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.

Four unreported monoterpene indole alkaloids, tabernaecorymines B-E (1-4), together with twenty-one known indole alkaloids (5-25) were obtained from the stem bark of Tabernaemontana corymbosa. Their structures and absolute configurations were elucidated by extensive spectroscopy, quantum chemical calculations, DP4+ probability analyses and Mo₂(OAc)₄-induced electronic circular dichroism experiment. The antibacterial and antifungal activities of these compounds were evaluated and some of them showed significant activity against Staphylococcus aureus,Bacillus subtilis, Streptococcus dysgalactiae and Candida albicans.
Tabernaemontana ; Anti-Infective Agents ; Antifungal Agents ; Anti-Bacterial Agents ; Indole Alkaloids

Background: There is no standard cut-off value of serum IgG4 concentration and serum IgG4/total IgG ratio for the diagnosis of IgG4-related disease (IgG4-RD) or as a marker of treatment responses. We aimed to explore this issue through a retrospective cohort analysis of adults in southwest China. Methods: The diagnostic performance of serum IgG4 concentration and IgG4/IgG ratio for IgG4-RD was evaluated in a retrospective analysis of 177 adults newly diagnosed as having IgG4-RD and 877 adults without IgG4-RD. Dynamic analysis was performed to evaluate the significance of serum IgG4 concentration on IgG4-RD treatment responses. Results: The serum IgG4 concentration differed according to sex. The optimal cut-off values of serum IgG4 concentration and IgG4/IgG ratio for IgG4-RD diagnosis were 1.92 g/L and 0.12 in males and 1.83 g/L and 0.11 in females, respectively. For patients with serum IgG4 concentration >2.01 g/L, the cut-off values in the total population were >3.00 g/L and 0.19, respectively. The median serum IgG4 concentration decreased over time, and the decrease rate increased over time. The serum IgG4 concentration significantly decreased at >1 week post-treatment (P=0.004), and the median decrease rate was close to 50% at >4 weeks post-treatment. Conclusions Serum IgG4 can be a good indicator for IgG4-RD diagnosis; however, different diagnostic cut-off values should be determined according to sex. The decreasing rate is more conducive than the serum IgG4 concentration to monitor treatment efficacy. The IgG4/IgG ratio did not improve the diagnostic efficacy for IgG4-RD.

As a sensor of cytosolic DNA, the role of cyclic GMP-AMP synthase (cGAS) in innate immune response is well established, yet how its functions in different biological conditions remain to be elucidated. Here, we identify cGAS as an essential regulator in inhibiting mitotic DNA double-strand break (DSB) repair and protecting short telomeres from end-to-end fusion independent of the canonical cGAS-STING pathway. cGAS associates with telomeric/subtelomeric DNA during mitosis when TRF1/TRF2/POT1 are deficient on telomeres. Depletion of cGAS leads to mitotic chromosome end-to-end fusions predominantly occurring between short telomeres. Mechanistically, cGAS interacts with CDK1 and positions them to chromosome ends. Thus, CDK1 inhibits mitotic non-homologous end joining (NHEJ) by blocking the recruitment of RNF8. cGAS-deficient human primary cells are defective in entering replicative senescence and display chromosome end-to-end fusions, genome instability and prolonged growth arrest. Altogether, cGAS safeguards genome stability by controlling mitotic DSB repair to inhibit mitotic chromosome end-to-end fusions, thus facilitating replicative senescence.

Objective:To construct a training program to improve the psychological nursing ability of clinical nurses, so as to provide a strong guarantee for the clinical development of psychological nursing.Methods:By consulting the literature, related books and investigating the curriculum of nursing colleges, the first draft of the training program was drawn up. Four departments of Cardiovascular Medicine of the Second Xiangya Hospital of Central South University from May to August 2019 were recruited and 64 nurses were trained. After the training, the training program was revised again. After two rounds of training and modification, the second draft of the training program was formed, and then Delphi method was used to conduct two rounds of expert consultation on the second draft of the training program.Results:The positive coefficients of experts in the two rounds of consultation were 94.1% and 96.7% respectively, and the average authority coefficient of experts was 0.81. The final training contents included 5 first-class indexes, 18 second-class indexes and 45 third-class indexes. The coefficient of variation of each item of training contents was 0.06-0.23, and the coefficient of variation of training methods and training duration of each part was 0.06-0.17.Conclusions:The training program is scientific, reasonable, detailed and practical, which can provide guarantee for improving the psychological nursing ability of clinical nurses.

Objective:To investigate the effects of RNA interference on the expression level of leptin and its effect on proliferation, TGF-β 1 and collagen type Ⅰ production in human pathological scar fibroblasts in vitro. Methods:Pathological scar tissues (hypertrophic scar, keloid) were collected from the Department of Burn Plastic Surgery in Affiliated Hospital of North Sichuan Medical College. After primary cell culture and cell passage, passage 3 cells were selected for experimental study. The cells were divided into two groups: the experimental group which was transfected with leptin siRNA, and the negative control group which was transfected with empty vector. Examinations were carried out 48 hours after transfection. Cell proliferation was determined by CCK-8. The transcription levels of leptin, TGF-β 1 and type Ⅰ collagen genes were detected by polymerase chain reaction (PCR). The protein expression levels of leptin, TGF-β 1 and type Ⅰ collagen were determined by immunofluorescence and Western blotting. Student′s t-test was used for comparison between groups, and P<0.05 was considered statistically significant. Results:Five hypertrophic scars and five keloids were included. Compared with the negative control groups, the proliferation ability ( A450) of leptin-SiRNA transfected fibroblasts were not significantly different ( P>0.05). The relative mRNA expression levels of leptin, TGF-β 1 and type Ⅰ collagen in hypertrophic scars and keloids were significantly decreased in the siRNA transfection groups compared with the negative control groups ( P<0.05). Immunofluorescence results showed that the expression levels of leptin, TGF-β 1 and type I collagen in keloids were higher than those in hypertrophic scars, and that siRNA induced leptin downregulation significantly reduced the levels of leptin, TGF-β 1 and type I collagen in both hypertrophic scars and keloids. Western blotting showed that the protein levels of leptin, TGF-β 1 and type Ⅰ collagen were significantly decreased in hypertrophic scar and keloid fibroblasts after leptin siRNA interference ( P<0.05). Conclusions:Downregulation of leptin gene expression by RNA interference inhibited TGF-β 1 and typeⅠ collagen expression, which could be used in treating pathological scar.

Objective:To investigate the effects of RNA interference on the expression level of leptin and its effect on proliferation, TGF-β 1 and collagen type Ⅰ production in human pathological scar fibroblasts in vitro. Methods:Pathological scar tissues (hypertrophic scar, keloid) were collected from the Department of Burn Plastic Surgery in Affiliated Hospital of North Sichuan Medical College. After primary cell culture and cell passage, passage 3 cells were selected for experimental study. The cells were divided into two groups: the experimental group which was transfected with leptin siRNA, and the negative control group which was transfected with empty vector. Examinations were carried out 48 hours after transfection. Cell proliferation was determined by CCK-8. The transcription levels of leptin, TGF-β 1 and type Ⅰ collagen genes were detected by polymerase chain reaction (PCR). The protein expression levels of leptin, TGF-β 1 and type Ⅰ collagen were determined by immunofluorescence and Western blotting. Student′s t-test was used for comparison between groups, and P<0.05 was considered statistically significant. Results:Five hypertrophic scars and five keloids were included. Compared with the negative control groups, the proliferation ability ( A450) of leptin-SiRNA transfected fibroblasts were not significantly different ( P>0.05). The relative mRNA expression levels of leptin, TGF-β 1 and type Ⅰ collagen in hypertrophic scars and keloids were significantly decreased in the siRNA transfection groups compared with the negative control groups ( P<0.05). Immunofluorescence results showed that the expression levels of leptin, TGF-β 1 and type I collagen in keloids were higher than those in hypertrophic scars, and that siRNA induced leptin downregulation significantly reduced the levels of leptin, TGF-β 1 and type I collagen in both hypertrophic scars and keloids. Western blotting showed that the protein levels of leptin, TGF-β 1 and type Ⅰ collagen were significantly decreased in hypertrophic scar and keloid fibroblasts after leptin siRNA interference ( P<0.05). Conclusions:Downregulation of leptin gene expression by RNA interference inhibited TGF-β 1 and typeⅠ collagen expression, which could be used in treating pathological scar.

Pituitary abscess is a rare but potentially life-threatening disease. Headache, visual disturbance, and hypopituitarism are the most common presenting symptoms of pituitary abscess. On magnetic resonance imaging(MRI), pituitary abscess may present as a round sellar cystic lesion, hypo- or isointense on T1 imaging and hyper- or isointense on T2 imaging with peripheral gadolinium enhancement. Diagnosis usually is made during surgical exploration when pus is found in a cystic lesion. The mainstay of treatment is transsphenoidal surgical resection in combination with antibiotic therapy, although a craniotomy approach is warranted in select conditions. Here we report 3 cases of pituitary abscess in our hospital and review the literatures.

Objective:To evaluate the clinicopathological characteristics and prognosis of IgA nephropathy (IgAN) patients with microangiopathy lesions and with no hypertension.Methods:Adult IgAN patients without hypertension were selected from Peking University First Hospital. All kidney biopsies were independently reviewed by 2 investigators. Patients were divided into three groups (microangiopathy group, simple arterio/arteriolosclerosis group and normal vascular group) by renal arteriolar lesions. Composite kidney end point event defined as a ≥30% reduction in estimated glomerular filtration rate (eGFR) and end-stage kidney disease. Cox regression analysis was used to test the association between microangiopathy lesions and the outcomes.Results:A total of 420 patients were included in this study, of which 37(8.8%) patients had renal arteriolar microangiopathy lesions, 134 (31.9%) patients had simple arterio/ arteriolosclerosis, and the others had no vascular lesion. Compared with simple arterio/arteriolosclerosis group or non-vascular lesion group, patients with renal arteriolar microangiopathy lesions had more severe urine protein ( P=0.002), worse renal function ( P<0.001), higher proportion of segmental glomerulosclerosis and/or balloon adhesion (S1), tubular atrophy/interstitial fibrosis (T1/2), cellular/fibrocellular crescents (C1/2) (all P<0.05). During the follow-up, 20(54.1%) patients with microangiopathy lesions, 45(33.6%) patients with simple arterio/arteriolosclerosis and 82(32.9%) patients without vascular lesion reached the composite kidney end points ( χ2=6.491, P=0.039). In a multivariable Cox regression model, the presence of microangiopathy lesions was an independent risk factor for kidney disease progression in IgAN patients ( HR=1.872, 95% CI 1.044-3.357, P=0.035), and simple arterio/arteriolosclerosis was not a risk factor for kidney disease progression. Conclusion:It is not uncommon for non-hypertensive patients with IgAN having microangiopathy lesions, which suggests that hypertension is not the sole risk factor for microangiopathy lesions.

Objective To study the influence of different support heights, support numbers and cross-sectional dimensions on support performance of NiTi thoracic aortic stents. Methods Twenty-seven scaffold models with different parameters were established by using AutoCAD 2016 and SoildWorks 2014 software. HyperMesh 14.0 was used for tetrahedral mesh division, and ABAQUS 2017 was used for support performance simulation analysis. Results With the decrease of support height, the support stiffness would increase; a larger cross-section size would lead to a larger support stiffness; with the increase of support numbers, the support stiffness would increase. Among the influencing factors of support performance, the order of influence degree was support height＞section size＞support numbers. Conclusions The research findings have certain guiding significance for the development and research of thoracic aortic stents, and provide theoretical basis for the selection and optimization of clinical stents.