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.

Ketosis in dairy cows is often accompanied by apoptotic and inflammatory responses in adipose tissue.In order to investigate the effect of pro-apoptotic protein Bid on adipocyte apoptosis in cows with ketosis,the adipose tissue was stained by TUNEL staining technique in this study to observe the apoptotic changes in adipose tissue of cows with ketosis.In the in vivo test,protein ex-pression of apoptosis-related factors Bid,Bax,C-Caspase-3,Bcl-2 and inflammation marker factors C1q,IL-1β,IL-10 and IL-6 in adipose tissues of healthy cows and ketosis cows were detected by Western blot.In the in vitro assay,the adipocyte lipolysis model was constructed by culturing pri-mary bovine adipocytes in vitro to inhibit Bid and adding isoproterenol(ISO),and the protein ex-pression levels of apoptosis-related molecules and inflammation-related molecules in adipocytes were detected by Western blot technique.The results of TUNEL staining showed that the protein expression of pro-apoptotic factors Bid,Bax and C-Caspase-3,and pro-inflammatory markers TNF-a,IL-1β,and IL-6 were significantly higher,and the protein expression of complement C1q,anti-ap-optotic factor Bcl-2,and anti-inflammatory factor IL-10 were significantly lower in adipose tissues of ketosis cows compared with that of healthy cows.The in vitro results showed that the protein expression levels of apoptosis and inflammation-related factors in adipocytes treated with the ISO group were significantly higher compared with those in the control group,while the protein ex-pression levels of apoptosis and inflammation-related factors in adipocytes treated with the addi-tion of the Bid inhibitor group were significantly lower.The above results showed that inhibition of Bid could alleviate the apoptotic and inflammatory responses of ISO on adipocytes.This will fur-ther clarify the role of Bid/C1q in the regulation of adipose tissue and cell apoptosis and inflamma-tion in ketosis cows.

This article reported two cases of axillary artery thrombosis in extremely low/very low birth weight infants following the placement of a local arterial catheter, who hospitalized in Shengjing Hospital of China Medical Universityin in April 2023 and August 2022, respectively. Case 1: Before surgery for necrotizing enterocolitis, an arterial catheter was placed in the left axilla of the infant. On the same day, the infant developed cyanosis of the left upper limb and weakened radial artery pulse. Ultrasound examination confirmed the presence of left axillary artery thrombosis. Despite subcutaneous injection of low molecular weight heparin (LMWH) and plasma infusion, there was no improvement in blood circulation. The infant also exhibited reduced movement in the left upper limb and loss of radial artery pulse. Thrombolytic therapy with recombinant tissue-type plasminogen activator was administered. Six hours after the treatment, the radial artery pulse became palpable. Thrombolysis was then terminated, and anticoagulation with LMWH was supplied for two weeks. At one year and eight months of age, the infant had a weaker left-hand grip strength compared to the right, but the overall functionality was largely preserved. Case 2: The infant developed late-onset sepsis at 17 days old and had an arterial catheter placed in the axilla. Pale left upper limb was observed in the following day, and the brachial and radial artery pulses were absent. Vascular ultrasound indicated the presence of left axillary artery thrombosis. Anticoagulation therapy with subcutaneous injection of LMWH was provided, along with thrombolysis using urokinase. On the sixth day after thrombolysis, an ultrasound examination showed no thrombus-like echoes. At one year and eight months of age, the development and movement of the affected upper limb became normal.

Objective:To observe the efficacy and safety of albumin paclitaxel in patients with advanced breast cancer.Methods:A retrospective analysis was performed on 138 patients with advanced breast cancer admitted to Xiangyang Central Hospital from June 2018 to June 2021. The patients were divided into groups according to molecular type, number of treatment lines for albumin paclitaxel, number of metastatic sites, specific metastatic sites, past use of docetaxel and paclitaxel and combination therapy of albumin paclitaxel. Median progression-free survival (mPFS) and treatment-related adverse reactions in different subgroups treated with albumin paclitaxel were investigated. Survival curves were plotted by Kaplan-Meier method and log-rank test was performed, and multivariate analysis was performed by Cox model.Results:The mPFS of the overall population was 8.2 months. The mPFS of triple negative breast cancer, human epidermal growth factor receptor-2 (HER-2) positive breast cancer and Luminal breast cancer were 6.4 months, 11.2 months and 8.1 months respectively, with a statistically significant difference (χ 2=7.42, P=0.025) . The mPFS of patients treated with first- and second-line albumin paclitaxel was 9.5 months, and the mPFS of patients treated with third- to seventh-line was 6.3 months (χ 2=3.86, P=0.049) . The mPFS of patients with ≤3 metastatic sites was 8.1 months, and the mPFS of patients with >3 metastatic sites was 7.0 months (χ 2=0.38, P=0.535) . The mPFS of patients with liver and brain metastases was 6.8 months, and the mPFS of patients with extrahepatic and extracerebral metastases was 9.6 months (χ 2=7.53, P=0.006) . The mPFS of patients who had previously treated with docetaxel and paclitaxel was 8.2 months, and the mPFS of patients who had not previously received docetaxel or paclitaxel was 9.6 months (χ 2=0.03, P=0.862) . The mPFS of patients with albumin paclitaxel combined with targeted therapy, combined with immunotherapy, combined with chemotherapy and monotherapy were 12.1, 7.8, 9.0 and 7.1 months respectively, with a statistically significant difference (χ 2=8.96, P=0.030) . Multivariate analysis showed that molecular type (triple negative breast cancer RR=1.87, 95% CI: 1.24-4.22, P=0.008; HER-2 positive breast cancer RR=0.63, 95% CI: 0.52-0.94, P=0.042) , number of treatment lines ( RR=0.67, 95% CI: 0.32-0.86, P=0.011) , specific metastatic sites ( RR=1.26, 95% CI: 1.12-2.75, P=0.014) and combination therapy (combined with targeted therapy RR=0.74, 95% CI: 0.16-0.86, P=0.021; combined with chemotherapy RR=0.93, 95% CI: 0.48-0.96, P=0.045; combined with immunotherapy RR=0.81, 95% CI: 0.17-0.78, P=0.032) were independent factors for prognosis. The main adverse reactions were alopecia, neutropenia, peripheral neurotoxicity and rash, and there was no death caused by adverse reactions. Conclusion:Albumin paclitaxel is effective in the treatment of advanced breast cancer with controllable adverse reactions.

Background Coal workers' pneumoconiosis (CWP) is a serious occupational disease. Whether ferroptosis, a form of necrotic regulated cell death, is involved in coal dust induced mouse models of CWP needs further survey. Objective This experiment is designed to elucidate the role of ferroptosis in the formation of CWP induced by coal dust in mice. Methods C57BL/6J mice were randomly assigned to a saline group or a CWP group, with eight mice in each group. The mice were treated with 0.1 mL normal saline or 0.1 mL coal dust suspensions (50g·L^-1) via intra-tracheal instillation. HE staining and Masson staining were used to show lung injury and lung fibrosis. Iron concentration in mouse lung tissues was measured using iron assay kit. Lipid peroxidation was estimated in lung tissues by malondialdehyde (MDA) concentration and immunofluorescence intensity, and the ratio of glutathione (GSH) to L-glutathione oxidized (GSSG). Western blotting and real-time fluorescence-based quantitative PCR were used to test protein and mRNA expression levels of glutathione peroxidase 4 (GPX₄) and ferritin in mice. Results Coal dust injured pulmonary structure, thickened alveolar wall, and caused collagen deposition and infiltration of inflammatory cells in the CWP group. The iron concentration in the CWP group [(10.75 ± 5.42) mg·L⁻¹] was higher than that in the saline group [(1.14 ± 0.37) mg·L⁻¹] (P < 0.01). The MDA concentration in the CWP group [(37.32 ± 12.18) μmol·L⁻¹] was higher than that in the saline group [(18.70 ± 8.22) μmol·L⁻¹] (P <0.01). The immunofluorescence intensity of MDA in the CWP group was stronger than that in the saline group. The GSH/GSSG ratio decreased in CWP treated mice (1.50 ± 1.70) compared with the normal saline treated ones (4.95 ± 2.86) (P < 0.01). Compared with the saline group (38.84 ± 15.61 for GPX₄, 225.90 ± 54.34 for ferritin), the relative expression levels of GPX₄ and ferritin mRNA in the CWP group were downregulated (14.29 ± 7.21 for GPX₄, 106.70 ± 36.70 for ferritin) (P < 0.01). Compared with the saline group (1.47 ± 0.54 for GPX₄, 1.73 ± 0.34 for ferritin), the relative expression levels of GPX₄ and ferritin protein in the CWP group were also downregulated (0.92 ± 0.22 for GPX₄, 0.97 ± 0.09 for ferritin) (P < 0.05). Conclusion Ferroptosis may be involved in the formation of coal workers' pneumoconiosis induced by coal dust in mice.

To address the increasing need for detecting and validating protein biomarkers in clinical specimens, mass spectrometry (MS)-based targeted proteomic techniques, including the selected reaction monitoring (SRM), parallel reaction monitoring (PRM), and massively parallel data-independent acquisition (DIA), have been developed. For optimal performance, they require the fragment ion spectra of targeted peptides as prior knowledge. In this report, we describe a MS pipe-line and spectral resource to support targeted proteomics studies for human tissue samples. To build the spectral resource, we integrated common open-source MS computational tools to assemble a freely accessible computational workflow based on Docker. We then applied the workflow to gen-erate DPHL, a comprehensive DIA pan-human library, from 1096 data-dependent acquisition (DDA) MS raw files for 16 types of cancer samples. This extensive spectral resource was then applied to a proteomic study of 17 prostate cancer (PCa) patients. Thereafter, PRM validation was applied to a larger study of 57 PCa patients and the differential expression of three proteins in prostate tumor was validated. As a second application, the DPHL spectral resource was applied to a study consisting of plasma samples from 19 diffuse large B cell lymphoma (DLBCL) patients and 18 healthy control subjects. Differentially expressed proteins between DLBCL patients and healthy control subjects were detected by DIA-MS and confirmed by PRM. These data demonstrate that the DPHL supports DIA and PRM MS pipelines for robust protein biomarker discovery. DPHL is freely accessible at https://www.iprox.org/page/project.html?id=IPX0001400000.

Long non-coding RNA (lncRNA) is a type of non-coding RNAs (ncRNA), and it involved in a wide range of biological processes. In recent years, the role of lncRNA in the development and progression of tumors has been widely concerned by the field of medical with the further researches. Mounting evidence also shows that many lncRNAs have altered expression in various types of human cancer and involved in the progress of tumor by multi ways. Thyroid cancer is a complex disease of uncertain origin, and it is lack of effective diagnosis, treatment and prognosis biomarkers. Therefore, finding the association between lncRNA and thyroid cancer is very important and helpful for clarifying the pathogenesis and finding new effective biomarkers for this disease.

OBJECTIVE: To summarize and analyze the postoperative short-term complications of laparoscope-assisted transanal total mesorectal excision (taTME) for rectal cancer patients after neoadjuvant therapy. METHODS: A prospectively established database on taTME patients at Peking University Cancer Hospital was screened with the following conditions: data retrieval from June 2016 to August 2018, pathologically confirmed adenocarcinoma, receiving preoperative neoadjuvant chemoradiotherapy or chemotherapy. The transabdominal procedure and the transanal procedure were performed simultaneously in the taTME operation. Occurrence of complications during perioperative period (within postoperative 3 months) in these patients, especially anastomosis-related complications and their management were analyzed. The relevant complications were recorded according to the Clavien-Dindo (CD) grading criteria. The severity of anastomotic leakage and anastomotic stenosis was evaluated according to criteria developed by the International Rectal Cancer Research Group. RESULTS: A total of 29 patients were enrolled in this study. In the 29 patients, 25 (86.2%) were male and 4 (13.8%) were female, the median age was 60 (range, 30 to 72) years, the median body mass index was 25.8 (range, 19.8 to 36.4) kg/m, the median distance from the tumor to anal verge was 4 (range, 2 to 8) cm. All the patients completed laparoscope-assisted taTME operations successfully without conversion to laparotomy, intra-operative severe complication or death. The median operation time was 300 (range, 198 to 405) minutes, and the median intra-operative blood loss was 100 (range, 50 to 200) ml. All the TME specimens were complete according to the Nagtegaal standard. All the patients underwent prophylactic ileostomy. Hartmann procedure was performed in one case due to poor blood supply in the proximal bowel without the possibility of anastomosis. Anal sphincter preservation rate was 96.6% (28/29). The median postoperative exhaust time was 2 (range, 1 to 10) days, and the median postoperative hospital stay was 9 (range, 7 to 24) days. Fifteen patients (51.7%) had postoperative complications, among which serious complication (CD grade IIIb and above) accounted for 6.9% (2/29). No perioperative death was observed. Five patients (17.2%) presented anastomosis-related complications, including 2 cases of grade C anastomotic leakage due to anastomotic rupture, who underwent abdominal perineal resection 1 month after operation; 2 cases of grade B anastomotic leakage, who improved after conservative treatment; 1 case of grade A anastomotic stenosis, who improved with anal expansion 1 month after operation. The incidence of postoperative infection was 24.1% (7/29), including 6 cases of pelvic infection and 1 case of trocar site infection, all of which were CD grade II. One case had incomplete intestinal obstruction (CD grade II); 1 case had gastroplegia; 1 case had abdominal trocar hernia. All the patients were followed up for a median of 12.0 (range, 3.9 to 29.9) months. Seven cases did not undergo ileal stoma closure. The anal sphincter preservation rate was 75.9% (22/29). CONCLUSION Pelvic infection and anastomosis-related complications are common after laparoscope-assisted taTME surgery for rectal cancer patients following neoadjuvant chemoradiotherapy, which require active management and appropriate treatment.
Adult ; Aged ; Anal Canal ; Female ; Humans ; Laparoscopes ; Male ; Middle Aged ; Neoadjuvant Therapy ; Postoperative Complications ; Rectal Neoplasms ; therapy

OBJECTIVETo explore the applicable value of transanal total mesorectal excision (taTME) in male low rectal cancer patients with narrow pelvis-"difficult pelvis", which remains difficult for both open and laparoscopic sphincter-saving operations.

METHODSClinical data of male low rectal cancer patients diagnosed by pathology undergoing taTME between June 2016 and January 2018 at Peking University Cancer Hospital were collected. A retrospective cohort study was performed. Patients were selected according to the following criteria: (1) low rectal cancer, the distance between inferior margin of tumor and anal verge ≤5 cm; (2) the distance between two sciatic tubercles <5 cm; (3) body mass index (BMI) >25 kg/m; (4) tumor horizontal diameter ≤4 cm. Operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications and anal function were analyzed.

RESULTSA total of 20 patients were included in this study. All the patients received preoperative neoadjuvant chemoradiation and hybrid transabdominal and transanal surgery. The median BMI was 27.7(26.2-36.4) kg/m; the median distance between two sciatic tubercles was 92.5 (78-100) mm; the median distance between the inferior margin of tumor to the anal verge was 4 (2-5) cm; the median operation time was 302 (215-402) min; the median intraoperative blood loss was 100 (50-200) ml; the median postoperative hospital stay was 9 (5-15) d. Postoperative complications occurred in 5 patients (25%), including 3 pelvic infection, 1 intestinal obstruction, 1 anastomotic leakage receiving sigmoid colostomy. There was no perioperative death. Sphincter-preservation rate was 100%. Nineteen patients received anal manometry 1 month after operation with normal resting pressure (41.5±8.6) mmHg and squeeze pressure (121.0±11.6) mmHg. All the patients were followed up to March 2018, and the median follow-up time was 4.5 months. Only 1 patient had supraclavicular lymph node metastasis and no local recurrence was found.

CONCLUSIONSThe safety of transanal total mesorectal excision for male patients with low rectal cancer and difficult pelvis is acceptable. TaTME is helpful to preserve the anal sphincter.

Adult ; Anal Canal ; surgery ; Humans ; Laparoscopy ; Male ; Neoplasm Recurrence, Local ; Pelvis ; surgery ; Postoperative Complications ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome ; Universities

Objective To identify the plasma miRNAs which are differentially expressed in the patients with traumatic avascular necrosis of the femoral head by means of high-throughput screening so as to provide data for further research into the pathogenesis of traumatic avascular necrosis of the femoral head.Methods We selected 10 patients with femoral neck fracture who had been treated from January to April 2015 for traumatic avascular necrosis of the femoral head following manual reduction and internal fixation with percutaneous hollow screws (necrosis group) and another contemporary age-matched 10 patients with femoral neck fracture who had been treated in the similar way but did not develop traumatic avascular necrosis of the femoral head for over 2 years (control group).After the peripheral blood was obtained from the 20 patients,Axon GenePix 4000B chip scanner was used for peripheral blood chip screening to identify the miRNAs which were differentially expressed.QPCR technique was used to verify the top 5 miRNAs which were significantly up-regulated and the top 5 miRNAs which were significantly down-regulated.Results The Harris score for the necrosis group was significantly lower than that for the control group while the Visual Analog Scale score for the former significantly higher than that for the latter (P ＜ 0.05).There were no significant differences between the 2 groups in general data (P ＞ 0.05).In comparison of the 2 groups,the chip screening identified 95 miRNAs which were significantly up-regulated and 413 miRNAs which were significantly down-regulated.The "volcano" analysis screened out 147 miRNAs differentially expressed of which 35 were up-regulated genes and 112 down-regulated genes.Of the 10 genes selected,8 were found in line with the results of microarray screening:hsa-miR-93-5p,hsa-let-7i-5p,hsa-miR-320a,hsa-miR-25-3p,hsa-miR-16-2-3p,hsa-miR-122-5p,hsa-miR-4711-3p and hsa-miR-3191-5p.Conclusion This study indentified 8 differentially expressed miRNAs associated with traumatic osteonecrosis of the femoral head,providing data for further study.