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.

Severe muscle injury is hard to heal and always results in a poor prognosis. Recent studies found that extracellular vesicle-based therapy has promising prospects for regeneration medicine, however, whether extracellular vesicles have therapeutic effects on severe muscle injury is still unknown. Herein, we extracted apoptotic extracellular vesicles derived from mesenchymal stem cells (MSCs-ApoEVs) to treat cardiotoxin induced tibialis anterior (TA) injury and found that MSCs-ApoEVs promoted muscles regeneration and increased the proportion of multinucleated cells. Besides that, we also found that apoptosis was synchronized during myoblasts fusion and MSCs-ApoEVs promoted the apoptosis ratio as well as the fusion index of myoblasts. Furthermore, we revealed that MSCs-ApoEVs increased the relative level of creatine during myoblasts fusion, which was released via activated Pannexin 1 channel. Moreover, we also found that activated Pannexin 1 channel was highly expressed on the membrane of myoblasts-derived ApoEVs (Myo-ApoEVs) instead of apoptotic myoblasts, and creatine was the pivotal metabolite involved in myoblasts fusion. Collectively, our findings firstly revealed that MSCs-ApoEVs can promote muscle regeneration and elucidated that the new function of ApoEVs as passing inter-cell messages through releasing metabolites from activated Pannexin 1 channel, which will provide new evidence for extracellular vesicles-based therapy as well as improving the understanding of new functions of extracellular vesicles.
Creatine/metabolism* ; Extracellular Vesicles ; Muscle, Skeletal/metabolism* ; Myoblasts/metabolism* ; Regeneration ; Connexins/metabolism*

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective    To discuss the feasibility of establishment of animal model of "functional" bicuspid aortic valve with swine and observe its effect on the wall shear stress inside the aorta. Methods    Four common Shanghai White Swine with body weight between 50 kg to 55 kg were selected. Under general anesthesia and cardiopulmonary bypass, the aortic transverse incision approach was used, continuous suture with 6-0 polypropylene to align the left and right coronary valve leaflets to create a bicuspid valve morphology. After the operation, echocardiography was used to observe the aortic valve morphology and the hemodynamic changes of the aortic valve orifice. The effect on the wall shear stress inside the aorta was studied with 4D-Flow magnetic resonance imaging (MRI). Results    A total of 4 swine "functional" bicuspid aortic valve models were established, with a success rate of 100.0%. Echocardiography showed that the blood flow velocity of the aortic valve orifice was faster than that before the operation (0.96 m/s vs. 1.80 m/s). 4D-Flow MRI showed abnormally increased wall shear stress and blood flow velocity in the aorta of the animal models. After the surgery, in model animals, the maximal wall shear stress inside the ascending aorta was greater than 1.36 Pa, and the maximum blood flow velocity was greater than 1.4 m/s. Conclusion    Establishment of the animal model of "functional" bicuspid aortic valve in swine is feasible, scientific and reliable. It can be used in researches on evaluating the pathophysiological changes.

Objective:To explore the effect of group visits on health condition among follow-up patients with chronic heart failure.Methods:Totally 126 outpatient follow-up patients with heart failure were divided into intervention group and control group by random number table from 2018 to 2019. The intervention group consisted of 63 cases and control group consisted of 59 cases. The intervention lasted 6 months. The intervention group received group visits, while the control group received routine outpatient follow-up. Medication adherence, quality of life and heart failure related indicators were evaluated at baseline and after 6 months of intervention.Results:At 6 months after intervention, the scores of medication adherence, total quality of life, body, emotion and others dimensions of the intervention group were (5.79±1.38), (30.11±8.22), (12.65±5.53), (5.24±4.57) and (12.22±4.76) points. These scores of the control group were (5.31±1.09), (37.26±9.02), (15.87±5.21), (7.03±5.14), (14.36±5.54) points. The differences between the two groups were statistically significant ( t values were -4.581-2.161, P<0.05 or 0.01). The BNP and proportion of New York Heart Association (NYHA) I the intervention group were (180.87±174.92) ng/L and 84.1% (53/63). These indicators of the control group were (351.02±268.13) ng/L and 67.8% (40/59). The differences between the two groups were statistically significant ( t value was -4.177, χ2 value was 4.484, P<0.01 or 0.05). Conclusions:Group visits program is an effective management mode to provide intensive patient education and foster peer support, improving medication adherence and quality of life of follow-up patients with heart failure.

Objective:To explore the application effect of group management in follow-up management of patients with chronic heart failure.Methods:By the convenient sampling method, patients with chronic heart failure who were admitted to Department of Cardiology of Peking University First Hospital in 2018 and participated in heart failure follow-up clinic management after discharge were selected as research objects. The patients were divided into the intervention group and the control group by the random number table method. Finally, 63 patients were included in the intervention group and 59 patients were included in the control group. The control group was followed up by heart failure clinic and the intervention group was followed up by group management. Atlanta Heart Failure Knowledge Test-V2 (AHFKT-V2) , the Heart Failure European Self-care Behavior Scale (EHFScBS) , heart function grade of NYHA and Type B natriuretic peptide (BNP) were used to compare intervention effects.Results:Six months after the intervention, the total score of AHFKT-V2, scores of nutrition, behavior, symptom management, and medication dimensions of the intervention group were all higher than those of the control group, the total score of EHFScBS was lower than that of the control group, and the differences were statistically significant ( P<0.05) . Six months after the intervention, the heart function grade of NYHA and BNP of the intervention group were better than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The group management model can effectively improve heart failure related knowledge, self-care behaviors, heart function grade of NYHA and BNP of patients with heart failure follow-up.

Hirayama disease(HD),also known as juvenile muscular atrophy of the distal upper extremity,is featured by concealed onset clinically and often occurs in male adolescence.In most cases,one or both of the asymmetrical distal muscles of the upper extremities are weak and atrophied without objective sensory abnormalities and this disease naturally stops developing after several years.Early Hirayama disease is similar to motor neuron diseases in clinical symptoms like amyotrophic lateral sclerosis.The limitation of medical diagnostic techniques and the lack of understanding by clinicians lead to a higher rate of misdiagnosis of Hirayama disease,making their treatment plan and prognosis completely different.Therefore,a timely and accurate diagnosis of Hirayama disease is essential.In recent years,domestic and foreign scholars conducted researches in the diagnosis of Hirayama disease mainly through clinical manifestation combined with the magnetic resonance imaging of the cervical flexion position and the application of various neurophysiological detection techniques.As the number of clinical cases gradually increases,Hirayama disease draws more attention of clinicians and there are more and more reports and researches on related cases.With the development of research and application of imaging and neuroelectrophysiological techniques,the importance and effectiveness of early diagnosis and treatment of the disease have been affirmed and emphasized,thus people acquire a better understanding of its pathogenesis,clinical diagnosis and treatment.Especially for those suspected patients with juvenile muscular atrophy of the distal upper extremity,it is more important to be vigilant against the possibility of Hirayama disease.Based on this reality,this paper will discuss the new understanding and research progress of pathogenesis,clinical diagnosis and treatment of Hirayama disease,which is very important for clinicians to better understand and pay more attention to this disease.

Objective To explore nursing intervention of integrative medicine on returned overseas Chinese elderly with depression .Methods A total of 71 elderly with depression were divided into control group (n=36) and intervention group (n =35) randomly.The control group received routine nursing while the intervention group underwent serval integrative medicine nursing intervention such as syndrome differentiation types, emotional adjustment, and dietetic regulation.We utilized the Geriatric Depression Scale ( GDS) and Social Support Rating Scale ( SSRS) and compared the result of nursing intervention .Results After 6 months, the scores of GDS in the intervention group was (12.71 ±7.31) while the control group was (14.45 ±6.33) with statistical significance (t=4.87,P<0.01).There was 48.6% of patients assessed as non-depression in the intervention group which was higher than the control group (19.5%) (χ2 =6.89,P<0.05).The score of SSRS in the intervention group acquired 5.52 ±0.72 higher than the control group (4.89 ±0.87) (t=5.02, P<0.01).Conclusions It is that integrative medicine nursing such as syndrome differentiation dietetic regulation and emotional adjustment is better than the normal nursing method and is worthy of promotion in clinic.

Objective To study the effect of extended nursing on puerperal melancholia incidence.Methods Two hundred perpetrates received interventions of extended nursing after delivery,including education about puerperal state,turning on hot line and creation of QQ group,follow-ups and supporting from family members.Result The incidence rate of puerperal melancholia since performance of extended nursing was significantly lower than what is after its performance(P<0.01).Conclusions The extended nursing can help perpetrates to receive nursing knowledge,alleviate their anxiety,strengthen the confidence to take care of baby.As the result,it can reduce the incidence of puerperal melancholia.

Objective To study effect of TCM-based syndrome differentiation combined with diet nursing and point massage on insomnia.Methods Five hundred and twelve patients with insomnia were randomized into control group(n=85)and intervention group (n=67).The patients in both groups received treatment by TCM-based syndrome differentiation.Besides,the control group was given conventional nursing while those in the intervention group received diet nursing and point massage.The two groups were compared in three months in terms of sleep quality and curative effect.Results In comparisons of sleep quality index,the two groups both had statistically significant improvements respectively(both P<0.05).In terms of time to sleep, duration of sleep an sleep efficacy and Pittsburg sleep quality index,the intervention group scored significantly lower than the control group(all P<0.05).In terms of curative effect,the intervention group was significantly higher than the control group(P<0.05).Conclusion The method of TCM-based syndrome differentiation combined with diet nursing and point massage is effective in improving the sleep quality of those with insomnia.