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.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Objective:To identify the proteins differentially expressed in extraocular muscles between restrictive strabismus patients with thyroid-associated ophthalmopathy (TAO) and concomitant esotropia patients by proteomic analysis using tandem mass tag (TMT).Methods:Extraocular muscles samples from 5 restrictive strabismus patients with TAO and 5 concomitant esotropia patients were collected at Peking University People's Hospital from August 2019 to December 2020.All the patients received strabismus surgery.Differentially expressed proteins (DEPs) in extraocular muscles samples were identified by quantitative proteomic analysis and bioinformatic analysis based on TMT.Fold change≥1.2 or≤0.83 and P value<0.05 was regarded as the threshold to screen DEPs.GO annotation, KEGG pathways enrichment analysis and protein-protein interaction (PPI) network of DEPs were conducted through UniProtGOA and STRING.This study protocol was approved by the Ethics Committee of Peking University People's Hospital (No.2021PHB058-001). Results:A total of 53 DEPs were identified, 34 of which were up-regulated and 19 were down-regulated.The biological processes DEPs mainly participated included response to stimulation, multicellular organismal process, metabolism, developmental process, intracellular signal transduction, and positive regulation of biological process.DEPs were involved in pathways including focal adhesion, tight junction, regulation of action cytoskeleton, and apoptosis.Six key proteins identified using PPI network were myosin heavy chain 2, myosin heavy chain 7, myosin regulatory light chain, α-actinin-2, fibrinogen alpha chain and fibrinogen beta chain.Conclusions:There are DEPs in extraocular muscles between restrictive strabismus patients with TAO and concomitant esotropia patients.Myosin, actinin and filamin may be involved in the pathogenesis of TAO through regulation of actin cytoskeleton and focal adhesion.

Objective:Partial stereotactic ablative boost radiotherapy(P-SABR)is a method to deliver SABR boost to the gross tumor boost volume(GTVb), followed by conventionally fractionated radiotherapy to the whole tumor area(GTV). GTVb is the max volume receiving SABR while ensuring the critical organ-at-risk(OAR)falloff to 3 GyE/f. We investigated the potential advantage of proton therapy in treating bulky non-small cell lung cancer(the tumor length greater than 8 cm).Methods:Nine patients with bulky NSCLC treated with photon P-SABR in our institute were selected. For the treatment planning of proton therapy, the GTVb target area was gradually outwardly expanded based on the photon GTVb target area until the dose to critical OARs reached 3 GyE/f. The GTV and CTV areas remained the same as photon plan. A proton intensity-modulated radiation treatment plan(proton-IMPT), a photon intensity-modulated radiation treatment plan(photon-IMRT)and a photon volumetric modulated arc therapy(photon-VMAT)were created for each patient, respectively. The dosimetric parameters of different treatment plans were compared.Results:The volume ratio of GTVb-photon and GTVb-proton to GTV was(25.4±13.4)% and(69.7±30.0)%,respectively( P<0.001). In photon-IMRT, photon-VMAT, and proton-IMPT plan groups, the mean dose of CTV was(76.1±4.9)Gy, (78.2±3.6)Gy, and(84.7±4.9)Gy, respectively; the ratio of tumor volume with Biologic Effective Dose(BED)≥ 90 Gy to GTV volume was(70.7±21.7)%, (76.8±22.1)%,and(97.9±4.0)%,respectively. The actual dose and BED to the tumor area of the proton-IMPT plan group were significantly higher than those of the photon plan group(both P<0.05). Besides, the OARs dose was significantly decreased in the proton-IMPT group, with(49.2±22.0)%, (56.8±19.0)% and(16.1±6.3)% of the whole lung V5 for photon-IMRT, photon-VMAT and proton-IMPT, respectively(all P<0.001). Conclusions:Larger GTV boost target volume, higher BED and reduced OARs dose can be achieved in proton plans compared with photon plans. Proton P-SABR is expected to further improve the local control rate of bulky NSCLC with fewer adverse effects.

Objective To investigate the risk of falling and nutritional status in elderly surgical patients,and to assess the correlation between them.Methods Patients aged ≥65 in Department of General Surgery of Beijing Hospital between January and June 2015 were enrolled in this study.The Morse Fall Scale was used to evaluate the risk of falling.Anthropometrics,body composition,and Nutritional Risk Screening 2002 (NRS 2002) scores were collected to evaluate the nutritional status of the patients.The correlation between risk of falling and nutritional status was analyzed.Results A total of 383 patients were included,including 314 cases under 80 (65-79 years) and 69 cases ≥ 80.Patients ≥ 80 years showed significantly lower grip [(24.53 ± 8.09)kgvs.(30.57 ±8.48)kg,P＜0.05] and4-meter gait speed [(0.66 ±0.19)m/s vs.(0.84 ± 0.20) m/s,P ＜ 0.05],but significantly increased undemutrition [15.9％ (11/69) vs.7.0％ (22/314),P ＜ 0.05] and nutritional risk [56.5％ (39/69) vs.38.2％ (120/314),P ＜0.05].Altogether 33.9％ of the patients (130/383) were at high risk of falling,and the prevalence was significantly higher in patients ≥80 than in patients ＜ 80 [44.9％ (31/69) vs.31.5％ (99/314),P =0.036].Compared with patients not at high risk of falling,high-risk patients had lower body mass index [(22.33 ± 1.82) kg/m2 vs.(23.76 ± 3.26) kg/m2] and grip [(24.95 ± 8.56) kg vs.(30.72 ± 8.39) kg],but higher prevalence of nutritional risk [46.9％ (61/130) vs.38.7％ (98/253)] (all P＜0.05).Conclusions Eldedy surgical patients have a high risk of falling,which may be related with their nutritional status.Nursing and nutrition intervention should be emphasized in there patients to prevent falling and improve clinical outcome.

Objective To investigate the nutritional status of elderly inpatients with benign orthopedic diseases and to assess its relationship with clinical outcomes.Methods Nutritional Risk Screening 2002 ( NRS 2002) was used to prospectively investigate undernutrition and nutritional risk in elderly patients hospitalized between April 1 and May 31, 2012 in Beijing Hospital for benign orthopedic diseases.Associations between nu-tritional status and clinical outcomes were analyzed.Results A total of 520 patients were included, with a mean age of (75 ±7.09) years.The mean body mass index (BMI) was (23.20 ±3.83) kg/m2, mean dominant-hand grip strength was (16.87 ±19.19) kg, mean mid-upper arm circumference was (25.62 ±3.81) cm, mean calf circumference was (31.92 ±4.02) cm.Compared with patients aged 65-79 years, patients≥80 years showed significantly lower hand grip strength [ (13.58 ±15.92) kg vs.(18.48 ±20.42) kg, P=0.004].All the pa-tients completed NRS 2002, which showed that 9.31%of the patients had undernutrition (BMI≤18.5 kg/m2), and 45.19%had nutritional risk (NRS 2002 score≥3).Compared with patients aged 65-79 years, patients≥80 years had significantly higher incidence of undernutrition (13.97% vs.7.21%, P=0.024) and nutritional risk (52.38%vs.41.76%, P=0.024), higher incidence of infectious complications in patients with nutritional risk (10.21%vs.5.26%, P=0.044), longer hospital stay [ (11.66 ±5.76) days vs.(10.42 ±4.37) days, P=0.016], and higher hospital expense [(20.28 ±1.811) thousand yuan vs.(16.39 ±1.362) thousand yuan, P=0.016].Conclusion Elderly patients hospitalized for benign orthopedic diseases have a high incidence of undernutrition and nutritional risk, which is associated with worse clinical outcomes.

Background How to control progression of myopia is a central issue in clinical optometry.Some clinical trials showed that wearing base-in (BI) prism can slow down progression of myopia to certain degree.However,whether BI prism or base-out (BO) prism should be used is worth discussing.Objective This study was to investigate the influences of different prisms on accommodative response and microfluctuation in emmetropias.Methods This clinical trail was approved by Ethic Committee of Peking University People's Hospital.During July in 2014,twenty-two emmetropias of 22 normal volunteers aged 21-27 years were recruited from Peking University People's Hospital under the written informed consent.An open-field infrared refractometer was used to monitor and record pupil diameter and accommodative response under three conditions including non-prism,3△ BI prism,and 3△ BO prism.The accommodative response value was calculated as the difference between reading value and-3.0 D,and root mean square (RMS) of accommodative response value served as amplitude of accommodative microfluctuation.Spectrum of accommodative response was analyzed by one dimension discrete Fourier transformation.The differences of accommodative response value,amplitude of accommodative microfluctuation and pupil diameter among three conditions were compared using repeated one-way ANOVA.Results The accommodative response values were (+0.31±0.78),(+0.51±0.75) and (+0.18±0.72) D under the non-prism,3△BI prism and 3△BO prismconditions,respectively,with a significant difference among them (F =28.078,P =0.000),and compared with the non-prism condition,the accommodative lag of 3△BI prism condition was increased and that of 3△BO prism condition was reduced (P =0.000,0.012).No significant difference was found in the amplitude of accommodative microfluctuation among the three conditions (F=0.062,P =0.879).The percentages of low frequency signal power (0-0.5 Hz)/total power (0-2.5 Hz) was 97.5％,98.3％ and 91.4％ under the non-prism,3△BI prism and 3△BO prism condition,respectively.The pupil diameter was (5.37-±0.69) mm under the 3 △ BI prism condition,which was larger than (5.07±0.66) mm under the non-prism condition and (5.01 ±0.69) mm under the 3△ BO prism condition (both at P =0.000).Conclusions Compared with wearing 3△ BI prism,wearing 3△ BO prism lessens the accommodative lag,decreases the pupil diameter and reduces the power of low frequency component in accommodative response.

OBJECTIVETo investigate the alteration of inflammasome and receptor during IgG promoter transfected to HepG2 cells.

METHODBy assay of Elisa to evaluate the secretion of IL-1 beta, IL-8, TNF-alpha and MCP-1 after puerarine and LPS administration, and by assay of real time PCR to evaluate the expression of mRNA of IL-1 beta, IL-8,TNF-alpha and MCP-1, as well as the receptors of TLR2, 4 and NOD2, MyD88.

RESULTIgG promoter did not active innate immunity and enhance the expression and secretion of inflammasome in HepG2. Puerarine did not active the inflammasome either. LPS activated the innate immunity and increased the secretion of IL-8, TNF-alpha and MCP-1.

CONCLUSIONIgG-HepG2 cells could be used specifically as the model of allergy type II for ingredients screening. It is suggested that puerarine was suite for the activator for this type of allergy as positive control.

Allergens ; analysis ; immunology ; Drugs, Chinese Herbal ; chemistry ; Gene Expression Regulation ; immunology ; Hep G2 Cells ; Humans ; Immunity, Innate ; immunology ; Immunoglobulin G ; genetics ; Inflammasomes ; immunology ; Promoter Regions, Genetic ; genetics ; Transfection

Objective To evaluate the early diagnosis value of MRI combined with DSA in cirrhotic nodules (regenerative nodules, dysplastic nodules) becoming small hepatocellular carcinoma. Methods 40 patients diagnosed as cirrhosis and whose liver nodules detected by ultrasound were followed up as MR dynamic study. All patients were followed up by three dynamic contrast-enhanced MR scanning once every 3 months,and the changes of cirrhotic nodules were observed and analyzed in the signal. If MRI suggested cancerous nodules cirrhosis, hepatic artery DSA would be carried out. Results 40 patients were followed up for 1.5 to 3 years,all patients MR nodules were found in liver regeneration. Follow-up process, the dysplastic nodules were founded in 28 cases and the small hepatocellular carcinoma were founded in 18 patients. 16 cases of 18 patients with small hepatocellular carcinoma carried out routine DSA all had typical of hepatic arterial blood supply and angiogenesis, and were given to Integrated Traditional and Western intervention simultaneously. Conclusion Combined use of MRI-DSA in the evaluation of cirrhotic nodules had a definite value, and could find smaller hepatocellular carcinoma,provide the basis for smaller hepatocellular carcinoma therapy.