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Chinese expert consensus on pre-hospital and emergency diagnosis and treatment of adult traumatic brain injury

Yang YANG ; Xiao-Xi TIAN ; Zheng-Hua SHI ; Ji-Peng WANG ; Li-Hong LI ; Ming-Hua LIU ; Xiao-Dong ZHAO

Medical Journal of Chinese People's Liberation Army.2025;50(2):123-133. doi:10.11855/j.issn.0577-7402.0144.2025.0211

Traumatic brain injury(TBI)is a serious condition characterized by high rates of mortality and disability.Deaths caused by severe TBI usually occur within the first few hours after the injury.Timely and effective management of TBI during pre-hospital and emergency treatment phases is crucial for improving patients'prognosis.To address this issue,the Emergency Physicians Branch of the Chinese Medical Doctor Association,the Emergency Medicine Professional Committee of the People's Liberation Army,the Beijing Emergency Medicine Society,and the Chinese Emergency Medicine Specialist Association have jointly selected national experts in emergency medicine and neurosurgery to formulate the"Chinese Expert Consensus on the Pre-hospital and Emergency Diagnosis and Treatment of Adult Traumatic Brain Injury".This consensus consists of two parts focusing on pre-hospital and emergency diagnosis and treatment of TBI,with 24 recommendations put forward to guide relevant clinical practices in pre-hospital and emergency management.

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Chinese expert consensus on emergent treatment of hypothermia(2025 edition)

Wei CHEN ; Lei HE ; Ming YIN ; Tao WAN ; You-Qing TANG ; Ai-Ping WANG ; Yang LI ; Wan-Xian YU

Medical Journal of Chinese People's Liberation Army.2025;50(6):641-655. doi:10.11855/j.issn.0577-7402.0648.2025.0510

Hypothermia is a clinical syndrome characterized by core body temperature<35℃,caused by significant heat loss from body surface in cold environment.As a systemic cold injury,it can be lethal if treatment is delayed.Emergent diagnosis and treatment of hypothermia are expected to improve the prognosis of patients.In 2005,the U.S.Army Research Institute of Environmental Medicine(USARIEM)issued guidelines for the prevention and management of cold injuries,but there has been no corresponding standard in China.Therefore,Emergency Branch of Chinese Medical Rescue Association,Emergency Medical Equipment Society of China Association of Medical Equipment,Integrated Rehabilitation Medical Branch of Chinese Medical Rescue Association,and Pre-Hospital Emergency Care Working Committee of Chinese Aging Well Association jointly developed the Chinese Expert Consensus on Emergent Treatment of Hypothermia(2025 edition).The consensus covers the pathophysiology,etiology and epidemiology,diagnosis and severity grading,prehospital treatment,and in-hospital treatment of hypothermia,including 15 recommendations in total,aiming to provide guidance for the relevant clinical rescue work.

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Effect of abdominal paracentesis drainage on TLR4 expression in intestine of rats with severe acute pancreatitis and its significance

Shang-Qing HUANG ; Yi WEN ; Bing WANG ; Shuai LI ; Xiao-Hui YUAN ; Hong-Yu SUN ; Li-Jun TANG

Medical Journal of Chinese People's Liberation Army.2020;45(12):1215-1221. doi:10.11855/j.issn.0577-7402.2020.12.01

Objective To investigate the potential mechanism of abdominal paracentesis drainage(APD)on severe acute pancreatitis(SAP)through regulating Toll-like receptor 4(TLR4)expression in rat intestine.Methods Male SD rats were randomized into the Sham group,SAP group,and APD group,with 15 rats in each group.Rats were treated with a retrograde injection of 5%sodium taurocholate into the pancreatic bile duct to induce SAP,followed by ADP treatment through placing a drainage tube in the right lower abdomen of rats.Rats without ADP treatment were used as controls:SAP group included rats without ADP surgical procedure;while Sham group included rats with ADP surgical procedure but without placing a drainage tube.About 24 hours after ADP treatment,pathological changes of small intestine and pancreas were observed by HE staining;serum amylase and lipase activities were detected by the automatic biochemical analyzer;serum endotoxin levels were detected by limulus amebocyte lysate method;serum DAO activity was detected by ultraviolet colorimetry;TNF-α,IL-6 and D-lactic acid levels were detected by ELISA;apoptosis of intestinal mucosal epithelial cells was detected by TUNEL assay;mRNA expression of TLR4 was detected by real-time PCR;the expression of TLR4 signaling pathway and apoptosis-related proteins were detected by immunohistochemistry and Western blotting.Results Compared with SAP rats,the pathological damage of small intestine and pancreas of APD rats was significantly reduced;the pathological score was decreased(P<0.05);serum amylase,lipase and DAO activity,serum TNF-α,IL-6,D-lactic acid and endotoxin levels were also declined(P<0.05).The expression of TLR4,MyD88,NF-κB p65,TNF-α and IL-6 in the small intestine was significantly lower in the APD group than those in the SAP group(P<0.05).In addition,compared with the SAP group,apoptotic index,cleaved caspase-3,and Bax expression were significantly decreased in the APD group,while Bcl-2 expression was increased(P<0.05).Conclusion Early implementation of APD can significantly reduce the expression of intestinal TLR4 in SAP rats,reduce the activation of a downstream inflammatory signaling pathway,and thus decrease the occurrence of intestinal mucosal epithelial cell apoptosis that contributes to intestinal protection.

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Protective effect of placental mesenchymal stem cells on lung injury in rats with severe acute pancreatitis and its mechanism

Shuai LI ; Qi-Lin HUANG ; Bing WANG ; Xiao-Hui YUAN ; Hong-Yu SUN ; Li-Jun TANG

Medical Journal of Chinese People's Liberation Army.2020;45(12):1222-1229. doi:10.11855/j.issn.0577-7402.2020.12.02

Objective To investigate the protective effect and mechanism of placental-derived mesenchymal stem cells(P-MSCs)on lung injury in rats with severe acute pancreatitis.Methods A total of 36 healthy adult male SD rats were randomly divided into control group(n=12),SAP group(n=12)and P-MSCs group(n=12).SAP rat model was established by retrograde injection of 4%sodium taurocholate into biliopancreatic duct.P-MSCs(1×106 cells/100 g)were delivered through the tail vein of the rats at 6 h after the induction of SAP.The rats were sacrificed 12 and 24 h after P-MSCs infusion.The ratio of wet to dry weight of lung tissue and the number of neutrophils,leukocytes and macrophages in bronchoalveolar lavage fluid(BALF)was calculated.The degree of pancreatic and lung injury was evaluated by HE staining.The concentration of amylase,lipase and inflammatory factors in serum was measured by ELISA.The MPO activity in pancreas and lung tissue was measured by MPO assay kit,and the mRNA expression levels of TNF-α,IL-1β in lung tissue were detected by RT-qPCR.The ratio of M1 and M2 in lung tissue was detected by immunofluorescence stain.Results Compared with SAP group,the ratio of wet to dry weight of lung tissue in P-MSCs group significantly decreased,the number of neutrophils,leukocytes and macrophages in BALF were significantly reduced(P<0.001).HE staining results showed that,compared with SAP group,the pathological injury of pancreas and lung tissue in P-MSCs group was significantly reduced(P<0.001).The results of ELISA showed that compared with SAP group,the levels of amylase,lipase,IL-1β,IL-6 and TNF-α in serum were significantly decreased,the level of IL-10 was significantly increased(P<0.001).Compared with SAP group,the concentration of MPO in pancreas and lung tissue were significantly reduced(P<0.001).Immunofluorescence staining results showed that the number of M1 type macrophages in the lung tissue of the P-MSCs group was significantly reduced,and the number of M2 type macrophages was significantly increased(P<0.001).Conclusion P-MSCs can reduce the inflammatory injury of lung in SAP rats,and its protective mechanism may be related to the induction of M2 polarization in pulmonary macrophages.

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Differential expression profiles of steroid-induced femoral head necrosis mRNA and non-coding RNA and analysis of endogenous competitive RNA regulatory network

Jia-Cheng LI ; Xi YANG ; Xue-Zhen LIANG ; Bo-Zhao YAN ; Bo XU ; Gang LI

Medical Journal of Chinese People's Liberation Army.2020;45(12):1230-1237. doi:10.11855/j.issn.0577-7402.2020.12.03

Objective To explore the pathogenesis of steroid-induced osteonecrosis of the femoral head(SONFH).Methods The SONFH-related deribosomal transcriptome sequencing data set SRP091890 in SRA database was retrieved,and differences in lncRNA and mRNA were obtained by R language analysis.GSE89587,a microarray data set related to SONFH in GEO database,was retrieved,and differential miRNAs were obtained by R language analysis.miRDB,miRTarbase and TargetScan databases were used to predict the target mRNAs of related miRNAs,respectively,to construct a miRNA-mRNA regulatory network.ClusterProfiler package was used for functional enrichment analysis of mRNAs in the above regulatory network.The lncRNA was predicted by Starbase database,and the lncRNA-miRNA-mRNA ceRNA regulatory network was constructed.Results A total of 422 significantly different mRNAs,22 significantly different miRNAs and 416 significantly different lncRNAs were screened by R language analysis.Forty-six mRNAs were identified to be involved in the construction of the SONFH-related miRNA-mRNA regulatory network by cross-mapping the predicted target mRNAs from miRDB,miRTarbase and TargetScan databases and the differentially expressed mRNAs.Through cross-mapping of targeted lncRNAs predicted by Starbase database and lncRNAs with the above differences,3 lncRNAs were determined to be involved in the construction of SONFH-related lncRNA-miRNA regulatory network,and finally the construction of VASH1-AS1-related ceRNA regulatory network.SLC5A6,NQO2 and THAP6 may be indirectly regulated by VASH1-AS1 through hsa-let-7d-5p or hsa-mir-3194-3p.Conclusion VASH1-AS1 may pass from the hsa-let-7d-5p or hsa-mir-3194-3p indirect control SLC5A6,NQO2 and THAP6 and involved in the pathogenesis of SONFH process,and VASH1 AS1,hsa-let-7d-5p and NQO2 may be as a control factor,through regulating network plays a"angiogenesis-bone formation decoupling couplet system",has played a key role in the process of SONFH.

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Effect and mechanism of the total paeony glycosides on spinal cord apoptosis in rats with spinal cord injury

Zong-Jin YUE ; Ru-Yin LIU ; Lu YU ; Xin-Li WANG ; Zhong-Kai FENG ; Xi-Bin WANG ; Yun-Peng LI ; Da-Yong XU

Medical Journal of Chinese People's Liberation Army.2020;45(12):1238-1241. doi:10.11855/j.issn.0577-7402.2020.12.04

Objective To investigate the effect and mechanism of total paeony glycosides(TPG)on spinal cord apoptosis in rats with spinal cord injury(SCI).Methods A total of 18 SD rats were randomly divided into control group,SCI group and TPG group(6 each).The SCI rat model was established using Allen method.For rats in control group,the spinal cord was sutured directly after laminectomy without spinal cord injury;those in TPG group were intraperitoneally injected with 25 mg/kg TPG every 24 hours after the establishment of SCI model,while those in SCI group and control group were intraperitoneally injected with the same volume of normal saline for 28 days.The rats'behavioral score were evaluated using Basso-Beattie-Bresnahan(BBB)method.The apoptosis of spinal cord cells was measured by flow cytometry.Western blotting was performed to detect the expression levels of cell apoptotic protein cleaved caspase-3 and cleaved caspase-9.The contents of MDA,SOD and LDH in the supernatant of spinal fluid were quantified with corresponding kits.Results Compared to those in control group,the BBB score decreased significantly,while the apoptosis rate of spinal cord cells and the expression levels of cleaved caspase-3 and cleaved caspase-9 were obviously elevated,and the contents of MDA and LDH increased,SOD decreased in the supernatant of spinal fluid in the rats of SCI group(P<0.05).Compared to those in SCI group,after treatment with TPG,the BBB score increased significantly,the apoptosis rate of spinal cord cells and the expression levels of cleaved caspase-3 and cleaved caspase-9 decreased obviously,while the contents of MDA and LDH decreased,and SOD increased in the supernatant of spinal fluid of the rats in SCI group(P<0.05).Conclusion TPG inhibits the apoptosis of spinal cord cells in SCI rats,which may related to the function of TPG in regulating oxidative stress.

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Heat shock protein 60 mediates chronic morphine antinociceptive tolerance through TLR4-p38MAPK in rats

Yan-Fen ZHAO ; Feng ZHAO ; Peng-Sen LIU ; Ke MAO

Medical Journal of Chinese People's Liberation Army.2020;45(12):1242-1247. doi:10.11855/j.issn.0577-7402.2020.12.05

Objective To investigate the function and potential mechanisms of heat shock protein 60(HSP60)in chronic morphine antinociceptive tolerance.Methods Fifty male rats were randomly divided into five groups(n=10):control group,morphine group,siRNA-negative control(siRNA-NC)+morphine group,siRNA-HSP60+morphine group,lipopolysaccharide(LPS)+siRNA-HSP60+morphine group.The control group and the morphine group were injected intrathecally with 10 μl of saline or morphine;the siRNA-NC+morphine group and the siRNA-HSP60+morphine group were given 10 μl of siRNA-NC and siRNA-HSP60 respectively,and then intrathecal morphine;LPS+siRNA-HSP60+morphine group was given 10 μl siRNA-HSP60 and LPS,and then intrathecal injection of morphine.All groups were treated continuously for 7 days.Real-time polymerase chain reaction(RT-PCR)and Western blotting were used to evaluate the expression of HSP60 in the spinal cord tissues of rats.The effect of siRNA-HSP60 on pain tolerance was explored by hot-water tail-flick test.Immunohistochemistry assay was applied to detect the expression of OX-42 in the spinal cord tissues of rats.RT-PCR was used to detect the mRNA levels of interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)in the spinal cord tissues of rats.Western blotting was used to measure the protein levels of TLR4,p-p38MAPK in the spinal cord tissues of rats.Result Intrathecal injection of siRNA-HSP60 significantly decreased morphine-induced HSP60 expression(P<0.05).Compared with the control group,morphine group rats were less tolerant to pain(P<0.05),and HSP60 deficiency enhanced analgesic effect(P<0.05).Compared with the siRNA-NC+morphine group,the expression levels of OX-42,IL-1β and TNF-α in siRNA-HSP60+morphine group decreased significantly(P<0.05).In addition,the protein levels of TLR4 and p-p38MAPK in siRNA-HSP60+morphine group were lower than those in the siRNA-NC+morphine group(P<0.05).LPS treatment increased the expression of TLR4 and p-p38MAPK(P<0.05);LPS reversed the effect of HSP60 deficiency on morphine tolerance(P<0.05).Conclusion HSP60 deficiency showed an obvious attenuation on morphine antinociceptive tolerance through inhibiting the microglia activation and the inflammatory response,which may be related to the inhibition of TRL4-p38MAPK signaling pathway.

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Relationship of the onset of fatigue symptoms and pulmonary artery pressure in people acutely rushing into high altitude areas

Jing-Du TIAN ; Chuan LIU ; Jie YANG ; Xu-Bin GAO ; Ji-Hang ZHANG ; Xiao-Hui ZHAO ; Lan HUANG

Medical Journal of Chinese People's Liberation Army.2020;45(12):1248-1253. doi:10.11855/j.issn.0577-7402.2020.12.06

Objective To explore the incidence of fatigue symptoms and the relationship with pulmonary artery pressure in healthy people who acutely rush into high altitude(HA)areas.Methods A hundred and thirty-six healthy subjects(young men)were recruited during June to July 2013,and transported from Chongqing C.(asl.400 m)to Litang Co.(asl.4100 m)by bus.The physiological parameters of subjects were collected before and after entering the plateau,the heart function and the hemodynamic indexes of pulmonary circulation were detected by echocardiography.The subjects were divided into fatigue+group(n=78)and fatigue-group(n=58)according to their degree of fatigue evaluated with Fatigue Assessment Scale.The changes of the above indicators were compared before and after entering the plateau and between the two groups of subjects.Logistic regression analysis was performed to screen the related risk factors of plateau fatigue.Results Following acute high altitude exposure,the mean pulmonary arterial pressure(mPAP),pulmonary artery systolic pressure(sPAP)and pulmonary vascular resistance(PVR)in subjects increased obviously.Compared with fatigue-group,the mPAP,sPAP and PVR increased significantly in fatigue+group[17.9 mmHg vs.20.6 mmHg;26.1 mmHg vs.30.4 mmHg;and 4.41 Woods vs.5.56 Woods],and more larger right ventricular end diastolic area(RVEDA)[(22.0±3.8)cm2 vs.(20.5±3.6)cm2],right ventricular end systolic area(RVESA)[(13.1±2.7)cm2 vs.(12.1±2.3)cm2]and transverse diameter of right ventricular base[(3.92±0.45)cm vs.(3.72±0.41)cm]were in fatigue+group than those in fatigue-group with statistical significance(P<0.05).Logistic regression analysis indicated that increased mPAP was an independent risk factor for the onset of high altitude fatigue(OR=1.130,95%CI 1.034-1.235,P=0.007).Conclusion Acutely rushing into the plateau may lead to the incidence of fatigue symptoms and increased pulmonary artery pressure,which is the independent risk factor for the occurrence of fatigue symptoms.

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Status of detecting fetal free DNA in maternal peripheral blood in Beijing in 2019

Yan-Chun ZHANG ; Hong-Yan XU ; Kai-Bo LIU

Medical Journal of Chinese People's Liberation Army.2020;45(12):1254-1258. doi:10.11855/j.issn.0577-7402.2020.12.07

Objective To assess the prenatal screening,diagnosis and pregnancy outcomes status with noninvasive prenatal testing(NIPT)in Beijing in 2019.Methods Descriptive statistical methods were used to analyze the screening and diagnosis status by detecting fetal free DNA in maternal peripheral blood in 8 prenatal diagnosis institutions in Beijing.Results A total of 65136 cases of pregnant women accepted NIPT in the 8 institutions in 2019,accounting for 29.8%of the total number of pregnant women(65 136/218 396).The compound coincidence positive predictive rate of 21\18\13-trisomy syndrome was 57.4%(152/265),the coincidence rates of 21-trisomy,18-trisomy,13-trisomy,sex chromosomes and other chromosomes were 76.0%(117/154),38.89%(28/72),18.0%(7/39),30.5%(85/279)and 16.4%(30/183),respectively.Among the 65 136 pregnant women,10 791 cases were suitable for population screening(16.6%);53 833 cases were used with caution(82.7%);343 cases were not suitable for population screening(0.5%).By following-up,one case of 21-trisomy and one case of 18-trisomy were found to be false negative cases.The detection rate of 21\18\13-trisomy syndrome was 98.7%(152/154),of 21-trisomy was 99.2%(117/118),of 18-trisomy was 96.6%(28/29),and of 13-trisomy was 100%(7/7).The prenatal diagnosis rate of NIPT was 84.6%for high-risk pregnant women(615/727),of them the prenatal diagnosis rate was 91.7%(243/265)for 21\18\13-trisomy syndrome cases.Conclusions Detection of fetal free DNA in maternal peripheral blood(NIPT)has become one of the important methods of screening 21-trisomy syndrome.In clinical applications,doctors should strictly grasp the test indications,pay attention to genetic counseling before and after testing,improve the prenatal diagnosis rate,strengthen laboratory quality control and improve the quality of testing.

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Anticoagulation effect of a citrate dialysate in the continuous blood purification of critical patients

Xin HU ; Zhi MAO ; Qing-Lin LI ; Shuang QI ; Fei-Hu ZHOU

Medical Journal of Chinese People's Liberation Army.2020;45(12):1259-1264. doi:10.11855/j.issn.0577-7402.2020.12.08

Objective To investigate the effect of a citrate dialysate contains no calcium in the continuous blood purification treatment of critically ill patients.Methods A retrospective analysis was performed on 88 patients with severe disease who received continuous blood purification treatment and needed anticoagulation with citrate from April 1,2018 to December 31,2019.According to the different use of dialysate,the patients were divided into study group(calcium-free dialysate containing citrate)and control group(traditional dialysat containing calcium).The hemofilter life and the changes of coagulation function,acid-base electrolyte,liver and kidney function were compared between the two groups.Results After treatment,there were no statistically significant differences in the changes of acid-base electrolytes,liver and kidney functions,and coagulation indexes between the two groups(P>0.05).The hemofilter life was(30.0±10.93)h in the study group and(24.3±8.19)h in the control group.The hemofilter life was prolonged by the use of anticoagulation with the citrate dialysate contains no calcium(P=0.039).The variation of venous pressure per hour and transmemtal pressure per hour in the dialysis machine were 1.9(1.5,2.5)mmHg,and 5.2(3.9,6.7)mmHg in study group.In control group,the variation of venous pressure per hour was 2.8(2.3,3.7)mmHg,and that of transmemtal pressure per hour was 8.7(6.0,9.1)mmHg.There were statistically significant differences in unit time pressure changes between the two groups(P<0.05).The vital signs of all patients were stable during the treatment,and no obvious complications such as hypotension and bleeding occurred.Conclusion Compared with the traditional dialysa containing calcium citrate in blood purification,the new citrate dialysa contains no calcium can not only achieve the therapeutic effect,but also delay the pressure rise of the hemofilter and prolong the hemofilter life.It is a safe and effective method for critically patients.

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