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.

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.

Objective: To explore the effects of cardiac support on delayed resuscitation in extensively burned patients with shock. Methods: Clinical data of 62 extensively burned patients with shock on admission, admitted to the 159th Hospital of PLA (hereinafter referred to as our hospital) from January 2012 to January 2017, were retrospectively analyzed. They were divided into cardiac support group (n=35) and control group (n=27) according to the use of deslanoside and ulinastatin. All patients were treated with routine fluid resuscitation based on the formula of the Third Military Medical University till post injury hour (PIH) 48. Patients in cardiac support group were given slow intravenous injection of deslanoside which was added in 20 mL 100 g/L glucose injection with first dose of 0.4 to 0.6 mg, 0.2 to 0.4 mg per 6 to 8 h, no more than 1.6 mg daily, and slow intravenous injection of 1×10⁵U ulinastatin which was added in 100 mL 50 g/L glucose injection, once per 12 h. Other treatments of patients in the two groups followed the same conventional procedures of our hospital. The following data of the two groups of patients were collected. (1) The data of urine volume per hour within PIH 48, heart rate, mean arterial pressure (MAP), central venous pressure (CVP), blood lactic acid, base excess, hematocrit, and albumin at PIH 48 were recorded. (2) The input volumes of electrolyte, colloid within the first and second 24 hours post burn and the total fluid input volumes within PIH 48 were recorded. (3) The data of creatine kinase, creatine kinase isoenzyme-MB, lactate dehydrogenase, total bile acid, alanine aminotransferase, aspartate aminotransferase, β₂-microglobulin, urea nitrogen, and creatinine at PIH 48 were recorded. (4) The complications including cardiac failure, pulmonary edema, pleural effusion, seroperitoneum, renal failure, sepsis, and death were also recorded. Data were processed with independent sample ttest, Fisher′s exact test, Pearson chi-square test, or continuous correction chi-square test. Results: (1) There were no statistically significant differences in urine volume within PIH 48, heart rate, MAP, CVP, hematocrit, or albumin at PIH 48 between the patients of two groups (t=0.150, 0.488, 0.805, 0.562, 1.742, 0.696, P>0.05). While the levels of blood lactic acid and base excess were respectively (4.2±2.2) and (-4.3±2.0) mmol/L in patients of cardiac support group, which were significantly better than (5.9±1.7) and (-6.0±3.1) mmol/L in patients of control group (t=3.249, 2.480, P<0.05 or P<0.01). (2) There was no statistically significant difference in input volume of colloid within the first 24 hours post burn between the patients of two groups (t=0.642, P>0.05). The input volume of electrolyte within the first 24 hours post burn, the input volumes of electrolyte and colloid within the second 24 hours post burn, and the total fluid input volume within PIH 48 of patients in cardiac support group were significantly less than those in control group (t=2.703, 4.223, 3.437, 2.515, P<0.05 or P<0.01). (3) The levels of creatine kinase, creatine kinase isoenzyme-MB, lactate dehydrogenase, total bile acid, alanine aminotransferase, aspartate aminotransferase, β₂-microglobulin, urea nitrogen, and creatinine of patients in cardiac support group at PIH 48 were significantly lower than those in control group (t=3.066, 3.963, 3.225, 2.943, 2.431, 3.084, 4.052, 2.915, 3.353, P<0.05 or P<0.01). (4) The occurrences of pleural effusion and seroperitoneum and mortality of patients in cardiac support group were significantly lower than those in control group (χ²=5.514, 6.984, 4.798, P<0.05 or P<0.01). There were no statistically significant differences in cardiac failure, pulmonary edema, renal failure, and sepsis between the patients of two groups [χ²=1.314 (sepsis), P>0.05]. Conclusions The cardiotonic and cardiac protection treatments in delayed resuscitation of extensively burned patients with shock contribute to improving the cellular anonic metabolism, reducing the volume of fluid resuscitation, and mitigating the ischemic and hypoxic damage to organs, so as to lay foundation for decreasing further complication incidences and mortality.

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.

OBJECTIVETo explore the epidemiological characteristics of inhalation injury and to summarize the clinical application experience of diagnostic standard of burn of larynx.

METHODSMedical records of 443 patients with inhalation injury admitted to our burn unit from January 1999 to June 2013 were analyzed, including gender, age, severity of inhalation injury, complications and diseases before injury; total area and that of full-thickness burn injury, admission time after burn, and burn condition of larynx of patients with different degrees of inhalation injury; treatment and outcome including rate, time, and complication of tracheotomy, mortality, and cause of death. Data were processed with nonparametric Kruskal-Wallis test and chi-square test. The relationship between severity of inhalation injury and total burn area, degree of burn of larynx, tracheotomy rate, and mortality was assessed by Spearman correlation analysis.

RESULTS(1) Among the patients, there were 353 (79.7% ) male and 90 (20.3% ) female, with the ratio of male to female 4:1. There were 64 (14.4%) patients younger than or equal to 20 years, 203 (45.8%) patients older than 20 years and younger than or equal to 40 years, 144 (32.5%) patients older than 40 years and younger than or equal to 60 years, and 32 (7.2%) patients older than 60 years. The numbers of patients with mild, moderate, and severe inhalation injury were respectively 297, 108, and 38. Seven patients suffered from complications, and 21 patients had diseases before injury. There were statistically significant differences among the patients with different degree of inhalation injury in regard to total burn area and full-thickness burn area (with H values respectively 73.752 and 142.830, P values below 0.01), while no statistically significant difference was observed in admission time after burn ( H = 1.528, P > 0.05). Correlation analysis showed that severity of inhalation injury was positively correlated with total burn area (r = 0.399, P < 0.001). Among the patients with mild inhalation injury, incidences of patients with mild, moderate, and severe burn of larynx were respectively 68.0% (202/297), 32.0% (95/297), and 0, and those among the patients with moderate inhalation injury were respectively 0,53.7% (58/108), and 46.3% (50/108). There were statistically significant differences in degree of burn of larynx of patients with different degree of inhalation injury (χ2 = 336.703, P < 0.001). Correlation analysis showed that severity of burn of larynx was positively correlated with severity of inhalation injury (r = 0.700, P < 0.001). (2) The rate of tracheotomy was 37.02% (164/443). The rates of tracheotomy in patients with mild, moderate, and severe inhalation injury were respectively 10.44% (31/297), 87.96% (95/108), and 100.00% (38/38), χ2 = 271.654, P < 0.001. Correlation analysis showed that the rate of tracheotomy was positively correlated with severity of inhalation injury (r = 0.784, P < 0.001). Tracheotomy was done mainly within 6 h post burn (63.4%, 104/164). The incidence rate of complication of tracheotomy was 5.5% (9/164). (3) Thirty-one patients died, with a mortality rate of 7.00%. The mortality rates of patients with mild, moderate, and severe inhalation injury were respectively 1.01% (3/297), 12.96% (14/108), and 36.84% (14/38), H = 74.273, P < 0.001. It was found that the mortality was positively correlated with severity of inhalation injury (r = 0.371, P < 0.001). The causes of death of the patients were respectively sepsis (14, 45.2%), respiratory failure (7, 22.6%), airway obstruction (2, 6.5%), airway hemorrhage (2, 6.5%), cerebral hemorrhage (2, 6.5%), cardiac accident (2, 6.5%), and diabetes insipidus (1, 3.2%), and 1 (3.2%) patient quit treatment and discharged from hospital for economic reason.

CONCLUSIONSAmong the patients with inhalation injury, male is dominated in number, and the young adults formed the highest constituent ratio. The severity of inhalation injury was correlated with total burn area, severity of burn of larynx, tracheotomy rate, and mortality. With the guidance of diagnostic criteria of burn of larynx and indication of tracheotomy, the risk of laryngeal obstruction can be eliminated. The early preventive tracheotomy can decrease the difficulty and risk of the operation.

Adolescent ; Adult ; Age Distribution ; Aged ; Airway Obstruction ; etiology ; surgery ; Burn Units ; Burns ; Burns, Inhalation ; complications ; mortality ; surgery ; China ; epidemiology ; Female ; Humans ; Incidence ; Injury Severity Score ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Sepsis ; epidemiology ; Severity of Illness Index ; Sex Distribution ; Tracheotomy ; methods ; Young Adult

Acinetobacter Infections ; drug therapy ; Acinetobacter baumannii ; drug effects ; pathogenicity ; Adult ; Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Burns ; drug therapy ; microbiology ; Cefoperazone ; administration & dosage ; therapeutic use ; Humans ; Middle Aged ; Minocycline ; administration & dosage ; therapeutic use ; Retrospective Studies ; Sulbactam ; administration & dosage ; therapeutic use ; Thienamycins ; adverse effects ; therapeutic use ; Young Adult

Objective To observe the effect of Interferon-α2b on HEL cells (human erythroleukemia cell line) growth, apoptosis and JAK2 V617F mutation gene expression. Methods HEL cells were placed in RPMI1640 containing 10% FBS and incubated in a cell incubator. Cells in the logarithmic growth phasem were collected, adjusting the cell density to 1 × 105/mL for experimental research. The interferon concentration in five groups were 0, 5 × 105, 10 × 105, 50 × 105, 100 × 105 U/L, with different incubation time (0, 24, 72, 120 h), respectively. The cell growth status in different groups was observed in the inverted optical microscope; MTT was used to detect the inhibition of interferon on HEL cell proliferation. Cell apoptosis was detected by flow cytometry. Fluorescence quantitative PCR was used to detect the mutation gene of JAK2 V617F expression. Results Inhibition rates of Interferon on the HEL cell proliferation in 5 × 105 U/L, 10 × 105 U/L, 50 × 105 U/L, 100 × 105 U/L groups were 18.57%, 25.10%, 42.10%, 57.00%, respectively. JAK2 V617F/GAPDH by fluorescence quantitative was 1.556, 1.213, 0.870 respectively under the concentration of interferon 100 × 105 U/L for 24, 72, 120 h. Conclusions Interferon-α2b can inhibit HEL cells proliferation and induce HEL cells apoptosis. Increasing concentration of interferon increases HEL cell apoptosis rate. Interferon can inhibit JAK2 V617F expression of HEL cells in a dose-dependent manner.

The aim of this study was to determine if the potassium aspartate and magnesium (PAM) prevent reperfusion-induced ventricular arrhythmias (RIVA) in ischemia-reperfusion (IR) rabbit heart. Thirty rabbits were randomly divided into control, ischemia and PAM groups. Arterially-perfused rabbit left ventricular preparations were made, and transmural ECG as well as action potentials from both endocardium and epicardium were simultaneously recorded in the whole process of all experiments. In control group rabbit ventricular wedge preparations were continuously perfused with Tyrode's solution, and in ischemia group and PAM groups the perfusion of Tyrode's solution was stopped for 30 min. Then the ischemia group was reperfused with Tyrode's solution and the PAM group with Tyrode's solution containing 2.42 mg/L PAM, respectively. ECG, QT interval, transmural repolarization dispersion (TDR) and action potentials from epicardium and endocardium were simultaneously recorded, and the RIVA of the wedge preparation was observed. Compared with control group, TDR and incidence of RIVA were significantly increased in ischemia group (P<0.05). The incidence of RIVA in control, ischemia and PAM group was 0/10, 9/10 and 1/10, respectively. Compared with ischemia group, TDR and incidence of RIVA were significantly reduced in PAM group (P<0.05). Potassium aspartate and magnesium significantly reduce TDR and prevent ventricular arrhythmia in ischemic rabbit heart.
Arrhythmias, Cardiac/etiology ; Arrhythmias, Cardiac/*prevention & control ; Myocardial Ischemia/*complications ; Myocardial Ischemia/physiopathology ; Myocardial Reperfusion Injury/*complications ; Potassium Magnesium Aspartate/*therapeutic use ; Random Allocation

Summary: The aim of this study was to determine if the potassium aspartate and magnesium (PAM) prevent reperfusion-induced ventricular arrhythmias (RIVA) in ischcmia-reperfusion (IR) rabbit heart. Thirty rabbits were randomly divided into control, ischemia and PAM groups. Arterially-perfused rabbit left ventricular preparations were made, and transmural ECG as well as action potentials from both endocardium and epicardium were simultaneously recorded in the whole process of all experiments. In control group rabbit ventricular wedge preparations were continuously perfused with Tyrode's solution, and in ischemia group and PAM groups the perfusion of Tyrode's solution was stopped for 30 min. Then the ischemia group was reperfused with Tyrode's solution and the PAM group with Tyrode's solution containing 2.42 mg/L PAM, respectively. ECG, QT interval, transmural repolarization dispersion (TDR) and action potentials from epicardium and endocardium were simultaneously recorded, and the RIVA of the wedge preparation was observed. Compared with control group, TDR and incidence of RIVA were significantly increased in ischemia group (P<0.05). The incidence of RIVA in control, ischemia and PAM group was 0/10, 9/10 and 1/10, respectively. Compared with ischemia group, TDR and incidence of RIVA were significantly reduced in PAM group (P<0.05). Potassium aspartate and magnesium significantly reduce TDR and prevent ventricular arrhythmia in ischemic rabbit heart.

BACKGROUND: Bone morphogenetic protein-2 is a high-efficient bone inducing factor, which can induce the inside and outside periosteum and marrow-derived stromal cells differentiate into osteoblast, strengthen the re generation of bone mattress, activate or lead MSCs around blood vessel to differentiate into chondroblast and osteoblast. OBJECTIVE: To observe the effects of yigu capsule to be used for pre vention and treatment on the expression of bone morphogenetic protein-2 in bone tissue of the ovariectomized rats with osteoporosis. DESIGN: A completely randomized grouping design and randomized con trol trial. SETTING: Department of Traditional Chinese Medicine, First Affiliated Hospital, Jinan University.MATERIALS: The experiment was carried out in the laboratory of Traditional Chinese Medicine of Jinan University form March to October 2003. Animals: 72 normal grand female SD rats, with 10-month-old ages, weighted (380±20) g, provided by the center of laboratory animal science of Guang dong (the quality exequatur number of No. 2002A024), were adopted. Totally 24 rats were randomly chosen from them anddivided into preventive group (12 rats) and therapeutic group (12 rats) of sham operation (only opened the rats' abdomen but not removed their ovary), and the left 48 rats were randomly divided into 4 groups after replicating OP model by ovariectomy (which opened the rats' abdomen and removed their ovary): OP model control group of prevention, OP model control group of treatment, OP model group of prevention with yigu capsule and OP model group of treatment with yigu capsule, with 12 rats in each group. Medicine: Yigu capsule was made up by epimedium, fruit of lycium barbaruml, radix angelica sinensis, root of achyranthes bidentata blume etc., the decoct-free granule of the drugs were provided by Shenzhen Sanjiu Medical & Pharmaceutical Co., Ltd, the aqueous solution was made to include crude drug 1.0 g/Ml. INTERVENTIONS: The prevented groups of yigu capsule were administered by gastric infusion 3 days after ovariectomy, 3 Ml NS was given to preventive group of sham operation and OP model control group and 3 Ml aqueous solution of yigu capsule was given to preventive group with yigu capsule,1 time a day for 24 weeks; the therapeutic groups of yigu capsule were administered by gastric infusion in the 13th week after ovariectomy, 3 Ml NS was given to therapeutic group of sham operation and OP model control group and 3 Ml aqueous solution of yigu capsule was given to therapeutic group with yigu capsule, 1 time a day for 12 weeks. Immunohistochemistry was used to detect the expression of BMP-2 on protein level in bone tissue. MAIN OUTCOME MEASURES: The mean gray (MG) of the BMP-2 positive reaction cells in bone tissue.RESLUTS: In the 24th week after ovariectomy, the MG of BMP-2 positive reaction cells in bone tissue of preventive OP model control group, preventive group with yigu capsule and preventive group of sham operation were 81.84±10.01, 124.46±6.55, 130.15±10.09, that of preventive OP model control group was obviously lower than that of preventive group of sham operation (P < 0.01), and that of preventive group with yigu capsule was obviously higher than that of preventive OP model control group (P < 0.01) and closed to that of preventive group of sham operation (P > 0.05). The MG of BMP-2 positive reaction cells in bone tissue of therapeutic OP model control group, therapeutic group with yigu capsule and therapeutic group of sham operation were 77.97±10.35, 110.32±8.69, 131.79±12.10, that of therapeutic OP model control group was obviously lower than that of therapeutic group of sham operation (P < 0.01), and that of therapeutic group with yigu capsule was obviously higher than that of therapeutic OP model control group (P < 0.01) and closed to that of therapeutic group of sham operation (P > 0.05). CONCLUSION: Thepreventive and therapeutic treatment of yigu capsule could both improve the expression of BMP-2 in bone tissue on albumen level.