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 characteristics and rules of acupoint sensitization phenomena based on knee osteoarthritis (KOA), one of the clinical dominant diseases of acupuncture-moxibustion. METHODS: In combination with literature and expert experiences, the acupoints with the highest use frequency in treatment of KOA were screened, e.g. Heding (EX-LE 2), Liangqiu (ST 34), Mingmen (GV 4), Neixiyan (EX-LE 4), Ququan (LR 8) and Dubi (ST 35). In 814 patients with KOA and 217 healthy subjects, the acupoint temperature, mechanic pain threshold and pressure pain threshold were detected separately. Using machine learning method, the sensitization was judged at each acupoint. RESULTS: Compared with healthy subjects, the acupoint temperature was increased and the mechanic pain threshold and pressure pain threshold were reduced in KOA patients (P<0.05). Besides, the cut-off value was presented to distinguish whether the acupoint was sensitized or not. The results of machine learning showed that the highest prediction accuracy of acupoint sensitization was 86.7% (Shenshu [BL 23]) and the lowest one was 73.9% (Heding [EX LE 2]). The prediction accuracy at the third clinical stage trial was higher, the highest was 93.3% (Ququan [LR 8]) in KOA patients. CONCLUSION It is confirmed that the acupoint sensitization reflects the characteristics of disease and is correlative with the conditions of illness, which may provide the reference for the auxiliary diagnosis and condition assessment of KOA.
Acupuncture Points ; Acupuncture Therapy ; Humans ; Moxibustion ; Osteoarthritis, Knee/therapy* ; Treatment Outcome

Since the 18th National Congress of the Communist Party of China(CPC), the CPC and the government have highligh-ted the development of traditional Chinese Medicine(TCM) and issued a series of policies, such as the Plan for Protection and Deve-lopment of Chinese Medicinal Materials(2015-2020) forwarded by the General Office of the State Council in 2015, the Plan for Healthy Development of Traditional Chinese Medicine(2015-2020) released by the General Office of the State Council in the same year, the Healthy China 2030 Plan published by the CPC Central Committee and the State Council in 2016, the Law of the People's Republic of China on Traditional Chinese Medicine which took effect on July 2017, On the Preservation and Innovative Development of Traditional Chinese Medicine promulgated by CPC Central Committee and the State Council in 2019, and Plan for the Development of Traditional Chinese Medicine during the 14th Five-Year Plan Period of China released by the General Office of the State Council in March 2022, to promote the development of the TCM industry, which have brought historical opportunities to the TCM industry. However, TCM industry faces various challenges in the development. In terms of drug development in TCM, the current studies mainly focused on the chemical research and technical requests, which neglected TCM characteristics and cased in conformity between new drug transformation of TCM and clinical practice. Therefore, a more considerable and profound authoritative guideline is needed, and innovative thought and research are necessary for academics and the industry. Through the investigation of the development TCM industry in recent years, this study summarized the policies on and trends of Chinese medicinal materials, new drug development in TCM, catalogue of national basic drugs, and national basic health insurance, and proposed suggestions for further development of TCM industry.
China ; Drugs, Chinese Herbal ; Humans ; Industry ; Medicine, Chinese Traditional ; Policy

Immune checkpoint therapy is a new mode of tumor therapy. At present, many kinds of PD-1/PD-L1 inhibitors have been approved for clinical application on various tumors, such as malignant melanoma, lung cancer, bladder cancer, lymphoma, etc. However, with the gradual promotion and application in clinical practice, various immune-related adverse reactions caused by PD-1/PD-L1 inhibitors have attracted extensive attention. Especially in recent years, a number of adverse reactions related to endocrine gland injury have been reported. This paper reviews the research status and corresponding clinical treatment methods of endocrine gland related adverse reactions caused by PD-1/PD-L1 inhibitors.

OBJECTIVE: To investigate the effects of exosomes from human umbilical cord mesenchymal stem cells on the development of Treg and TH17 cells. METHODS: Exosomes from the serum-free-culture supernatants of hUC-MSC were harvested by ultracentrifugation. The electron microscopy, nanoparticle tracking analysis and western blot were used to identify the hUC-MSC-exosomes, such as the morphology, the paticle chameter, and the protein content. The PBMC stimulated with anti-CD3/CD28 were incubated with the exosomes for five days, and then the percentage changes of Treg and TH17 cells were analyzed by using flow cytometry. RESULTS: The hUC MSC-derived exosomes were saucer-like in morphology the averge diameter was approximately 142 nm. They were identified as positive for CD9 and CD63. Flow cytometry showed that the proportion of CD4CD25Foxp3 Treg cells in the PBMC were significantly higher, but the proportion of CD4IL17A T cells in the hUC-MSC-exosome group was obviously lower than that in the group without the hUC-MSC-exosom (control group) (P<0.05). CONCLUSION The hUC-MSC-exosomes have an immunomodulatory effect on T cells in vitro by increasing the ratio of Treg and reducing the ratio of TH17 cells, expecting the hUC-MSC-exosom as a novel cell-free target for immunotherapy.
Exosomes ; Humans ; Leukocytes, Mononuclear ; Mesenchymal Stem Cells ; T-Lymphocytes, Regulatory ; Th17 Cells ; Umbilical Cord

Objective: To investigate the effects of artesunate treatment on chronic graft-versus-host disease (cGVHD). Methods: Recipient BALB/c mice received 8 × 10(6) bone marrow cells with 8×10(6) spleen cells from B10D2 mice. Artesunate solubilized in acetone was injected intraperitoneally every day at the dose of 1 mg/kg at Day 28 after BMT. The clinical scores, survival and histopathological damage were analyzed. The frequency of Th17 and Tregs in PB and spleens from the mice were evaluated by flow cytometry. In addition, CD4(+) T cells from the spleens of mice were cultured in vitro, then stimulated with artesunate, the frequency of Th17 and Tregs in these splenocytes were evaluated by flow cytometry. Results: Artesunate administration diminished clinical and histopathological damage, and improved the survival of cGVHD mice[(46.57±7.83)% vs (55.71±6.99)%, χ(2)=5.457, P=0.020]; Artesunate contributed to Tregs development [(4.45±0.04)% vs (8.40±0.23)%, t=15.679, P<0.001; (6.62±0.24)% vs (10.48±0.48)%, t=6.587, P=0.003] while decreased Th17 cells [(1.51±0.18)% vs (0.58±0.19)%, t=7.233, P<0.001; (1.48±0.38)% vs (0.71±0.18)%, t=3.653, P=0.011] expressions in both PB and spleens, and decreased the Th17/Treg ratio (0.34±0.05 vs 0.09±0.03, t=7.621, P=0.002; 0.19±0.03 vs 0.06±0.02, t=6.993, P=0.002). Moreover, artesunate suppressed the Th17 cells expressions [(0.82±0.37) % vs (3.39±1.22) %, t=4.044, P=0.007] and contributed to Tregs development [(34.63±1.29) % vs (14.28±1.69) %, t=19.119, P<0.001], and also decreased the Th17/Treg ratio (0.24±0.09 vs 0.02±0.01, t=4.780, P=0.003) in vitro. Conclusions: Artesunate suppressed the Th17 cells expressions and contributed to Tregs development, which provided new sights into the development of a novel drug for cGVHD, e.g., artemisinin.
Animals ; Artesunate ; Graft vs Host Disease ; Mice ; Mice, Inbred BALB C ; T-Lymphocytes, Regulatory ; Th17 Cells

Objective: To analyze and evaluate the diagnostic value of plasma D-dimer combined with echocardiography and lower extremity vascular ultrasound for pulmonary thromboembolism (PTE). Methods: The clinical data of 140 clinically suspected PTE patients admitted to Department of Respiratory and Critical Care Medicine, Ruijin Hospital between January 2012 and December 2016 were retrospectively analyzed. Based on the results of computed tomographic pulmonary angiography (CTPA), all included patients were divided into CTPA negative group (non-PTE group) and CTPA positive group (PTE group). The univariate and multivariate analyses were used to compare and evaluate the diagnostic and predictive efficacy of plasma D-dimer combined with echocardiography and lower extremity vascular ultrasound for PTE. Results: There was no significant difference in gender, age, smoking, underlying diseases (malignancy, hypertension, coronary heart disease, dyslipidemia, and chronic obstructive pulmonary disease) and surgical history within 30 days between the two groups (All P>0.05). Univariate analysis revealed significant differences in D-dimer (P=0.003), pulmonary artery pressure (P=0.000), and partial pressure of carbon dioxide (P=0.000) between the groups. Multivariate analysis suggested that deep venous thrombosis of the lower extremities, pulmonary hypertension, and elevated D-dimer levels were significantly associated with the incidence of PTE. Further ROC curve analysis suggested that the area under the curve (AUC) of deep venous thrombosis, pulmonary hypertension and D-dimer increase was 0.624, 0.673 and 0.624, respectively. The AUC of combined three factors was 0.837. The sensitivity, specificity, positive predictive value and negative predictive value of the combined diagnosis reached 86.8%, 88.4%, 87.5%, and 84.6%, respectively. Conclusion: D-dimer combined with echocardiography and vascular ultrasound of lower extremity might have diagnostic and predictive value for PTE.

Objective To observe the effect of electroacupuncture on early enteral nutrition (EEN) support in patients with severe craniocerebral injury.Methods A prospective, randomized, controlled study was conducted, 50 patients with severe craniocerebral injury admitted to the the Department of Intensive Care Unit of Traditional Chinese Medicine Hospital of Ningbo from January 2014 to October 2016 were enrolled, and they were randomly divided into electroacupuncture experimental group (26 cases) and conventional treatment control group (24 cases) by randome number table. Enteral nutrition (EN) support was implemented in 24 - 48 hours after admission for all the patients, additionally, the electroacupuncture experimental group was treated by electroacupuncture stimulating acupoint from the 1st day after admission, once 30 minutes daily for consecutive 10 days. The levels of EN calorie reaching standard situation and the parenteral nutrition (PN) necessary for addition were recorded on 3 days and 5 days after admission; the nasal feeding amount of the two groups was recorded on the 1, 4, 7 days; the incidences of complications during EN support period were observed in both groups.Results The proportion of EN calorie reaching the standard in electroacupuncture experimental group was significantly higher than that in the conventional treatment control group in 5 days of treatment [92.3% (24/26) vs. 70.8% (17/24),P < 0.05]. The proportions necessary for addition of PN support were lower in electroacupuncture experimental group than those in the conventional treatment control group on 3 days and 5 days of treatment [3 days: 19.2% (5/26) vs. 25.0% (6/24), 5 days: 7.7% (2/26) vs. 16.7% (4/24)], but there were no significant statistical differences between the two groups (bothP > 0.05). The nasal feeding amounts in electroacupuncture experimental group were significantly higher than those in the conventional treatment control group on 4 days and 7 days of treatment [4 days (mL): 1292.31±123.04 vs.1204.17±139.81,7 days (mL):1342.31±113.75 vs.1275.00±103.21, bothP < 0.05]. The incidence of complications of the electroacupuncture experimental group was significantly lower than that of the conventional treatment control group in 10 days of treatment [26.92% (7/26) vs. 41.67% (10/24),P < 0.05].Conclusions Application of electroacupuncture has a certain clinical value during implementing EN support for treatment of patients with severe craniocerebral injury, early intervention of electroacupuncture can effectively improve the patients' gastrointestinal function and elevate the successful rate of EN, and the therapy is simple, effective and safe without any obvious adverse reactions.

Objective To investigate the effects of nutritional therapy under energy metabolic monitoring on nutrition indicators and clinical prognosis of elderly patients with critical severe diseases in the department of Intensive Care Unit (ICU).Methods One hundred and twenty elderly patients admitted to the Department of ICU of Integrate Traditional Chinese Medicine Hospital of Ningbo, from January 2013 to December 2016 were enrolled, and they were divided into a control group (62 cases) and an observation group (58 cases) by randomized block method. The patients in observation group received nutritional support treatment under the guidance of energy metabolic monitoring, the amount of nitrogen needed was measured every day, and appropriate energy was provided according to the amount of nitrogen and the ratio of heat to nitrogen; the patients in the control group were given the nutritional support program according to experience. The clinical efficacy was evaluated after 7 days of treatment in the two groups, the differences in hemoglobin (Hb), serum albumin (Alb), prealbumin (PA), weaning success rate within 7 days, duration of mechanical ventilation, length of stay in ICU, the standard rate of enteral nutrition (EN) in 7 days, parenteral nutrition support rate, reaching EN target calorie time, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score on the 7th day after admission and at discharge, the incidence of complications such as abdominal distention, stress ulcer, ventilator associator pneumonia (VAP), heart failure during nutritional treatment and mortality were observed and compared after EN support between the two groups.Results Compared with control group, after treatment Hb (g/L: 136.5±2.5 vs. 90.4±2.3), Alb (g/L: 35.7±4.6 vs. 32.8±4.2), PA contents (g/L: 211.0±20.8 vs. 190.9±30.7), weaning success rate within 7 days [55.2% (32/58) vs. 33.9% (21/62)], the standard rate of EN in 7 days in the observation group were obviously higher [82.8% (48/58) vs. 51.61% (32/62) allP < 0.05], but duration of mechanical ventilation (days: 8.8±3.5 vs. 11.1±4.0), length of stay in ICU (days: 21.2±5.0 vs. 25.9±6.5), parenteral nutrition support rate [29.3% (17/58) vs. 51.6% (32/62)], reaching EN target calorie time (days: 4.4±2.1 vs. 6.2±2.9), APECHE Ⅱ score 7 days after admission (18.7±5.8 vs. 20.8±8.1), APACHEⅡscore at discharge (13.0±5.2 vs. 15.6±4.5) and the incidence of complications such as abdominal distension [10.3% (6/58) vs. 41.9% (26/62)], stress ulcer [3.4% (2/58) vs. 12.9%(8/62)], VAP [22.4% (13/58) vs. 25.8% (16/62)], heart failure [15.5% (9/58) vs. 24.2% (15/62)] etc, were all lower in observation group (allP < 0.05), and 2 weeks later the mortality was significantly lower in the observation group than that in the control group [13.79% (8/58) vs. 22.58% (14/62),P < 0.05].Conclusions Nitrogen required in elderly patients critically ill patients with early determination, the supply of nutrients to guide empirical method is more accurate compared to the nutritional therapy. Nutritional support under energy metabolism monitoring can shorten clinical course, improve nutritional indicators and help reduce the risk of complications and death.

OBJECTIVETo investigate the distribution of pathogenic bacteria in the patients with hematologic malignancies received hematopoietic stem cell transplantation (HSCT) and its influence on the expression of BCL-2 and BAX proteins.

METHODSThe clinical data of 64 patients with malignant lymphoma (ML) received auto-HSCT from January 2011 to December 2015 in our hospital were analyzed. On basis of post-treansplant infection, the patients were divided into infection group (36 cases) and non-infection group (28 cases). The distribution of pathogenic bacteria in 2 groups was identified, the T lymphocyte subsets of peripheral blood, expression level of apoptotic proteins and C-reaction protein (CRP) in 2 group were detected.

RESULTSThirty-six strains of pathogenic bacteria were isolated from 36 case of hematological malignancy after HSCT, including 24 strains of Gram-negative bacteria (66.67%) with predominamce of klebsiella pneumoniae (19.44%). The periperal blood CD4+ (t=2.637, P<0.01), CD4+/CD8+ ratio (t=8.223, P<0.01), BCL-2 protein (t=5.852, P<0.05), BCL-2/BAX ratio (t=14.56, P<0.01) in infection group were significantly lower than those in non-infection group, while CD8+ (t=2.285, P=<0.01), CRP (t=39.71, P<0.01), BAX level in infection group were higher than those in non-infection group. The pearson correcation analysis showed that the CD4+/CD8+ ratio in infection group positively correlated with BCL-2/BAX ratio (t=0.341, P<0.05), while serum CRP level in infection group negatively correlated with BCL-2/BAX ratio (t=-0.362, P<0.05).

CONCLUSIONThe pathogenic bacteria infecting ML patients after HSCT were mainly Gram-negative bacteria. The post-transplant infection can promote the expression up-regulation of related inflammatory factors and apoptotic proteins. The pathogens may be involved in cell apoptisis that provides a new strategy to treat the hematologic malignancies.

C-Reactive Protein ; analysis ; CD4-CD8 Ratio ; Gram-Negative Bacteria ; isolation & purification ; Hematologic Neoplasms ; metabolism ; microbiology ; Hematopoietic Stem Cell Transplantation ; Humans ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; T-Lymphocyte Subsets ; cytology ; Up-Regulation ; bcl-2-Associated X Protein ; metabolism