【Objective】 To investigate the effect of double plasma molecular adsorption system and sequential half-dose plasma exchange (DPMAS+HPE) on the short-term survival rate of patients with hepatitis B associated acute-on-chronic liver failure (HBV-ACLF). 【Methods】 Data on HBV-ACLF cases hospitalized in our hospital from January 1, 2015 to December 31, 2022 were retrospectively collected, and were divided into standard comprehensive medical treatment group and DPMAS+HPE group according to different treatment methods. Propensity score matching (PSM) was used to eliminate inter group confounding bias. The baseline data and improvement of laboratory indicators after treatment between two groups were compared. Death related risk factors in HBV-ACLF patients were screened by logistic regression analysis, and cumulative survival rates at 30 and 90 days between the two groups were compared by Kaplan-Meier survival analysis. 【Results】 A total of 373 cases of HBV-ACLF were included in this study. Among them, 136 cases in the treatment group received DPMAS+HPE once on the basis of comprehensive internal medicine treatment, and 237 cases only received comprehensive internal medicine treatment. After PSM, 136 patients were included as the control group. The decrease in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total protein (TP) in the treatment group before and after treatment was significantly greater than that in the control group (446.5 vs 159.0, 317.0 vs 92.0,5.2 vs 0.3), with statistically significant difference (P<0.05). DPMAS+HPE treatment is an independent protective factor for mortality in HBV-ACLF patients at 30 and 90 days (30 days: OR=0.497, P<0.05; 90 days: OR= 0.436, P<0.05). The cumulative survival rates at 30 and 90 days in the treatment group were significantly higher than those in the control group (30 days: 50.71% vs 44.12%, P<0.05; 90 days: 30.15% vs 22.79%, P<0.05). 【Conclusion】 DPMAS+HPE improves the short-term prognosis of HBV-ACLF patients and can serve as an effective artificial liver model for the treatment of HBV-ACLF patients.

Objective With the focus on emerging infectious diseases and diseases of unknown cause,the study aims to realize multi-point trigger monitoring of infectious diseases through key monitoring sites and key populations.Methods Using ar-tificial intelligence,deep learning,big data and other information technologies to build an intelligent information center for infec-tious diseases with patients'disease files as the core,construct a core capacity of infectious disease surveillance,early warning and situation prediction,and predict and evaluate the importance of infectious disease warning signals.Results The system cov-ered 1 425 primary-level medical institutions,18 hospitals,2 580+schools,4 134 pharmacies,4 laboratories and civil affairs departments,detected 55 kinds of infectious diseases and 6 kinds of syndrome monitoring signals.Since its launch,121 000 ac-tive notification cards have been issued,more than 54 000 new notification cards have been added,35.256 million times of multi-source monitoring and 14.4 million disease files have been recorded.Conclusion By expanding monitoring content and chan-nels,we realized early monitoring,auxiliary investigation and multi-mode visual early warning of infectious diseases,built a multi-point trigger mechanism,and moved forward the infectious disease surveillance.

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: Immunotherapies such as adoptive immune cell infusion and immune-modulating agents are widely used for cancer treatment, and the concomitant symptoms, including cytokine release syndrome (CRS) or immune-related adverse events (irAEs), are frequently reported. However, clinical manifestations induced by mismatched donor granulocyte colony-stimulating factor mobilized peripheral blood mononuclear cell (GPBMC) infusion in patients receiving microtransplant (MST) have not yet been well depicted. METHODS: We analyzed 88 cycles of mismatched GPBMC infusion in patients with acute myeloid leukemia receiving MST and 54 cycles of chemotherapy without GPBMC infusion as a comparison. Clinical symptoms and their correlation with clinical features, laboratory findings, and clinical response were explored. RESULTS: Fever (58.0% [51/88]) and chills (43.2% [38/88]) were the significant early-onset symptoms after GPBMC infusion. Patients possessing less human leukocyte antigen-matching loci with the donor or those with unrelated donors experienced more chills (3 [2-5] loci vs. 5 [3-5] loci, P  = 0.043 and 66.7% [12/18] vs. 37.1% [26/70], P  = 0.024). On the other hand, those with decreased CD4 + /CD8 + T-cell ratio developed more fever (0.8 [0.7-1.2] vs. 1.4 [1.1-2.2], P  = 0.007). Multivariable analysis demonstrated that younger patients experienced more fever (odds ratio [OR] = 0.963, 95% confidence interval [CI]: 0.932-0.995, P  = 0.022), while patients with younger donors experienced more chills (OR = 0.915, 95% CI: 0.859-0.975, P  = 0.006). Elevated ultra-sensitive C-reactive protein levels in the absence of cytokine storm were observed following GPBMC infusion, which indicated mild and transient inflammatory response. Although no predictive value of infusion-related syndrome to leukemia burden change was found, the proportion of host pre-treatment activated T cells was positively correlated with leukemia control. CONCLUSIONS Mismatched GPBMC infusion in MST induced unique infusion-related symptoms and laboratory changes, which were associated with donor- or recipient-derived risk factors, with less safety and tolerance concerns than reported CRS or irAEs.
Humans ; Leukocytes, Mononuclear ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Leukemia, Myeloid, Acute/therapy* ; Unrelated Donors ; Granulocyte Colony-Stimulating Factor ; Graft vs Host Disease

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Undergraduate education started late in rehabilitation medicine in mainland China.At present,there are some shortcomings in current undergraduate education for rehabilitation medicine in mainland China,mainly due to the shortage of teachers,the poor pertinence of professional subjects,the broad and superficial knowledge,and the lack of close connection with the necessary professional knowledge of rehabilitation technologies.The Department of Rehabilitation in Taiwan starts its undergraduate education earlier.The curriculum has been sub-professionally oriented.Its subjects are highly targeted and detailed in content.At the same time,it emphasizes forward-looking education such as "statistics".In view of this,the mainland colleges and universities should standardize the undergraduate education of rehabilitation therapies,strengthen the training of professional teachers,pay attention to the cross-mutualism of theory and practice in the teaching plan,enrich the number of professional courses,the appropriate introduction of teaching methods of scientific research,standardize the teaching management system.

Mitochondria are morphologically dynamic organelles which undergo fission and fusion processes. Our previous study found that arterial constriction was always accompanied by increased mitochondrial fission in smooth muscle cells, whereas inhibition of mitochondrial fission in smooth muscle cells was associated with arterial relaxation. Here, we used the typical vasorelaxants, verapamil and phentolamine, to further confirm the coupling between arterial constriction and mitochondrial fission in rat aorta. Results showed that phentolamine but not verapamil induced vasorelaxation in phenylephrine (PE)-induced rat thoracic aorta constriction. Verapamil, but not phentolamine, induced vasorelaxation in high K(KPSS)-induced rat thoracic aorta constriction. Pre-treatment with phentolamine prevented PE- but not KPSS-induced aorta constriction and pre-treatment with verapamil prevented both PE- and KPSS-induced aorta constriction. Transmission electron microscopy (TEM) results showed that verapamil but not phentolamine inhibited KPSS-induced excessive mitochondrial fission in aortic smooth muscle cells, and verapamil prevented both PE- and KPSS-induced excessive mitochondrial fission in aortic smooth muscle cells. Verapamil inhibited KPSS-induced excessive mitochondrial fission in cultured vascular smooth muscle cells (A10). These results further demonstrate that arterial relaxation is coupled to inhibition of mitochondrial fission in arterial smooth muscle cells.

Objective:To explore the relationship between big endothelin-1 (big ET-1) and cardiac remodeling in patients with hypertrophic obstructive cardiomyopathy (HOCM).
Methods:A total of 167 consecutive HOCM patients admitted in our hospital from 2015-01 to 2016-05 were enrolled. Blood levels of big ET-1 and NT-proBNP were measured;electrocardiogram(ECG), dynamicECG,echocardiography (UCG) and cardiovascular magnetic resonance (CMR) were examined for relevant statistical analysis.
Results:In all 167 HOCM patients, blood level of Big ET-1 was positively related to NT pro-BNP (r=0.35, P=0.000), left atrial (LA) diameter (r=0.169, P=0.019) and heart rate (r=0.141, P=0.037);negatively related to hemoglobin (r=-0.173, P=0.013) and the ratio of interventricular septum (IVS)/posterior wall of left ventricle (r=-0.165, P=0.017). Based on the finding of positive correlation between Big ET-1 and LA diameter, the patients were divided into 2 groups:Normal LA group, n=74 and Enlarged LA group, n=93. Compared with Normal LA group,Enlarged LA group had the higher blood level of Big ET-1 (P=0.001);increased left ventricular end-diastolic diameter (LVEDD) (P=0.024), thicker IVS (P=0.003), lower LVEF (P=0.001);enlarged LVED volume (P=0.002) and IVS (P=0.002);elevated ratio of atrial fibrillation(AF);more patients with moderate to severe mitral regurgitation (MR) and NYHA functional classIII/IV.
Conclusion: Blood level of Big ET-1 was positively related to NT pro-BNP and LA diameter in HOCM patients;the patients with enlarged LA had increased Big ET-1, more obvious cardiac remodeling and the higher incidence of AF occurrence which implied that Big ET-1 might play the role in cardiac remodeling in HOCM patients.

Objective To study the effects of the rehabilitation robot-assisted task-oriented training on the hand function in patients after stroke. Methods From June, 2015 to September, 2016, 35 inpatients suffering from stroke were randomly allocated to control group (n=17) and trial group (n=18). Based on the routine rehabilitation, the trial group accepted robot-assisted task-oriented training, while the control group accepted therapist-assisted task-oriented training, for two weeks. They were measured the active range of motion (AROM) of fingers, assessed with fingers motor of Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI) invovled with hands before and after train-ing. Results The inpatients dropped three in the control group, two in the trial group. AROM of extension and flexion of all the fingers, the AROM of extension and total of three fingers of thumb, index and middle, and the total AROM of each finger improved in the trial group af-ter training (t>2.937, P<0.05), while the AROM of extension and flexion of all the fingers, AROM of extension, flexion and total of the fin-gers of thumb, index and middle, total AROM of the fingers of thumb, index and little improved in the control group after training (t>2.528, P<0.05);the AROM of extension and total of the fingers of thumb, index and middle, and the total AROM of fingers of thumb and index im-proved more in the trial group than in the control group (t>2.535, P<0.05). The scores of mass flexion, mass extension, opposition, cylinder grip, spherical grip and total score of FMA improved in the trial group after training (Z>2.000, P<0.05), while the scores of mass extension, opposition and the total score of FMA improved in the control group after training (Z>2.000, P<0.05). There was no significant difference between the two groups on the items and total scores after training (P>0.05). The scores of feeding, dressing, toilet transfers, bathing, groom-ing of MBI and the total score of them improved in the trial group after training (Z>2.041, P<0.05), while the total score of MBI improved in the control group after training (Z=-2.527, P<0.05). There was no significant difference between the two groups in the items and total scores after training (P>0.05). Conclusion The rehabilitation robot-assisted task-oriented training can improve AROM of hemiplegic fingers and grip function.

Objective To investigate the protective effect of electroacupuncture pretreatment on myocardial ischemia/reperfusion (I/R) injury and its influence on high mobility group box 1 (HMGB1) expression in rats. Methods Sixty Wistar rats were randomly divided into sham operation group, myocardial I/R model group and electroacupuncture pretreatment group by random number table (each n = 20). Myocardial I/R injury model was reproduced by ligating the left ventricular branch coronary artery at about 0.5 cm below the atrial appendage lower margin for 10 minutes to occlude the blood flow, then the ligature was relaxed for 1 hour reperfusion; in electroacupuncture pretreatment group, 7 days before I/R, the electroacupuncture at Neiguan acupoint was applied once daily for 20 minutes till the 7th day when I/R was established. Under light microscope, the pathological changes of myocardial specimen stained by hematoxylin-eosine (HE) method were observed. The myocardial histopathological integral was detected by semi quantitative integral method, and the changes of histological scores in three groups were investigated. The levels of plasma HMGB1, tumor necrosis factor-α (TNF-α), cardiac troponin T (cTnT) were detected by enzyme-labeled immunosorbent assay (ELISA). The expressions of HMGB1, monocyte chemotactic protein-1 (MCP-1), TNF-αmRNA and protein in myocardium were detected by reverse transcription-polymerase chain reaction (PT-PCR) and Western Blot. Results Under light microscope, the myocardial tissue in myocardial I/R model group showed partial fracture of myocardial fibers, large patches of myocardial cell necrosis, hazy boundary, cellular condensation, rupture and dissolution or even disappearance, interstitial edema with a lot of inflammatory cell infiltration; the above myocardial tissue injury in electroacupuncture pretreatment group was significantly milder than that in myocardial I/R model group. Compared with sham operation group, in myocardial I/R model group the HMGB1, TNF-α, cTnT contents and histological score were significantly increased [HMGB1 (μg/L):9.64±1.16 vs. 2.15±0.31, TNF-α(μg/L):91±22 vs. 19±5, cTnT (μg/L):1.50±0.35 vs. 0.07±0.03, histological score:2.5±0.3 vs. 0.0±0.0, all P<0.01], HMGB1, MCP-1, TNF-α mRNA and protein expressions were increased obviously (HMGB1 mRNA: 1.42±0.16 vs. 0.02±0.00, MCP-1 mRNA:0.46±0.06 vs. 0.01±0.00, TNF-αmRNA:0.75±0.04 vs. 0.03±0.00;HMGB1 protein:1.08±0.01 vs. 0.20±0.01, MCP-1 protein:0.92±0.03 vs. 0.40±0.01, TNF-αprotein:1.10±0.02 vs. 0.35±0.01, P<0.05 or P<0.01);compared with myocardial I/R model group, in electroacupuncture pretreatment group, HMGB1 (6.58±0.73), TNF-α (63±19), cTnT (1.15±0.31) levels were significantly decreased (all P < 0.01), HMGB1, MCP-1, TNF-αmRNA and protein expressions were markedly reduced (mRNA expression was 0.74±0.12, 0.18±0.02, 0.10±0.03, and protein expression was 0.40±0.01, 0.36±0.02, 0.50±0.02, respectively all P<0.05), and histological score (1.2±1.0) was remarkably lowered (P < 0.01). Conclusion Electroacupuncture pretreatment may reduce the myocardial I/R injury in rats, and the mechanism may be related to the amelioration of inflammatory response mediated by HMGB1 at late stage.