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.

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managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control.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.

Objective To assess the clinical efficacy of vacuum sealing drainage (VSD) in the treatment of mixed poisonous snake bite. Methods A prospective study was conducted. Forty-three snake bite patients by mixed poisonous snakes admitted to Department of Emergency of the 175th Hospital of People's Liberation Army from February 2015 to February 2017 were enrolled. All patients were divided into routine treatment group (n = 20) and VSD treatment group (n = 23) according to whether early incision decompression and using the VSD technique. The patients in the routine treatment group were treated with injection of antivenoms, Jidesheng snake tablets external coating, and wound incision detoxification. Beside the routine treatments, patients in the VSD treatment group were treated with incision decompression and the VSD suction aspiration for the swelling limb. Bite wound infection rate, local skin necrosis area, maximum level of C-reactive protein (CRP), length of hospital stay and disability rate were compared between the two groups. Results Forty-three patients were followed up for 6-12 months with average of (10.3±1.4) months postoperatively. There were no deaths in both groups. Compared with the routine treatment group, wound infection rate in the VSD treatment group was significantly lowered [8.7% (2/23) vs. 40.0% (8/20)], local skin necrosis area was significantly reduced (cm2: 4.2±0.8 vs. 6.0±1.3), the maximum CRP was significantly lowered (mg/L: 50.0±12.1 vs. 68.0±13.4), the hospitalization time was significantly shortened (days: 11.7±2.9 vs. 17.7±4.9), and the difference above was statistically significant (all P < 0.05). The disability rate of the VSD treatment group was lowered as compared with routine treatment group [13.0% (3/23) vs. 13.0% (6/20)] without statistically significant difference. Conclusion Early incision decompression and VSD pressure suction of the swelling limb associated with combination therapy of drugs is a reliable and effective method for severe snakebite, and can promote physical rehabilitation and shorten hospital stay.

Objective To investigate the effects of Notch1,2,3 genes silencing by siRNA on Notch signaling pathway (Delta-like 4 (DLL4),Jagged 1 (JAG1)) and nuclear factor-κB (NF-κB) signaling pathway (IκBα,P52) of macrophages derived from patients with coronary artery disease (CAD),thus to explore the potential genetic treatment perspectives for CAD.Methods Peripheral blood mononuclear cells of CAD patients were isolated by density gradient centrifugation and transformed by phorbol-12-myristate-13-acetate (PMA) to macrophages.Macrophages were then transfected with Notch1-small interference RNA (siRNA,Notch1-siRNA group),Notch2-siRNA (Notch2-siRNA group),Notch3-siRNA (Notch3-siRNA group),negative control siRNA (NC group) and none siRNA (control group) respectively.Reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis were applied to assess the mRNA and protein expression levels of DLL4,JAG1,IκBα and p52,respectively.Electrophoretic mobility shift assay (EMSA) was used to observe the NF-κB DNA binding activity.Subcellular distributions of NF-κB/p52 were detected through immunofluorescence.Results (1) The mRNA and protein expressions of DLL4,JAG1 and p52 in Notch1-siRNA group,Notch2-siRNA group and Notch3-siRNA group were significantly downregulated,while the mRNA and protein expression of IκBα was significantly upregulated compared with NC group and control group (P ＜ 0.05 or 0.01).The mRNA and protein expressions of DLL4,JAG1 and p52 in Notch1-siRNA group were significantly downregulated,while the mRNA and protein expression of IκBα was significantly upregulated compared with Notch2-siRNA group and Notch3-siRNA group(P ＜0.05 or 0.01).The mRNA and protein expressions of DLL4,JAG1,IκBα and p52 were similar between NC group and control group (all P ＞ 0.05).(2) The binding activity of NF-κB DNA was significantly lower in Notch1-siRNA group (613 ± 57),Notch2-siRNA group (1 169 ± 85) and Notch3-siRNA group (1 454 ± 90) compared with control group (2 643 ± 115) and NC group (2 407 ± 100) (all P ＜0.01),which was also significantly lower in Notch1-siRNA group compared to Notch2-siRNA group and Notch3-siRNA group (P ＜ 0.01);was significantly lower in Notch2-siRNA group compared with Notch3-siRNA group (P ＜ 0.01) and was similar between control group and NC group (P ＞ 0.05).(3) The fluorescence intensity of NF-κB/p52 was significantly lower both in the nucleus and cytoplasm in Notch1-siRNA group,Notch2-siRNA group and Notch3-siRNA group compared with NC group and control group (all P ＜0.01),and the decrease was more obviously in the nucleus than in cytoplasm in Notch1-siRNA group,Notch2-siRNA group and Notch3-siRNA group (P ＜ 0.05 or 0.01).The fluorescence intensity of NF-κB/p52 was similar between control group and NC group (P ＞ 0.05).Conclusion There is a positive regulation between Notch and NF-κB pathway in macrophages derived from CAD patients,the regulation power on NF-κB signaling pathway of Notch1 is stronger than that of Notch2 and Notch 3.

Objective To explore the clinical pathological data of the elderly patients with paroxysmal supraventricular tachycardia(PSVT) and the timing of the radiofrequency ablation treatment for PSVT and its clinical efficacy.Methods The clinical pathological data of 45 elderly patients with PSVT for radiofrequency ablation were retrospectivly analyzed,and the information of cardiovascular and cerebrovascular diseases,the duration of PSVT and frequency of attacks,the reason of patients had to accept radiofrequency catheter ablation,the treatment effective of electrophysiological study and radiofrequency ablation were recorded.Results The duration and frequency of attacks with PSVT were positively related with pathogenesis in the elderly patients.Elderly PSVT patients with severe cardiovascular disease accounted for 28.89％.The first radiofrequency ablation treatment success rate was 100％ in this research and the recurrence rate was 4.4％.Conclusion It is recommended that elderly PSVT patients early access to the radiofrequency ablation.

Abelmoschus manihot (AM) is a medicinal plant rich in twenty kinds of separated active bio-components including flavones, polysaccharides, trannic acid, and long chain hydrocarbons. Among these, total flavones of A. manihot (TFA) are the major active component. In this review, the mechanisms of Huangkui capsule will be discussed as a preparation of AM to treat chronic kidney disease (CKD) by improving immunological reaction, inflammation, renal fibrosis, and renal tubular epithelial injury. Additionally, it has been reported that Huangkui capsule can ameliorate some clinical symptoms, proteinuria, hematuria, and renal function in patients with common CKD, such as nephrotic syndrome, diabetic nephropathy, Henoch-Schönlein purpura nephritis, IgA nephropathy, and membranous nephropathy.
Abelmoschus ; chemistry ; Animals ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Kidney ; drug effects ; metabolism ; Renal Insufficiency, Chronic ; drug therapy ; metabolism

Objective To assess the effects of intracoronary tirofiban on preventing no-reflow during emergency percutaneous coronary intervention(PCI).Methods All 99 cases with acute myocardial infarction who underwent emergency PCI between March 2009 and March 2012 were randomized into test group of intracoronary bolus administration of tirofiban (n=50) and group of control (n =49).The clinical characteristics and the result of coronarography were observed.Thrombolysis in myocardial infarction (TIMI) flow grade,and corrected TIMI frame count (cTFC) of the two groups were compared.Incidence of 30 days follow-up major adverse cardiac events(MACE) and major bleeding events were also observed in both groups.Results Compared with control group,tirofiban treated group showed significantly more patients higher TIMI-3 flow (P＜0.05).cTFC was decreased in tirofiban treated group (21.3 ± 6.7) as compared to control group (37.6 +7.2),(P＜0.05).The incidence of no-reflow in tirofiban treated group was lower than in control.The incidence of major bleeding events were the same among two groups,while the incidence of 30 days follow-up MACE in tirofiban treared group (8％) was reduced compared with control group (18.4 ％),(P＜ 0.05).Conclusions Intracoronary tirofiban prior to emergency PCI is safe and effective for the patients with acute STEMI.It might lead to improved TIMI flow and myocardial reperfusion.

Objective To evaluate the relationship between NT-probrain natriuretic peptide (NT-proBNP) levels and the degree of coronary artery stenosis in elderly patients with non-ST elevation acute coronary syndromes (NST-ACS).Methods The levels of NT-proBNP were determined in 258 elderly patients with NST-ACS divided into 3 quartile groups based on the degree of coronary artery stenosis,and 62 normal controls.And NT-pro BNP were compared among 4 groups.Results The serum levels of NT proBNP were increased in the NST-ACS patients with single,two or three-artery lesion compared with normal controls [(197.3±80.2)ng/L,(381.7±73.5)ng/L,(496.5± 99.8) ng/L vs.(68.2 ± 36.1) ng/L].The level of NT proBNP was enhanced along with increasing severity coronary artery disease (all P＜0.01).And with aging,the NT-proBNP levels were rising [aged＞60-69 years:(182.34±69.13) ng/L; aged≥70-79 years:(302.68±87.51)ng/L; aged≥80 years:(482.09±82.2)ng/L] (all P＜0.01).Conclusions The NT-proBNP level is enhanced along with aging and increasing severity of coronary artery stenosis in elderly NST-ACS patients.

Objective To study whether prostaglandin E1 (LipoPGE1) could prevent contrast medium-induced nephropathy (CIN) in patients with coronary heart disease (CHD) plus diabetes mellitus type 2 (DM).Methods Total 198 CHD patients with DM received coronary angiography (CAG) or PCI were randomly divided into PGE1 group and control group.All patients received routine treatment,and the PGE1 group also received 20 ml normal saline and 20 μg PGE1 (intravenous injection,1 time/d) for 10 days.The rate of CIN and the level of serum urea nitrogen (BUN),creatinine (Scr),cystatin C (Cys C) were measured before and 48 hours and 5 days after contrastmedium administration.Results The level of Scr,BUN and Cys C were lower in PGE1 group [(113.92±54.89)μmmol/ L,(7.85±4.05)mmol/L,(1.38±0.34)mg/L]for 48 hours and[(86.72±35.26)μmmol/L,(6.61 ± 3.09 ) mmol/L,( 1.29 ± 0.29) mg/L]for 5 days than in control group [(129.22±50.18)μmmol/L,(9.26±3.95)mmol/L,(1.56±0.23)mg/L]for 48 hours and[(109.83+31.76)μmmol/ L,(8.07±3.11)mmol/L,(1.37±0.21)mg/L]for 5 days (all P＜0.05).The dose of contrast-medium was positively correlated with the level of Scr and BUN (r=0.74,P＜0.05 and r =0.82,P＜0.01,respectively).The patients' renal function in the PGE1 group was better than in control group after contrast-medium administration (P ＜0.05).BUN and Scr were positively correlated with the volume of contrast-medium (r=0.74,P＜0.05,r=0.82,P＜0.01).Conclusions PGE1 may prevent contrast medium-induced nephropathy in patients with CHD combined with DM.

Objective To evaluate and analyze relationship of plasma level of N-terminal probrain natriuretic peptides (NT-proBNP) and serum level of cystatin C (CysC) with cardiac and renal functions in patients with chronic heart failure (CHF) , and explore significance of CysC measurement in early diagnosis for renal damage in patients with CHF. Methods Totally, 162 patients with CHF and 150 normal healthy (controls) undergone routine physical check-up at, Taizhou People's Hospital, Jiangsu were enrolled in the study. Their plasma level of NT-proBNP and serum level of CysC, as well as serum levels of creatinine ( SCr) , urea nitrogen ( BUN) were measured and echocardiography was performed. Glomerular filtration rate (eGFR) was evaluated by modification of diet in renal disease (MDRD) study group formula. Results Compared with the control group, blood levels of NT-proBNP, CysC, SCr, BUN and left ventricular end diastolic diameter ( LVEDD) all elevated, both eGFR and left ventricular ejection fraction ( LVEF) decreased (P <0. 05 or P <0. 01 ) in CHF group, and CHF patients were prone to complicate with renal dysfunction (P<0. 01). Blood levels of NT-proBNP and CysC elevated significantly and LVEF lowered significantly in CHF patients with NYHA functional classes II , III and IV than those in control group. There was significant difference in blood levels of NT-proBNP and CysC between patients with varied NYHA functional classes (P<0. 05). Blood levels of NT-proBNP and CysC reversely correlated with LVEF (r = -0. 36, P < 0. 01 and r = - 0. 39, P < 0. 01) . Blood level of CysC correlated with that of NT-proBNP ( r = 0. 87 , P < 0. 01). Results of logistic regression analysis showed that elevated blood levels of NT-proBNP and CysC were risk factors for mortality during hospitalization in patients with CHF. Conclusions Patients with CHF were more likely to complicate with renal dysfunction than controls, with main manifestations of more severe damaged eGFR, more severe heart failure and more obviously renal damage. Blood levels of NT-proBNP and CysC can be used as indicators for evaluating exacerbation of chronic condition, and serumlevel of CysC can be used as marker for early diagnosing renal damage in patients with CHF.