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 introduce a partially nested design based on the characteristics of TCM in treating the same disease with different treatments and syndrome differentiation and treatment.Methods Partially nested design was used for standardized treatment of complex interventions.The TCM group was divided into multiple subsets according to"syndrome type-treatment method-prescription"(with nested structure),while the control group was treated with standardized Western medicine(without nested structure);taking a case study of"different treatments for the same disease"data for ulcerative colitis,this design type was applied and analyzed using a multi-level model.Results The partially nested design was consistent with the feature of TCM of"different treatments for the same disease"and met the methodological requirements for evidence-based evaluation.Multilevel models allowed analyses with this type of data.Conclusion The use of partially nested design enables the evaluation of the comprehensive effectiveness of"different treatments for the same disease",which can provide a methodological reference for the assessment of clinical effectiveness of TCM.

In the design of randomized controlled trials （RCT）， difficulties in patient recruitment and enrollment of control group would limit the overall implementation of the trials. In recent years， as a data source， real-world data （RWD） plays an increasingly important role in the medical field. In RCT of Chinese medicine， RWD could be designed as control group. This design can effectively solve the problem of inclusion difficulty for the patients in the western medicine control group of traditional Chinese medicine（TCM） RCT， it also can provide high quality evidence to evaluate the efficacy of TCM. In recent years， propensity score method has been widely used to deal with confounding factors in real world study. In this paper， four common research designs based on propensity score method were introduced with examples， including propensity score matching and data augmentation， two-stage design of propensity score stratification method， propensity score-integrated composite likelihood approach， and combination of different propensity score methods. However， there are some methodological challenges in this type of design， including the RWD data sources must be of high quality and the key information needs to be collected in a standardized method， the baseline characteristics of RCT and RWD patients should be comparable， and all known covariates related to the intervention and outcome need to be included for analysis. When adopting this design in the field of TCM， there are still some problems such as the lack of TCM syndrome information and TCM outcomes in RWD. When using RWD， it is necessary to decide how to analyze according to the data condition. This paper discussed the design types and methodological challenges of using RWD as control group in RCT， hoping to provide methodological ideas for researchers to use this type of design in the future.

Clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for sepsis is strictly in accordance with the latest diagnostic criteria for sepsis (sepsis-3) for the treatment of septic patients at different stages through syndrome differentiation. At present, the abuse of antibiotics and the prevalence of drug-resistant bacteria are very serious, without effective solutions. Thus, this is the first time to focus on traditional Chinese medicine combined with antibiotics to treat sepsis, in order to minimize the incidence of drug-resistant bacteria. This Guideline tends to systematically analyze the sepsis period, septic shock period as well as different clinical symptoms and traditional Chinese medicine measures for organ dysfunction in the sepsis process. By analyzing and interpreting the Guideline systematically, the clinicians could understand its purpose, significance and core ideas more thoroughly, and grasp the recommended specific interventions as well as their advantages and disadvantages, hoping to better implement the Guideline, provide guidance to clinicians and standardize the treatment of sepsis by traditional Chinese medicine.
Anti-Bacterial Agents ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Sepsis ; drug therapy

To investigate the clinical application of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for sepsis, in order to promote the follow-up revision and further promotion of the Guidelines. Copies of 500 application evaluation questionnaire and 500 copies of applicability evaluation questionnaire were given to the clinicians who had used this Guideline in China, both in a form of registered questionnaire, and a database was established by Excel 2016 for descriptive statistical analysis. Copies of 211 application evaluation questionnaire and 211 copies of applicability evaluation questionnaire were collected. We can conclude from the survey that we should adjust the whole content and structure on the basis of better evaluation of the present recommendation scheme, update the prescription selection and clinical evidence of the recommendation scheme, and put forward the improvement measures for the hindrance factors in the application of the Guideline. Furthermore, in order to promote the Guideline more clearly, we should strengthen the doctor-patient education, improve guidance quality and increase the publicity, providing basis for the implementation and promotion strategies of the Guideline.
Anti-Bacterial Agents ; therapeutic use ; China ; Humans ; Medicine, Chinese Traditional ; Sepsis ; drug therapy ; Surveys and Questionnaires

Objective To investigate the correlation between inflammatory cells, body temperature changes, and TCM syndromes of deep venous thrombosis (DVT) patients in acute and subacute phases. Methods The data of age, gender, body temperature, blood routine, venous ultrasonography, and four diagnostic information of 130 DVT patients in acute and subcute phases were collected and analyzed in a cross-sectional study. The correlation between inflammatory cells and the changes of body temperature and TCM syndromes were analyzed. Results Among 130 DVT patients, 37 patients had damp-heat syndrome, 64 patients had blood stasis and dampness syndrome, and 29 patients had qi stagnation syndrome. Neutrophils increased most obviously in blood stasis and dampness syndrome (P<0.05), which had close correlation with the skin redness (OR=1.287, 95%CI: 9.412-21.247). The mononuclear cells increased most obviously in the damp-heat syndrome, which has close correlation with nouhof (OR=7.364, 95%CI:1.189–45.603), high skin temperature (OR=6.683, 95%CI:1.791–24.938), skin tightness (OR=6.107, 95%CI:1.423–26.203) and weakness (OR=3.302, 95%CI: 1.002–9.169). The temperature rising was the most common in the damp-heat syndrome, and the increase of mononuclear cells was the most common one. Conclusion DVT is often accompanied with elevated levels of inflammatory cells and body temperature. Damp-heat syndrome has close correlation with body temperature and mononuclear cells increasing. Dampness and blood stasis syndrome and neutrophils are closely related.

Background Leber hereditary optic neuropathy (LHON) is mitochondrial DNA (mtDNA) disease and mainly leads to optical nerve degeneration.Its primary mechanism is synthesis disorder of DN4 protein due to variation of mtDNA 11778 locus.So to construct a vector with exogenous normal ND4 and transfect into mitochondria is a key of gene therapy for LHON.Objective This study was to investigate the in vitro transfection of adeno-associated virus (AAV)-ND4 gene into mitochondria.Methods Human renal epithelial cell lines transfected adenovirus E1A (293 cells) were regularly cultured and divided into two groups.Framework plasmids of recombinant AAV-ND4 or simple AAV2 were added to the cell medium respectively.The expression of ND4 in cells were located 12,24,36 and 48 hours after transfected by Y03 dual fluorescent quantum dots staining.The positive response for ND4 showed the green fluorescence.Results Cultured 293 cells grew well with 80％ confluence.Abundant green fluorescence particles were seen in cytoplasm in the AAV-ND4 transfected group,but only red fluorescence from mitochondrial protein was seen in the simple AAV transfected group under the fluorescence microscope.Conclusions Exogenous ND4 protein can been successfully transfected into mitochondria using the ND4 gene constructed AAV.This result provides experimental evidence for the further study on gene therapy of LHON.

OBJECTIVETo evaluate the feasibility and safety of early chest tube removal after lobectomies for lung diseases.

METHODSA prospective randomized control study was performed with data collected from lobectomies between March 2012 and September 2012. Eligible patients (n = 70) were randomized into two groups; early removal group (removal of chest tube when drainage less than 300 ml/24 h, n = 41) and traditional management group (removal of chest tube when drainage less than 100 ml/24 h, n = 29). Criteria for early removal were established and met before chest tube removal. The volume and character of drainage, time of extracting drainage tube and postoperative hospital stay were measured. All patients received standard care during hospital admission and a follow-up visit was performed after 7 days of discharge from hospital.

RESULTSThere were no differences between two groups with respect to age, sex, comorbidities, or pathologic evaluation of resection specimens. The median volume of drainage within 24 h after surgery was 300 ml and within 48 h was 250 ml, there was significantly different between two groups (Z = -2.059, P = 0.039). Patients undergoing early removal management had a shorter Chest tube duration (44 hours vs. 67 hours, Z = -2.914, P = 0.004) and a shorter postoperative hospital stay (5.0 days vs. 6.0 days, Z = -3.882, P = 0.000). Analysis of data showed no statistically significant differences between the rate of pleural effusions developed, thoracentesis and complications, one week after discharge from hospital.

CONCLUSIONSCompared to the traditional management group (drainage ≤ 100 ml/24 h), early removal of chest tube after lobectomy (drainage ≤ 300 ml/24 h) is feasible and safe. It could result in a shorter hospital stay, and most importantly, reduces morbidity without the added risk of complications.

Aged ; Chest Tubes ; Device Removal ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Pleural Effusion ; epidemiology ; Pneumonectomy ; Postoperative Complications ; epidemiology ; Prospective Studies

OBJECTIVETo explore the association between hypertension and the tendency of change among children,so as to lay a foundation for the prevention and control of hypertension.

METHODSBased on findings from the prevalence survey that carried out in September 1999 in Daqing of Heilongjiang province. New admission children were selected as subjects to conduct a five-year cohort study. All the subjects were interviewed with questionnaires and their blood specimens were collected for biochemical analysis. All data were analyzed using SPSS 10.0 software. Results The prevalence of hypertension among 447 children was found 2.01% at the baseline study but increased to 5.37% in the fifth year. During a five year period, the systolic pressure level among children increased from (100.65 +/- 11.62)mmHg (1 mm Hg = 0.133 kPa) to (106.67 +/- 9.29) mm Hg,while the diastolic pressure level was from (66.27 +/- 11.31) mm Hg to (70.28 +/- 7.98) mm Hg and showed significant difference between boys and girls. There were association between hypertension and family history, body mass index (BMI), triglyceride, insulin, insulin resistance index while insulin sensitivity index and family history, BMI and insulin sensitivity index appeared to be the important factors. Children under this study were divided to 'with family history or without' and then every group was divided to 'with over weight-obesity or normal'. Obesity and insulin sensitivity seemed the key risk factors on hypertension. Descent of insulin sensitivity was an independent risk factor.

CONCLUSIONThe level of blood tension among children in Daqing city was higher than that from the national data. The present study confirmed that over-weight,obesity, heredity and insulin resistance were the risk factors of hypertension while insulin resistance was related to hypertension. The interaction of these risk factors was independent or correlated to each other.

Blood Pressure ; Body Mass Index ; Child ; Child, Preschool ; China ; epidemiology ; Cohort Studies ; Female ; Humans ; Hypertension ; blood ; complications ; epidemiology ; Insulin Resistance ; Male ; Overweight ; complications ; Risk Factors ; Triglycerides ; blood