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.

Itch is an unpleasant sensation that provokes the desire to scratch. While acute itch serves as a protective system to warn the body of external irritating agents, chronic itch is a debilitating but poorly-treated clinical disease leading to repetitive scratching and skin lesions. However, the neural mechanisms underlying the pathophysiology of chronic itch remain mysterious. Here, we identified a cell type-dependent role of the anterior cingulate cortex (ACC) in controlling chronic itch-related excessive scratching behaviors in mice. Moreover, we delineated a neural circuit originating from excitatory neurons of the ACC to the ventral tegmental area (VTA) that was critically involved in chronic itch. Furthermore, we demonstrate that the ACC→VTA circuit also selectively modulated histaminergic acute itch. Finally, the ACC neurons were shown to predominantly innervate the non-dopaminergic neurons of the VTA. Taken together, our findings uncover a cortex-midbrain circuit for chronic itch-evoked scratching behaviors and shed novel insights on therapeutic intervention.
Mice ; Animals ; Gyrus Cinguli/physiology* ; Pruritus/pathology* ; Mesencephalon ; Cerebral Cortex/pathology* ; Neurons/pathology*

To compare the pancreatic proteomics and autophagy between Rehmanniae Radix-and Rehmanniae Radix Praeparata-treated mice with type 2 diabetes mellitus(T2DM). The T2DM mouse model was established by high-fat diet coupled with streptozotocin(STZ, intraperitoneal injection, 100 mg·kg~(-1), once a day for three consecutive days). The mice were then randomly assigned into a control group, low-(5 g·kg~(-1)) and high-dose(15 g·kg~(-1)) Rehmanniae Radix groups, low-(150 mg·kg~(-1)) and high-dose(300 mg·kg~(-1)) catalpol groups, low-(5 g·kg~(-1)) and high-dose(15 g·kg~(-1)) Rehmanniae Radix Praeparata groups, low-(150 mg·kg~(-1)) and high-dose(300 mg·kg~(-1)) 5-hydroxymethyl furfuraldehyde(5-HMF) groups, and a metformin(250 mg·kg~(-1)) group. In addition, a normal group was also set and each group included 8 mice. The pancreas was collected after four weeks of administration and proteomics tools were employed to study the effects of Rehmanniae Radix and Rehmanniae Radix Praeparata on protein expression in the pancreas of T2DM mice. The expression levels of proteins involved in autophagy, inflammation, and oxidative stress response in the pancreatic tissues of T2DM mice were determined by western blotting, immunohistochemical assay, and transmission electron microscopy. The results showed that the differential proteins between the model group and Rehmanniae Radix/Rehmanniae Radix Prae-parata group were enriched in 7 KEGG pathways, such as autophagy-animal, which indicated that the 7 pathways may be associated with T2DM. Compared with the control group, drug administration significantly up-regulated the expression levels of beclin1 and phosphorylated mammalian target of rapamycin(p-mTOR)/mTOR and down-regulated those of the inflammation indicators, Toll-like receptor-4(TLR4) and Nod-like receptor protein 3(NLRP3), in the pancreas of T2DM mice, and Rehmanniae Radix showed better performance. In addition, the expression levels of inducible nitric oxide synthase(iNOS), nuclear factor erythroid 2-related factor 2(Nrf2), and heine oxygenase-1(HO-1) in the pancreas of T2DM mice were down-regulated after drug administration, and Rehmanniae Radix Praeparata demonstrated better performance. The results indicate that both Rehmanniae Radix and Rehmanniae Radix Praeparata can alleviate the inflammatory symptoms, reduce oxidative stress response, and increase the autophagy level in the pancreas of T2DM mice, while they exert the effect on different autophagy pathways.
Mice ; Animals ; Diabetes Mellitus, Type 2/genetics* ; Streptozocin/pharmacology* ; Diet, High-Fat/adverse effects* ; Proteomics ; Inflammation ; TOR Serine-Threonine Kinases ; Autophagy ; Mammals

OBJECTIVES: To investigate the incidence of extrauterine growth retardation (EUGR) and its risk factors in very preterm infants (VPIs) during hospitalization in China. METHODS: A prospective multicenter study was performed on the medical data of 2 514 VPIs who were hospitalized in the department of neonatology in 28 hospitals from 7 areas of China between September 2019 and December 2020. According to the presence or absence of EUGR based on the evaluation of body weight at the corrected gestational age of 36 weeks or at discharge, the VPIs were classified to two groups: EUGR group (n=1 189) and non-EUGR (n=1 325). The clinical features were compared between the two groups, and the incidence of EUGR and risk factors for EUGR were examined. RESULTS: The incidence of EUGR was 47.30% (1 189/2 514) evaluated by weight. The multivariate logistic regression analysis showed that higher weight growth velocity after regaining birth weight and higher cumulative calorie intake during the first week of hospitalization were protective factors against EUGR (P<0.05), while small-for-gestational-age birth, prolonged time to the initiation of total enteral feeding, prolonged cumulative fasting time, lower breast milk intake before starting human milk fortifiers, prolonged time to the initiation of full fortified feeding, and moderate-to-severe bronchopulmonary dysplasia were risk factors for EUGR (P<0.05). CONCLUSIONS It is crucial to reduce the incidence of EUGR by achieving total enteral feeding as early as possible, strengthening breastfeeding, increasing calorie intake in the first week after birth, improving the velocity of weight gain, and preventing moderate-severe bronchopulmonary dysplasia in VPIs.
Female ; Fetal Growth Retardation ; Gestational Age ; Hospitalization ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Prospective Studies ; Risk Factors

Cerebral ischemia can induce weak endogenous neurogenesis, which is not enough to repair neural injury after cerebral ischemia.In the treatment of cerebral ischemic diseases with Chinese medicine, different treatment methods based on syndrome differentiation are adopted according to the pathological mechanism of the diseases, and the advantages of neural repair after cerebral ischemia are well shown through comprehen-sive regulation.And in this paper, the effects of inflammation, neurovascular units, exogenous stem cell transplantation, exo- somes and other factors on neurogenesis and repair after cerebral ischemia and the intervention of Chinese medicine are described.

BACKGROUNDAcute minor ischemic stroke (AMIS) or transient ischemic attack (TIA) is a common cerebrovascular event with a considerable high recurrence. Prior research demonstrated the effectiveness of regular long-term remote ischemic conditioning (RIC) in secondary stroke prevention in patients with intracranial stenosis. We hypothesized that RIC can serve as an effective adjunctive therapy to pharmacotherapy in preventing ischemic events in patients with AMIS/TIA. This study aimed to investigate the feasibility, safety, and preliminary efficacy of daily RIC in inhibiting cerebrovascular/cardiovascular events after AMIS/TIA.

METHODSThis is a single-arm, open-label, multicenter Phase IIa futility study with a sample size of 165. Patients with AMIS/TIA receive RIC as an additional therapy to secondary stroke prevention regimen. RIC consists of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of cuffs on bilateral upper limbs twice a day for 90 days. The antiplatelet strategy is based on individual physician's best practice: aspirin alone, clopidogrel alone, or combination of aspirin and clopidogrel. We will assess the recurrence rate of ischemic stroke/TIA within 3 months as the primary outcomes.

CONCLUSIONSThe data gathered from the study will be used to determine whether a further large-scale, multicenter randomized controlled Phase II trial is warranted in patients with AMIS/TIA.

TRIAL REGISTRATIONClinicalTrials.gov, NCT03004820; https://www.clinicaltrials.gov/ct2/show/NCT03004820.

A method for the determination of trace elements such as lead, arsenic and mercury in cream cosmetics by total reflection X-ray fluorescence spectrometry (TXRF) with suspension sampling was developed. The mixed solvents of water,tetrahydrofuran,methanol and were used to disperse paste, cream, and additives of triton X-100 to promote the test liquid uniform. The test suspension fluid were taken into the sample carrier,drying and then introduced into TXRF. Poly(1-vinylpyrrolidone-co-vinyl acetate) (P(VP-co-VAc)) was added to curing sediments,inhibiting proliferation. Triton X-100 and P(VP-co-VAc) were found to have the function of reducing mercury loss in the drying process. The loss of elements in the drying process and the effect of triton X-100 and P(VP-co-VAc) were investigated. The effect of cream matrix, element interference, spectral line and the inner standard were discussed. The calibration curves for quantitative analysis were established using matrix standards, so the error of software decomposition peak and the error caused by thick sample were avoided within a certain range. In this work,the linear correlation coefficients of Pb,As and Hg calibration curve were greater than 0.998 The detection limit of Pb,As and Hg in the solution were 0.005,0.004 and 0.006 μg/mL,respectively. Relative standard diviations(RSDs, n=11) of Pb, As and Hg were 7.8%-14.9%,6.6%-13.3% and 7.6%-14.6% respectively. The results of Pb, As, and Hg in cream cosmetics determinated by this method agreed with those obtained from inductively coupled plasma atomic emission spectrometry and the value of standard reference material. The TXRF method was proved to be accurate,simple and valuable in determination of trace heavy metal ions in cosmetic samples.

Objective:To explore the lipid metabolic characteristics of functionally exhausted CD8+T cells in tumor microenvironment of hepatocellular carcinoma(HCC).Methods:By using flow cytometry analysis and real-time PCR to detect the functions and lipid metabolism-related proteins and genes expression of CD8+T cells in HCC and peri-tumor tissues,then the relationship between function and lipid metabolism was analyzed.Objective:The infiltrated CD8+T cells in HCC have the following characteristics: functional exhaustion(decreased interferon-γ secretion and up regulated programmed death molecule-1 expression);down regulated expression of multiple fatty acid synthases,and the decreased content of intracellular fatty acids;impaired mitochondrial structure and function(P<0.05).Conclusions:Fatty acid metabolism abnormalities are the characteristics of exhausted CD8+T cell infiltrated in HCC.

Objective To investigate the effect of early high-loading-dose tirofiban on platelet activity for patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.Methods A total of 120 acute STEMI patients were treated with 300 mg aspirin and 600 mg loading dose clopidogrel and randomized to high-dose tirofiban (25 μg/kg bolus followed by0.15 μg · kg-1 · min-1 infusion for 36 hours,n =40),standard-dose tirofiban (10 μg/kg bolus followed by 0.15 μg · kg-1 · min-1 infusion for 36 hours,n =40) or control (no tirofiban,n =40) before angiography.Inhibition of platelet aggregation (IPA) was assessed before angiography,at 10 min and 24 hours after tirofiban infusion, and at 12 and 24 hours after stopping tirofiban infusion by the thrombelastography assay.Results There was no significant difference in baseline of IPA between the 3 groups (P ＞ 0.05 ).IPA was significantly higher in high-dose tirofiban group compared with standard-dose tirofiban and no tirofiban group at 10 minutes after tirofiban infusion [ ( 84.2 ± 12.0 ) ％ vs.( 67.8 ±26.8 ) ％ and (31.5 ± 21.9) ％,all P ＜ 0.01 ].At 24 hours after tirofiban infusion,the IPA of high-dose and standard-dose tirofiban was similar [ ( 93.0 ± 9.8 ) ％ vs. ( 88.5 ± 18.1 ) ％,P ＞ 0.05 ] and was significantly higher than no tirofiban group [ (40.4 ± 22.8 ) ％,all P ＜ 0.01 ].IPA was similar at 12 and 24 hours after stopping tirofiban use among the 3 groups( all P ＞ 0.05 ).The maximum amplitude of high-dose tirofiban and standard-dose tirofiban groups at different time points was similar( all P ＞ 0.05),and maximum amplitude in both tirofiban groups was significantly lower than in no tirofiban group at 10 min [ (47.2 ± 7.6)mm and (50.0 ± 9.8 ) mm vs.(57.7 ± 6.5 ) mm,all P ＜ 0.01 ] and at 24 hours after stopping tirofiban infusion [ (54.6 ± 5.6 )mm and ( 54.3 ± 9.0) mm vs.(59.6 ± 4.0) mm,all P ＜ 0.01 ].Conclusion Early use of high-loading-dose of tirofiban on top of 600 mg loading dose clopidogrel is more efficient on inhibiting platelet activity than standard dose of tirofiban in patients with acute STEMI undergoing primary primary percutaneous coronary intervention.