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.

The incidence of breast cancer is increasing year by year,and its pathogenesis is highly complex.The dysregulation of gut microbiota function is closely related to the occurrence and development of breast cancer.The estrogen levels through enterohepatic circulation is regulated by β-glucuronidase produced by the gut microbiota,thereby influencing the occurrence and development of hormone receptor-positive breast cancer and leading to tamoxifen resistance.The metabolites from the gut microbiota,such as short-chain fatty acids(SCFAs)and lithocholic acid(LCA),can participate in regulating the tumor cell cycles and cell proliferation.The colonization of gut microbiota maintains the integrity of the intestinal barrier and regulates the anti-tumor immunity mediated by T lymphocytes.Maintaining gut microbiota homeostasis can enhance the efficacy of tumor chemotherapy and immunotherapy and reduce the adverse reactions in anti-tumor treatments.The targeted action of engineered probiotics in immunotherapy can improve the precision of drug treatment.The effect of gut microbiota on radiotherapy is not yet clear,but regulating gut microbiota can aid in the treatment of radiation enteritis.This review discusses the correlation and effect of gut microbiota on breast cancer and analyzes its role in the treatment of breast cancer.

Background and objective Cystic lung cancer,a special type of lung cancer,has been paid more and more attention.The most common pathological type of cystic lung cancer is adenocarcinoma.The invasiveness of cystic lung adenocarcinoma is vital for the selection of clinical treatment and prognosis.The aim of this study is to analyze the multiple clinical features of cystic lung adenocarcinoma,explore the independent risk factors of its invasiveness,and establish a risk pre-diction model.Methods A total of 129 cases of cystic lung adenocarcinoma admitted to the Department of Thoracic Surgery of the First Affiliated Hospital of Nanjing Medical University from January 2021 to July 2022 were retrospectively analyzed and divided into pre-invasive group[atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS)and minimally invasive adenocarcinoma(MIA)]and invasive group[invasive adenocarcinoma(IAC)]according to pathological findings.There were 47 cases in the pre-invasive group,including 19 males and 28 females,with an average age of(51.23±14.96)years.There were 82 cases in the invasive group,including 60 males and 22 females,with an average age of(61.27±11.74)years.Mul-tiple clinical features of the two groups were collected,including baseline data,imaging data and tumor markers.Univariate analysis,LASSO regression and multivariate Logistic regression analysis were used to screen out the independent risk factors of the invasiveness of cystic lung adenocarcinoma,and the risk prediction model was established.Results In univariate analysis,age,gender,smoking history,history of emphysema,neuron-specific enolase(NSE),number of cystic airspaces,lesion di-ameter,cystic cavity diameter,nodule diameter,solid components diameter,cyst wall nodule,smoothness of cyst wall,shape of cystic airspace,lobulation,short burr sign,pleural retraction,vascular penetration and bronchial penetration were statisti-cally different between the pre-invasive group and invasive groups(P<0.05).The above variables were processed by LASSO regression dimensionality reduction and screened as follows:age,gender,smoking history,NSE,number of cystic airspaces,lesion diameter,cystic cavity diameter,cyst wall nodule,smoothness of cyst wall and lobulation.Then the above variables were included in multivariate Logistic regression analysis.Cyst wall nodule(P=0.035)and lobulation(P=0.001)were found to be independent risk factors for the invasiveness of cystic lung adenocarcinoma(P<0.05).The prediction model was established as follows:P=e^x/(1+e^x),x=-7.927+1.476* cyst wall nodule+2.407* lobulation,and area under the curve(AUC)was 0.950.Conclusion Cyst wall nodule and lobulation are independent risk factors for the invasiveness of cystic lung adenocarcinoma,which have certain guiding significance for the prediction of the invasiveness of cystic lung adenocarcinoma.

OBJECTIVE: To analyze PET/CT imaging manifestations of different pathological subtypes of liposarcoma. METHODS: The F-fluorodeoxyglucose(FDG) PET/CT features of 13 patients pathologically confirmed as liposarcoma were retrospectively reviewed. The metabolism degree and distribution of different subtypes of liposarcoma were compared. RESULTS: The well-differentiated liposarcoma showed fat density mass with septa and irregular strip with mild FDG uptake. The myxoid liposarcoma showed cystic or cystic solid mass, single or multiple with mild-moderate FDG uptake heterogeneously or homogeneously. The dedifferentiated liposarcoma showed mixed soft tissue mass with high FDG uptake heterogeneously, larger lesion with necrosis centrally. The mixed type contained well differentiated type and dedifferentiated type, and showed multiple lesion with combined imaging manifestations. There were local invasions in 12 cases, no lymph node matastasis, and the recurrence of dedifferentiated liposarcoma with lung metastasis in 1 case. The maximum standard values (SUVmax) of FNCCLE grade G1, G2 and G3 liposarcoma were 3.00, 5.67 and 10.33, respectively; there was significant difference between G1 and G3 groups, G2 and G3 groups (all <0.05). CONCLUSIONS PET/CT manifestations of liposarcoma of various pathological subtypes are different. Preoperative PET/CT examination can clarify the pathological types, scope of tumor invasion and metastasis of liposarcoma, which provides more information for clinical decision-making and is helpful for the preparation of surgical plan.
Humans ; Liposarcoma ; classification ; diagnostic imaging ; pathology ; Neoplasm Recurrence, Local ; Positron Emission Tomography Computed Tomography ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo assess the value ofF-fluorodeoxyglucose (F-FDG) positron emission tomography-CT (PET-CT) in detection of primary tumor and pelvic lymph node metastasis in International Federation of Gynecology and Obstetrics (FIGO) stages ⅠA2-ⅡA cervical cancer.

METHODSThe clinical data of 91 patients with FIGO stagesⅠA2-ⅡA cervical cancer were retrospectively analyzed. The sensitivity ofF-FDG PET-CT in detection of cervical cancer was calculated. The long diameter, short diameter and SUVmax were compared between metastatic lymph nodes (MLN) and non-metastatic lymph nodes (NMLN). The optimal cut-off values of different indexes were determined by receiver operating characteristic (ROC) curve and area under curve (AUC), and the sensitivity, specificity and accuracy were calculated.

RESULTS F-FDG PET-CT examinations were positive in 89 patients (89/91, 96.7%). The short diameters of NMLN and MLN were (6.50±2.31)mm and (4.21±1.49)mm(=4.855,<0.05); the SUVmax of NMLN and MLN were 4.56±3.34 and 1.92±1.41(=31.685,<0.05). ROC AUCs of the short diameter and SUVmax in diagnosis of metastatic lymph nodes were 0.802 and 0.861. Taken short diameter ≥ 5.05 mm and SUVmax ≥ 2.05 as cut-off values, the corresponding sensitivity, specificity and accuracy in diagnosis of metastatic lymph nodes were 85.0%, 93.0% and 86.8%, respectively.

CONCLUSIONS F-FDG PET-CT is sensitive to detect primary lesion and pelvic lymph node metastases in FIGO stages ⅠA2-Ⅱ A cervical cancer, and the highest diagnostic accuracy may be obtained by taking short diameter ≥ 5.05 mm and SUVmax ≥ 2.05 as the standard.

Objective:To provide clinicians with insights about the patients with breast cancer complicated with thyroid cancer and dermatomyositis,and to improve early detection of the diseases by observing the clinical characteristics of 1 case of breast cancer complicated with thyroid cancer and dermatomyositis and reviewing the literatures about the relationships between these three kinds of diseases.Methods:The medical information of this patient,including gender,age,clinical manifestations,glucocorticoid treatment dose,type of concurrent tumor and the time point it occured and therapeutic regimen were collected and recorded.These clinical data were retrospectively analyzed.Results:The patient with dermatomyositis was diagnosed with breast cancer and thyroid cancer in succession.Oral administration of 50 mg dexamethasone per day was continued in the treatment of dermatomyositis.Then the patient received 4 cycles of pirarubicin/cyclophosphamide (AC) followed by 4 cycles of paclitaxel/Hessaitin (TH) as neoadjuvant chemotherapy for breast cancer.During the 24 weeks of chemotherapy,the breast tumor size was gradually decreased while there was no significant change in thyroid tumor size.The clinical symptoms of dermatomyositis were also improved.The blood lactic acid dehydrogenase and alpha hydroxybutyrate dehydrogenase levels were decreased,but not obviously.After 8 courses of AC-TH neoadjuvant chemotherapy followed by radical resection of thyroid cancer,there was no significant improvement in the symptoms of dermatomyositis 1 week after operation and the myocardial enzyme levels remained unchanged.Then modified radical mastectomy was performed.The myocardial enzymes were examined again 1 week after the second operation all of them were decreased to the normal levels.The clinical symptoms of dermatomyositis were also improved.Conclusion:Although the relationships between the three diseases is still controversial,the clinical data of the patient and relevant literatures collected in this paper support that breast cancer is associated with thyroid cancer and dermatomyositis is associated with breast cancer,but not thyroid cancer.

Objective To evaluate the role of caspase-1 in the spinal cord in a rat model of incisional pain.Methods Eighteen adult male Sprague-Dawley rats,weighing 250-280 g,in which intrathecal catheters were successfully implanted,were divided into 3 groups (n =6 each) using a random number table:incision pain group (group Ⅰ),incision pain plus dimethyl sulfoxide group (group ID) and incision pain plus caspase-1 inhibitor (Ac-YVAD-CMK) group (group IA).At 10 min before establishment of the model,0.9％ normal saline 20 μl was intrathecally injected in group Ⅰ,dimethyl sulfoxide 20 μl was intrathecally injected and then the catheter was washed with 0.9％ normal saline 10 μl in group ID,and Ac-YVAD-CMK 1 nmol/μl (dissolved in 20 μl dimethyl sulfoxide) and then the catheter was washed with 0.9％ normal saline 10 μl in group IA.The mechanical paw withdrawal threshold (MWT) of the ipsilateral hind paw was measured at 2 h before intrathecal catheterization (T0),3 days after intrathecal catheterization (T1) and 2,6,24 and 48 h after establishment of model (T2-5).The rats were sacrificed after the last measurement of pain threshold at T5,and lumbar enlargement segments of the spinal cord were removed for detection of caspase-1 (p20) expression and interleukin-1beta (IL-1β) content by Western blot and enzyne-linked immunosorbent assay,respectively.Results Compared with the baseline at T0,the MWT was significantly decreased at T2-5 in Ⅰ and ID groups (P＜0.05),and no significant change was found in MWT at T1-5 in group IA (P＞0.05).Compared with Ⅰ and ID groups,the MWT at T2-5 was significantly increased at T2-5,and the caspase-1 (p20) protein expression and IL-1β content were decreased in group IA (P＜0.05).There was no significant difference in MWT,expression of caspase-1 (p20) protein or IL-1β content between group Ⅰ and group ID (P＞0.05).Conclusion The activation of caspase-1 in the spinal cord can promote the release of IL-1β and thus is involved in the incision pain in rats.

Objective:To prepare PLGA nanoparticles modified with folic acid conjugated chitosan oligosaccharide containing pa-clitaxel (F-CS-PLGA-NPs) and study the inhibitory effect on SKOV-3. Methods:F-CS-PLGA-NPs were prepared by an interface dep-osition method, 30% ethanol was used as the release medium for the in vitro release profiles of nanoparticles, and MTT was adopted to evaluate the inhibitory effect of paclitaxel with different formulations and concentrations on SKOV-3. Results:The particle size and zeta potential of F-CS-PLGA-NPs was (321 ± 0. 76) nm and (22. 6 ± 0. 26) mV, respectively, the drug loading was (5. 1 ± 0. 25)%, and the encapsulation efficiency was (41. 96 ± 1. 96)%. F-CS-PLGA-NPs had a similar in vitro release profiles with the ordinary nanoparti-cles ( PLGA-NPs) . About 35% of paclitaxel was released from the nanoparticles in the initial 24 h, and then a near zero order release at a relative slow rate was shown, and the cumulative release rate in 144 h was about 75%. The results of cell experiments suggested that at the same paclitaxel concentration, the inhibition effect of F-CS-PLGA-NPs group was stronger than that of the PLGA-NPs group and the solution group. The inhibition effect of F-CS-PLGA-NPs could be reduced by free folic acid. Conclusion:PLGA nanoparticles modified with folic acid conjugated chitosan oligosaccharide can increase the targeting efficiency in SKOVS-3 tumor cells.

Objective This study was conducted to investigate the clinical outcomes and safety of percutaneous coronary intervention (PCI) to the single-opened vessel lesion among patients with severe left ventricular systolic dysfunction. Methods Twenty-seven patients with severe left ventricular systolic dysfunction (ejection fraction≤35%) undergoing PCI were included. All the patients received PCI only to the single-opened vessel lesion under the conditions of: (1) There were limitations to open chronic total occlusion (CTO);(2) Single-opened vessel lesion was not calcified and tortuous. Clinical outcomes, including success rate of PCI, changes of symptoms in-hospital, brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) pre-and one week post-PCI, the major adverse cardiac events (MACE, including death, myocardial infarction and target vessel revascularization) at 30-days after discharged were observed. Results The success rate of PCI was obtained in all 27 patients(100%), and all the patients received drug eluting stent implantation. The symptoms improvement occurred in all patients and the NYHA class improved from grade Ⅳto grade Ⅲin 22 patients(81.5%) in-hospital. Significant differences were noted in the mean BNP and LVEF between pre-PCI and one week post-PCI, BNP[(2699.6±1104.7) pg/ml vs. (737.0 ± 261.7) pg/ml, P<0.05],LVEF[(26.9±5.7)%vs. (36.0±3.41)%, P<0.05)]. No MACE happened in-hospital and at 30-days follow up. Conclusions PCI only to the single-opened vessel lesion among patients with severe left ventricular systolic dysfunction under the condition of limitations to open CTO is safe and can significantly improve clinical outcomes in-hospital and at 30-days follow up, but it must be emphasized that single-opened vessel lesion not with obvious calcification and tortuosity.

Objective To quantitatively measure the masticatory movement and to investigate the change of stomatognathic function in patients with cleft lip and palate.Methods Fifteen patients with complete cleft lip and palate were selected.Electromyography of bilateral anterior temporalis and masseter was measured and mandibular movement was examined during masticatory movement before and after maxillary protraction.Results After treatment,the activity of masticatory muscles in the functional side was increased significantly.In the unilateral mastication side (left) and the right side,the activities of anterior temporalis increased from 45.57(26.75,67.84) mV to 80.24(72.31,91.36) mV and from 45.25(37.34,57.42) mV to 73.56 (59.63,94.80) mV,respectively.In the unilateral mastication side (left) and the right side,the activities of masseter increased from 62.37 (45.76,72.45) mV to 90.35 (78.94,110.45) mV and from 67.53(59.65,80.53) mV to 87.97(72.35,99.79) mV,respectively.No significant increment in the balance side was found during masticatory movement.The masticatory trajectory was not changed significantly.The width of lateral and vertical scale of right side mastication increased significantly (P ＜0.05).Conclusions After the treatment,the activity of masticatory muscles increased significantly,and the width of lateral and vertical scale of right side mastication increased significantly.