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.

BACKGROUND: Lung cancer is the second most common cancer worldwide, with non-small-cell lung cancer (NSCLC) accounting for the majority of cases. Patients with NSCLC have achieved great survival benefits from immunotherapies targeting immune checkpoints. Glucocorticoids (GCs) are frequently used for palliation of cancer-associated symptoms, as supportive care for non-cancer-associated symptoms, and for management of immune-related adverse events (irAEs). The aim of this study was to clarify the safety and prognostic significance of glucocorticoid use in advanced patients with NSCLC treated with immune checkpoint inhibitors (ICIs). METHODS: The study searched publications from PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine disc, Chinese National Knowledge Infrastructure, Wanfang Data, and Chinese Science and Technology Journal Database up to March 1st, 2022, and conducted a meta-analysis to assess the effects of glucocorticoid use on overall survival (OS) and progression-free survival (PFS) in NSCLC patients treated with ICIs through the available data. The study calculated the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: This study included data from 25 literatures that were mainly retrospective, with 8713 patients included. Patients taking GCs had a higher risk for tumor progression and death compared with those not taking GCs (PFS: HR = 1.57, 95% CI: 1.33-1.86, P <0.001; OS: HR = 1.63, 95% CI: 1.41-1.88, P <0.001). GCs used for cancer-associated symptoms caused an obviously negative effect on both PFS and OS (PFS: HR = 1.74, 95% CI: 1.32-2.29, P <0.001; OS: HR = 1.76, 95% CI: 1.52-2.04, P <0.001). However, GCs used for irAEs management did not negatively affect prognosis (PFS: HR = 0.68, 95% CI: 0.46-1.00, P = 0.050; OS: HR = 0.53, 95% CI: 0.34-0.83, P = 0.005), and GCs used for non-cancer-associated indications had no effect on prognosis (PFS: HR = 0.92, 95%CI: 0.63-1.32, P = 0.640; OS: HR = 0.91, 95% CI: 0.59-1.41, P = 0.680). CONCLUSIONS In advanced NSCLC patients treated with ICIs, the use of GCs for palliation of cancer-associated symptoms may result in a worse PFS and OS, indicating that they increase the risk of tumor progression and death. But, in NSCLC patients treated with ICIs, the use of GCs for the management of irAEs may be safe, and the use of GCs for the treatment of non-cancer-associated symptoms may not affect the ICIs' survival benefits. Therefore, it is necessary to be careful and evaluate indications rationally before administering GCs in individualized clinical management.
Humans ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Glucocorticoids/therapeutic use* ; Immune Checkpoint Inhibitors/therapeutic use* ; Lung Neoplasms/drug therapy* ; Retrospective Studies

Background::Abnormal lipids are strong predictors of cardiovascular disease in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). However, the potential associations of insulin resistance (IR) and beta-cell function (BCF) with abnormal lipids in newly diagnosed T1DM or T2DM patients are not fully understood.Methods::A cross-sectional survey of 15,928 participants was conducted. Homeostasis model assessment and postprandial C-peptide levels were used to estimate IR and BCF. A restricted cubic spline (RCS) nested in binary logistic regression was used to examine the associations of IR and BCF with abnormal lipids.Results::High triglyceride (TG), low high-density lipoprotein cholesterol, and high low-density lipoprotein cholesterol (LDL-C) accounted for 49.7%, 47.8%, and 59.2% of the participants, respectively. In multivariable analysis, high IR was associated with an increased risk of high TGs ( P for trend <0.001) in T1DM and is associated with an elevated risk of high TG and low HDL-C (all P for trend <0.01) in T2DM. Low BCF was not associated with risks of dyslipidemia in patients with T1DM or T2DM after adjustment for potential confounders. Conclusion::High IR had different associations with the risk of dyslipidemia in newly diagnosed T1DM and T2DM patients, suggesting that early treatment that improves IR may benefit abnormal lipid metabolism.

With continuous discovery of tumor immune targets and continuous changes in antibody research and development technology, antibody drugs are becoming more and more widely used in clinical practice. However, some targets are not only expressed on tumor cells, but also on red blood cells. Therefore, the clinical application of antibodies against the corresponding targets may interfere with the detection of blood transfusion compatibility, resulting in difficulty in blood matching or delay of blood transfusion. This consensus summarizes the current solutions for the interference of CD38 monoclonal antibody (CD38 mAb) in transfusion compatibility testing. After analyzing the advantages and disadvantages of different methods, polybrene and sulfhydryl reducing agents [dithiothreitol (DTT) or 2-mercaptoethanol (2-Me)], as a solution for CD38 mAb interference in blood compatibility testing, are recommended for Chinese patients, so as to eliminate blood transfusion interference produce by CD38 mAb and further provide a pre-transfusion workflow for clinicians and technicians in Department of Blood Transfusion.

PURPOSE: This study aimed to identify potential epidermal growth factor receptor (EGFR) gene mutations in non-small cell lung cancer that went undetected by amplification refractory mutation system-Scorpion real-time PCR (ARMS-PCR). MATERIALS AND METHODS: A total of 200 specimens were obtained from the First Affiliated Hospital of Guangzhou Medical University from August 2014 to August 2015. In total, 100 ARMS-negative and 100 ARMS-positive specimens were evaluated for EGFR gene mutations by Sanger sequencing. The methodology and sensitivity of each method and the outcomes of EGFR-tyrosine kinase inhibitor (TKI) therapy were analyzed. RESULTS: Among the 100 ARMS-PCR-positive samples, 90 were positive by Sanger sequencing, while 10 cases were considered negative, because the mutation abundance was less than 10%. Among the 100 negative cases, three were positive for a rare EGFR mutation by Sanger sequencing. In the curative effect analysis of EGFR-TKIs, the progression-free survival (PFS) analysis based on ARMS and Sanger sequencing results showed no difference. However, the PFS of patients with a high abundance of EGFR mutation was 12.4 months [95% confidence interval (CI), 11.6−12.4 months], which was significantly higher than that of patients with a low abundance of mutations detected by Sanger sequencing (95% CI, 10.7−11.3 months) (p < 0.001). CONCLUSION: The ARMS method demonstrated higher sensitivity than Sanger sequencing, but was prone to missing mutations due to primer design. Sanger sequencing was able to detect rare EGFR mutations and deemed applicable for confirming EGFR status. A clinical trial evaluating the efficacy of EGFR-TKIs in patients with rare EGFR mutations is needed.
Adenocarcinoma/genetics ; Adenocarcinoma/pathology ; Aged ; Aged, 80 and over ; Animals ; Base Sequence ; Disease-Free Survival ; Female ; Humans ; Lung Neoplasms/genetics ; Lung Neoplasms/pathology ; Male ; Middle Aged ; Mutation/genetics ; Mutation Rate ; Real-Time Polymerase Chain Reaction/methods ; Receptor, Epidermal Growth Factor/genetics ; Sequence Analysis, DNA/methods ; Treatment Outcome

Objective To explore the effect of postoperative diet nursing with patient invovled on nutri-tional status of the patients with rectal cancer. Methods A total of 88 patients with rectal cancer were randomly divided into observation group and control group, with 44 patients in each. The patients in the control group received routine nursing, and the patients in the observation group were involved in postoperative diet care on the basis of routine nursing. The anal exhaust time, defecation time, parenteral nutrition supply time, time of get out of bed, length of stay, defecation function score, and preoperative and one month postoperative prealbumin (PA), albumin (ALB), total protein (TP) and body mass index, the incidence of complications during hospitalization, the quality of life of one month after surgery were compared between the two groups. Results The anal exhaust time, defecation time, parenteral nutrition supply time, time of get out of bed, length of stay, defecation function score were lower in the observation group than in the control group ( P<0. 05) . There was no significant difference in PA, ALB, TP and BMI between the two groups ( P>0. 05) . At one month after surgery, there were no significant changes in the nutritional indexes of the observation group ( P>0. 05) , while those in the control group significantly decreased ( P<0. 05) , and the levels of PA, ALB, TP and BMI were higher in the observation group than in the control group ( P<0. 05) . The overall incidence of complications in the observation group was 13. 64%, which was lower than 31. 82% in the control group ( P<0. 05) . The overall score of postoperative quality of life was (84. 08±2. 31) points in the observation group, which was higher than (81. 28±2. 05) points in the control group (P<0. 05). Conclusions With the patients involved in rectal cancer postoperative diet care, patient’s prefer can be fully used to promote the patient’s post-operative intake, the required nutrition can be supplemented, postoperative recovery can be accelerated, the in-cidence of postoperative complications can be reduced and the improvement of quality of life can be promoted, thus it is worth promoting.

Objective Established the model of atherosclerosis (AS) cells.To explore Hydrogen sulfide donor (NaHS) in atherosclerosis model by oxidized low density lipoprotein (ox-LDL) induced of the NF-κBp65 factor expression.MethodsApplication concentration of 80ug/mL ox-LDL induced liver cancer cell HepG2 cells AS model, set up a control group and treatment group (10μmol/L、15μmol/L、30μmol/L、100μmol/L、500μmol/L、1000μmol/L), to observe hydrogen sulfide this cell model of the cell proliferation activity and the determination of TNF-α and IL-10 factors of the expression, through the RT-qPCR and Western-blot method for determining the expression of the NF-κBp65 expression situation.ResultsAt 24h the ox-LDL induced a large number of red-stained granules, free cholesterol and total cholesterol in HepG2 cells increased, and free cholesterol content was more than 50% of total cholesterol in HepG2 cells, indicating that AS cell model was established successfully.CCK8 method of cell proliferation activity test results showed that the NaHS in 30umol/L, duration of 48 h when the largest cell proliferation activity.The TNF-α cytokine by ELISA method for testing the results showed that the treatment group in 15umol/L and 30umol/L concentration compared with the control group decreased significantly (P<0.05), while the expression of IL-10 increased significantly (P<0.05), with statistical significance.RT-qPCR and Western-blot method results show that the NF-κBp65 factor expression significantly reduced compared with control group (P<0.05), with statistical significance.ConclusionH2S play a protective role in atherosclerotic lesions by reducing the NF-κBp65 factor expression, and provide a valuable reference for the development and clinical treatment of H2S donor-type drugs.

OBJECTIVE:To study the effects of Heishun tablets combined with Rheum palmatum on the pharmacokinetics of hypaconitine in rats. METHODS:Rats were randomly divided into single drug group(Heishun tablets decoction)and drug combi-nation group(Heishun tablets-R. palmatum mixture decoction),with 18 rats in each group. They were given relevant drugs intragas-trically,by 10 g(medicinal materials)/kg of Heishun tablets. 0.3 ml blood samples were collected before(0 h)and 0.083,0.167, 0.333,0.5,0.75,1,1.5,2,3,4,6,8,10 h after medication with 6 rats at each time point,respectively. The blood concentra-tion of hypaconitine was determined by HPLC-MS using palmatine hydrochloride as internal standard. DAS 2.0.1 software was used to calculate pharmacokinetic parameters. RESULTS:The linear range of hypaconitine was 0.102 4-100 ng/ml (r=0.998 7),and the limit of quantification was 0.1 ng/ml. The pharmacokinetic parameters of single drug group vs. drug combination group were as follows as tmax of (0.50 ± 0.086) h vs. (0.75 ± 0.132)h;t1/2 of (9.967 ± 1.123) h vs. (3.708 ± 0.507) h;AUC0-10 h of (26.087 ± 0.672) μg·h/L vs.(6.516 ± 1.135) μg·h/L;cmax of (6.124 ± 2.312) μg/L vs. (1.592 ± 0.051) μg/L. Compared with single drug group,t1/2,AUC0-10 h and cmax of hypaconitine were decreased in drug combination group,with statistical significance (P<0.05). CONCLUSIONS:R. palmatum can inhibit the absorption of hypaconitine in rats,and speed up the elimination of it in rats.

Objective To investigate whether there existed a healthy obese subtype.Methods A total of 116 healthy subjects were recruited.They were divided into 3 groups according to BMI and metabolic disorders:40 cases of normal weight and metabolic normality (NMN),36 cases of obesity and metabolic normality (OMN) and 40 cases of obesity and metabolic abnormality (OMA).Anthropometic parameters as height,weight,waist circumference,hip circumference and blood pressure was recorded.Blood glucose,lipids,insulin,high-sensitivity C-reactive protein (hs-CRP) was detected.Body fat distribution was detected by dual-energy X-ray absorptiometry (DXA).Serum von Willebrand factor (vWF),a marker of endothelial dysfunction,were detected by ELISA.Results Both serum vWF levels in OMN group [(733.6±86.2)U/L] and OMA group[(809.2 ±46.3)U/L] are higher than that in NMN group [(466.9 ±65.3)U/L,P ＜0.05] with serum vWF level in OMA group is higher than in OMN group (P ＜ 0.05).Among android fat mass percentage (AFM％),BMI,waist height ratio,waist circumference,hs-CRP,weight,hip circumference and trunk fat mass,AFM％,BMI and hs-CRP are main influencing factors of vWF.Conclusions Endothelial dysfunction existed in obese adults regardless of their metabolic status.There is no healthy obese subtype.AFM％,BMI and hs-CRP are the main influencing factors of endothelial dysfunction.

OBJECTIVETo investigate the effect and clinical significance of glucocorticoid on CD4+CD25+ regulatory T cells (Tregs) in patients with hepatitis B virus (HBV)-related pre-liver failure.

METHODSThe subjects of this study included 78 patients with pre-liver failure induced by HBV (cases) and 24 healthy individuals (controls). Among the 78 cases, 42 received glucocorticoid treatment and 36 did not. Between-group differences in Tregs (in peripheral blood) were evaluated by flow cytometry and statistical analysis.

RESULTSTwo weeks of glucocorticoid treatment led to an increase in Treg level compared to baseline (before therapy: 2.76 ± 0.73 vs. 3.88 ± 1.60). In addition, after the two weeks of glucocorticoid treatment, the Treg level of improved patients was significantly higher than that measured at baseline (before therapy: 2.70 ± 0.77 vs 3.97 ± 1.59, P < 0.05).

CONCLUSIONGlucocorticoids up-regulate the expression of Treg cells, which may contribute to the immunological mechanism that protects pre-liver failure patients from deterioration of their condition. Careful inspection and monitoring of Treg levels may help improve prognosis of these patients.

Adult ; Case-Control Studies ; Female ; Glucocorticoids ; therapeutic use ; Hepatitis B virus ; Hepatitis B, Chronic ; drug therapy ; immunology ; Humans ; Liver Failure ; immunology ; virology ; Male ; Middle Aged ; T-Lymphocytes, Regulatory ; cytology ; immunology ; Young Adult