中华烧伤与创面修复杂志

Effects and mechanism of aminoguanidine on acute liver injury in mice

Xiao Hongyan, Su Shan, An Jiawei, Liu Guochen, Chen Yuping, Chen Yi, Zhu Junyu, Ouyang Yibin

, Available online , doi: 10.3760/cma.j.cn501225-20251016-00431

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Objective To explore the effect and mechanism of aminoguanidine on acute liver injury in mice. Methods This was an experimental study. Sixty 6-8-week-old male C57BL/6J mice were randomly divided into blank control group, model group, aminoguanidine control group, and aminoguanidine intervention group, with 15 mice in each group. Mice in model group and aminoguanidine intervention group were induced to acute liver injury by intraperitoneal injection of lipopolysaccharide+D-galactosamine, and mice in aminoguanidine intervention group were intraperitoneally injected with aminoguanidine 12 hours before modeling; mice in aminoguanidine control group were only intraperitoneally injected with an equal amount of aminoguanidine; mice in blank control group were intraperitoneally injected with an equal volume of phosphate buffered saline. At 6 hours after modeling, hematoxylin-eosin staining was used to detect the pathological conditions of liver tissues in blank control group, model group, and aminoguanidine intervention group. According to the kit instructions, a microplate reader was used to determine the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the serum of mice in blank control group, model group and aminoguanidine intervention group, as well as the contents of malondialdehyde (MDA), glutathione (GSH) and iron ions in the liver tissues. TdT-mediated dUTP nick-end labeling (TUNEL) staining was used to detect the cell apoptosis in liver tissues of mice in blank control group, model group, and aminoguanidine intervention group. Reverse transcription polymerase chain reaction was used to detect the mRNA levels of inflammatory factors such as nitric oxide synthase 2 (NOS2), interleukin (IL)-18, IL-1β, and NOD-like receptor pyrin domain-containing protein 3 (NLRP3) in liver tissues of mice in blank control group, model group, aminoguanidine control group, and aminoguanidine intervention group. Western blotting was used to detect the relative expression levels of ferroptosis marker proteins acyl-CoA synthetase long-chain family member 4 (ACSL4), GSH peroxidase 4 (GPX4), and inflammation-related pathway protein NLRP3 and Phosphorylated P65 (p-P65)/P65 ratio in liver tissues of mice in blank control group, model group, aminoguanidine control group, and aminoguanidine intervention group. Results At 6 hours after modeling, the liver lobule structure of mice in blank control group was intact, the arrangement of hepatocyte cords was regular, and there was no inflammatory cell infiltration or hepatocyte necrosis. The liver lobule structure of mice in model group was abnormal, the arrangement of hepatocyte cords was disordered, hepatocytes were necrotic, and there was a large amount of inflammatory cell infiltration and liver sinus dilation and congestion. The degree of pathological damage in aminoguanidine intervention group was between that of blank control group and model group. At 6 hours after modeling, compared with that in blank control group, the levels of AST and ALT in the serum of mice in model group were significantly increased (P<0.05); compared with that in model group, the levels of AST and ALT in the serum of mice in aminoguanidine intervention group were significantly decreased (P<0.05). At 6 hours after modeling, compared with that in blank control group, the contents of MDA and iron ions in liver tissues of mice in model group were significantly increased (P<0.05), and the content of GSH was significantly decreased (P<0.05); compared with that in model group, the content of MDA in liver tissues of mice in aminoguanidine intervention group was significantly decreased (P<0.05), and the level of GSH was significantly increased (P<0.05). At 6 hours after modeling, the proportion of TUNEL-positive cells in liver tissues of mice in model group was 26.93%, which was significantly higher than 0.43% in blank control group (P<0.05); the proportion of TUNEL-positive cells in liver tissues of mice in aminoguanidine intervention group was 0.37%, which was significantly lower than that in model group (P<0.05). At 6 hours after modeling, compared with that in blank control group, the aminoguanidine control group of mice showed no statistically significant differences in the mRNA levels of NOS2, IL-18, IL-1β, and NLRP3 in the liver tissues (P>0.05); compared with that in blank control group, the mRNA levels of aforementioned genes in liver tissues of mice in model group were significantly increased (P<0.05); compared with that in model group, the mRNA levels of aforementioned genes in liver tissues of mice in aminoguanidine intervention group were significantly decreased (P<0.05). At 6 hours after modeling, Compared with that in blank control group, the aminoguanidine control group of mice showed no statistically significant differences in the relative expression levels of ACSL4, NLRP3, and GPX4 or p-P65/P65 ratio in liver tissues (P > 0.05); compared with that in blank control group, the relative expression levels of ACSL4 and NLRP3 or p-P65/P65 ratio in the liver tissues of mice in model group were significantly increased (P<0.05), while the relative expression level of GPX4 was significantly decreased (P<0.05). Compared with that in model group, the relative expression levels of ACSL4 and NLRP3 or p-P65/P65 ratio in aminoguanidine intervention group were significantly decreased (P<0.05), and the relative expression level of GPX4 protein was significantly increased (P<0.05). Conclusions Aminoguanidine can improve liver function and alleviate acute liver injury induced by lipopolysaccharide+D-galactosamine in mice by down-regulating inflammatory response and inhibiting ferroptosis.

Establishing a rat model of sepsis by combining seawater immersion with Vibrio vulnificus infection after burns

Deng Bihan, Cheng xinyue, Zhu Xiaomei, Wang Jun, Yao Yongming

, Available online , doi: 10.3760/cma.j.cn501225-20251017-00432

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Objective To establish a rat model of sepsis induced by combining seawater immersion with Vibrio vulnificus infection after burns, providing an experimental basis for research on marine burn wound-associated sepsis. Methods This study was conducted using an experimental animal model. A total of 115 eight-week-old male Sprague Dawley rats were randomly allocated using a random number table (grouping method was the same as below) into three groups: burn+seawater immersion+infection group (model group for short, n=45), burn-only group (n=40), and sham injury group (n=30). Rats in the first two groups received standardized dorsal burn injury, followed by either artificial seawater immersion for 30 min+subcutaneous injection of Vibrio vulnificus or injection of an equal volume of normal saline, respectively. In sham injury group, the dorsal region was immersed in warm water to induce sham injury, followed by injection of an equal volume of normal saline. On 1, 3, and 5 days after modeling, hematoxylin-eosin staining was performed to evaluate histopathological changes in the liver, kidney, lung, and heart in the three groups of rats, the pathological damage of the aforementioned organs was evaluated using a semi-quantitative scoring system. According to the instructions of the kit, an enzyme-linked immunosorbent assay reader was used to detect the contents of aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen, creatinine, creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), and myeloperoxidase (MPO) in the serum of the three groups of rats, to reflect the degree of liver, kidney and heart injury. Fresh lung tissues in the three groups of rats were weighed and then dried to a constant weight to calculate the lung wet-to-dry weight ratio. In addition, the proportions of helper T cells, B cells, and cytotoxic T cells in peripheral blood of rats in sham and model groups were determined by flow cytometry. Serum levels of inflammatory cytokines in the three groups of rats, including IL-6, IL-10, IL-1β, and TNF-α, were measured using enzyme-linked immunosorbent assay. An additional 70 eight-week-old male Sprague Dawley rats were randomly assigned to seven groups (with each group of 10 rats): sham, burn-only, burn+freshwater immersion, burn+seawater immersion, burn+infection, infection-only, and model groups. The rats in model, burn-only group and sham injury groups were treated as before. The rats in burn+freshwater immersion and burn+seawater immersion groups were first received dorsal burn injury, followed by 30 min immersion in freshwater or artificial seawater, respectively. Rats in infection-only group received subcutaneous injection of the same dose of Vibrio vulnificus at the corresponding dorsal site. Rats in burn+infection group first received dorsal burn injury and then injected with the same dose of Vibrio vulnificus 30 min after injury. Within 7 days after modeling, the survival status of the rats was observed every day and their survival rate was calculated. Results On 1, 3, and 5 days after modeling, the tissue structures of the liver, kidney, lung, and heart of rats in sham injury group were basically normal, and no obvious pathological damage was observed; the tissues of the aforementioned organs of rats in burn-only group had mild to moderate inflammatory reactions, with loose cytoplasm and obvious cellular edema, but the overall structure was basically normal; the tissues of the aforementioned organs of rats in model group showed obvious pathological changes, with the most severe changes on 3 days after modeling, mainly manifested as severe inflammatory reactions, tissue damage, and even necrosis. Compared with that in sham injury group, histopathological injury scores for the liver, kidney, lung, and heart of rats in model group were significantly increased on 1, 3, and 5 day after modeling (P<0.05). Compared with that in burn-only group, histopathological injury scores for the liver, kidney, lung, and heart of rats in model group were significantly increased on 1 day after modeling (P<0.05), and histopathological injury scores for the liver, kidney, and lung were significantly increased on 3 and 5 days after modeling (P<0.05). Compared with that in sham injury group, the serum levels of AST, ALT, blood urea nitrogen, creatinine, CK-MB, LDH, and MPO, as well as the lung wet-to-dry weight ratio of rats in model group were significantly increased on 1 day after modeling (P<0.05), and the serum levels of AST, ALT, blood urea nitrogen, creatinine, LDH, and MPO, as well as the lung wet-to-dry weight ratio were significantly increased on 3 and 5 days after modeling (P<0.05). Compared with that in burn-only group, the serum levels of AST, ALT, blood urea nitrogen, creatinine, CK-MB, LDH, and MPO, as well as the lung wet-to-dry weight ratio of rats in model group were significantly increased on 1 day after modeling (P<0.05), the serum levels of AST, ALT, creatinine, and LDH were significantly increased on 3 days after modeling (P<0.05),and the serum levels of AST, ALT, creatinine, LDH, and MPO on 5 days after modeling (P<0.05). On 1, 3, and 5 days after modeling, compared with that in sham injury group, the proportions of helper T cells, B cells, and cytotoxic T cells in peripheral blood of rats in model group were significantly increased (P<0.05). On 1, 3, and 5 days after modeling, the serum levels of IL-6, IL-10, IL-1β, and TNF-α of rats in model group were significantly higher than those in both sham injury and burn-only groups (P values all <0.05). on 7 days after modeling, the survival rate of rats in model group was only 50%, whereas it was 100% in both sham injury and infection-only groups. Within 7 days after modeling, the survival rate of rats in model group was significantly lower than that in sham, burn-only, burn+freshwater immersion, burn+seawater immersion, and infection-only groups (with χ² values of 19.31, 12.11, 12.33, 9.01, and 17.61, respectively, P values all <0.05), but was comparable to that in burn+infection group (χ²=1.75, P>0.05). Conclusions Combining seawater immersion with Vibrio vulnificus infection after burns successfully established a rat model of sepsis. This model exhibited marked pathological alterations in major organs, significantly elevated inflammatory cytokine levels, increased proportions of immune cells including helper T cells, B cells, and cytotoxic T cells, and a markedly reduced survival rate, indicating that it is a reliable experimental animal model.

Establishment and efficacy evaluation of a rabbit lower limb partial-thickness scald model

Guan Hao, Zhang Hao, Zhang Wanfu, Chen Yang, Yang Yunshu, Han Fei, Tong Lin, Zhou Qin

, Available online , doi: 10.3760/cma.j.cn501225-20241028-00418

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Objective To establish a rabbit lower limb partial-thickness scald model and evaluate its efficacy. Methods This study was a repeated measures designed and group designed experimental study. Forty healthy male New Zealand rabbits aged 6 to 8 months were selected, and divided into scald group (30 rabbits) and normal control group (10 rabbits) according to the random number table method. The rabbits in scald group were anesthetized, then a bucket-type constant temperature water bath pot and a self-made rabbit scald fixation bracket were used to immerse the right lower limb in water at 70 ℃ for 12 s to prepare a rabbit lower limb partial-thickness scald model, then fluid supplementation were conducted within 6 h after injury. The rabbits in normal control group were subjected to hair removal and anesthesia as scald group at the same time point except for scald and fluid supplementation. Ten rabbits were randomly selected from scald group, and the wound tissue morphology was observed after hematoxylin-eosin staining before injury and at 6 and 24 h after injury, respectively. Another 10 rabbits in scald group were observed for skin blood perfusion in right lower limb using laser Doppler flowmetry before injury and at 0 (immediate), 1, 3, 6, 12, 24, and 48 h after injury, respectively. The remaining 10 rabbits in scald group were measured for subcutaneous and deep muscle temperatures in right lower limb using non-contact infrared temperature sensors and contact temperature sensors before injury and at 10 s, 20 s, 40 s, 2 min, 10 min, 20 min, 40 min, 1 h, 2 h, 3 h, 4 h, 5 h, and 6 h after injury, respectively. After blood perfusion observation, the 10 rabbits in scald group were measured for right lower limb circumference before injury and at 1, 2, 3, 4, 5, 6, 24, 48, and 72 h after injury, respectively, and wound healing time of dorsal foot, plantar foot, and crural regions were recorded. Ten rabbits from normal control group and 10 rabbits after temperature measurement from scald group were taken to detect the serum levels of interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD), and malondialdehyde by enzyme-linked immunosorbent assay. Results Before injury, epidermis and skin appendages of the right lower limb of rabbits in scald group were intact. At 6 h after injury, epidermal continuity was interrupted, partial skin appendages disappeared, interstitial spaces increased, and edema increased. At 24 h after injury, skin appendages atrophied and disappeared, tissue edema increased significantly, and inflammatory cell infiltration increased in superficial dermis. The skin blood perfusion of right lower limb of rabbits in scald group before injury and at 0, 1, 3, 6, 12, 24, and 48 h after injury was (1.00±0.26), (1.03±0.29), (1.04±0.29), (1.19±0.37), (1.30±0.50), (1.36±0.99), (1.39±0.22), and (0.72±0.21) perfusion units, respectively (main effect of time factor, F=12.55, P<0.05). The subcutaneous temperature in right lower limb of rabbits in scald group before injury and at 10 s, 20 s, 2 min, 10 min, 20 min, 40 min, 1 h, 2 h, 3 h, 4 h, 5 h, 6 h after injury was significantly lower than that at 40 s after injury (P<0.05). The deep muscle temperature in right lower limb of rabbits in scald group before injury and at 10 s, 20 s, 40 s, 2 min, 20 min, 40 min, 1 h, 2 h, 3 h, 4 h, 5 h, and 6 h after injury was significantly lower than that at 10 min after injury (P<0.05). The right lower limb circumference in rabbits in scald group at 24 h after injury was significantly larger than that before injury and at 1, 2, 3, 4, 5, 6, 48, and 72 h after injury (with P values all <0.05). The wound healing time of plantar foot of rabbits in scald group was significantly shorter than that of dorsal foot and crural region (with P values both <0.05). At 24 h after injury, compared with those in normal control group, serum levels of IL-1β, IL-6, TNF-α, and malondialdehyde in rabbits in scald group were significantly increased (with t values of 21.92, 7.48, 12.58, and 117.34, respectively, P<0.05), while serum level of SOD was significantly decreased (t=117.34, P<0.05). Conclusions The rabbit lower limb partial-thickness scald model established in this study can safely and stably simulate the pathophysiological process and clinical characteristics of human limb scald, thus is a favorable model for studying partial-thickness scald of human limbs.

Discussion on key issues in the treatment of pediatric burns

Liu Yan, Yu Jia'ao, Zhong Shan

, Available online , doi: 10.3760/cma.j.cn501225-20250713-00302

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Due to the immaturity of skin tissue and organ function, pediatric burn patients exhibit distinct characteristics in etiology, shock resuscitation, characteristics of wounds healing, infection susceptibility, and prognosis. There are still aspects that need further discussion in the current treatment protocols for pediatric burns. This paper focuses on the key issues in the treatment of pediatric burns, with an emphasis on the fluid resuscitation for burn shock, the management of burn wounds, and the early identification of burn sepsis. The aim is to provide insight into current practices and future development in the management of pediatric burns.

Efficacy of free multiple lateral crural perforator flaps on one side under CDU precise localization for repairing multiple wounds at different sites on the finger

Cheng Heyun, Ju Jihui, Zhao Qiang, Hou Ruixing, Cheng Junnan, Liu Shuang, Wang Benyuan, Guo Quanwei, Zhou Wei

, Available online , doi: 10.3760/cma.j.cn501225-20241210-00484

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Objective To explore the efficacy of free multiple lateral crural perforator flaps on one side under color Doppler ultrasound (CDU) precise localization for repairing multiple wounds at different sites on the finger. Methods This study was a retrospective study of case series. From April 2018 to October 2022, 20 patients with 3 or 4 wounds at different sites on the finger who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital. There were 15 males and 5 females, aged 26 to 59 years. Preoperative CDU-guided precise perforator localization was performed. After intraoperative debridement, the single wound area ranged from 1.8 cm×1.2 cm to 8.0 cm×4.0 cm. Free multiple lateral crural perforator flaps on one side were harvested to repair the wounds, with the area of single flap resected ranging from 2.0 cm×1.3 cm to 9.0 cm×4.2 cm. The donor site wounds were closed by direct suturing. During surgery, the distance between perforator entry point and CDU-marked perforator location, perforator artery diameter, pedicle length, tunica intima condition, and perforator origin were recorded. After surgery, the occurrence of vascular crisis and flap survival were recorded. The wound recovery in recipient and donor areas were recorded during follow-up. At the final follow-up, the sensory function of the flaps was assessed by the sensory function evaluation standard of the British Medical Research Council, and the flap repair outcome was evaluated using a flap comprehensive assessment scale. Results During surgery, the distances between perforator entry point and CDU-marked perforator location ranged from 0 to 5 mm, the perforator artery diameters ranged from 0.3 to 0.7 mm, the pedicle lengths ranged from 3 to 8 cm, and the tunica intima was smooth, flat, and elastic. Fifty-one perforators were originated from the superficial peroneal artery, 8 perforators were originated from the anterior tibial artery, and 6 perforators were originated from the peroneal artery. After surgery, two flaps developed arterial crisis, which both survived after surgical exploration and arterial reanastomosis. The other flaps survived. During follow-up of 4-14 months, the flaps exhibited good texture, no significant swelling, and no noticeable color difference from the recipient site; neither donor nor recipient sites showed pain or significant scar hyperplasia. At the final follow-up, the sensory function rating of the flaps was graded as S2 in 31 flaps and S3 in 34 flaps, the flap repair outcome was evaluated as excellent in 21 flaps and good in 44 flaps. Conclusions The lateral cutaneous perforators of the lower leg offer several advantages, including numerous vessels, large caliber, long pedicle, high-quality endangium, and multiple source arteries. The application of free multiple lateral crural perforator flaps on one side under CDU precise localization for repairing multiple wounds at different sites on the finger has low surgical risk, excellent flap repair outcome, and minimal number and damage of donor site.

Postburn infection and immune dysfunction: new translational horizons from the pathogenesis to precision medicine

Yao Yongming, Ren Chao

, Available online , doi: 10.3760/cma.j.cn501225-20251104-00457

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The "pathological vicious cycle" between skin barrier disruption and immune dysfunction renders infection a primary complication and main cause of death among burn patients. Burn-related sepsis patients account for more than 50% of all burn-associated deaths. Currently, the prevention and treatment of burn infections are confronted with multiple challenges: the superimposed effects of uncontrolled inflammatory response and immune disorder triggered by infection, the rapid progression from local wound to systemic damage, and the massive colonization of multidrug-resistant bacteria, which significantly increases the difficulty of antibacterial therapy. This paper conducted an in-depth analysis of the mechanisms underlying immune dysfunction after burn-related infections from phenotypic manifestations to intrinsic regulation. It systematically elaborated on the crucial roles and mechanisms in the pathogenesis of immune dysfunction, including immune evasion of multidrug-resistant bacteria, the failed balance of immune responses, intestinal flora, and novel subtypes of immune regulatory cells. This paper further reported the emerging technologies for infection assessment and immune monitoring among burn patients by integrating the latest advancements in intelligent wound detecting system and novel biomarkers. Focusing on innovative therapeutic strategies targeting postburn immune regulation and local microenvironment remodeling, it further analyzed the challenges in clinical translation and future development directions.

Technological innovations in the mechanism and reduction of surgical incision scars based on the mechano-chemo-biological theory

Lyu Kaiyang, Li Yashu

, Available online , doi: 10.3760/cma.j.cn501225-20251013-00424

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Surgical incisions often heal with linear scars, which may further develop into hypertrophic scars or keloids. Research indicates that biomechanical factors, particularly mechanical forces and matrix stiffness, regulate scar formation by influencing cellular behavior and extracellular matrix remodeling. Our team proposes that the dynamic coupling and synergistic interactions among mechanical, chemical, and biological factors collectively drive scar development. We emphasize that sustained tension control following wound closure is crucial to prevent scar widening and hyperplasia. Current tension-reducing methods have limitations: intraoperative sutures provide only short-term support; external tension-reducing devices (e.g., tension-reducing tape or zipper) are prone to detachment, may cause skin irritation, and suffer from poor patient compliance; fractional laser may still cause the scar to widen when used alone in high-tension areas. Therefore, our team proposes a scheme utilizing an intradermal suturing technique based on slow-absorbing sutures with in-situ backstitch, which aims to achieve long-term and effective tension management. Preliminary clinical observations suggested that this scheme provided sustained tension reduction of surgical wound and, when combined with fractional laser therapy, showed potential for synergistic improvement in scar width, overcoming the shortage of conventional methods. Moving forward, further research will optimize this technique, validate its efficacy and safety, and promote its standardization and widespread adoption. Ultimately, we aim to promote the ideal healing of surgical incisions.

Latent profile analysis of the relationship between immune subtypes and glucocorticoid treatment response and prognosis in sepsis patients

Hong Dejiang, Zeng Wanting, Wang Wei, Hu Jinhao, Luo Lindi, Zhu Yingbo, Zhao Guangju

, Available online , doi: 10.3760/cma.j.cn501225-20251030-00451

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Objective To explore the relationship between immune subtypes and glucocorticoid (GC) treatment response and prognosis in sepsis patients, so as to provide reference for immune typing and treatment of sepsis patients with burn and trauma. Methods The study was a retrospective cohort study. From January 1, 2021 to June 20, 2024, 499 sepsis patients were admitted to the emergency intensive care unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University, including 304 males and 195 females, aged 67.0 (55.0, 75.0) years. The patients were divided into survival group (n=395) and death group (n=104) according to the death within 30 days after admission (hereinafter referred to as 30-day death). The clinical characteristics of the two groups of patients were compared, including age, body mass index, and other basic data, chronic lung, kidney, and liver diseases and other complications, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, mechanical ventilation, and hemodialysis within 24 hours after admission, and the intravenous administration of GC within 48 hours of hospitalization, i.e., early GC treatment, and length of hospital stay. Based on the 11 immune indicators of all patients within 48 hours after admission, latent profile analysis (LPA) was used to identify the immune subtypes of patients. The clinical characteristics of patients with different immune subtypes were compared. The impact of immune subtypes on the 30-day death risk of patients and the impact of early GC treatment on the 30-day death risk of patients with different immune subtypes were evaluated. Results There were statistically significant differences in age, body mass index, SOFA score and APACHE Ⅱ score within 24 hours after admission, length of hospital stay, complications of chronic lung, kidney, and liver diseases, mechanical ventilation and hemodialysis within 24 hours after admission, and early GC treatment between patients in survival group and death group (with U values of 15 316.00, 24 534.00, 16 981.50, 12 242.00, and 40 685.00, respectively, χ² values of 7.66, 9.47, 5.17, 35.70, 20.76, and 6.57, respectively, P<0.05). LPA identified 4 immune subtypes, including 287 patients with immune stable type, 78 patients with immune activated type, 44 patients with immune suppressed type, and 90 patients with immune paralyzed type. There were statistically significant differences in SOFA score, APACHE Ⅱ score within 24 hours after admission, complication of chronic kidney disease, mechanical ventilation and hemodialysis within 24 hours after admission, and early GC treatment among the four immune subtypes of patients (with H values of 46.82 and 22.55, respectively, χ² values of 12.56, 17.77, 13.81, and 14.84, respectively, P<0.05). Among patients with immune paralyzed type, the 30-day death ratio of patients with early GC treatment was significantly higher than that of patients without early GC treatment (χ²=5.95, P<0.05). After adjusting for age, gender, body mass index, complications, SOFA score, and APACHE Ⅱ score, the 30-day death risk of patients with immune stable type was significantly lower than that of patients with immune paralyzed type (HR=0.53, with 95% CI of 0.33-0.86, P<0.05), and early GC treatment for patients with immune paralyzed type had a significant impact on the 30-day death risk (HR=2.92, with 95% CI of 1.16-7.32, P<0.05). Conclusions There are 4 immune subtypes in sepsis patients. Patients with different subtypes exhibit unique clinical features, prognoses, and varying responses to early GC treatment. Early GC treatment has a significant impact on the increased risk of death in patients with immune paralyzed type.

Expert consensus on prevention and management of orthopedic surgical site infection wounds (2026 edition)

, Available online , doi: 10.3760/cma.j.cn501225-20250515-00228

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Orthopedic surgical site infection (SSI) represents a major complication post-orthopedic surgery, with incidence rates differing based on the specific procedure, typically ranging from 0.4% to 16.1%, and potentially exceeding 50% in high-risk scenarios. When orthopedic SSI advances to a stage necessitating intervention—characterized by wound dehiscence, tissue necrosis, or exposed implants—it not only substantially extends the recovery duration but also escalates the healthcare burden. Presently, there is an absence of standardized prevention and management protocols for such wounds both nationally and internationally, resulting in significant variability in clinical practice. In order to augment postoperative safety for orthopedic patients, diminish the incidence of orthopedic SSI wounds, and enhance the quality of diagnosis and treatment for these wounds, the Wound Repair Professional Committee of Chinese Medical Doctor Association has convened a multidisciplinary panel of experts to formulate this consensus. This consensus encompasses a range of topics, including prevention strategies, clinical manifestations, diagnostic evaluation, wound management and repair, functional reconstruction, and rehabilitation therapy for orthopedic SSI wounds. The objective is to furnish a comprehensive reference for the prevention and treatment of these wounds.

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