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 quantitatively analyze infection prevention and control policy texts related to medical alliance, aiming to provide reference for further policy improvement.Methods:with the " medical alliance" and " infection prevention and control" as keywords, relevant policy documents issued from January 2015 to March 2023 were searched on the Chinese government website, the official website of the National Health Commission, and the Peking University law database. Content analysis method was used to quantitatively analyze policy texts from two dimensions: policy tools (supply oriented, environmental oriented, demand oriented) and systems theory (management, service, human resources, and financing systems as internal subsystems, while political, economic, social, and technological systems as external subsystems).Results:A total of 91 infection prevention and control policy documents related to medical alliance were included, and 199 codes were obtained. There were 114, 78, and 7 codes for environmental oriented, supply oriented, and demand oriented policy tools, respectively; among the demand oriented tools, there were only 1 code for government purchases, 1 code for price subsidies, and 5 codes for demonstration project sub tools, respectively. The internal subsystem had a total of 119 codes, with only 2 codes related to the fundraising system; and the external subsystem had a total of 80 codes, with the least 10 codes related to the technical system.Conclusions:The structure of infection prevention and control policy tools in China′s medical alliance needed to be optimized, and the application of demand oriented policy tools was insufficient. It is necessary to strengthen the use of pull tools such as government purchases, price subsidies, and demonstration projects. At the same time, it is necessary to improve the construction of internal and external systems, especially in terms of fundraising and technology systems, to enhance the overall effectiveness of the medical alliance′s infection prevention and control system.

Parkinson's disease (PD) is the most common neurodegenerative movement disease. It is featured by abnormal alpha-synuclein (α-syn) aggregation in dopaminergic neurons in the substantia nigra. Macroautophagy (autophagy) is an evolutionarily conserved cellular process for degradation of cellular contents, including protein aggregates, to maintain cellular homeostasis. Corynoxine B (Cory B), a natural alkaloid isolated from Uncaria rhynchophylla (Miq.) Jacks., has been reported to promote the clearance of α-syn in cell models by inducing autophagy. However, the molecular mechanism by which Cory B induces autophagy is not known, and the α-syn-lowering activity of Cory B has not been verified in animal models. Here, we report that Cory B enhanced the activity of Beclin 1/VPS34 complex and increased autophagy by promoting the interaction between Beclin 1 and HMGB1/2. Depletion of HMGB1/2 impaired Cory B-induced autophagy. We showed for the first time that, similar to HMGB1, HMGB2 is also required for autophagy and depletion of HMGB2 decreased autophagy levels and phosphatidylinositol 3-kinase III activity both under basal and stimulated conditions. By applying cellular thermal shift assay, surface plasmon resonance, and molecular docking, we confirmed that Cory B directly binds to HMGB1/2 near the C106 site. Furthermore, in vivo studies with a wild-type α-syn transgenic drosophila model of PD and an A53T α-syn transgenic mouse model of PD, Cory B enhanced autophagy, promoted α-syn clearance and improved behavioral abnormalities. Taken together, the results of this study reveal that Cory B enhances phosphatidylinositol 3-kinase III activity/autophagy by binding to HMGB1/2 and that this enhancement is neuroprotective against PD.

Objective    To analyze the clinical efficacy of right minithoracotomy approach in the treatment of patients with regurgitation after left-sided valve surgery (LSVS). Methods    The clinical data of 77 patients who suffered tricuspid regurgitation (TR) after LSVS and received surgical treatment in the Heart Center of Henan Provincial People's Hospital from 2012 to 2019 were selected. According to the operation method, the patients were divided into a right minithoracotomy group (n=32), including 13 (40.6%) males, aged 57.3±5.3 years and a median sternotomy group (n=45), including 17 (37.8%) males, aged 55.7±6.6 years. Preoperative and postoperative clinical data of the two groups were compared and analyzed. Results    There was no significant difference in preoperative data between the two groups. There were 24 patients of tricuspid valvuloplasty (TVP) and 8 patients of tricuspid valve replacement (TVR) in the right minithoracotomy group. There were 29 patients of TVP and 16 patients of TVR in the median sternotomy group. The operation time, postoperative hospitalization time, intubation time and ICU stay time of the right minithoracotomy group were shorter than those of the median sternotomy group (P<0.001). The operative bleeding, postoperative drainage in 24 hours, postoperative blood transfusion rate and incision poor healing of the right minithoracotomy group were significantly decreased compared with those of the median sternotomy group (P<0.05). The extracorporeal circulation time between the two groups was not significantly different (P=0.382). The postoperative complications and mortality of the righ minithoracotomy group were significantly lower than those of the median sternotomy group (P<0.05). Conclusion    The procedure of right minithoracotomy access can reduce perioperative morbidity and mortality compared with the median sternotomy, and results in satisfied clinical efficacy.

Periodontitis is an inflammatory disease that is characterized by progressive destruction of the periodontium and causes tooth loss in adults.Periodontitis is known to be associated with dysbiosis of the oral microflora,which is often linked to various diseases.However,the complexity of plaque microbial communities of periodontitis,antibiotic resistance,and enhanced virulence make this disease difficult to treat.In this study,using metagenomic shotgun sequencing,we inves-tigated the etiology,antibiotic resistance genes(ARGs),and virulence genes(VirGs)of periodontitis.We revealed a significant shift in the composition of oral microbiota as well as several functional pathways that were represented significantly more abundantly in periodontitis patients than in con-trols.In addition,we observed several positively selected ARGs and VirGs with the Ka/Ks ratio＞1 by analyzing our data and a previous periodontitis dataset,indicating that ARGs and VirGs in oral microbiota may be subjected to positive selection.Moreover,5 of 12 positively selected ARGs and VirGs in periodontitis patients were found in the genomes of respiratory tract pathogens.Of note,91.8％of the background VirGs with at least one non-synonymous single-nucleotide polymorphism for natural selection were also from respiratory tract pathogens.These observations suggest a potential association between periodontitis and respiratory infection at the gene level.Our study enriches the knowledge of pathogens and functional pathways as well as the positive selection of antibiotic resistance and pathogen virulence in periodontitis patients,and provides evidence at the gene level for an association between periodontitis and respiratory infection.

Objective:To investigate the multi-sites high frequency ultrasound features of rectus diastasis (RD) in early postpartum women and their relationships with different delivery modes.Methods:Total of 571 primiparas who gave birth in the Obstetrics and Gynecology Hospital Affiliated to Zhejiang University Medical College from March to May 2020 and underwent 6-week postpartum examination were chosen, they were divided into vaginal delivery group (336 cases) and the cesarean section group (235 cases). The inter-rectus distance(IRD) of five loci (umbilical on 4.5 cm, umbilical on 3 cm, umbilical edge, edge of umbilical, umbilical down 3 cm) at resting state and two loci (umbilical edge, edge of umbilical) at curling state as well as the rectus thickness on the right side of umbilical level were observed by high frequency ultrasound. The impacts of the two delivery modes on IRD at each site and the changes of IRD under the two conditions were analyzed. Spearman correlation analysis was used to evaluate the correlation between the thickness of rectus abdominis and IRD at each site.Results:The incidence of early postpartum RD was 79.7% (455/571), most of which occurring at 3 cm above the umbilicus and the umbilicus levels. At resting state, the IRDs at the 5 loci of vaginal delivery group were (1.62±0.79)cm, (2.03±0.84)cm, (2.65±0.94)cm, (2.09±0.93)cm, and 0.54(0.00, 1.13)cm respectively, while the IRDs at 5 loci of the cesarean section group were (1.75±0.85)cm, (2.26±0.99)cm, (2.99±1.14)cm, (2.57±1.21)cm, and 1.00(0.41, 1.59)cm, with statistical differences at all the levels between groups ( P<0.05). Under the curling state, the IRDs at the 2 loci of vaginal delivery group were (2.10±0.84)cm and (1.66±0.86)cm respectively, while the IRDs at the 2 loci of cesarean section group were (2.28±0.87)cm and (1.91±0.87)cm, with statistical differences between groups( P<0.05). The incidences of increased IRD when compared between resting and curling states at the upper and lower umbilicus in the vaginal delivery group were 16.1% and 26.5%, with 17.4% and 20.4% in the cesarean section group. At the resting state, there was a significant difference in the thickness of rectus abdominis between the vaginal delivery and cesarean section groups [(0.74±0.12)cm vs (0.67±0.12)cm, P<0.05]. At the curling state, the difference between two groups was statistically significant [(1.11±0.23)cm vs (0.99±0.22)cm, P<0.05]. The thickness of rectus abdominis was negatively correlated with IRD(all the 5 loci at resting state, rs=-0.116, -0.140, -0.185, -0.143, -0.144, all P<0.01; and the upper umbilical loci at curling state, rs=-0.091, P<0.05). There was no significant correlation between the thickness of rectus abdominis and IRD at the lower umbilical edge at the curling state ( P>0.05). Conclusions:High frequency ultrasound can evaluate the morphological characteristics of the abdominal rectus muscle in early postpartum stage. Compared with vaginal delivery, rectus abdominis thickness, the IRD is larger in cesarean section primiparas, but less affected by the curling state.

Objective To evaluated the correlations between MSCT features and expression of VEGF-C,lymphatic vessel density (LVD)in gastric carcinoma.Methods Both plain MSCT and triphasic dynamic contrast-enhanced scan were performed in 58 patients with gastric carcinoma.All patients underwent total/subtotal gastrectomy after MSCT scanning.All specimens were collected into liquid nitrogen or deep freeze refrigerator.Detection procedure for VEGF-C mRNA was performed using RT-PCR,and the LVD was detected with 5’-nucleotidase (5’-Nase)histochemistry.Results The VEGF-C positive rate and the LVD in tumor tissue were high-er than those in normal tissue (P < 0.05 ).In the tumors between diffused and intestinal groups and between non-metastasis and lymph node metastasis groups,the VEGF-C positive rate was 87.1% and 59.3%,87.8% and 41.2%,and the LVD was 8.04±4.58 and 4.08±2.44,8.50±4.70 and 3.64 ± 1.41,respectively,indicating statistically significant differences (P <0.05 ).Conclusion Over-expression of VEGF-C and higher LVD are closely correlated with the lymph node metastasis and Lauren types of MSCT fea-tures of gastric carcinoma.VEGF-C can promote the lymphangiogenesis in carcinoma and further lymph metastasis.

In recent years,laparoscopic total gastrectomy (LTG) with lymphadenectomy is increasingly utilized for the management of gastric cancer located in the middle or upper third of the stomach.However,esophagojejunostomy is the key technical difficulty in operation.Compared with conventional extracorporeal esophagojejunostomy via mini-laparotomy,pioneers are attempting to perform intracorporeal anastomosis in order to gain better manipulation and minimally invasive benefits,as well as reducing the difficulties in digestive tract reconstruction.

Objective To raise the level of clinical diagnosis for the patients with pituitary stalk interruption syndrome (PSIS). Methods Five patients (4 males) with PSIS were retrospectively analyzed with respects to the clinical features, endocrine status and image characteristics. Magnetic resonance imaging (MRI) scan was performed at hypothalamic-pituitary region. Results The clinical manifestations of all patients consisted of growth retardation and delayed puberty without polyuria. Deficiency of multiple anterior pituitary hormones was revealed in all patients by the evaluation of endocrine status. The features of MRI included a lack of visible pituitary stalk, absence of posterior lobe hypersignal in the sella turcica and a hyperintense spot in the region of the thalamus opticus. Conclusion The clinical characteristics of patients with PSIS are growth retardation and delayed puberty. The evaluation of anterior pituitary function is necessary. The detection of an anatomical abnormality around hypothalamic-pituitary region by MRI is important diagnostic evidence.

Objective To study the relationship between a CAG repeat polymorphism of the androgen receptor (AR) gene and postmenopausal osteoporosis (PMO). Methods Genotypes for the AR polymorphisrn were determined by gene scan and DNA sequence methods in a case-control study,including 78 cases of PMO at femoral neck and 73 cases as controls, and 108 cases of PMO at lumbar spine (L2-4) and 60 cases as controls. Bone mineral density for the proximal femur and L2-4 was measured by NORLAND XR-46 dual-energy X-ray absorptiometry. The relationship between the CAG repeat polymorphism and PMO was investigated. Results Eleven different allelic variants,containing 18, 20, 21, 23, 24, 25, 26, 27, 28, 29, and 30 CAG repeats were detected, 16 genotypes were present in the subjects. There were no significant differences in the genotype and allele distributions of (CAG) n polymorphism between PMO group (SS : 25.6 %, SL : 39.7%, LL : 34.6 % ;S:45.5%,L:54.5%) and control group (SS: 23.3%,SL=45.2% ,LL:31.5%;S:45.9%,L:54.1%) at the femoral neck site (all P＞0.05). The risk of PMO at femoral neck in females with the genotypes of SL (0R:0.798,95%CI:0.335～1.797), the LL (0R:0.998,95%CI:0.425～2.341), and the combined SL and LL (OR:0.880, 95% CI: 0.419～1.852) were not significantly increased in comparison with those of females with the SS genotype (all P＞0.05). There were no significant differences in the genotype and allele distributions of (CAG)n polymorphism between PMO group(SS: 18.5%, SL: 49.1%, LL: 32.4%;S:43.1%, L: 56.9%) and control group (SS: 21.7%, SL:45.0% ,LL:33.3% ;S:44.2% ,L:55.8%) at the L2-4 site (P＞0. 05). The risk of PMO at L2-4 in females with the genotypes of SL (OR:1. 276,95%CI:0. 552～2. 950), the LL (OR:1. 137,95%CI:0.468～2.766), and the combined SL and LL (OR: 1. 217,95% CI: 0. 556 ～2. 663 ) were not significantly increased in comparison with those of females with the SS genotype (all P＞0.05). After adjustments for age, postmenopausal period, menopausal age, and body mass index, the logistic regression analyses revealed the (CAG)n polymorphism was not significantly associated with PMO at the femoral neck and L2-4 site (all P＞0.05). Conclusions The CAG repeat polymorphism in the AR gene may not be associated with PMO at the femoral neck and L2-4 site.