BacKground:Acetic acid spray combined with narrow-band imaging ( NBI ) endoscopy can improve the earIy diagnosis of coIorectaI cancer and precancerous Iesions. Aims:To assess the vaIue of acetic acid spray combined with NBI in diagnosis of earIy coIorectaI cancer and precancerous Iesions. Methods:A totaI of 236 coIorectaI cancer and precancerous Iesions in 180 patients detected by screening endoscopy from Nov. 2011 to JuIy 2013 were enroIIed in this study. Acetic acid spray combined with NBI( combination group),singIe NBI,and indigo carmine staining were used to observe pit pattern,bIood capiIIary forms of the Iesion and mucosa whitening time,and vaIues of the three methods in diagnosis of earIy coIorectaI cancer and precancerous Iesions were evaIuated. Results:Image cIarity of pit pattern in combination group was significantIy improved than that in NBI group and indigo carmine group(χ2 =15. 113,P=0. 000;χ2 =6. 128,P=0. 013);image cIarity of bIood capiIIary forms in combination group was significantIy improved than that in NBI group(χ2 =7. 384,P =0. 007). The overaII coincidence rates of diagnosis in combination group,NBI group, indigo carmine group were 91. 9%,89. 0%,86. 9%,respectiveIy. The diagnosis rate of pit pattern in combination group was significantIy higher than that in NBI group(χ2 =4. 490,P=0. 034),but no significant difference in bIood capiIIary forms was found between combination group and NBI group. The sensitivity of type Ⅲ,Ⅳ,Ⅴ pit pattern,type Ⅱ,ⅢbIood capiIIary forms,mucosa whitening time <30 seconds for diagnosis of coIorectaI cancer and precancerous Iesions in combination group were 94. 0%,92. 8%,92. 2%,respectiveIy,the specificity were 87. 4%,88. 1%,88. 0%, respectiveIy,and the accuracy were 91. 5%,91. 1%,90. 7%,respectiveIy. The sensitivity,specificity and accuracy of type ⅤN or highIy irreguIar ⅤI pit pattern,type ⅢB bIood capiIIary forms and mucosa whitening time 0-5 seconds for predicting invasive carcinoma in combination group were aII quite weII. Conclusions:Acetic acid spray combined with NBI can cIearIy show the pit pattern and bIood capiIIary forms of earIy coIorectaI cancer and precancerous Iesions,and is fairIy consistent with the pathoIogicaI diagnosis. It is heIpfuI for diagnosing the nature of Iesion and depth of invasion.

Objective: To investigate the mechanism of microRNA (miR)-524-5p mediating the effect of cisplatin in the treatment of gastric cancer. Methods: The level of miR-524-5p in gastric cancer tissues, the matched non-tumor tissues, cisplatin-resistant and parental gastric cancer cell lines was measured by real-time fluorescent quantitative PCR. The viability of cisplatin-resistant gastric cancer SGC-7901 and MKN-45 cells transfected with miR-524-5p mimics or the control RNA was detected by CCK-8 method. The expression of SRY-related high mobility group-box gene 9 (SOX9), a targeting protein of miR-524-5p, was identified by luciferase reporter assay and Western blotting. The “rescue” assay was used to explore the effect of SOX9 overexpression on the cisplatin-resistance of gastric cancer cells induced by miR-524-5p. Results: Compared with the normal gastric epithelial GES1 cells, the level of miR-524-5p in gastric cancer SGC-7901 and MKN-45 cells was significantly down-regulated (both P < 0.05); while the level of miR-524-5p in gastric cancer tissues was significantly lower than that in the adjacent non-tumor tissues (P < 0.05). After the treatment of cisplatin, the expression level of miR-524-5p in cisplatin-resistant gastric cancer SGC-7901 and MKN-45 cells was decreased as compared with the sensitive parental cells (both P< 0.05). After the transfection of miR-524-5p mimics, the sensitivity of cisplatin-resistant gastric cancer SGC-7901 and MKN-45 cells was significantly enhanced (both P< 0.05). Subsequently, SOX9 was identified as a functional target gene of miR-524-5p. Overexpression of SOX9 could counteract the chemosensitizing effect of miR-524-5p, in other words, the cisplatin-sensitivity of SGC-7901 and MKN-45 cells transfected with SOX9 overexpression plasmids and miR-524-5p mimics was significantly lower than that in single miR-524-5p mimics transfection group (both P< 0.05). Conclusion: The expression of miR-524-5p influences the sensitivity of human gastric cancer cells to cisplatin, suggesting that miR-524-5p has the potential to be a novel target for the treatment of chemoresistant gastric cancer patients.

Objective To evaluate the diagnostic value of acetic acid spray combined with narrow-band imaging ( NBI) for early gastric cancer and precancerous lesion. Methods A total of 136 gastric cancers and precancerous lesions from 132 patients detected by screening endoscopy from November 2015 to November 2017 in Guangming Chinese Medicine Hospital of Pudong New Area, Shanghai were enrolled in this study, and were divided into NBI group, acetic acid spray group, and acetic acid spray combined with NBI group ( combination group) . The image clarity, microsurface pattern, microvascular pattern, demarcation line, and mucosal whitening time were observed, and value of the 3 methods in diagnosis of early gastric cancer and precancerous lesions was analyzed. Results Image clarity of micro glandular in combination group was significantly better than that in NBI group and acetic acid spray group (χ2=8. 766, P=0. 003;χ2=5. 273, P=0. 022) , and image clarity of microvascular in combination group was significantly better than that in NBI group (χ2=7. 457, P=0. 006) . The overall diagnostic coincidence rate with pathology of combination group, NBI group, and acetic acid spray group was 91. 9％(125/136), 85. 3％(116/136), and 89. 7％(122/136), respectively. The diagnostic sensitivity of irregular or missing microsurface, irregular or missing microvascular, obvious demarcation line, mucosal whitening time <30 s for carcinoma ( including high grade intraepithelial neoplasia, early carcinoma and infiltrating carcinoma ) were 92. 3％, 91. 3％, 92. 3％ and 90. 4％, respectively, in the combination group, and the diagnostic specificity of above indicators were 93. 8％, 93. 8％, 96. 9％ and 90. 6％, respectively, accuracy were 92. 6％, 91. 9％, 93. 4％ and 90. 4％, respectively. For observation of microsurface, the combination group was superior to the NBI group (χ2 =7. 378, P=0. 007) , but there was no significant difference compared with the acetic acid spray group (χ2=0. 427, P=0. 513);the acetic acid spray group was superior to the NBI group (χ2=4. 405, P=0. 036) . For observation of microvascular, the combination group was not significantly better than the NBI group (χ2=2. 398, P=0. 122). For observation of demarcation line, the combination group was not significantly better than the NBI group (χ2=2. 722,P=0. 099) and the acetic acid spray group (χ2=0. 216, P=0. 642). There was no difference between the acetic acid spray group and the NBI group (χ2=1. 433, P=0. 231) in observation of demarcation line. Conclusion Acetic acid spray combined with NBI has a good consistency with pathological results with high diagnostic sensitivity and specificity, and can clearly show microsurface of early gastric cancers and precancerous lesions compared to single NBI.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.