomes.It is worthy of clinical promotion and application.

Abstract:Objective To investigate the effect of internal stabilization technique on early functional recov-ery of anterior cruciate ligament(ACL)injuries after reconstruction.Methods A retrospective analysis was per-formed on 65 cases of ACL sports injuries that received reconstruction at the Department of Orthopaedics,General Hospital of the Northern Theater Command from Mar.2020 to Mar.2022.Patients were divided into control group with autologous tendon graft(n=39)and internal support group(internal stabilization technique was additionally performed based on autologous tendon graft,n=26).All the patients were males aged 18-34 years,with an average age of 24.7 years,due to high-intensity sports or training.The follow-up period ranged from 12 to 14 months,mean 12.6 months.Postoperative complications were recorded and Lysholm knee function scores,International Knee Doc-umentation Committee(IKDC)scores,and Tegner activity scale(TAS)scores were used to evaluate the outcomes.Results During the perioperative period,no neurovascular injuries,infection,venous thrombosis or other complica-tions were observed in both groups,with significantly improved knee joint function after surgery(both P＜0.05 com-pared to that before surgery).At postoperative 3 months,the internal support group showed much better scores than the control group,i.e.,Lysholm score:62.4±4.9 vs.58.7±3.9,IKDC score:65.0±4.8 vs.61.6±6.6,and Tegn-er score:4.9±0.6 vs.4.3±0.4,all P＜0.05,but all the scores showed no significant difference at 12 months(all P＞0.05).Conclusion As an auxiliary technology to improve the strength of grafts,the internal stabilization tech-nique can help patients quickly recover motor function and then improve the knee joint function in the early stage,and thus is worth promoting.

Abstract:As a key link and cornerstone of trauma treatment,trauma center is important to improve the effi-ciency of trauma care.In current trauma care system,the construction of trauma center is still very scarce in China and far behind developed countries in Europe and the United States.The emergency department or trauma depart-ment has played similar role of"trauma center"in a few hospitals,but there are still many deficiencies.Government departments and trauma medical staffs have recognized the importance of trauma center,and made efforts in stand-ardization of the construction,specialist establishment and personnel training.The construction of trauma center is a long-term task in China.