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.

Pelvic and acetabular fractures are one of the serious traumatic diseases, leading to a high rate of disability and fatality. Their operative principles are anatomical repositioning and rigid fixation to achieve early functional exercise and avoid complications. The updating modern technology has made precision and minimally invasion a trend in orthopedic surgery. An increasingly number of new technologies has been applied in clinical surgery, such as three-dimensional printing, three-dimensional navigation, and orthopedic robotics, each with its own characteristics. Of them, three-dimensional printing technology is more advantageous in terms of reducing surgical cost and risk, enhancing surgical efficiency, achieving surgical precision and reducing radiation exposure, as evidenced by a large number of clinical case reports and randomized controlled trials. This paper summarizes the current situation and assesses the prospects of three-dimensional printing technology in the diagnosis and treatment of pelvic and acetabular fractures in order to provide reference for orthopedic colleagues.

Natural killer (NK) cells are essential in controlling cancer and infection. However, little is known about the dynamics of the transcriptional regulatory machinery during NK cell differen-tiation. In this study, we applied the assay of transposase accessible chromatin with sequencing (ATAC-seq) technique in a home-developed in vitro NK cell differentiation system. Analysis of ATAC-seq data illustrated two distinct transcription factor (TF) clusters that dynamically regulate NK cell differentiation. Moreover, two TFs from the second cluster, FOS-like 2 (FOSL2) and early growth response 2 (EGR2), were identified as novel essential TFs that control NK cell maturation and function. Knocking down either of these two TFs significantly impacted NK cell differentia-tion. Finally, we constructed a genome-wide transcriptional regulatory network that provides a bet-ter understanding of the regulatory dynamics during NK cell differentiation.

Objective: To investigate the methylation status and expression of FOXP3 in CD4+ T cells of patients with chronic hepatitis B (CHB). Methods: Peripheral blood mononuclear cells (PBMCs) from 59 CHB patients and 22 healthy controls (HC) were collected. The percentage of CD4+ CD25+ Foxp3+ Tregs in CD4+ T cells was estimated by flow cytometry. FOXP3 expression was measured by quantitative real time-polymerase chain reaction (RT-qPCR) and Western blotting. The methylation status of FOXP3 was determined by methylation-specific polymerase chain reaction. Results: The percentage of CD4+ CD25+ pFoxp3+ Tregs in CD4+ T cells, FOXP3 mRNA and protein expression levels were significantly higher in patients with CHB than HCs (P<0.05). Meanwhile, the methylation frequency of FOXP3 was significantly lower in CHB patients than HCs (P<0.05). FOXP3 mRNA levels and the percentage of CD4+ CD25+ Foxp3+ Tregs were significantly lower (P<0.05) in patients with gene methylation than those without. Conclusions Aberrant demethylation of FOXP3 gene existed in CD4+ T cells of CHB, which contributed to an elevation in FOXP3 expression and percentage of CD4+ CD25+ Foxp3+ Tregs. It might provide a new target for prevention and treatment of CHB.

Objective To evaluate the cardioprotection induced by combination of dexmedetomidine and limb ischemic preconditioning in the patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods Eighty American Society of Anesthesiologists physical starus Ⅱ or Ⅲ patients of both sexes,aged 52-64 yr,weighing 51-78 kg,with New York Heart Association Ⅱ or Ⅲ,scheduled for elective CABG with CPB,were divided into 4 groups (n =20 each) using a random number table method:control group (group C),limb ischemic preconditioning group (group L),dexmedetomidine group (group D) and dexmedetomidine plus limb ischemic preconditioning group (group DL).Limb ischemic preconditioning was induced by 3 cycles of 5-min unilateral lower limb ischemia followed by 5-min reperfusion starting from 30 min before aortic clamping in L and DL groups.Dexmedetomidine was injected via the central vein in a loading dose of 1 μg/kg after induction of anesthesia,followed by an infusion of 0.4 μg · kg-1 · h-1 until the end of operation in D and DL groups.Venous blood samples were obtained immediately before aortic clamping,at the end of CPB and at the end of operation for determination of plasma concentrations of cardiac troponin Ⅰ (cTnI) by enzyme-linked immunosorbent assay.Myocardial tissues were obtained from the right auricle immediately before aortic clamping and at the end of CPB for determination of the expression of Bcl-2 and Bax (by immunohistochemistry) and apoptosis index (AI) (using TUNEL).The restoration of spontaneous heart beat was recorded.Bcl-2/Bax ratio was calculated.Results Compared with group C,the plasma cTnI concentrations were significantly decreased,the Bcl-2 expression was up-regulated,the Bcl-2/Bax ratio was increased,Bax expression was down-regulated,and AI was decreased in the other three groups (P＜0.05).Compared with L and D groups,the plasma cT-nI concentrations were significantly decreased,the Bcl-2 expression was up-regulated,the Bcl-2/Bax ratio was increased,Bax expression was down-regulated,and AI was decreased in group DL (P＜0.05).The rate of restoration of spontaneous heart beat was significantly increased in group DL as compared with the other three groups (P＜0.05).Conclusion Combination of dexmedetomidine and limb ischemic preconditioning can mitigate myocardial injury,it provides better efficacy than either alone,and the mechanism is related to inhibiting cell apoptosis in the patients undergoing CABG with CPB.

Normal feed and stone-leading feed were used respectively to raise guinea pigs in the control group and stone-causing group. The dynamic changes of total cholesterol, mucoprotein, total phospholipid and total cholic acid were measured during various raising periods. The formation of crystal nucleus and the growth of gallstone were studied under polarzing microscope. It was found that the contents of total cholesterol, mucoprotein, total phospholipid and total cholic acid in the gallbladder bile of control group were nearly the same during the whole feeding process, and no shaped stone crystal was formed. In the stone-causing group, however, the contents of total cholesterol and mucoprotein gradually went up and the contents of total phospholipid and total cholic acid gradually went down. After 10 days' feeding, significant difference was seen,and after 25 days' feeding, highly significant difference was noted. With the increase of feeding days, the liquid crystal vesicles in the bile increased, became bigger, gathered in strings, and then formed liquid crystal cells. The stone crystal growth along these nuclei of bile liquid crystal cells spread out rapidly, and the micro-crystal grains formed further in number. It was shown that, during the process of gallbladder stone formation, bile liquid crystal cells form a basic kind of nucleus, and the gathering and merging of bile liquid crystal vesicles be the key to crystal growth. So cholesterol and mucoprotein play the role of nucleation-leading factors in enhancing the gathering and merging of liquid crystal vesicles, and phospholipid and cholate play the role of anti-nucleation during the formation of gallbladder stone.
Animals ; Cholesterol ; metabolism ; Crystallization ; Female ; Gallstones ; chemically induced ; metabolism ; Guinea Pigs ; Male ; Mucoproteins ; metabolism ; Phospholipids ; metabolism ; Random Allocation ; Taurocholic Acid ; metabolism

OBJECTIVETo study the relation between the expression of transcription factor T-bet/GATA3 and Th1/Th2 type cytokines in peripheral blood mononuclear cells (PBMC) from lung cancer patients and their interference by the traditional Chinese herbal medicine.

METHODSThe gene expression of Th1/Th2 type cytokine IFN gamma, IL-2, IL-4, IL-6, IL-10, transcription factor T-bet/GATA3 and tumor tissue specific mRNA CEA, CK19 in PBMC from lung cancer patients were detected by reverse transcription-polymerase chain reaction RT-PCR. Meanwhile, the change of IFN gamma, IL-4, T-bet and GATA3 in PBMC before and after being cultured with the traditional Chinese herbal medicine-Astragulus and Tetramethylpyrazine was also observed.

RESULTSPredominant expression of Th2 type cytokines was detected in 42 lung cancer patients. The positive rates of IL-4, IL-6, IL-10, IFN gamma and IL-2 were 27/42, 24/42, 31/42, 4/42 and 5/42, respectively. But, the positive rates of transcription factor T-bet and GATA3 were 16/42 and 34/42. Moreover, the expression intensity of T-bet was lower in the CEA and CK19 positive patients than the negative ones. On the contrary, the expression intensity of GATA3 was significantly higher in the same patients.

CONCLUSIONPredominant expression of Th2 type cytokines may be related to lower expression of T-bet or higher expression of GATA3. This condition can be interfered by the traditional Chinese herbal medicine-Astragulus and Tetramethylpyrazine.

Cytokines ; blood ; drug effects ; DNA-Binding Proteins ; biosynthesis ; genetics ; Drugs, Chinese Herbal ; pharmacology ; GATA3 Transcription Factor ; Gene Expression ; drug effects ; Humans ; Lung Neoplasms ; blood ; genetics ; Medicine, Chinese Traditional ; RNA, Messenger ; biosynthesis ; drug effects ; T-Box Domain Proteins ; Th1 Cells ; drug effects ; immunology ; Th2 Cells ; drug effects ; immunology ; Trans-Activators ; biosynthesis ; genetics ; Transcription Factors ; biosynthesis ; genetics

Objective:To investigate the changes of lung lymphocytes in OVA induced murine asthma model,and study the involvement of NK cells in this process.Methods:C57BL/6J(B6) mice were induced to develop asthma by intrapenitoneal injection of OVA with alum as adjuvant, and then inhalation of nebulized OVA. After collecting serum and Bronchoalveolar Lavage Fluid(BALF),IL-4 level was determined by ELISA. The kinetics of pulmonary lymphocyte recruitment and cytokine release were detected by flow cytometry.Results:IL-4 expression increased in BALF after OVA nebulization, while there was no significant difference in serum. IFN-?,IL-4+NK cells accumulation in lung parenchymal tissues,and exhibited an evident NK2 shift in mice with asthma.Conclusion:NK cell involved in OVA-induced mouse asthma and NK2 shift accompany with Th2, indicating that NK2 played an important role in this process.

Objective:To investigate the influence of concanavalin A(Con A) pretreatment on the development of the fulminant murine hepatitis induced by an adequate dose of Con A.Methods:An adequate dose of Con A(15 ?g/g.body.wt) was injected intravenously into C57BL/6 mice to provoke severe liver damage,an extensively-used murine hepatitis model.A low dose of Con A(3 ?g/g.body.wt) was administrated intravenously 12 h before injection with an adequate dose of Con A.Liver injury was evaluated by serum transaminase assay and H&E staining.Hepatic lymphocytes were analyzed by flow cytometry and the absolute amount of lymphocytes per liver was calculated.Results:Pretreatment with a low dose of Con A significantly inhibited Con A-induced liver injury.Both the percentage and the absolute number of liver CD3~+T cells in Con A-pretreated mice were lower than those of PBS-pretreated mice.The activation of liver CD3~+T cells in Con A-pretreated mice was also prominently inhibited.Conclusion:Con A pretreatment exerted the negative effect on the development of Con A-induced hepatitis,which may be result from the decreased recruitment of T cells into the liver.The underlying mechanisms are under investigation.