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.

Formaldehyde is a prevalent organic solvent in industrial and indoor environment,which can seriously harm human health,so it is of great significance to develop highly sensitive formaldehyde sensors with fast response,low detection limit and long life.In this study,the NiO-In2O3 composite structure was prepared using indium-based metal organic framework(In-MOF)as the precursor,and the formaldehyde gas sensor was constructed with In2O3 and NiO-In2O3 composite structure as the sensitive material.The results demonstrated that the In2O3 material had a microflower-like structure,while the NiO-In2O3 composite structure was composed of NiO nanoparticles attached to the surface of In2O3.The sensor exhibited excellent detection performance for formaldehyde in the environment of relative humidity of 33%and 75%,especially the response characteristic of the NiO-In2O3 composite structure sensor to formaldehyde was considerably better than that of the In2O3 sensor under the same test conditions,which was closely related to the catalytic effect of NiO and the heterogeneous structure formed between NiO and In2O3.The NiO-In2O3 composite structure sensor had a response value of 21.3 and 12.6 to 10 μL/L formaldehyde when the relative humidity was 33%and 75%at 200℃.The response/recovery time was 4/6 s and 7/10 s,and the limit of detection(LOD)was 1.2×10-7 μL/L and 4.1×10-5 μL/L respectively.Meanwhile,the sensor had excellent selectivity and long-term stability.This sensor showed a wide application prospect in the field of high-performance detection of low concentration of formaldehyde gas.

Objective To study the effect of intervertebral grafting area on the effect of single segment lumbar posterior de-compression and intervertebral bone grafting fusion.Methods The clinical data of 52 patients who underwent single-segment lumbar posterior decompression pedicle internal fixation and bone grafting fusion from January 2020 to December 2022 were retrospective reviewed.The area of the intervertebral bone graft was measured one week postoperatively using Computed To-mography(CT),and based on the ratio of the bone graft area to the average area of the endplates,the patients were divided into three groups:17 cases in group A(the intervertebral bone graft area did not exceed the area of one pedicle)included 9 males and 8 females with an average age of(56.0±1 1.5)years old;15 cases in group B(the intervertebral bone graft area exceeded one pedicle but did not reach the opposite pedicle)included 10 males and 5 females with an average of(52.0±14.0)years old;20 cases in group C(the intervertebral bone graft area exceeded the opposite pedicle)included 12 males and 8 females with an average of(49.5±12.8)years old.X-rays and CT scans were performed at 3,6,12 months,and the final follow-up postopera-tively,the interbody fusion Brantigan scores,pain visual analogue scale(VAS),and Oswestry Disability Index(ODI)at each follow-up were recorded.Results The gender,age,and surgical segments showed no significant differences among three groups(P＞0.05).There was also no significant difference in the preoperative VAS and ODI among three groups(P＞0.05).All patients of three groups were followed up from 12 to 36 months.Compared with preoperative,VAS and ODI scores of three groups showed significant improvement at 1 week postoperatively and the final follow-up(P＜0.05).Compared with preoperative mea-surements,the height of the intervertebral space was restored at 1 week postoperatively in three groups;at the final follow-up,the loss of height in the intervertebral space was less in groups B and C,and the height of the intervertebral space in group B and C was significantly higher than in group A(P＜0.05).The modified Brantigan scores at 3 and 6 months postoperatively were significantly higher in group C than in groups A and B(P＜0.05);at 12 months postoperatively,the scores in groups B and C were significantly higher than in group A(P＜0.05);however,at the final follow-up,there was no significant difference in the modified Brantigan scores among three groups(P＞0.05).The bone graft fusion rate in group C was significantly higher than in groups A and B at 3 months postoperatively(P＜0.05);at 6 and 12 months postoperatively,the fusion rates in groups B and C were significantly higher than in group A(P＜0.05);at the final follow-up,the fusion rate in group A was still lower than in groups B and C,but the difference among three groups was not significant(P＞0.05).Conclusion Single segment posterior lum-bar decompression and interbody fusion surgery can significantly improve the clinical symptoms of patients with lumbar degen-erative related diseases.However,as the proportion of bone grafting area increases,the early bone grafting fusion rate and fu-sion score of patients are significantly improved.

The study explored the pathological mechanism of doxorubicin chemotherapy-induced neurotoxicity and the intervention methods of traditional Chinese medicine. BALB/c mice were selected to establish tumor-bearing mouse models by orthotopic injection of 4T1 triple-negative breast cancer cells. After randomization, the mice were treated with doxorubicin chemotherapy or doxorubicin chemotherapy + Kaixin San(KXS). The lesions in the prefrontal cortex of mice were observed by pathological examination, and the lesion information was obtained by long non-coding RNA sequencing. The occurrence of lesions was determined by Western blot and biochemical indicators. In addition, neuroblastoma cells and microglia cells were used to construct in vitro models, and drug-containing serum and p-AMPK dephosphorylation inhibitors were used to further verify the accuracy of animal experiments. Pathological results showed that KXS could alleviate doxorubicin-induced neuronal degeneration in the prefrontal cortex. The long non-coding RNA sequencing suggested that neuronal degeneration and the intervention process of KXS were related to ferroptosis, immune diseases, AMPK signaling pathway, etc. Western blot and biochemical indicators confirmed that this process was directly related to the activation of the AMPK/HIF-1α/ACSL4 signaling pathway to alleviate ferroptosis of neurons and immune response of glial cells. In conclusion, KXS could alleviate doxorubicin-induced neurotoxicity by activating the AMPK signaling pathway and reducing the ferroptosis of neurons and immune response of glial cells.
Animals ; Doxorubicin/toxicity* ; Mice ; AMP-Activated Protein Kinases/genetics* ; Signal Transduction/drug effects* ; Mice, Inbred BALB C ; Drugs, Chinese Herbal/administration & dosage* ; Female ; Humans ; Cell Line, Tumor ; Neurotoxicity Syndromes/genetics*

Humans ; Consensus ; Hypersensitivity ; Desensitization, Immunologic/adverse effects* ; Immunotherapy/adverse effects* ; Injections, Subcutaneous ; Allergens

Cardiac Catheterization ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Humans ; Treatment Outcome ; Tricuspid Valve/surgery* ; Tricuspid Valve Insufficiency/surgery*

OBJECTIVE: To describe and assess the repair technique and perioperative management for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture via extradural anterior skull base approach. METHODS: This was a retrospective review conducted at the Department of Neurosurgery of the Shanghai Tenth People's Hospital from January 2015 to April 2020. Patients with traumatic CSF rhinorrhea resulting from extensive anterior skull base fracture treated surgically via extended extradural anterior skull base approach were included in this study. The data of medical and radiological records, surgical approaches, repair techniques, peritoperative management, surgical outcome and postoperative follow-up were analyzed. Surgical repair techniques were tailored to the condition of associated injuries of the scalp, bony and dura injuries and associated intracranial lesions. Patients were followed up for the outcome of CSF leak and surgical complications. Data were presented as frequency and percent. RESULTS: Thirty-five patients were included in this series. The patients' mean age was 33 years (range 11-71 years). Eight patients were treated surgically within 2 weeks; while the other 27 patients, with prolonged or recurrent CSF rhinorrhea, received the repair surgery at 17 days to 10 years after the initial trauma. The mean overall length of follow-up was 23 months (range 3-65 months). All the patients suffered from frontobasal multiple fractures. The basic repair tenet was to achieve watertight seal of the dura. The frontal pericranial flap alone was used in 20 patients, combined with temporalis muscle and/or its facia in 10 patients. Free fascia lata graft was used instead in the rest 5 patients. No CSF leak was found in all the patients at discharge. There was no surgical mortality in this series. Bilateral anosmia was the most common complication. At follow-up, no recurrent CSF leak or meningitis occurred. No patients developed mucoceles, epidural abscess or osteomyelitis. One patient ultimately required ventriculoperitoneal shunt because of progressive hydrocephalus. CONCLUSION Traumatic CSF rhinorrhea associated with extensive anterior skull base fractures often requires aggressive treatment via extended intracranial extradural approach. Vascularized tissue flaps are ideal grafts for cranial base reconstruction, either alone or in combination with temporalis muscle and its fascia---fascia lata sometimes can be opted as free autologous graft. The approach is usually reserved for patients with traumatic CSF rhinorrhea in complex frontobasal injuries.

Arthritis, Rheumatoid/complications* ; Biomarkers ; Humans ; Lung Diseases, Interstitial/etiology* ; Prognosis

Objective:To evaluate the effect of laparoscopic-assisted anorectoplasty in the treatment of children′s congenital anal atresia.Methods:In this study , 49 children undergoing laparoscopic-assisted anorectoplasty between Mar 2009 and Mar 2015 were compared in terms of outcomes with 42 children under going posterior sagittal anorectoplasty during this period.The post-operative complications, bowel functions and courses were evaluated.Results:The ratio of primary healing in laparoscopic-assisted anorectoplasty was higher than posterior sagittal anorectoplasty(22 % vs. 10%, χ 2=4.306, P=0.038), the age of sequential operation in the former was lower than control group [(9.9±6.5) d vs. (13.4±5.1) d, t=2.823, P=0.003]. The perioperative complications were lower than that in the control group(20% vs. 50%, χ 2=8.817, P=0.003), the bowel function was better than control group(χ 2=7.419, P=0.025). Conclusions:Perioperative complications in laparoscopic-assisted anorectoplasty is lower than posterior sagittal anorectoplasty, with better bowel function and higher primary healing rate.

In the clinical practice of traditional Chinese medicine, Pinelliae Rhizoma is a commonly used traditional Chinese medicinal material, with a very important medicinal value, but its raw products have certain toxicity. According to the basic theory of traditional Chinese medicine, after Pinelliae Rhizoma is processed, its toxic and side effects can be reduced, there by ensuring its medication safety in clinic. Based on the processing characteristics of Pinelliae Rhizoma replication method, this article discusses the changes before and after processing of Pinelliae Rhizoma with multiple materials and multiple processes. This method does not have a unified process. One or more materials are added, and various processes, such as dipping, soaking, bleaching, or steaming, cooking or combined methods are adopted. Then, Pinelliae Rhizoma is repeatedly processed to meet the specified quality requirements. By different processing methods, the efficacy changes accordingly, and Pinelliae Rhizoma can be used for the treatment of different diseases. The article starts in the two directions of multi-materials and multi-processes, and summarizes the effects of multi-materials or multi-processes on the chemical composition and efficacy, as well as the processing mechanism of reducing toxicity and increasing efficiency, in the expectation of reducing the toxicity and enhancing the efficacy of Pinelliae Rhizoma. The medicinal scope provides a reference and theoretical basis for further studies on the processing mechanism. An in-depth study is conducted to make Pinelliae Rhizoma more safe and effective in clinic application, and ensure its clinical efficacy. It will provide reference for future studies on quality control, active ingredients and new drug development of the processing of pinellia slices. It has laid a scientific foundation for exploring the best processing techno-logy, and provided a theoretical basis for solving the production problems of processed Pinelliae Rhizoma products, so as to improve the production efficiency and the quality of medicines.
Drugs, Chinese Herbal/chemistry* ; Medicine, Chinese Traditional ; Pinellia/chemistry* ; Rhizome/chemistry* ; Technology, Pharmaceutical