{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T13:16:56Z","timestamp":1767705416017,"version":"3.48.0"},"reference-count":21,"publisher":"Centre for Evaluation in Education and Science (CEON\/CEES)","issue":"9","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/BY\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Biochemistry"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:p>Background: This study aimed to evaluate the impact of intraosseous (IO) access on inflammatory mediators, hematopoietic cell function, and coagulation-metabolic disturbances in patients presenting with emergency traumatic hemorrhagic shock (THS), thereby providing clinical evidence to refine IO resuscitation protocols in emergency settings. Methods: We conducted a randomized controlled trial involving 84 THS patients admitted between February 2024 and February 2025. Participants were allocated equally into two groups: the IO group (n= 42), where vascular access was established via humeral or proximal tibial puncture, and the intravenous (IV) group (n= 42), where conventional peripheral or central venous access was prioritized. Serial measurements were performed at baseline (T0), 24 hours (T1), and 72 hours (T2) post-intervention to assess: (1) inflammatory mediators (IL-1 b, IL-6, IL-10, HMGB1, MDA); (2) hematopoietic parameters (CD34+ cell proportion, CFU-GM \/BFU-E colony formation, CXCL12, EPO, and TPO ); (3) coagulation profiles (PT, APTT, and D-dimer); and (4) tissue perfusion indicators (blood lactate and lactate clearance rate). Comparative analyses were conducted both between groups and across different time points. Results: The IO group demonstrated significantly elevated levels of IL-1P, HMGB1, and MDA at T1 and T2 compared to the IV group (P&amp;lt; 0.05), coupled with reduced IL-10 expression (P&amp;lt; 0.05), indicating exacerbated inflammatory imbalance and oxidative stress. Hematopoietic evaluation revealed progressive declines in CD34+ cell populations, CFU-GM \/BFU-E colony formation, and CXCL12 concentration in the IO group at T1 and T2 (P&amp;lt; 0.05), despite modest compensatory increases in EPO and TPO that remained inferior to the IV group (P&amp;lt; 0.05). Coagulation studies showed prolonged PT\/APTT (P&amp;lt; 0.01) and higher D-dimer levels (P&amp;lt; 0.05) in the IO group, along with worse blood lactate levels and lactate clearance rates compared to the IV group (P&amp;lt; 0.05), suggesting increased tissue hypoxia and coagulopathy risk. Conclusions: While IO access enables rapid vascular access for resuscitation and reduces critical intervention time, despite its procedural efficiency in rapid vascular access for resuscitation, IO may inadvertently aggravate systemic inflammatory dysregulation, impair hematopoietic function, and worsen coagulation-metabolic disturbances through mechanisms such as mechanical stimulation, hypothermic fluid infusion, and oxidative stress.<\/jats:p>","DOI":"10.5937\/jomb0-58956","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T03:19:27Z","timestamp":1750648767000},"page":"2008-2015","source":"Crossref","is-referenced-by-count":0,"title":["Randomized controlled trial of intraosseous access vs. intravenous access in traumatic hemorrhagic shock: Effects on inflammation, hematopoiesis, and coagulation"],"prefix":"10.5937","volume":"44","author":[{"given":"Gaorong","family":"Deng","sequence":"first","affiliation":[{"name":"Second Affiliated Hospital of Xi'an Jiaotong University, Department of Orthopaedics, Xian, Shaanxi, 710004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Fourth Affiliated Hospital of Nanchang University, Department of Orthopaedics, Nanchang, Jiangxi, 330002, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Miao","sequence":"additional","affiliation":[{"name":"Fourth Affiliated Hospital of Nanchang University, Department of Orthopaedics, Nanchang, Jiangxi, 330002, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuying","family":"Dong","sequence":"additional","affiliation":[{"name":"Fourth Affiliated Hospital of Nanchang University, Department of Obstetrics and Gynecology, Nanchang, Jiangxi, 330002, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang","family":"Gao","sequence":"additional","affiliation":[{"name":"Fourth Affiliated Hospital of Nanchang University, Department of Orthopaedics, Nanchang, Jiangxi, 330002, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zongfang","family":"Li","sequence":"additional","affiliation":[{"name":"Second Affiliated Hospital of Xi'an Jiaotong University, National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, Xian, Shaanxi, 710004, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3964","reference":[{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Jones AR, Miller JL, Jansen JO, Wang HE. Whole Blood for Resuscitation of Traumatic Hemorrhagic Shock in Adults. Adv Emerg Nurs J 2021; 43(4): 344-54;","DOI":"10.1097\/TME.0000000000000376"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Kuo K, Palmer L. Pathophysiology of hemorrhagic shock. J Vet Emerg Crit Care (San Antonio) 2022; 32(S1): 22-31;","DOI":"10.1111\/vec.13126"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Dufour-Gaume F Frescaline N, Cardona V, Prat NJ. Danger signals in traumatic hemorrhagic shock and new lines for clinical applications. Front Physiol 2022; 13: 999011;","DOI":"10.3389\/fphys.2022.999011"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Tyler JA, Perkins Z, De'Ath HD. Intraosseous access in the resuscitation of trauma patients: a literature review. Eur J Trauma Emerg Surg 2021; 47(1): 47-55;","DOI":"10.1007\/s00068-020-01327-y"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Liu BC, Cheng MR, Lang L, Li L, Si YH , Li AJ, Xu Q, Zhang H. Autologous bone marrow infusion via portal vein combined with splenectomy for decompensated liver cirrhosis: A retrospective study. World J Gastrointest Surg 2023; 15(9): 1919-31;","DOI":"10.4240\/wjgs.v15.i9.1919"},{"key":"ref6","unstructured":"Dornhofer P Kellar JZ. Intraosseous Vascular Access. In. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Jesse Kellar declares no relevant financial relationships with ineligible companies.; 2025;"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Takase B, Higashimura Y Asahina H, Masaki N, Kinoshita M, Sakai H. Intraosseous infusion of liposome-encapsulated hemoglobin (HbV) acutely prevents hemorrhagic anemia-induced lethal arrhythmias, and its efficacy persists with preventing proarrhythmic side effects in the subacute phase of severe hemodilution model. Artificial organs 2022; 46(6): 1107-21;","DOI":"10.1111\/aor.14170"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Wang D, Deng L, Zhang R, Zhou Y Zeng J, Jiang H. Efficacy of intraosseous access for trauma resuscitation: a systematic review and meta-analysis. World J Emerg Surg 2023; 18(1): 17;","DOI":"10.1186\/s13017-023-00487-7"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Qasim ZA, Joseph B. Intraosseous access in the resuscitation of patients with trauma: the good, the bad, the future. Trauma Surg Acute Care Open 2024; 9(Suppl 2): e001369;","DOI":"10.1136\/tsaco-2024-001369"},{"key":"ref10","unstructured":"Chen Y Liu Z, Zhang P Huang W. Consistency of injury severity score in severe trauma patients. Beijing Da Xue Xue Bao Yi Xue Ban 2024; 56(1): 157-60;"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Ibrahim N, Mohd Noor H, Shuid AN, Mohamad S, Abdul Malik MM, Jayusman PA, Shuid AN, Naina Mohamed I. Osteoprotective Effects in Postmenopausal Osteoporosis Rat Model: Oral Tocotrienol vs. Intraosseous Injection of Tocotrienol-Poly Lactic-Co-Glycolic Acid Combination. Front Pharmacol 2021; 12: 706747;","DOI":"10.3389\/fphar.2021.706747"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Fan H, Tang HB, Chen Z, Wang HQ, Zhang L, Jiang Y Li T, Yang CF, Wang XY, Li X , Wu SX, Zhang GL. Inhibiting HMGB1-RAGE axis prevents pro-inflammatory macrophages\/microglia polarization and affords neuroprotection after spinal cord injury. J Neuroinflammation 2020; 17(1): 295;","DOI":"10.1186\/s12974-020-01973-4"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Singh H, Agrawal DK. Therapeutic Potential of Targeting the HMGB1\/RAGE Axis in Inflammatory Diseases. Molecules 2022; 27(21);","DOI":"10.3390\/molecules27217311"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Deng C, Zhao L, Yang Z, Shang JJ, Wang CY Shen MZ, Jiang S, Li T, Di WC, Chen Y, Li H, Cheng YD , Yang Y. Targeting HMGB1 for the treatment of sepsis and sepsis-induced organ injury. Acta Pharmacol Sin 2022; 43(3): 520-8;","DOI":"10.1038\/s41401-021-00676-7"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Stern M, Kok WF Doorduin J, Jongman RM, Jainan-dunsing J, Nieuwenhuijs-Moeke GJ, Absalom AR, Henning RH, Bosch DJ. Mild and deep hypothermia differentially affect cerebral neuroinflammatory and cold shock response following cardiopulmonary bypass in rat. Brain Behav Immun 2024; 119: 96-104;","DOI":"10.1016\/j.bbi.2024.03.046"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Lajqi T Kostlin-Gille N, Hillmer S, Braun M, Kranig SA, Dietz S, Krause C, Ruhle J, Frommhold D, Poschl J, Gille C, Hudalla H. Gut Microbiota-Derived Small Extracellular Vesicles Endorse Memory-like Inflammatory Responses in Murine Neutrophils. Biomedicines 2022; 10(2);","DOI":"10.3390\/biomedicines10020442"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Gao Z, Feng Y Xu J, Liang J. T-cell exhaustion in immune-mediated inflammatory diseases: New implications for immunotherapy. Front Immunol 2022; 13: 977394;","DOI":"10.3389\/fimmu.2022.977394"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Asker ME, Ali SI, Mohamed SH, Abdelaleem RMA, Younis NN. The efficacy of bone marrow-derived mesenchymal stem cells and\/or erythropoietin in ameliorating kidney damage in gamma irradiated rats: Role of non-hematopoietic erythropoietin anti-apoptotic signaling. Life Sci 2021; 275: 119388;","DOI":"10.1016\/j.lfs.2021.119388"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Liu Y Wu W, Feng S, Chen Y Wu X , Zhang Q, Wu S. Dynamic response of the cell traction force to osmotic shock. Microsyst Nanoeng 2023; 9: 131;","DOI":"10.1038\/s41378-023-00603-2"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Wang YW, Dong HZ, Tan Y X , Bao X , Su YM , Li X , Jiang F, Liang J, Huang ZC, Ren YL, Xu YL, Su Q. HIF-1alpha-regulated lncRNA-TUG1 promotes mitochondrial dysfunction and pyroptosis by directly binding to FUS in myocardial infarction. Cell Death Discov 2022; 8(1): 178;","DOI":"10.1038\/s41420-022-00969-8"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Ueno T, Ikeda T, Okihara M, Akashi I, Yokoyama T, Kihara Y, Konno O, Nakamura Y, Iwamoto H, Ueno Y Chandraker A. Cytokine modulation in abdominal septic shock via the crucial role of IL-6 signaling in endothelial dysfunction. Front Med (Lausanne) 2023; 10: 1042487;","DOI":"10.3389\/fmed.2023.1042487"}],"container-title":["Journal of Medical Biochemistry"],"original-title":["Randomizovano kontrolisano ispitivanje intraosealnog pristupa u odnosu na intravenski pristup kod traumatskog hemoragi\u010dnog \u0161oka - efekti na upalu, hematopoezu i koagulaciju"],"language":"en","link":[{"URL":"https:\/\/scindeks-clanci.ceon.rs\/data\/pdf\/1452-8258\/2025\/1452-82582509008D.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T12:51:52Z","timestamp":1767703912000},"score":1,"resource":{"primary":{"URL":"https:\/\/scindeks.ceon.rs\/Article.aspx?artid=1452-82582509008D"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":21,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.5937\/jomb0-58956","relation":{},"ISSN":["1452-8258","1452-8266"],"issn-type":[{"type":"print","value":"1452-8258"},{"type":"electronic","value":"1452-8266"}],"subject":[],"published":{"date-parts":[[2025]]}}}