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.

Five new megastigmanes (1-5) were isolated from a decoction of Uncaria rhynchophylla by separation techniques of column chromatography using a combination of multiple stationary phases, including macroporous adsorbent resin, MCI resin, silica gel, Sephadex LH-20, and Toyopearl HW-40F, and reversed phase HPLC. Their structures were characterized by spectroscopic data analysis of HR-ESI-MS, NMR, and CD, in combination with Mosher's mothed as well as ECD and NMR calculations. The new compounds were named uncarphyllonone A (1), uncarphyllonols A (2) and B (3), and uncarphabscisic acids A (4) and B (5). Although the structures of 3 and 4 were previously reported, the reported NMR spectroscopic data were incorrect or do not support the assigned structures in literatures. This is also the first report of discovery of new megastigmane natural products from the Uncaria genus.

Objective: To analyze the clinical characteristics of children with Burkitt lymphoma (BL) and to summarize the mid-term efficacy of China Net Childhood Lymphoma-mature B-cell lymphoma 2017 (CNCL-B-NHL-2017) regimen. Methods: Clinical features of 436 BL patients who were ≤18 years old and treated with the CNCL-B-NHL-2017 regimen from May 2017 to April 2021 were analyzed retrospectively. Clinical characteristics of patients at disease onset were analyzed and the therapeutic effects of patients with different clinical stages and risk groups were compared. Survival analysis was performed by Kaplan-Meier method, and Cox regression was used to identify the prognostic factors. Results: Among 436 patients, there were 368 (84.4%) males and 68 (15.6%) females, the age of disease onset was 6.0 (4.0, 9.0) years old. According to the St. Jude staging system, there were 4 patients (0.9%) with stage Ⅰ, 30 patients (6.9%) with stage Ⅱ, 217 patients (49.8%) with stage Ⅲ, and 185 patients (42.4%) with stage Ⅳ. All patients were stratified into following risk groups: group A (n=1, 0.2%), group B1 (n=46, 10.6%), group B2 (n=19, 4.4%), group C1 (n=285, 65.4%), group C2 (n=85, 19.5%). Sixty-three patients (14.4%) were treated with chemotherapy only and 373 patients (85.6%) were treated with chemotherapy combined with rituximab. Twenty-one patients (4.8%) suffered from progressive disease, 3 patients (0.7%) relapsed, and 13 patients (3.0%) died of treatment-related complications. The follow-up time of all patients was 24.0 (13.0, 35.0) months, the 2-year event free survival (EFS) rate of all patients was (90.9±1.4) %. The 2-year EFS rates of group A, B1, B2, C1 and C2 were 100.0%, 100.0%, (94.7±5.1) %, (90.7±1.7) % and (85.9±4.0) %, respectively. The 2-year EFS rates was higher in group A, B1, and B2 than those in group C1 (χ²=4.16, P=0.041) and group C2 (χ²=7.21, P=0.007). The 2-year EFS rates of the patients treated with chemotherapy alone and those treated with chemotherapy combined with rituximab were (79.3±5.1)% and (92.9±1.4)% (χ²=14.23, P<0.001) respectively. Multivariate analysis showed that stage Ⅳ (including leukemia stage), serum lactate dehydrogenase (LDH)>4-fold normal value, and with residual tumor in the mid-term evaluation were risk factors for poor prognosis (HR=1.38,1.23,8.52,95%CI 1.05-1.82,1.05-1.43,3.96-18.30). Conclusions: The CNCL-B-NHL-2017 regimen show significant effect in the treatment of pediatric BL. The combination of rituximab improve the efficacy further.
Adolescent ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Burkitt Lymphoma/drug therapy* ; Child ; Disease-Free Survival ; Female ; Humans ; Lactate Dehydrogenases ; Lymphoma, B-Cell/drug therapy* ; Male ; Prognosis ; Retrospective Studies ; Rituximab/therapeutic use* ; Treatment Outcome

ObjectiveTo analyze the timeliness of health science popularization during the outbreak of coronavirus disease 2019 （COVID-19） and its correlation with the epidemic situation and policies. MethodsThe original reports of health science popularization by 26 major media in Shanghai during the COVID19 outbreak between January 19 and March 25 of 2020 were retrieved， and the timeliness of the number of reports， media sources and categories， and contents were analyzed. ResultsDuring the epidemic of COVID-19， public media reported timely. Online media accounted for 63.35%， and text-based reports accounted for 85.90%. There was a correlation between the trend of the number of reports and the development of COVID-19 and the prevention and control policy issued by the government. After the change in the epidemic or the release of policy， the number of reports increased. The top four topics were personal protection， disease treatment， healthy lifestyle and psychological health， accounting for 18.62%， 18.54%， 12.96% and 11.74%， respectively. Reports focused on different aspects at different stages of COVID-19 epidemic， and the number of reports tended to increase one week after the occurrence of major events. ConclusionDuring the COVID-19 epidemic， the coverage of health science on media is timely and targeted. For future similar public health emergencies， it is suggested to respond quickly to major events according to the trend， to carry out publicity timely， to innovate the report forms， and thus make it easy for the public to accept and implement.

：【Objective】Toinvestigatetheeffectsofinterleukin-17（IL-17）ontheproliferationandmigrationof bronchialsmoothmusclecells（BSMC）andtheroleofJAK/STAT3signalingpathwayinthisprocess.【Methods】BSMC weretreatedwithdifferentconcentrationsofIL-17fordifferenttimestodeterminethebestoftheexperimentalcondition. ThenMTTassaywasusedtodetectcellviability.CellproliferationstatesweredetectedbyBrdUstaining，andthecell cyclewasassessedbyPIstainingusingaflowcytometer.Transwellcellmigrationassaywasfurtherusedtodetectcell migrationability.TheexpressionofJAK，p-JAK，STAT3andp-STAT3inBSMCafterbeingtreatedwithIL-17was detectedbyWesternblotting.JAK/STAT3signalingpathwayspecificblockerAG490wasusedtoinvestigatetheroleof JAK/STAT3signalingpathwayinIL-17-inducedBSMCproliferationandmigration.TheeffectsofIL-17oncellproliferation， migration and JAK/STAT3 signaling pathway related protein expression were evaluated after blocking the JAK/STAT3 signaling.【Results】IL-17enhancedtheproliferation（P<0.05），promotedthecellcycletransitions（P<0.05）andsig⁃nificantlyincreasesthemigrationability（P<0.05）inBSMC.ThisprocesswasaccompaniedbytheenhancementofJAK/ STAT3signalingpathwayinBSMC（P<0.05）.InhibitionofJAK/STAT3signalingpathwayalleviatedBSMCproliferation andmigrationinducedbyIL-17（P<0.05） .【Conclusions】JAK/STAT3signalingpathwayparticipatesinthestimulation processofIL-17ontheproliferationandmigrationofBSMC.AG490inhibitstheenhancementofJAK/STAT3signaling pathwayinBSMCinducedbyinterleukin-17.

Objective To evaluate the effects on Stroke Volume Variation (SVV) during ventilation with selective lobar collapse (SLC) and one-lung ventilation (OLV) in thoracoscopic operation. Methods 60 patients scheduled for thoracoscopic operation to treat lower thoracic esophageal cancer or cardial carcinoma were randomly assigned into two groups: patients in one lung ventilation (OLV) group received right lung ventilation and left lung collapses, patients in selective lobar collapse (SLC) group received right lung and superior lobe of left lung ventilation by the use of endobronchial blocker. The intraoperative blood oxygen saturation (SpO2) and end-tidal carbon dioxide tension (PETCO2) were maintained in normal range. Record SVV, cardiac output (CO), stroke volume (SV), systolic blood pressure (SBP), diastolic blood pressure (DBP), the heart rate (HR), cardiac index (CI) at four time points: 10 min after two lung ventilation in supine position (T1), 10 min after two lung ventilation in lateral position (T2), OLV or SLC for 10 min after the pleura was opened (T3), two lung ventilation for 10 min before the pleura was closed (T4). Results There was no statistically significant difference between the two groups (P > 0.05). Comparison between groups: There was no significant difference between the patients in OLV group and SLC group, including HR, SBP, DBP, CO, CI, SV and SVV (P > 0.05). Comparison in the group: SBP and DBP in OLV group and SLC group were significantly higher than T1at T3(P < 0.05). The SVV of OLV group and SLC group was significantly reduced at T3and T4(P < 0.05). Conclusion There was no significant difference in SVV monitoring of Vigileo monitoring with OLV and SLC in thoracoscopic operation. SVV can be used to monitor blood volume state during ventilation by SLC.

Background:The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment.We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods:We conducted a multicenter,cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014.Each enrolled patient was interviewed using a structured questionnaire.All expenditure data were inflated to the 2014 Chinese Yuan (CNY;1 CNY =0.163 USD).We quantified the overall expenditure and financial burden and by subgroup (hospital type,age at diagnosis,sex,education,occupation,insurance type,household income,clinical stage,pathologic type,and therapeutic regimen).We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results:A total of 2356 patients with a mean age of 57.4 years were included,57.1％ of whom were men;13.9％ of patients had stage Ⅰ cancer;and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY,and the expenditures for stage Ⅰ,Ⅱ,Ⅲll,and Ⅳ disease were 56,099 CNY,59,952 CNY,67,292 CNY,and 82,729 CNY,respectively.Non-medical expenditure accounted for 8.3％ of the overall expenditure.The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY,which accounted for 59.9％ of their previous-year household income and caused 75.0％ of families to suffer an unmanageable financial burden.Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P ＜ 0.05),except for sex.Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less (all P ＜ 0.05).Conclusions:For patients in China,direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable.The financial burden varied among subgroups,especially among patients with different clinical stages of disease,which suggests that,in China,CRC screening might be cost-effective.

BACKGROUNDSpinocerebellar ataxias (SCAs) are a group of neurodegenerative disorders that primarily cause the degeneration in the cerebellum, spinal cord, and brainstem. We study the clinical characteristics, radiological features and gene mutation in Chinese families with SCAs.

METHODSIn this study, we investigated 10 SCAs Chinese families with SCA1, SCA3/Machado-Joseph disease (MJD), SCA7, SCA8. There were 27 people who were genetically diagnosed as SCA, of which 21 people showed clinical symptoms, and 6 people had no clinical phenotype that we called them presymptomatic patients. In addition, 3 people with cerebellar ataxia and cataracts were diagnosed according to the Harding diagnostic criteria but failed to be recognized as SCAs on genetic testing. Clinical characteristic analyses of each type of SCAs and radiological examinations were performed.

RESULTSWe found that SCA3/MJD was the most common subtype in Han population in China, and the ratio of the pontine tegmentum and the posterior fossa area was negatively correlated with the number of cytosine-adenine-guanine (CAG) repeats; the disease duration was positively correlated with the International Cooperative Ataxia Rating Scale score; and the CAG repeats number of abnormal alleles was negatively correlated with the age of onset.

CONCLUSIONSCollectively our study is a systematic research on SCAs in China, which may help for the clinical diagnosis and prenatal screening of this disease, and it may also aid toward better understanding of this disease.

Adult ; DNA Repeat Expansion ; genetics ; Female ; Humans ; Machado-Joseph Disease ; genetics ; pathology ; Male ; Mutation ; genetics ; Spinocerebellar Ataxias ; genetics ; pathology ; Trinucleotide Repeat Expansion ; genetics

Objective To evaluate the effect and safety of valsartan combined with atorvastatin in the treatment of early stage diabetic nephropathy ( DN).Methods Sixty-three patients with early stage DN were recruited in this study and divided into two groups.The patients in experiment group ( n =30 ) were given valsartan 80 mg· d -1 combined with atorvastatin 20 mg · d -1 , and the control group ( n =33 ) were only given valsartan treatment.The treatment lasted for 4 months.After treatment, the data of serum level of serum creatinine ( Scr) , urinary albumin excretion rate ( UAER) , glomeru-lar filtration rate ( GFR ) and β2 -microglobulin (β2 -MG ) were compared between the two groups.Results After 4 -month treat-ment, the serum Scr, UAER and β2 -MG were decreased in both groups ( P<0.05 ) , but the changes in experiment group was much more significant than that in control group ( P<0.05 ).The adverse reactions such as cough, headache and dizziness were not statistically different between the two groups ( P<0.05 ).Conclusion Valsar-tan combined with atorvastatin treatment can improve the clinical efficacy in the treatment of diabetic nephropathy, without increasing adverse reactions.

Objective To evaluate the efficacy and safety of multi-target treatment of multi glycosides of tripterygium wilfordii combined small dose of tacrolimus on idiopathic membranous nephropathy.Methods A total of 40 cases with idiopathic membranous nephropathy were selected in our hospital and were randomly divided into two groups, 20 cases in control and treatment group, respectively.Patients in treatment group were given tacrolimus 0.05 mg· kg-1 · d-1 for the first time, maintaining the blood drug concentration at 2 to 5 ng · mL-1 , at the same time, tripterygium wilfordii 60 mg· d -1 were additionally given.After 6 months, the dose of tripterygium wilfordii was gradually reduced or stopped.While patients in control group were only administrated with tacrolimus with the initial dose of 0.1 mg· kg -1 · d-1 , maintaining the blood drug concentration at 5 to 10 ng· mL-1.After 6 months, the using of tacrolimus began to re-duce to maintain the concentration at 2 to 5 ng· mL-1.The data of cura-tive effect, adverse reaction and the concentration of tacrolimus in two groups were observed in 12 months.Results Compared with before treatment, the data of 24 h urinary protein, serum albumin and triglyceride were significantly improved in two groups ( P<0.05).After 12 -month of treatment, the data of 24 h urinary protein and serum albumin were statistically different between two groups ( P<0.05).After 6 months follow-up, the complete remission rate was 55% in treat-ment group, significantly higher than 30%in control group ( P<0.05).After 12 months follow-up, the recurrence rate in treatment group (17%) was lower than that in control group (41%, P<0.05).The incidence rate of adverse reactions between the two groups had no significant difference( P>0.05).Conclusion The multi-target treatment of small dose of tacrolimus combined tripterygium wilfordii for idiopathic membranous nephropathy has been confirmed with a faster onset, higher clinical remission rate, lower relapse rate, and patients are well tolerated.