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.

ObjectiveWe aimed to investigate the efficacy and mechanism of Yishen Shengjing Prescription （YSP） in the treatment of oligoasthenospermia in rats. MethodThe oligoasthenospermia rat model was established by injection with cyclophosphamide （35 mg·kg^-1·d^-1） for 5 consecutive days. Rats were randomly assigned into control group （without treating with cyclophosphamide）， model group， low- （YSP-L）， medium- （YSP-M）， and high- （YSP-H） dose （2.91， 5.83， and 11.66 g·kg^-1， respectively） groups， Wuzi Yanzongwan （WYW， 1.03 g·kg^-1） group， and L-carnitine （0.17 g·kg^-1） group， with 8 rats in each group. After 28 days of drug intervention， the body weight， testicular weight， and testicular index of rats were recorded. The sperm quality in epididymis was detected by computer-assisted sperm analysis （CASA） system. Hematoxylin-eosin （HE） staining was employed for observation of testicular tissue morphology. The levels of malondialdehyde （MDA） and superoxide dismutase （SOD） in testicular tissue were detected by colorimetry. The levels of follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， and testosterone （T） in serum were determined by enzyme-linked immunosorbent assay（ELISA）. TdT-mediated dUTP nick-end labeling （TUNEL） was employed to detect the apoptosis of testicular cells. The protein levels of B cell lymphoma-2（Bcl-2）， Bax， and cleaved Caspase-3 in testicular tissue were detected by Western blot. ResultCompared with the control group， the model group showed decreased body weight， testicular weight and index， sperm concentration and motility （P<0.01） and increased testicular pathological score （P<0.01）. Compared with the model group， the YSP-M， YSP-H， WYW， and L-carnitine groups showed increased body weight， testicular weight， testicular index， sperm concentration and motility and decreased testicular pathological score. After modeling， the SOD level decreased （P<0.01） while the MDA content increased （P<0.01） in the testicular tissue. YSP-H， WYW， and L-carnitine reversed the SOD and MDA level changes caused by modeling. Compared with the control group， the model group exhibited declined T level （P<0.01） and increased FSH and LH levels （P<0.01）. Compared with the model group， YSP， WYW， and L-carnitine increased the T level （P<0.01） and decreased the LH level （P<0.05， P<0.01）. The apoptosis rate of spermatogenic cells in the model group was higher than that in the control group （P<0.01）， whereas YSP-M， WYW， and L-carnitine reversed such changes （P<0.01）. The model group rats showed decreased expression of Bcl-2（P<0.05） and increased expression of Bax and cleaved Caspase-3 （P<0.05， P<0.01）. Compared the model group， YSP-M， YSP-H， WYW， and L-carnitine up-regulated the Bcl-2 expression and down-regulated the cleaved Caspase-3 expression （P<0.05， P<0.01）. ConclusionYSP improved the sperm quality of oligoasthenospermia model rats by regulating the antioxidant system and sex hormone levels and inhibiting the apoptosis of spermatogenic cells.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease, affecting about 0.6% of the Chinese population. Many patients are not well controlled by conventional treatments, thus there is need for new treatment regimens. In this study, we assessed the efficacy and safety of secukinumab in Chinese patients with moderate to severe plaque psoriasis. METHODS: This study was a 52-week, multicentre, randomized, double-blind, placebo-controlled, parallel-group, Phase 3 trial. A sub-population of study participants (≥18 years) of Chinese ethnicity were randomized to receive subcutaneous injections of 300 or 150 mg secukinumab, or placebo. The co-primary endpoints were psoriasis area severity index (PASI) 75 and Investigator's Global Assessment (IGA) 0/1 at Week 12. RESULTS: A total of 441 Chinese patients were enrolled in this study. Co-primary outcomes were achieved; 300 and 150 mg secukinumab were superior to placebo as shown in the proportion of patients that achieved PASI 75 (97.7% and 87.2% vs. 3.7%, respectively; P < 0.001), and IGA 0/1 (82.3% and 69.7% vs. 2.7%; P < 0.001) at Week 12. Treatment efficacy was maintained until Week 52. There was no increase in overall adverse events with secukinumab relative to placebo throughout the 52-week period. CONCLUSION: Secukinumab is highly effective and well tolerated in Chinese patients with moderate to severe plaque psoriasis. TRIAL REGISTRATION ClinicalTrials.gov, NCT03066609; https://clinicaltrials.gov/ct2/show/record/NCT03066609.
Antibodies, Monoclonal/therapeutic use* ; Antibodies, Monoclonal, Humanized ; China ; Double-Blind Method ; Humans ; Psoriasis/drug therapy* ; Severity of Illness Index ; Treatment Outcome

Acute Kidney Injury ; etiology ; Betacoronavirus ; Coronavirus Infections ; complications ; Humans ; Kidney ; enzymology ; Pandemics ; Peptidyl-Dipeptidase A ; physiology ; Pneumonia, Viral ; complications ; Sequence Analysis, RNA ; methods ; Serine Endopeptidases ; physiology ; Single-Cell Analysis ; methods

OBJECTIVETo compare the clinical value of narrow band imaging (NBI) and iodine staining for margin determination of early esophageal cancer during endoscopic submucosal dissection (ESD).

METHODSClinical data of 87 patients with early esophageal cancers undergoing endoscopic submucosal dissection (ESD) were analyzed retrospectively. Patients were assigned to NBI group and iodine staining group according to the staining method before ESD operation. Clinicopathological features, esophageal spasm ratio, operation time, en bloc resection rate, complications, local recurrence, and distant metastases were compared between the two groups.

RESULTSThere were 37 patients in NBI group while 50 patients in iodine staining group. Location and size of the lesions between two groups were not significantly different. The ratio of moderate-severe esophageal spasm in NBI group was significantly lower as compared to iodine staining group [10.8%(4/37) vs. 32.0%(16/50), P<0.05]. The average operation time in NBI group was significantly shorter than that in iodine staining group [(42.2±19.5) min vs. (53.3±30.9) min, P<0.05). All the tumors were resected in an en bloc fashion and the R0 resection rate was 100%. Perforations in 2 patients and delayed bleeding in 1 patient were successfully treated by endoscopic methods. Esophageal strictures occurred in 3 patients of NBI group and 4 patients of iodine staining group, who were treated by endoscopic dilation and retrievable stents. During mean 13.2 months (range 4 to 20 months) follow-up periods, local recurrence occurred in 2 patients of NBI group and 2 patients of iodine staining group. These patients received ESD or other surgery.

CONCLUSIONCompared with iodine staining, using NBI for margin determination of early esophageal cancer during ESD is more convenient and fast because of distinctly lower degree of esophageal spasm.

Adult ; Aged ; Esophageal Neoplasms ; pathology ; surgery ; Esophagoscopy ; methods ; Female ; Humans ; Iodine ; Male ; Middle Aged ; Narrow Band Imaging ; Retrospective Studies ; Staining and Labeling

A practical approach to the synthesis of the A, B and C-ring subunit of cyclopamine has been developed. This synthetic tactic highlights the utility of mandelate acetal-mediated resolution of the fused ring ketone (±)-4 and IBX-mediated oxidation cascades from 12 to 9. The availability of advanced intermediates from enantiomerically pure (+)-4 and 2 could provide efficient access to biologically active and structurally diverse C-nor-D-homo-steroidal alkaloids such as cyclopamine.
Chemistry Techniques, Synthetic ; methods ; Molecular Structure ; Organic Chemistry Phenomena ; Stereoisomerism ; Steroids ; chemistry ; Veratrum Alkaloids ; chemical synthesis ; chemistry

OBJECTIVETo prospectively evaluate the clinical value of different magnifying chromoendoscopy(MCE) methods in screening gastric precancerous lesions and early cancers.

METHODSBetween March 2010 and October 2011, among all the patients aged over 40 who received esophagogastroduodenoscopy at Zhongshan hospital, Fudan University, suspicious lesion was detected in 699 patients, who were randomly assigned to three groups: epinephrine dye(n=240), indigo carmine dye(n=246), and acetic acid-indigo carmine mixture dye(n=213). Diagnosis was made according to surface patterns and microvessels of the lesion. Pathological diagnosis was used as the gold standard. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement(Kappa) test. McNemar Paired chi-square test was used to compare the concordance of three MCE methods, regular white light, magnification alone, and NBI magnifier before and after MCE.

RESULTSPathological examination showed inflammatory lesions in 415 patients, intestinal metaplasia in 190, low grade intra-epithelial neoplasia in 17, and high grade intra-epithelial neoplasia or early cancer in 77. The percentage of patients with consistent endoscopic and pathological diagnosis was 77.1%(185/240) for epinephrine dye, 80.5%(198/246) for indigo carmine dye, and 81.2%(173/213) for acetic acid-indigo carmine mixture dye. Kappa values were 0.579, 0.502, and 0.667 respectively(all P<0.01). For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 84.0%, 83.3%, and 92.9%, respectively, and the specificities were 98.6%, 97.3%, and 98.4%. All the three chromoendoscopy methods improved the diagnostic accuracy for precancerous lesions compared with conventional gastroscopic observation with white light(all P<0.01). Indigo carmine and acid-indigo carmine mixture dye improved the diagnostic accuracy of magnification alone(both P<0.05). There was no significant difference in diagnostic accuracy between each MCE method and magnifying NBI observation(all P>0.05).

CONCLUSIONNBI magnification and all the three MCE methods may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.

Acetic Acid ; Adult ; Aged ; Aged, 80 and over ; Coloring Agents ; Epinephrine ; Female ; Gastroscopy ; methods ; Humans ; Indigo Carmine ; Male ; Middle Aged ; Precancerous Conditions ; diagnosis ; pathology ; Prospective Studies ; Sensitivity and Specificity ; Staining and Labeling ; methods ; Stomach Neoplasms ; diagnosis ; pathology

OBJECTIVETo investigate the clinical application and indication of endoscopic dissection technique for submucosal tumors (SMTs) of the esophagogastric junction (EGJ) originating from the muscularis propria.

METHODSA total of 143 SMTs of the EGJ were treated by endoscopic resection in the Endoscopy Center of Zhongshan Hospital Affiliated to Fudan University between March 2007 and June 2011. The clinical and histopathologic feature, surgical approach, en bloc resection rate, complications, and postoperative follow up were evaluated.

RESULTSThere were 74 males and 69 females with a mean age of 49.1 years old. The en bloc resection rate was 94.4%(135/143). There were 126 patients who underwent endoscopic submucosal excavation in an en bloc fashion. Six patients underwent endoscopic full-thickness resection without laparoscopic assistance. Three patients underwent submucosal tunneling endoscopic resection. The other 8 SMTs were partially resected for histological evaluation and the residual tumors were further treated with nylon snare ligation. The mean lesion size was 17.6 mm. The mean procedure time was 45.1 minutes and the mean intraoperative bleeding was 50.0 ml. Perforations occurred in 6 patients and metal clips were used to close the defect. One patient with Mallory-Weiss syndrome was successfully treated with conservative treatment. Pathological examination showed that the lesions were leiomyoma (n=121), gastrointestinal stromal tumor (n=20), granulosa cell tumor (n=1), and intermuscular lipoma (n=1). No local recurrence and distant metastasis were noted during the follow-up (range, 3-48 months).

CONCLUSIONEndoscopic resection technique is safe and effective, and should be selected for each patient individually.

Adenocarcinoma ; surgery ; Adult ; Aged ; Endosonography ; Esophagogastric Junction ; pathology ; Female ; Follow-Up Studies ; Gastroscopy ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo evaluate the expression of EphA2 protein in tissue specimens and cell lines of laryngeal squamous cell carcinoma (LSCC), and to further study the correlation of EphA2 protein expression with clinicopathological characteristics and prognosis in LSCC.

METHODSWestern blot was applied to assess the EphA2 protein expression in LSCC cell line Hep-2 cells and the head and neck immortalized epithelial cell line NP-69 cells. Immunohistochemical staining was performed on paraffin sections of 88 cases of LSCC specimens and 16 cases of adjcent normal tissue samples to investigate the EphA2 protein expression, and to futher elucidate its correlation with clinicopathological characteristics.

RESULTSCompared with the NP-69 cells, EphA2 expression in LSCC cell line Hep-2 cells was upregulated. The positive rates of EphA2 expression in LSCC and adjcent normal tissues samples were 80.7% and 43.8%, respectively, with a significant difference between the two groups (P < 0.001). EphA2 overexpresion was closely correlated with clinical stage (I + II/III + IV, P = 0.005), metastasis (P = 0.025) and recurrence (P = 0.021) in LSCC. Furthermore, patients with EphA2 overexpression had poorer tumor-free survival and 5-year overall survival compared with that in patients with low EphA2 expression (33.3% vs. 63.2%, P = 0.003; 46.7% vs. 81.6%, P = 0.002). EphA2 expression combined with clinical stage provided a better predictive value in prognosis. Univariate and multivariate Cox regression analysis revealed that EphA2 expression is an independent prognostic factor for patients with LSCC (P = 0.019).

CONCLUSIONSThe results of this study demonstrate that EphA2 protein expression is significantly increased in LSCC tissues and cell lines, and EphA2 protein overexpression is associated with tumor recurrence, metastasis and poorer prognosis in LSCC patients. These results suggest that EphA2 may play a critical role in the initiation and progression of LSCC, implicating EphA2 as a valuable marker for the prediction of recurrence, metastasis and prognosis in LSCC.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; metabolism ; pathology ; surgery ; Cell Line ; Cell Line, Tumor ; Disease-Free Survival ; Epithelial Cells ; metabolism ; Female ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; metabolism ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Proportional Hazards Models ; Receptor, EphA2 ; metabolism ; Survival Rate

Objective To study the relationship between ischemic stroke (IS) and both gene polymorphisms of methylenetetrahydrofolate reductase (MTHFR) and cigarette smoking. Methods Four hundred and fifty-four patients with IS and 334 controls were recruited in our study; their gene polymorphisms of MTHFR were detected by PCR and denaturing high performance liquid chromatogram (DHPLC). The patients were further divided into different subgroups based on TOAST criteria and scores of neurological impairments and the distribution of MTHFR genotypes were analyzed accordingly. The relationships between IS and both cigarette smoking and these genotypes were measured by odds ratios (ORs) and 95％ confidence intervals (95％CIs). The ORs and 95％ Cls were calculated by unconditional logistic regression. Results TT genotype and T allele were associated with LAA type and CE type,moderate type and severe type of IS. OR of TT genotype and T allele in smoking patients with IS were 4.393 and 2.359, respectively; but the OR ofCC genotype in smoking patients with IS was 0.353. On the other hand, the OR of all genotypes and alleles in non-smoking patients with IS were not significantly different as compared with those in controls. Conclusion Cigarette smokers with T alleles are likely to suffer IS, but those cigarette smokers with C alleles are not; and there exist interactions between cigarette smoking and MTHFR gene in the pathogenesis of IS.