In view of the problem of slow development of intensive care medicine in Xizang, the research team made full use of the national partner assistance to Xizang, gathered resources across all cities in Xizang, and formed a national academic platform for critical care medicine in plateau areas. Adhering to the academic orientation with hemodynamics as the main topic, critical care ultrasound as the bedside dynamic monitoring and evaluation method, and blood flow-oxygen flow resuscitation as the core connotation, we have achieved the goals of improving the critical care talent echelon throughout Xizang, driving the overall progress of intensive care medicine in Xizang, making a figure in China, and focusing on training of top-notch talents.

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 investigate the serum and follicular fluid levels of sterol regulatory element-binding protein 1c(SREBP-1c), leucine-rich α-2-glycoprotein 1(LRG1) and the correlation with insulin resistance(IR) in non-ovarian etiology infertility patients and polycystic ovary syndrome(PCOS) patients with or without IR.Methods:Forty-nine PCOS patients and 66 infertility patients with non-ovarian etiology were collected in this retrospective study, homeostasis model assessment for insulin resistance(HOMA-IR) was used to evaluate IR, and were divided into control group( n=36), IR group( n=30), PCOS alone group( n=28) and PCOS-IR group(PCOS with IR group, n=21). The concentrations of serum, follicular fluid LRG1 and SREBP1c levels in each group were compared, and their correlation with relevant hormones and glycolipid metabolism were analyzed. Results:The levels of serum, follicular fluid LRG1 and SREBP1c in IR group, PCOS alone group and PCOS-IR group were significantly higher than those in control group; The PCOS-IR group showed a more significant increase in the levels of serum, follicular fluid LRG1 and SREBP1c( P<0.05). Correlation analysis showed that serum, follicular fluid LRG1 was positively correlated with body mass index, fasting plasma glucose(FPG), fasting insulin(FINS), triglycerides(TG), and HOMA-IR( P<0.05). Serum, follicular fluid SREBP1c was positively correlated with body mass index, FPG, FINS, TG, total cholesterol, LDL-C, LH, total teststerone, DHEAS, FAI, and HOMA-IR( P<0.05). Binary logistic regression analysis showed that serum SREBP1c was a risk factor for PCOS( P<0.05). Conclusion:The serum and follicular fluid levels of LRG1 and SREBP-1c were elevated in PCOS patients, especially in those with IR. The elevated levels of serum and follicular fluid LRG1 and SREBP-1c may be associated with IR and glucose-lipid metabolism abnormalities in PCOS patients. Serum LRG1 and SREBP-1c levels may serve as new indicators for predicting IR, early diagnosis, and intervention in PCOS patients.

BACKGROUND: Total knee arthroplasty (TKA) can reduce severe joint pain and improve functional disability in hemophilia. However, the long-term outcomes have rarely been reported in China. Therefore, this study aimed to evaluate the long-term outcomes and complications of TKA in Chinese patients with hemophilic arthropathy. METHODS: We retrospectively reviewed patients with hemophilia who underwent TKA between 2003 and 2020, with at least 10 years of follow-up. The clinical results, patellar scores, patients' overall satisfaction ratings, and radiological findings were evaluated. Revision surgery for implants during the follow-up period was recorded. RESULTS: Twenty-six patients with 36 TKAs were successfully followed up for an average of 12.4 years. Their Hospital for Special Surgery Knee Score improved from an average of 45.8 to 85.9. The average flexion contracture statistically significantly decreased from 18.1° to 4.2°. The range of motion (ROM) improved from 60.6° to 84.8°. All the patients accepted patelloplasty, and the patients' patellar score improved from 7.8 preoperatively to 24.9 at the last follow-up. There was no statistically significant difference in clinical outcomes between the unilateral and bilateral procedures, except for a better ROM at follow-up in the unilateral group. Mild and enduring anterior knee pain was reported in seven knees (19%). The annual bleeding event was 2.7 times/year at the last follow-up. A total of 25 patients with 35 TKAs were satisfied with the procedure (97%). Revision surgery was performed in seven knees, with 10- and 15-year prosthesis survival rates of 85.8% and 75.7%, respectively. CONCLUSIONS TKA is an effective procedure for patients with end-stage hemophilic arthropathy, which relieves pain, improves knee functions, decreases flexion contracture, and provides a high rate of satisfaction after more than ten years of follow-up.
Humans ; Arthroplasty, Replacement, Knee/methods* ; Hemophilia A/surgery* ; Follow-Up Studies ; Retrospective Studies ; Treatment Outcome ; Knee Joint/surgery* ; Range of Motion, Articular ; Arthritis/complications* ; Pain ; Contracture/surgery* ; Surgeons ; Knee Prosthesis

Objective To evaluate the safety and efficiency of composite microporous polysaccharide pow-der in non-varicose veins of gastrointestinal bleeding treatment. Methods We retrospectively analyzed 35 cases of the past 2 years in this hospital. Those patients were clinical diagnosed with non-varicose veins of gastrointestinal bleeding and received composite microporous polysaccharide powder in hemostasis. Results All 35 patients stopped bleeding after treatment with combined treatment of composite microporous polysaccharide powder spray. All vital signs were smooth and steady such as oxyhemoglobin saturation and heart rate,without complications like irritability,deterioration of inflammation and delayed hemorrhage. Conclusion The combined utilization of com-posite microporous polysaccharide powder provided rapid and effective hemostasis in therapy of non-varicose veins of gastrointestinal bleeding,which is an effective,simple and safe operation and to be worth of being generalized.

Objective To study the quality of life of patients with lower extremity artery disease (LEAD) and explore the effect of demographic and clinical factors on their quality of life. Method A self-designed demographic and clinical data questionnaire and the MOS 36 items short form health survey were used to investigate the life quality of 90 LEAD patients. Results The scores on the dimensions of life quality of the LEAD patients were significantly lower than those of common population (P<0.001). The marriage status and education affected patients′physical function, general health and social health;the longer the course of disease, the worse the general health;the complications, exercise and kind of disease affected patients'physical responsibility, physical function and emotion;the kind of disease affected patients'vitality; patients with exercise had higher general health (all P<0.05). Conclusions The life quality of LEAD patients is in general lower. The life quality of patients with different demographic and clinical data factors is varied. Therefore, doctors and nurses should correctly assess the life quality of LEAD patients and instruct those with problems so as to improve their quality of life.

Objective To evaluate the feasibility of detecting macrophage content on atherosclerotic plaques by optical coherence tomography (OCT) technique.Methods Thirty New Zealand white rabbits were equally divided into 3 groups at random:Control group(fed normal rabbit chow,n =10);lipid diet group(fed regular chow supplemented with cholesterol,n =10)and balloon injury + lipid diet group (balloon catheter injury of the common carotid artery after 2 weeks lipid diet,n =10).After 12 weeks,all rabbits underwent pharmacological triggering with Chinese Russell's viper venom (CRVV,15 mg/kg,i.p.) and histamine (0.02 mg/kg,i.v.).Common carotid arteries were detected with OCT and the Movat pentachrome stain respectively.OCT and histological examination results were compared and the correlation was analyzed.Results The intra thickness measured by Movat pentachrome stain and by the OCT was (15.2 ± 0.9) μm and (20.2 ± 7.6) μm,the medial thickness was (434.2 ± 86.5) μm and (453.8 ± 87.2) μm,the plaque thickness was (330.2 ± 87.1) μm and (392.2 ± 134.5) μm,the fibrous cap thickness was (58.3 ± 5.6) μm and (61.2 ± 4.9) μm,respectively (all P ＞ 0.05).The normalized standard deviation of the OCT signal (NSD) was compared with immunohistochemical detection.The OCT signal within the cap is relatively homogeneous for low macrophage density in high lipid diet group.For the raw OCT data,a correlation of r =0.846 (P ＜ 0.01) was found between OCT NSD and a CD68 area ＜ 10％,whereas for the base 10 logarithm OCT data,a correlation of r =0.646 (P ＜ 0.05) was found between OCT NSD and a CD68 area ＜ 10％.In balloon injury + high lipid diet group,the OCT signal within the cap was relatively heterogeneous for high macrophage content.For the raw OCT data,a correlation of r =0.906 (P ＜ 0.01) was found between OCT NSD and a CD68 area ＞ 10％,whereas for the base 10 logarithm OCT data,a correlation of r =0.593 (P ＜0.05) was found between OCT NSD and a CD68 area ＞ 10％.For the raw OCT signal NSD,a range of NSDs (7.12％ to 7.35％) demonstrated 100％ sensitivity and specificity (Kappa value 1.0) for differentiating caps containing ＞ 10％ CD68 staining.For the base 10 logarithm OCT signal,NSD values ranging from 7.81％ to 7.92％ provided 70％ sensitivity and 75％ specificity (value 0.44) for identifying caps containing ＞ 10％ CD68 staining.Conclusions OCT is an effective tool to determine macrophage content in this model.OCT imaging can clearly visualize different types of atherosclerotic plaques and provide detailed information on plaque characteristics.

Objective To investigate the effect of programmed death ligand 2 (PDL2) in human placenta derived mesenchymal stem cells(hPMSCs) mediated immunoregulation on peripheral blood T cells activation,proliferation and cell cycle.Methods The expression of the PDL2 on hPMSCs was detected by RT-PCR,LSCM and FCM,respectively.Specific PDL2 siRNAs were transfected into hPMSCs via cathodolyte liposome transfection method.T cells were sorted from healthy peripheral blood by gradient centrifugation.The expression of early activation phenotype,proliferation and cell cycle of T cells were analyzed by FCM.Results PDL2 siRNA could effectively block the expression of PDL2 which was highly expressed on hPMSCs.The expression of CD69 on T cells had no significantly difference in blocking groups compared with unblocking groups.hPMSCs could inhibit the proliferation of T cells induced by PMA,compared with that of unblocking groups,the number of the T cells in G0/G1 phase was decreased while the number of the T cells in S phase was increased in the blocking groups.Conclusion PDL2 expressed on hPMSCs could promote the inhibitory effect of hPMSCs on T cell cycle and proliferation.

Objective To investigate the effect of B7-H3 on human hepatocellular carcinoma cell line HepG2 mediating regulation on human peripheral blood CD8+T cell activation,cell cycle and secretion of IL-17.Methods The expression of the B7-H3 on HepG2 cells was detected by RT-PCR and FCM respectively.B7-H3 was silenced by PGPU6/GFP/neo-B7-H3shRNA plasmid via cathodolyte liposome transfection method.CD8+T cells were sorted from healthy human peripheral blood with immunomagetic beads.The effect of HepG2 cells on activation,cell cycle and cytokine secretion of CD8+T cells which was stimulated by PHA or PMA respectively were analyzed by FCM.Results B7-H3 was highly expressed on HepG2 cells,and PGPU6/GFP/neo-B7-H3shRNA plasmid could effectively block down its expression.Otherwise,HepG2 cells could inhibit the expression of CD69,the early activation phenotype of T cell,blockade B7-H3 on HepG2 cells could significantly attenuate the inhibitory effects.Likewise,blockade B7-H3 on HepG2 cells apparently reversed the inhibitory effects of HepG2 cells on CD8+T cell cycle through down-regulating the cell number in G0/G1 phase and up-regulating the cell number in S phase;Moreover,HepG2 cells caused a sharp increase of IL-17 which was secreted by CD8+T cells and the level of IL-17 was further up-regulated after blocking down B7-H3.Conclusion HepG2 cells highly expressed B7-H3 that could promote the inhibitory the effect of HepG2 on expression of CD69 and cell cycle of CD8+T cells.HepG2 cells were able to up-regulate the level of IL-17 secreted by CD8+T cells,in which B7-H3 played an inhibitory role.

BACKGROUNDTo study the clinical effects of ¹⁵³Sm-EDTMP plus chemotherapy in the treatment of bone metastasis of lung cancer.

METHODSOne hundred and ten lung cancer patients with one metastasis [male 82 and female 28, aged from 32 to 76 yrs; squamous cell carcinoma 28, adenocarcinoma 27, small cell lung cancer (SCLC) 7, mix type 41, alveolar carcinoma 7] who did not undergo an operation were entered into this study. The patients were divided into 3 groups: ¹⁵³Sm-EDTMP therapy only (37 cases), ¹⁵³Sm-EDTMP plus chemotherapy after 3 days (42 cases), 30 days after chemotherapy plus ¹⁵³Sm-EDTMP (31 cases). The dosages of ¹⁵³Sm-EDTMP ranged from 1 111 to 2 660 MBq. The patients with SCLC were adapted CCNU, MTX and CTX; those with non-small cell lung cancer (NSCLC) were adapted MMC, VCR and DDP. Statistic analysis of the data was performed by Chi-square test.

RESULTSTotal pain relief rate for ¹⁵³Sm-EDTMP only was 89.2% , for ¹⁵³Sm-EDTMP plus chemotherapy was 92.8%, and for chemotherapy plus 153 Sm EDTMP was 90.3% . The foci disappeared in 9 cases with ¹⁵³Sm-EDTMP only, in 12 cases with ¹⁵³Sm-EDTMP plus chemotherapy, and in 9 cases with chemotherapy plus ¹⁵³Sm-EDTMP. The 1 year survival rate was 29.7%(11/37) by 153 Sm only, 40.5%(17/42) by 153 Sm plus chemotherapy, 38.7%(12/31) by chemotherapy plus ¹⁵³Sm-EDTMP.

CONCLUSIONS¹⁵³Sm-EDTMP plus chemotherapy is effective in the treatment of bone metastasis of lung cancer.