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.

Objective:To explore the clinical efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) combined with selective serotonin reuptake inhibitors (SSRIs) in the treatment of first-episode late-life depression.Methods:From June 2019 to January 2020, first-episode elderly patients with depression in Beijing Anding Hospital affiliated to Capital Medical University were screened and randomly divided into test group (true rTMS+SSRIs, n=26) and control group (rTMS sham+SSRIs, n=25) according to the random number table method. All the patients were treated for 4 weeks and followed up for 4 weeks after treatment. The test group received 20 sessions (5 sessions per week) of 10 Hz rTMS (120% of motor threshold). Hamilton Depression Scale (HAMD 17) and The Patient Health Questionnaire-9 (PHQ-9) were used to assess the clinical symptoms at the end of the 1st, 2nd, 3rd and 4th week of treatment and at the end of the 4th week of the follow-up after treatment, and the response rate and the rate of recovery were compared between the two groups,analyzed by the χ 2 test and repeated measurement analysis of variance. Results:(1) At the end of the 4th week of treatment 69.23% (18/26) subjects in the test group and 36.00% (9/25) in the control group significantly improved their depressive condition, which was defined as a more than 50% HAMD 17 reduction (χ 2=5.649, P=0.017). However, there was no significant difference between the two groups when compared the rate of recovery,which was defined as a HAMD 17 ≤7 ( P>0.05). (2) At the end of the 4th week of the follow-up, there was no significant difference in the response rate nor the rate of recovery between the two groups ( P>0.05). (3) During the entire observation period, there was an interaction between the time point and the group in HAMD 17 total score and PHQ-9 total score ( F=66.313, P=0.008; F=8.571, P<0.01). Conclusion:There might be potential advantages in the combination treatments by rTMS at 120% MT and SSRIs antidepressants for the elderly depressive patients, and the onset of efficacy is faster than that of pharmacotherapy alone, while the large sample clinical studies are still needed to confirm the benefits.

Objective:To explore the clinical efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) combined with selective serotonin reuptake inhibitors (SSRIs) in the treatment of first-episode late-life depression.Methods:From June 2019 to January 2020, first-episode elderly patients with depression in Beijing Anding Hospital affiliated to Capital Medical University were screened and randomly divided into test group (true rTMS+SSRIs, n=26) and control group (rTMS sham+SSRIs, n=25) according to the random number table method. All the patients were treated for 4 weeks and followed up for 4 weeks after treatment. The test group received 20 sessions (5 sessions per week) of 10 Hz rTMS (120% of motor threshold). Hamilton Depression Scale (HAMD 17) and The Patient Health Questionnaire-9 (PHQ-9) were used to assess the clinical symptoms at the end of the 1st, 2nd, 3rd and 4th week of treatment and at the end of the 4th week of the follow-up after treatment, and the response rate and the rate of recovery were compared between the two groups,analyzed by the χ 2 test and repeated measurement analysis of variance. Results:(1) At the end of the 4th week of treatment 69.23% (18/26) subjects in the test group and 36.00% (9/25) in the control group significantly improved their depressive condition, which was defined as a more than 50% HAMD 17 reduction (χ 2=5.649, P=0.017). However, there was no significant difference between the two groups when compared the rate of recovery,which was defined as a HAMD 17 ≤7 ( P>0.05). (2) At the end of the 4th week of the follow-up, there was no significant difference in the response rate nor the rate of recovery between the two groups ( P>0.05). (3) During the entire observation period, there was an interaction between the time point and the group in HAMD 17 total score and PHQ-9 total score ( F=66.313, P=0.008; F=8.571, P<0.01). Conclusion:There might be potential advantages in the combination treatments by rTMS at 120% MT and SSRIs antidepressants for the elderly depressive patients, and the onset of efficacy is faster than that of pharmacotherapy alone, while the large sample clinical studies are still needed to confirm the benefits.

Objective:To investigate the damaging traits of cognitive function in late-onset depression.Methods:In this cross-sectional study,30 elderly out-and in-patients whose first onset of major depression occurred at 60 years of age and older were included as the case group,and 30 age-and gender-matched normal elderly people were included as the controls.The diagnoses of moderate to severe depressive episode or recurrent depression were made according to the International Statistical Classification of Diseases and Related Health Problems,Tenth Revision (ICD-10) diagnostic criteria.The Wisconsin Card Sorting Test (WCST),Stroop Test and Verbal Fluency Test (VFT) were used to assess attentional set shifting,attentional inhibition and working memory.The severity of depression was evaluated with the Hamilton Depression Scale-17(HAMD-17).Results:The performance scores of errors,perseverative responses,perseverative errors,percent of perseverative errors in the WCST were significantly higher in the patient group then in the control group[(61 ± 23) vs.(41 ± 25),(44 ± 27) vs.(27± 19),(36 ± 20) vs.(23 ± 16),(28 ± 15) vs.(19 ± 11),P ＜ 0.01].The scores of conceptual level responses [(36±24) vs.(54 ±26)],the correct scores of consistent group in Stroop test[(19 ±3) vs.(20 ±2)] and the scores of VFT in WCST[(10 ±2) vs.(11 ±2)] were lower in the patient group than in the control group (Ps ＜0.01).The scores of perseverative responses in the WCST were positively correlated with retardation factor scores(r =0.38,P ＜ 0.05).The correct scores of consistent group in the Stroop test were negatively correlated with retardation factor scores(r =-0.41,P ＜ 0.05).The scores of VFT were negatively correlated with retardation factor scores(r =-0.52,P ＜ 0.01).Conclusion:There may be impairment of cognitive function in late-onset depression,especially severe executive dysfunction.

Objective To compare the effect of combining individual medicine with cognitive behavioral therapy(CBT) or supportive psychotherapy on geriatric depression. Methods One hundred geriatric depression patients were randomly divided into study group(n=50) or control group(n=50) based on random number table method and received the combination of usual medicine with CBT or supportive psychotherapy. They were assessed blindly with17-item Hamilton Depression Rating Scale(HAMD17), HAMA and Social Function Rating Scale(SFRS) after 0, 6, 12 and 20 week of combined treatment. According to age and education years, different subgroups of the two group were divided respectively and compared on the total score of HAMD17. Results There was no statistic difference between the two groups on the total score of HAMD17. After 6 week treatment of combining usual medicine with supportive psychotherapy or CBT, the depressed level of two groups declined significantly, and comparing with control group, the total score of HAMD17 in study group decreased significantly with the time of treatment(t=2.48, 3.89,4.72;P<0.01 or P<0.05);except for weight factor, reducing score rates in study group on other factors or the total score of HAMD17 differed significantly from those in control group at the end of 20th week of treatment(t=-4.58,-3.76,-4.66,-2.53,-7.48,all P<0.01), and reducing score rates of study group on the total score or each factor score of HAMA and SFRS differed significantly than those in control group (t=-4.26,-3.12,-4.90, all P<0.01; t=-7.13,-3.47,-4.19, all P<0.01). The effective ratio in study group was significantly different with that in control group (83.7%(41/49) vs. 68.1%(32/47); χ2=6.26,P=0.007). The clinical cured rate was significantly higher in study group than control group(32.7%(16/49) vs.12.8%(6/47), χ2=8.53,P=0.004).Compared with supportive psychotherapy, CBT had no significant effect on patients who were 70 or over 70 years old and the educational level of high school or below. Conclusions With the exception of advanced age and lower educational level, CBT could be more effective in improving elderly depressed patients'' clinical symptoms and social function.

Objective To compare the effect of combining individual medicine with cognitive behavioral therapy(CBT) or supportive psychotherapy on geriatric depression. Methods One hundred geriatric depression patients were randomly divided into study group(n=50) or control group(n=50) based on random number table method and received the combination of usual medicine with CBT or supportive psychotherapy. They were assessed blindly with17-item Hamilton Depression Rating Scale(HAMD17), HAMA and Social Function Rating Scale(SFRS) after 0, 6, 12 and 20 week of combined treatment. According to age and education years, different subgroups of the two group were divided respectively and compared on the total score of HAMD17. Results There was no statistic difference between the two groups on the total score of HAMD17. After 6 week treatment of combining usual medicine with supportive psychotherapy or CBT, the depressed level of two groups declined significantly, and comparing with control group, the total score of HAMD17 in study group decreased significantly with the time of treatment(t=2.48, 3.89,4.72;P<0.01 or P<0.05);except for weight factor, reducing score rates in study group on other factors or the total score of HAMD17 differed significantly from those in control group at the end of 20th week of treatment(t=-4.58,-3.76,-4.66,-2.53,-7.48,all P<0.01), and reducing score rates of study group on the total score or each factor score of HAMA and SFRS differed significantly than those in control group (t=-4.26,-3.12,-4.90, all P<0.01; t=-7.13,-3.47,-4.19, all P<0.01). The effective ratio in study group was significantly different with that in control group (83.7%(41/49) vs. 68.1%(32/47); χ2=6.26,P=0.007). The clinical cured rate was significantly higher in study group than control group(32.7%(16/49) vs.12.8%(6/47), χ2=8.53,P=0.004).Compared with supportive psychotherapy, CBT had no significant effect on patients who were 70 or over 70 years old and the educational level of high school or below. Conclusions With the exception of advanced age and lower educational level, CBT could be more effective in improving elderly depressed patients'' clinical symptoms and social function.

Objective To investigate executive function in late-onset depression (LOD),to assess activation characteristics of prefrontal cortex and to examine the relationship between cognitive deficits and activation in the prefrontal regions.Methods Twenty-nine patients with LOD and 30 normal controls were included in this study.The severity of depression was evaluated by the 17-item Hamilton Depression Scale (HAMD17).Hemoglobin concentration changes in bilateral prefrontal areas were measured during verbal fluency test (VFT) using 44-channel near infrared spectroscopy (NIRS).Results (1) In LOD group,the correct scores of VFT were significantly lower than that of the control group(9.6±2.4 vs.11.3±2.2,t=-2.89,P＜0.01).(2) In VFT,the part of right prefrontal,left inferior frontal gyrus regions in LOD patients were significantly lower than controls (t=-3.54 to-2.02,all P＜0.05).(3) The score of VFT was negatively correlated with retardation factor score (r=-0.52,P＜0.01).In LOD group,the spearman correlation analysis showed that the part of prefrontal regions in the VFT was correlated with HAMD17 total score (right,CH4:r=-0.44,P＜0.01),retardation factor score (right,CH7:r=-0.53,P＜0.01;CH12:r=-0.48,P＜0.01;CH17:r=-0.40,P＜0.05,CH18:r=-0.48,P＜0.01;CH22:r=-0.46,P＜0.01;left,CH10:r=-0.41,P＜0.05;CH11:r=-0.57,P＜0.01;CH15:r=-0.45,P＜0.05),anxiety/somatization factor score (left,CH11:r=-0.44,P＜0.05;CH15:r=-0.45,P＜0.01) and agitata factor score (right,CH11:r=-0.38,P＜0.05;left,CH19:r=-0.38,P＜0.05).Conclusion LOD patients may have executive dysfunction and prefrontal dysfunction,which be positively related to severity of depressive symptoms.

Objective To investigate executive function in late-onset depression (LOD),to assess activation characteristics of prefrontal cortex and to examine the relationship between cognitive deficits and activation in the prefrontal regions.Methods Twenty-nine patients with LOD and 30 normal controls were included in this study.The severity of depression was evaluated by the 17-item Hamilton Depression Scale (HAMD17).Hemoglobin concentration changes in bilateral prefrontal areas were measured during verbal fluency test (VFT) using 44-channel near infrared spectroscopy (NIRS).Results (1) In LOD group,the correct scores of VFT were significantly lower than that of the control group(9.6±2.4 vs.11.3±2.2,t=-2.89,P＜0.01).(2) In VFT,the part of right prefrontal,left inferior frontal gyrus regions in LOD patients were significantly lower than controls (t=-3.54 to-2.02,all P＜0.05).(3) The score of VFT was negatively correlated with retardation factor score (r=-0.52,P＜0.01).In LOD group,the spearman correlation analysis showed that the part of prefrontal regions in the VFT was correlated with HAMD17 total score (right,CH4:r=-0.44,P＜0.01),retardation factor score (right,CH7:r=-0.53,P＜0.01;CH12:r=-0.48,P＜0.01;CH17:r=-0.40,P＜0.05,CH18:r=-0.48,P＜0.01;CH22:r=-0.46,P＜0.01;left,CH10:r=-0.41,P＜0.05;CH11:r=-0.57,P＜0.01;CH15:r=-0.45,P＜0.05),anxiety/somatization factor score (left,CH11:r=-0.44,P＜0.05;CH15:r=-0.45,P＜0.01) and agitata factor score (right,CH11:r=-0.38,P＜0.05;left,CH19:r=-0.38,P＜0.05).Conclusion LOD patients may have executive dysfunction and prefrontal dysfunction,which be positively related to severity of depressive symptoms.

BACKGROUND: Previous studies suggest that vascular endothelial growth factor 121 may be an optimal target gene for thetreatment of acute myocardial infarction.OBJECTIVE: To investigate effect of direct myocardial injection of adenovirus recombinant human vascular endothelial growthfactor 121 gene (Ad-hVEGF121) on myocardial infracted rat heart structure, function and angiogenesis.METHODS: Totally 78 male SD rats were randomly divided into the sham-surgery (n=18), acute myocardial infarction (n=24),Ad-VEGF121 (n=19) and normal saline (n=17) groups. Among them, left anterior descending coronary arteries of the latter threegroups were ligated to prepare acute myocardial infarction models and rats were randomly selected to receive Ad-hVEGF12 ornormal saline via three points in the cardiac muscle at the 10-15 minutes after ligation. The chest was exposed without ligation inthe sham-surgery group.RESULTS AND CONCLUSION: At 2 weeks after injection, cardiac ultrasound showed that, compared with the sham-surgerygroup, the number of new capillaries, body weight and left ventricular mass / body weight of the acute myocardial infarction,Ad-hVEGF121 and normal saline groups were obviously increased (P < 0.05 or P < 0.01), especially those received transfectedrAd-hVEGF12, had higher density of blood capillaries than those of the normal saline and acute myocardial infarction groups.However, there were no obviously differences between each group in infarct size, cardiac structure or functions. The directmyocardial injection of Ad-VEGF121 can significantly promote the formation of new blood vessels within the myocardium.

The clozapine treatment of schizophrenic patients (n=26) for 6 weeks showed the significantly (all P