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 impact of coronary CT angiography (CCTA) image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve (CT-FFR).Methods:Based on the CT-FFR CHINA trial, the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA, CT-FFR and FFR measurement. The subjective and objective assessments of CCTA image were performed on a per-vessel level. The objective assessments included the enhancement degree of coronary artery, the signal-to-noise ratio (SNR) of the aortic root. We used χ 2 test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups (non-artifact vs. artifact), enhancement degree of coronary artery groups (≤400 vs. 401-500 vs.>500 HU), SNR of the aortic root groups (≤16.9 vs.>16.9), body mass index (BMI) groups (<25 kg/m 2 vs.≥25 kg/m 2) and heart rate groups (<75 bpm vs.≥75 bpm). FFR and CT-FFR values≤0.80 was identified as myocardial ischemia. Results:The study enrolled 317 patients with 366 vessels. All target vessels in CCTA images were successfully analyzed by CT-FFR. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of the non-artifact group were 90.45%, 86.75%, 93.10%, 90.00%, 90.76% and 0.928, respectively, and those of the artifact group were 83.23%, 87.21%, 79.01%, 81.52%, 85.33% and 0.869, respectively. The differences in accuracy and specificity were statistically significant (χ 2=4.23, P=0.040; χ 2=8.55, P=0.003). The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups (all P>0.05). Conclusions:The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia. The degree of vascular enhancement, SNR, BMI, and heart rate have no significant effect on the diagnostic performance of CT-FFR.

Objective To evaluate the effect of dexmedetomidine administered at different time points on the quality of anesthesia recovery and inflammatory response in children undergoing craniotomy.Methods According to the randomized double-blind method,200 pediatric patients who underwent craniotomy in Beijing Fengtai Hospital from August 2017 to August 2022 were divided into 4 groups,with 50 cases in each group.In preoperative group,0.5μg/(kg?h)dexmedetomidine was intravenously pumped 30min before anesthesia induction,and the drug was stopped before the start of surgery.In intraoperative group,0.5μg/(kg?h)dexmedetomidine was infused intravenously after the beginning of the operation,and the drug was stopped 30min before the end of the operation.In postoperative group,0.5μg/(kg?h)dexmedetomidine was infused intravenously after the main steps of the operation,and the drug was discontinued at the end of the operation.In control group,the same volume of normal saline was injected intravenously 30min before anesthesia induction.The recovery quality,hemodynamics,inflammatory response,and adverse reactions were compared among the four groups.Results The extubation time of postoperative group[(43.84±5.12)min]was significantly longer than that of preoperative group[(16.73±3.28)min],intraoperative group[(18.05±3.47)min],and control group[(25.63±4.64)min],the difference was statistically significant(P<0.05).Ramsay sedation scores,mean arterial pressure(MAP),heart rate(HR),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin(IL)-6 were compared between preoperative group and intraoperative group before anesthesia induction in a quiet state(T0),immediately after extubation(T1)and 5min after extubation(T2).The difference was not statistically significant(P>0.05).Ramsay sedation scores and levels of CRP,TNF-α and IL-6 at T1 and T2 in postoperative group were significantly higher than those in preoperative group,intraoperative group and control group,and MAP and HR were significantly lower than those in preoperative group,intraoperative group and control group,with statistically significant differences(P<0.05).There was no significant difference in the overall incidence of adverse reactions among the four groups(P>0.05).Conclusion Intravenous infusion of dexmedetomidine at different time points in children undergoing craniotomy has no obvious adverse reactions,but intravenous infusion of dexmedetomidine before and during operation has little effect on hemodynamics and inflammatory response during anesthesia recovery period,and the quality of recovery and sedation is better.Intravenous infusion of dexmedetomidine after operation will prolong extubation time.

Objective:To probe the diagnostic performance of the combined evaluation of stenosis and plaque characteristics based on coronary computed tomography angiography (CCTA) in identification of myocardial ischemic lesions, using the invasive coronary angiography (ICA)-based fractional flow reserve (FFR) as the gold standard.Methods:From November 2018 to March 2020, the patients with suspected or known coronary artery disease and scheduled for ICA at 5 clinical trials centers were enrolled in this study. All the patients underwent CCTA, ICA and FFR in turn in one week. The luminal stenosis and plaque characteristics were measured and assessed including plaque burden, volume ratios of calcification and non-calcification, lesion length and CT vulnerable features. All culprit vessels were divided into FFR≤0.8 and FFR>0.8 groups, and the parameters of plaque characteristics were compared. The correlation of ischemic lesions with CCTA stenosis and plaque characteristics was analyzed by the logistic regression analysis. The ROC curve was used to evaluate the sensitivity and specificity of CCTA stenosis rate and plaque characteristics, meanwhile the area under curve (AUC) of each parameter was compared by Delong test.Results:Three hundred and sixty-six culprit vessels in 317 patients were analyzed in this study (169 vessels in ischemia group and 197 in nonischemia group). The plaque burden [34.3% (30.3%, 38.8%) vs. 32.4% (28.5%, 37.9%); Z=-2.622, P=0.009], proportion of CT vulnerable features [26.9% (45/169) vs.11.7% (23/197); χ 2=15.311, P<0.001] and lesion length [22.1 (14.4, 35.0) mm vs. 17.6 (11.0, 26.0) mm; Z=-4.388, P<0.001] in FFR≤0.8 group were higher than those in FFR>0.8 group. The results of logistic regression analysis revealed that CCTA stenosis, lesion length, and CT vulnerable features were significant predictors for myocardial ischemia (OR values: 3.794, 2.461, 1.027; P<0.001, P=0.002, P=0.002). The diagnostic performance of CCTA ≥50% stenosis alone in identification of ischemic lesions was low (AUC=0.625). When it combined high-risk plaque characteristics and lesion length, the AUC was improved to 0.714 with a statistical significance. Conclusions:CCTA stenosis, lesion length, and CT vulnerable features are major predictors in identification of myocardial ischemic lesions, and the combination will significantly improve the diagnostic performance of CCTA ≥50% stenosis.

Objective To evaluate the effects of leptin on brain injury and long-term cognitive function in rats undergoing orthotopic liver transplantation. Methods Ninety clean-grade male Sprague-Dawley rats, aged 3 months, weighing 200-250 g, were divided into 3 groups by a random number table method: sham operation group ( S group) , liver ischemia-reperfusion ( I∕R) group ( I∕R group) and lep-tin group ( L group) , with 18 rats in each group. Orthotopic liver transplantation was performed to estab-lish the model of liver I∕R injury in I∕R and L groups. Leptin 1 mg∕kg was intraperitoneally injected at the onset of ischemia in L group, and the equal volume of normal saline was given instead of leptin in S and I∕R groups. Twelve rats in each group were sacrificed at 3 days after operation, and brains were removed for ex-amination of the pathological changes in hippocampal CA1 region ( with a light microscope) and for determi-nation of apoptosis in hippocampal neurons ( by TUNEL assay) and expression of aquaporin 4 ( AQP4) and protein kinase C ( PKC) in the hippocampus ( by Western blot) . The apoptosis rate was calculated. The remaining 6 rats in each group underwent a Morris water maze test at 30 days after surgery to evaluate long-term cognitive function. Results Compared with S group, the apoptosis rate of hippocampal neurons was significantly increased, the expression of AQP4 and PKC was up-regulated, the escape latency was pro-longed, and the time of staying at the platform quadrant was shortened in I∕R and L groups (P<0. 05). Compared with I∕R group, the apoptosis rate of hippocampal neurons was significantly decreased, the ex-pression of AQP4 and PKC was down-regulated, the escape latency was shortened, and the time of staying at the platform quadrant was prolonged in L group (P<0. 05). Conclusion Leptin can reduce the brain damage in rats undergoing orthotopic liver transplantation, the mechanism may be related to down-regulating the expression of PKC and AQP4, and leptin can also improve long-term cognitive function after orthotopic liver transplantation in rats.

OBJECTIVE: To assess the predictive value of myocardial scar mass in malignant ventricular arrhythmia (MVA) after myocardial infarction. METHODS: Thirty myocardial infarction patients with complete electrophysiology and cardiac MRI data admitted from January 2012 to August 2017 were enrolled in the study. According to the results of intracavitary electrophysiological study, MVA developed in 16 patients (MVA group) and not developed in 14 patients (non-MVA group). The qualitative and quantitative analysis of left ventricular ejection fraction (LVFE) and scar mass was performed with CV post-processing software and predictive value of myocardial scar and LVEF for MVA after myocardial infarction was analyzed using ROC curves. RESULTS: LVEF in MVA group was significantly lower than that in non-MVA group, and scar mass in MVA group was significantly higher than that in non-MVA group (all <0.05). Regression analysis showed that LVEF (=1.580) and scar mass (=6.270) were risk factors for MVA after myocardial infarction. For predicting MVA, the area under ROC curve () of LVEF was 0.696 with a sensitivity of 0.786 and the specificity of 0.685; the of the scar mass was 0.839 with a sensitivity was 0.618 and the specificity of 0.929; the of LVEF combined with scar mass was 0.848 with a sensitivity of 0.688 and specificity of 0.857. CONCLUSIONS Myocardial scar assessed by late gadolinium enhancement MRI is more effective than LVEF in predicting MVA after myocardial infarction.
Arrhythmias, Cardiac ; diagnosis ; Cicatrix ; diagnostic imaging ; Contrast Media ; Gadolinium ; Humans ; Myocardial Infarction ; complications ; diagnostic imaging ; Predictive Value of Tests ; Ventricular Function, Left

Objective To study the clinical value of whole －body magnetic resonance diffusion weighted imaging(WB－DWI) in evaluating the chemotherapy response for lung cancer,thus to provide evidence for optimizing clinical imaging examination. Methods From October 2017 to May 2018,60 patients with lung cancer confirmed by histopathology in Linfen Central Hospital were selected. The patients underwent DWI examinations before chemotherapy and after two cycles of chemotherapy. The change of tumor size,distant metastasis and apparent diffusion coefficient (ADC) value were compared before and after chemotherapy. The correlation between the change rate of ADC value and the shrinkage rate of tumor size in the effective group was analyzed. Results Of 60 cases,1 case had new cerebral metastases after chemotherapy. There were statistically significant differences in ADC value [(1. 12 ± 0.33) ×10 －3mm2/svs.(1.56±0.40) ×10 －3mm2/s]andtumorsize[(4.63±2.75)cmvs.(2.28±1.45)cm] between before and after chemotherapy in the effective group(t= －3. 954,4. 711,all P＜0. 01). There was correlation between the change of ADC value and tumor size(r=0. 34,P＜0. 05). Conclusion WB－DWI can not only detect the change of tumor size and distant metastasis quickly and effectively,but also can observe the microscopic changes of tumor cells by measuring ADC value. So it can predict the early therapeutic response of the tumor and make effective evaluation for the staging and chemotherapy response of lung cancer.

Objective To investigate the effect of dexmedetomidine (DEX) on brain injury and long-term cognitive dysfunction in rats after orthotopic liver transplantation ischemia/reperfusion and its mechanism. Methods Fifty-four male Sprague-Dawley (SD) rats were randomly divided into sham-operated group (n=18), orthotopic liver transplantation ischemia/reperfusion group (I/R group, n=18) and DEX pre-administration group (DEX group, n=18). The orthotopic liver transplantation ischemia/reperfusion models were established in I/R group and DEX group. Rats of the DEX group were intraperitoneally injected with DEX 100 μg/kg 30 min before the incision, and an equal volume of normal saline was injected into rats of the sham-operated group and I/R group at the same time. Twelve rats in each group were sacrificed 3 d after operation and brain tissues were taken. The pathological changes of the hippocampus were observed under light microscope. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) was used to detect neuronal apoptosis index of the hippocampus. Western blotting was used to detect the protein levels of aquaporin 4 (AQP4) and protein kinase C (PKC) in the hippocampus. The remaining 6 rats accepted Morris water maze test to evaluate the long-term cognitive function 30 d after surgery. Results As compared with those in the sham-operated group, rats in the I/R group and DEX group had hippocampus edema and disordered cell arrangement; as compared with sham-operated group, I/R group and DEX group had significantly increased neuronal apoptosis index, significantly increased protein levels of AQP4 and PKC, significantly shorter quadrant retention time of the platform, and statistically longer escape latency (P<0.05). As compared with those in the I/R group, the pathological damage of hippocampal neurons was significantly alleviated, the neuronal apoptosis index was significantly decreased, the protein levels of AQP4 and PKC were statistically decreased, and the residence time of the quadrant in the platform was significantly prolonged, and the escape latency was statistically shorter in DEX group (P<0.05). Conclusion Pre-administration of DEX may reduce the brain damage and improve long-term cognitive dysfunction in rats after orthotopic liver transplantation ischemia/reperfusion, which may be related to down-regulating the AQP4 and PKC expression levels and reducing neuronal apoptosis.

Objective To investigate the effect of dexmedetomidine (DEX) on platelet activating factor (PAF) levels in the plasma and hippocampus of mice with postoperative cognitive dysfunction (POCD).Methods A total of 30 specific pathogen free C57BL/6J mice were randomly divided into three groups (n=10):sham-operated group,POCD group and DEX intervention group.Mice in sham-operated group only received anesthesia but not partial hepatectomy surgery;the POCD models of POCD group and DEX intervention group were established by partial hepatectomy surgery under anesthesia;DEX (25 μg/kg) was given to mice from the DEX intervention group by intraperitoneal injection 30 min prior to partial hepatectomy surgery;normal saline of the same volume was injected intraperitoneally prior to partial hepatectomy surgery in sham-operated group and POCD group.Behavioral test was performed via fear conditioning tests (FCS),and the percentage of freezing time was recorded on the 3rd d of POCD modeling.The PAF levels in the blood and hippocampus were measured by enzyme-linked immunosorbent assay (ELISA).Results (1) As compared with the sham-operated group,POCD group had significantly lower percentage of freezing time in audible alerts on FCS (57.3％±9.1％ vs.30.0％±5.4％,P＜0.05);as compared with the POCD group,DEX intervention group had significantly higher percentage of freezing time in audible alerts on FCS (30.0％±5.4％ vs.46.5％±6.6％,P＜0.05).(2) The PAF levels in the plasma and hippocampus of POCD group were significantly increased as compared with those in the sham-operated group ([0.5±0.3] ng/mL vs.[22.5±2.2] ng/mL;[5.7±1.0]ng/mL vs.[9.8±1.4] ng/mL],P＜0.05);the PAF levels in the plasma and hippocampus of DEX intervention group were significantly increased as compared with those in the POCD group ([22.5±2.2] ng/mL vs.[14.6±1.6] ng/mL;[9.8±1.4] ng/mL vs.[7.4±1.2] ng/mL,P＜0.05).Conclusion DEX can improve early POCD in mice after partial hepatectomy surgery by reducing PAF levels in the plasma and hippocampus.

Objective To investigate the effect of dexmedetomidine (DEX) on mammalian target of rapamyein (mTOR) signaling pathway in the hippocampus of mice with postoperative cognitive dysfunction (POCD).Methods A total of 64 specific pathogen free (SPF) adult C57BL/6J mice were randomly divided into four groups (n=16):sham-operated group,POCD group,DEX-L group (giving low dose of DEX) and DEX-H group (giving high dose of DEX).Mice only received anesthesia but not partial hepatectomy surgery in sham-operated group;mouse models of POCD in POCD group were established by partial hepatectomy surgery under anesthesia;DEX (25 μg/kg or 50 μg/kg) was given by intraperitoneal injection 30 min prior to partial hepatectomy surgery,and then,the mouse models of POCD were established in DEX-L group and DEX-H group;normal saline of the same volume was injected intraperitoneally prior to partial hepatectomy surgery in sham-operated group and POCD group.Behavioral test was performed via Fear Conditioning Test (FCS) one d before surgery and 3 d after surgery for training and behavioral testing,and the percentage of freezing time was recorded.Enzyme linked immunosorbent assay (ELISA) was used to detect the protein levels of beta amyloid protein 42 (Aβ-42) and phosphorylated(p)-tau-181 in cerebrospinal fluid of mice 3 d after surgery.The hippocampus tissues of mice were collected 3 d after surgery,and the mRNA expressions of mTOR,Tau,nuclear factor-κB (NF-κB) and tumor necrosis factor-α (TNF-α) in hippocampal tissues were tested by reverse transcription-polymerase chain reaction (RT-PCR).The protein expressions ofmTOR,p-tau (pS396 Tau protein),NF-κB and TNF-α in hippocampal tissues were tested by Westem blotting.Results (1) As compared with that in sham-operated group,the percentage of freezing time in conditioning FCS in POCD group was statistically lower (P＜0.05);as compared with that in POCD group,the percentage of freezing time in conditioning FCS in DEX-L group and DEX-H group was significantly higher (P＜0.05).(2) The protein levels of Aβ-42 and p-tau-181 in cerebrospinal fluid of POCD group,DEX-L group and DEX-H group were significantly higher than those in sham-operated group (P＜0.05);the protein levels of Aβ-42 and p-tau-181 in cerebrospinal fluid of DEX-L group and DEX-H group were significantly lower as compared with those in POCD group (P＜0.05);DEX-H group had significantly lower protein levels of Aβ-42 and p-tau-181 in cerebrospinal fluid as compared with DEX-L group (P＜0.05).(3) The mRNA and protein expressions of mTOR,NF-κB p65 and TNF-α,Tau mRNA expression,and pS396 Tau protein expression in the hippocampus of the POCD group were significantly higher as compared with those in the sham-operated group (P＜0.05);the mRNA and protein expressions ofmTOR,NF-κB p65 and TNF-α,Tau mRNA expression,and pS396 tau protein expression in the hippocampus of the DEX-L group and DEX-H group were significantly lower as compared with those in the POCD group (P＜0.05);those in the DEX-H group were significantly lower than those in the DEX-L group (P＜0.05).Conclusion DEX can improve early POCD in mice,and the mechanism may be related to down-regulation of mTOR signaling pathway.