BACKGROUND:Ischemic stroke is a serious threat to human health.After ischemia and hypoxia,astrocyte expresses lipocalin-2 in large amounts to aggravate brain injury,but the specific mechanism is not clear.Hydroxysafflor yellow A has anti-ischemia,anti-oxidation,anti-thrombosis and anti-inflammatory effects.However,whether hydroxysafflor yellow A affects the expression of lipocalin-2 in astrocytes after cerebral ischemia and hypoxia and its mechanism are not clear. OBJECTIVE:To investigate the effect and mechanism of hydroxysafflor yellow A on the expression of lipocalin-2 in astrocytes after cerebral ischemia and reperfusion. METHODS:(1)Thirty adult SD rats were randomly divided into three groups:sham operation group,middle cerebral artery occlusion and reperfusion group,and hydroxysafflor yellow A group.The middle cerebral artery occlusion and reperfusion model was established in the latter two groups,and hydroxysafflor yellow A group was intraperitoneally injected with 12 mg/kg hydroxysafflor yellow A after reperfusion.Longa score was used to evaluate the degree of neurological impairment.Infarct volume was determined by TTC staining.JAK2/STAT3 pathway and lipocalin-2 expression were detected by western blot assay and immunofluorescence.Levels of interleukin 1β,interleukin 6 and tumor necrosis factor α were detected by ELISA.(2)Astrocytes were divided into four groups:Normal group,glucose-oxygen deprivation group,hydroxysafflor yellow A group and AG490 group.In the latter three groups,glucose-oxygen deprivation and glucose-oxygen recovery models were established.Astrocytes were treated with 75 μmol/L hydroxysafflor yellow A and 10 μmol/L tyrosine phosphorylation inhibitor AG490 for 8 hours during glucose-oxygen deprivation,respectively.The mechanism of hydroxysafflor yellow A on lipocalin-2 was further verified. RESULTS AND CONCLUSION:(1)Compared with the sham operation group,cerebral infarction was significantly increased in the middle cerebral artery occlusion and reperfusion group,accompanied by aggravated neurological impairment(P<0.01).Hydroxysafflor yellow A treatment could reduce cerebral infarction volume and improve neurological function(P<0.01).(2)The expressions of p-JAK2,p-STAT3 and lipocalin-2 in the middle cerebral artery occlusion and reperfusion group were higher than those in the sham operation group(P<0.01).Hydroxysafflor yellow A treatment reduced the expressions of JAK2,STAT3 and lipocalin-2(P<0.01).(3)The expression levels of interleukin 1β,interleukin-6 and tumor necrosis factor α in the middle cerebral artery occlusion and reperfusion group were higher than those in the sham operation group(P<0.01).Hydroxysafflor yellow A inhibited the expressions of interleukin 1β,interleukin-6 and tumor necrosis factor α(P<0.01).(4)In vitro,the expressions of p-JAK2,p-STAT3 and lipocalin-2 in the glucose-oxygen deprivation group were significantly higher than those in the normal group(P<0.01).After adding AG490,the phosphorylation of JAK2 and STAT3 decreased,and the expression of lipocalin-2 was inhibited(P<0.01).The results suggest that hydroxysafflor yellow A may inhibit the expression of lipocalin-2 in astrocytes after ischemia and hypoxia by regulating the JAK2/STAT3 signaling pathway,thereby reducing brain injury.

OBJECTIVE To investigate the protective effect proanthocyanidin B2(PC-B2) on oxidative damage and apoptosis of mouse astrocytes(AS) induced by hydrogen peroxide(H2O2) and its mechanism. METHODS AS were isolated and cultured from neonatal C57BL/6 mice(1−3 d). The optimal concentration of H2O2 and PC-B2 was divided into four groups: normal group, normal+PC-B2 group(100 μg·mL‒1 PC-B2 treated for 24 h), H2O2 model group(200 μmol·L‒1 H2O2 treated for 24 h), PC-B2 group(200 μmol·L‒1 H2O2 and 100 μg·mL‒1 PC-B2 treated for 24 h). The cell viability of each group was detected by CCK-8 method. Cytotoxicity was detected by LDH method. The antioxidant capacity was detected by ABTS and DPPH. The content of MDA and the activity of SOD, CAT and GSH-Px were detected by ELISA kit. Detection of apoptosis in each group was done by TUNEL staining. The mRNA and protein expression levels of Bax, Bcl-2, Caspase-3, Akt/Stat3, p-Akt, p-Stat3 and Nrf2/HO-1 in AS were detected by RT-PCR and Western blotting, respectively. RESULTS PC-B2 could significantly enhance cell viability and inhibit AS apoptosis. Compared with the H2O2 model group, PC-B2 intervention could significantly reduce the content of LDH and MDA in AS, and increase the activity of SOD, CAT and GSH-Px. PC-B2 intervention could inhibit the mRNA and protein expression of Bax and Caspase-3, and up-regulate the mRNA and protein expression of Akt/Stat3, Bcl-2, Nrf2/HO-1. CONCLUSION PC-B2 can enhance the antioxidant capacity of AS through Akt/Stat3 and Nrf2/HO-1 pathways, therefore reduce H2O2-induced AS oxidative damage and apoptosis.

Trauma is recognized globally as a great public health challenge.It stands as the predomi-nant cause of mortality among those under the age of 45 and is also ranked among the top five causes of death for both urban and rural populations within China.This stark reality underscores the critical urgen-cy in establishing an efficient system for trauma care,which is pivotal for substantially enhancing the sur-vival rates of patients.An optimally developed system for trauma care not only guarantees that patients promptly receive professional medical assistance but also facilitates significant improvements in the out-comes of trauma care through the strategic establishment of trauma centers.At present,a considerable variation exists in the quality of trauma care provided across various regions within China.The adoption of comprehensive quality management strategies for the medical processes involved in trauma care,alongside the standardized management of on-site rescue operations,pre-hospital emergency care,and in-hospital treatment protocols,stands as a fundamental approach to boost the capabilities of trauma care and,conse-quently,the survival rates of trauma patients.Serving as the cornerstone of comprehensive medical quali-ty management,key quality control indicators possess the capacity to steer the development direction of trauma centers.In a concerted effort to further augment the medical quality management of trauma care,standardize clinical diagnosis and treatment methodologies,and advocate for the standardization and ho-mogenization of medical services,the Medical Quality Control Professional Committee of the National Center for Trauma Medicine has undertaken a detailed refinement and update of the 16 key quality control indicators for trauma centers.These were initially put forward in the"Notice on Further Enhancing Trau-ma Care Capabilities"disseminated by the National Health Commission in 2018.Consequent to this en-deavor,a revised set of 19 quality control indicators has been devised.This comprehensive set,inclusive of the indicators'names,definitions,calculation methodologies,significance,and the subjects for quali-ty control,is designed for utilization within the quality management and control operations of trauma cen-ters across various levels.This initiative aims to furnish a concrete and executable roadmap for the quality control endeavors of trauma centers.Through the enactment of these quality control indicators,medical institutions are empowered to conduct more stringent monitoring and evaluative measures across all facets of trauma care.This not only facilitates the prompt identification and rectification of existing challenges but also substantially boosts the efficiency of internal collaboration.It enhances the synergy between dif-ferent departments,thereby markedly improving the efficiency and quality of trauma care.

125I seeds implantation for the treatment of various malignant tumors has been widely recognized in clinical practice in recent years. It has a wide application prospect and is an effective treatment method. With the development of ultrasound, CT, MR, endoscopy and three-dimensional (3D)-printing technology, the clinical application of 125I seeds implantation technology is progressing rapidly. This article summarizes its implementation methods, clinical applications and development trends.

Objective To investigate the efficacy and safety of bivalirudin versus unfractionated heparin during perioperative primary percutaneous coronary intervention(PCI)in elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 423 elderly patients with acute STEMI who underwent primary PCI in our hospital were consecutively en-rolled in this study.According to different perioperative anticoagulant regimens,they were divided into bivalirudin group(187 cases)and unfractionated heparin group(236 cases).Baseline data,characteristics of interventional procedures and complications during hospitalization were ana-lyzed.Primary endpoint was major adverse cardiac or cerebral events(MACCE).Secondary end-points were net adverse clinical events.Other observational indicators included stent thrombosis,acquired thrombocytopenia,BARC types 1-2 bleeding and total bleeding events.Results In-hospital MACCE and all-cause mortality were significantly lower in the bivalirudin group than unfractionated heparin group(3.7％vs 9.7％,P=0.021;3.7％vs 8.9％,P=0.039).Univariate logistic regression analysis showed that perioperative application of bivalirudin significantly reduced all-cause mortality in the patients with Killip grade Ⅰ and creatinine clearance ≥60 ml/min when compared with unfractionated heparin(P＜0.05).Conclusion In elderly patients with acute STEMI,perioperative use of bivalirudin significantly reduces the incidences of MACCE and all-cause death during hospitalization,especially in the patients with Killip grade Ⅰ and creatinine clearance ≥60 ml/min.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Objective:To evaluate the trauma center model in general hospitals for patients with severe trauma.Methods:The data of 1,248 patients with severe trauma (ISS≥16) were retrospectively analyzed who had been admitted to the trauma centers in 6 Chinese general hospitals from January 2019 through June 2020. They were 987 males and 261 females with an age of 50.4 years ± 15.4 years. Their injuries were caused by a traffic accident in 622 cases, falling from a height in 357 cases, a knife in 62 cases, and others (like a heavy object and fall) in 207 cases. Upon admission, their injury severity scores (ISS) were 24.9±8.5 and their Glasgow coma scores (GCS) 12.6±3.6. They were all treated in a scientific and standard manner by a multidisciplinary team at the trauma center of their specific general hospital. Recorded were deaths within 30 days after admission, 30-day mortality and causes of death.Results:All the patients were treated effectively. 101 deaths occurred within 30 days after admission, yielding a 30-day mortality of 8.1%. The main causes of death were severe craniocerebral injury in 56 cases, hemorrhagic shock in 26 cases, multi-organ failure in 11 cases and others in 8 cases.Conclusions:Establishment of trauma centers in China can make up for the disadvantage of over-division of clinical specialties in large general hospitals which has led to insufficient care for patients with severe trauma and multiple injuries. The trauma centers in general hospitals may be a feasible model to be popularized in treatment of patients with severe trauma and multiple injuries.

Objective:To establish a rat model of volume-controlled hemorrhage and observe the pathophysiological changes that ensued.Methods:Sprague Dawley (SD) rats were subjected to femoral arterial cannulation and hemorrhage for 40% or 50% of total volume. The hemodynamics data and arterial blood gas were collected, and survival after hemorrhage was monitored for 24 hours ( n=8/group). Then lung, liver, intestine and kidney were collected for HE staining after 40% hemorrhage at 4, 8 and 12 hours ( n=6/group). Results:Mean arterial pressure of 40% and 50% blood loss group decreased significantly from (90±5)mmHg and (93±4)mmHg to (40±4)mmHg and (34±4)mmHg ( P<0.05). Heart rate of 40% and 50% blood loss group increased significantly from (330±35) bpm and (336±32) bpm to (478±36) bpm and (490±21) bpm ( P<0.05). Hemoglobin and pH decreased significantly following hemorrhage, while lactate increased. The survival rate of 50% blood loss group was just 12.5% and 40% blood loss group was 100% ( P<0.05). Compared with sham group, the most significant injury was observed in lung and small intestine after 4 hours, in liver after 8 hours and in kidney after 12 hours following hemorrhage. Conclusion:This study established a stable and repeatable volume-controlled hemorrhagic shock model in rat.

Objective:To explore the application effect of 3D printing technology in comprehensive reconstruction of thumb and finger.Methods:From January, 2018 to January, 2020, 67 patients with 84 thumbs and fingers defects were selected, which were 37 thumbs and 47 fingers, and 45 of I-III degree and 39 of IV-VI degree. The method of operation was comprehensive reconstruction of thumbs and fingers assisted by 3D printing technology. The patient's hands and feet were scanned with CT and 3D modeling, and the 1∶1 model was derived. The skin model and bone model of thumb and finger defect were printed. Put the skin model on the great toes, and design the shape of the nail flap to be cut. Then the flap was spread in the groin area to design the perforating branch flap of the superficial circumflex iliac artery. The interphalangeal joint or metatarsophalangeal joint of the second toe was cut off according to the skeleton model (when the length of the bone joint was not enough, the iliac bone strip was taken to be connected in series). The effect of operation was observed in outpatient.Results:All of the 84 thumbs and fingers survived and were followed-up for 3 to 24 months. The appearance of the reconstructed thumbs and fingers was similar to that of the normal ones, with good texture and elasticity. The nail was smooth and glossy. The sensory recovery was S 3+, and the TPD was 4-6 mm. According to the Evaluation Standard of Finger Replantation and Reconstruction of Hand Surgery Society of Chinese Medical Association, 70 thumbs and fingers were excellent and 14 thumbs and fingers were good. In 64 thumbs and fingers, all toes were preserved in the donor area, and the color and texture of the flap were satisfactory, which did not affect walking, running and jumping, and had no walking pain. Conclusion:With the help of 3D printing technology, the tissues can be cut more accurately during the thumb and finger comprehensive reconstruction, which not only improves the beauty of reconstructed thumbs and fingers, but also avoids unnecessary trauma and improves the satisfaction of patients.

Objective To explore the clinical effect of neuronavigation assisted endoscopic surgery in treatment of patients with hypertensive intracerebral hemorrhage. Methods Fifty patients with hypertensive cerebral hemorrhage, admitted to our hospital from June 2014 to June 2016, were selected. All patients were treated with neuronavigation guided endoscopic surgery. Their clinical data and surgical efficacies were retrospectively analyzed. Results Patients' head CT was reviewed 6 h after operation, and residual hematoma volume was less than 15％among 31 patients, and in the ranges of 15％-30％among 14 patients. Re-bleeding occurred in 4 patients, and death in one patient. Glasgow outcome scale (GOS) of 49 patients 6 months after operation indicated vegetative state in 5 patients, severe disability in 9, moderate disability in 10, and good recovery in 25. Conclusion Neuronavigation assisted endoscopic surgery has good clinical effect on patients with hypertensive intracerebral hemorrhage in terms of few complications and high safety, so it is worthy of promotion and application in clinical practice.