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.

Trimethylamine N-oxide (TMAO), a metabolite of intestinal flora, can promote Atherosclerosis (AS) in various ways. Current studies have found that it has a close relationship with plaque stability in clinical practice, but its molecular mechanism remains unclear at present. Extracellular matrix metalloproteinase inducers (CD147) / matrix metalloproteinases (MMPs) regulate a signal pathway highly related to plaque stability, which can promote plaque instability and lead to cardiovascular adverse events by weakening the thickness of the fibrous cap. Therefore, in this study, the mouse macrophageRAW264. 7 was stimulated by TMAO to establish a cell model to observe the effects on CD147, MMP2, and MMP9, and the CD147 gene silencing model was further constructed by using the siRNA transfection method to explore the interaction between CD147 and MMP2 and MMP9. Rt-qPCR and Western blotting results showed that there was no significant change in the gene expression level of CD147 in mouse macrophage RAW264. 7, but significantly increased in protein levels (P < 0. 05), while MMP2 andMMP9 were increased in mRNA and protein levels (P<0. 05). The expression of CD147, MMP2, andMMP9 was significantly inhibited in CD147 siRNA transfected cells (P<0. 05). In conclusion, TMAO significantly increases the expression of MMP2 and MMP9 in mouse macrophages RAW264. 7, and this effect may be partially realized through the CD147/ MMP pathway.

In order to provide the basis for the development of famous classical formulas containing Myrrha， the name， origin， quality evaluation， harvest and processing of Myrrha were systematically researched by consulting the ancient herbal and medical books， combining with the modern related literature. According to textual research， the results showed that Commiphora myrrha was the main base in ancient times， which was produced in Somalia， Ethiopia and northern Kenya. In addition， raw and fried products of Myrrha were the commonly used specifications in ancient herbal medicine， which are still used today. Nowadays， Myrrha， fried Myrrha and vinegar-processed Myrrha were the commonly used specifications. Among the three specifications， Myrrha is the raw products after cleaning， fried Myrrha is a kind of processed products， which has relevant records in ancient materia medica and is still used today. Vinegar-processed Myrrha is a new processing specification in modern times. Based on the research results， it is suggested that Myrrha in Shentong Zhuyutang should be the purified raw Myrrha in accordance with the 2020 edition of Chinese Pharmacopoeia.

The active ingredients of Ficus hirta and Hypericum perforatum were collected from Traditional Chinese Medicine Database and Analysis Platform(TCMSP) and related papers. The potential targets of these two medicinal herbs were searched from HERB database, and those associated with microvascular angina were screened out from GeneCards, Online Mendelian Inheritance in Man(OMIM), Therapeutic Target Database(TTD), and HERB. Cytoscape was used to construct a protein-protein interaction(PPI) network of the common targets shared by the two herbs and microvascular angina based on the data of String platform. Metascape was employed to identify the involved biological processes and pathways enriched with the common targets. Cytoscape was used to draw the "active ingredient-target-pathway" network. AutoDock Vina was used to dock the core ingredients with the key targets. A total of 19 potential active ingredients and 71 potential targets were identified to be associated with microvascular angina. Bioinformatics analysis showed that phosphatidylinositol-3-kinase/protein kinase B(PI3 K-AKT), interleukin-17(IL17), hypoxia-inducible factor 1(HIF-1) and other signaling pathways were related to the treatment of microvascular angina by F. hirta and H. perforatum. Molecular docking results showed that β-sitosterol, luteolin and other ingredients had strong affinity with multiple targets including mitogen-associated protein kinase 1(MAPK1), epidermal growth factor receptor(EGFR) and so on. These findings indicated that F. hirta and H. perforatum may regulate PI3 K-AKT, IL17, HIF-1 and other signaling pathways by acting on multiple targets to alleviate oxidative stress, inhibit inflammatory response, regulate angiogenesis, and improve vascular endothelium and other functions. This study provides reference for in vitro and in vivo studies of the treatment of microvascular angina.
Drugs, Chinese Herbal/pharmacology* ; Ficus ; Humans ; Hypericum ; Medicine, Chinese Traditional ; Microvascular Angina ; Molecular Docking Simulation ; Network Pharmacology

Objective To observe the clinical efficacy of acupuncture plus medication in treating chronic pelvic inflammatory disease. Method By using the random number table, sixty-eight patients with chronic pelvic inflammatory disease were randomized into an acupuncture-medication group of 34 cases and a medication group of 34 cases. The clinical efficacies were compared after 2 courses of treatment, and the symptoms and body signs scores and syndrome score of traditional Chinese medicine (TCM) were also compared. Result There was a significant difference in comparing the therapeutic efficacy between the acupuncture-medication group and the medication group (P<0.05). After the treatment, the symptoms and body signs scores and TCM syndrome score dropped significantly in both groups (P<0.05), indicating that the two groups both had improvement in the symptoms, body signs and TCM syndrome; there were significant between-group differences in comparing the score differences in the symptoms and body signs scores and TCM syndrome score after the treatment (P<0.05), and the acupuncture-medication group was higher than the medication group. Conclusion Acupuncture plus medication can better ameliorate the symptoms and body signs and TCM syndrome in chronic pelvic inflammatory disease.

ObjectiveTo investigate the protective effect of human urine-derived stem cells (USCs) on erectile function and cavernous structure in rats with cavernous nerve injury (CNI).

METHODSSixty adult male SD rats with normal sexual function were randomly divided into four groups of equal number: sham operation, bilateral CNI (BCNI) model control, phosphate buffered saline (PBS), and USC. The BCNI model was established in the latter three groups of rats by clamping the bilateral cavernous nerves. After modeling, the rats in the PBS and USC groups were treated by intracavernous injection of PBS at 200 μl and USCs at 1×106/200 μl PBS respectively for 28 days. Then, the maximum intracavernous pressure (mICP) and the ratio of mICP to mean arterial pressure (mICP/MAP) of the rats were calculated by electrical stimulation of the major pelvic ganglions, the proportion of nNOS- or NF200-positive nerve fibers in the total area of penile dorsal nerves determined by immunohistochemical staining, the levels of endothelial cell marker eNOS, smooth muscle marker α-SMA and collagen I detected by Western blot, and the smooth muscle to collagen ratio and the cell apoptosis rate in the corpus cavernosum measured by Masson staining and TUNEL, respectively.

RESULTSAfter 28 days of treatment, the rats in the USC group, as compared with those in the PBS and BCNI model control groups, showed significant increases in the mICP (［81 ± 9.9］ vs ［31 ± 8.3］ and ［33 ± 4.2］ mmHg, P <0.05), mICP/MAP ratio (0.72 ± 0.05 vs 0.36 ± 0.03 and 0.35 ± 0.04, P <0.05), the proportions of nNOS-positive nerve fibers (［11.31 ± 4.22］% vs ［6.86 ± 3.08］% and ［7.29 ± 4.84］% , P <0.05) and NF200-positive nerve fibers in the total area of penile dorsal nerves (［27.31 ± 3.12］% vs ［17.38 ± 2.87］% and ［19.49 ± 4.92］%, P <0.05), the eNOS/GAPDH ratio (0.52 ± 0.08 vs 0.31 ± 0.06 and 0.33 ± 0.07, P <0.05), and the α-SMA/GAPDH ratio (1.01 ± 0.09 vs 0.36 ± 0.05 and 0.38 ± 0.04, P <0.05), but a remarkable decrease in the collagen I/GAPDH ratio (0.28 ± 0.06 vs 0.68 ± 0.04 and 0.70 ± 0.10, P <0.05). The ratio of smooth muscle to collagen in the corpus cavernosum was significantly higher in the USC than in the PBS and BCNI model control groups (17.91 ± 2.86 vs 7.70 ± 3.12 and 8.21 ± 3.83, P <0.05) while the rate of cell apoptosis markedly lower in the former than in the latter two (3.31 ± 0.83 vs 9.82 ± 0.76, P <0.01; 3.31 ± 0.83 vs 9.75 ± 0.91, P <0.05).

CONCLUSIONSIntracavernous injection of USCs can protect the erectile function of the rat with cavernous nerve injury by protecting the nerves, improving the endothelial function, alleviating fibrosis and inhibiting cell apoptosis in the cavernous tissue.

Actins ; analysis ; Animals ; Arterial Pressure ; Collagen ; analysis ; Disease Models, Animal ; Erectile Dysfunction ; prevention & control ; Male ; Nitric Oxide Synthase Type I ; analysis ; Nitric Oxide Synthase Type III ; analysis ; Penile Erection ; physiology ; Penis ; innervation ; Pudendal Nerve ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Saline Solution ; administration & dosage ; Stem Cell Transplantation ; methods ; Stem Cells ; Urine ; cytology

Objective: To report on the two years outcome of Chinese multi-center study of the treatment of high risk non-calcified pure aortic regurgitation with transcatheter heart valve replacement (TAVR) using domestic made J-Valve™ system. Methods: The national multi-center clinical study of the treatment of high risk non-calcified pure aortic regurgitation with transcatheter heart valve replacement using domestic made J-Valve™ system was conducted during the period from April 2014 to July 2015. The follow-up time was up to 2 years. Forty-three cases with predominant aortic valve regurgitation were enrolled for transapical implantation of the J-Valve™ system from 3 Chinese centers, including 16 patients from Zhongshan Hospital, Fudan University, 23 patients from West China Hospital, Sichuan University, and 4 patients from Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. There were 30 males and 13 females in this cohort. The age of the patients was (74±6) years (range: 61 to 84 years). The patiens were all sympotmatic preoperatively. All patients were considered at prohibitive or high risk for surgical valve replacement (Logistic European System for Cardiac Operative Risk Evaluation of (25.5±5.3)%, range: 20.0% to 44.4%) after evaluation by an interdisciplinary heart team. Comprehensive clinical and echocardiographic assessments were scheduled before discharge and at 30 days, 12 months, and 24 months after the procedure. Results: One patients was converted to surgical aortic valve replacement (SAVR) due to valve embolism into the arch. The other 42 cases had J-Valve™ systems implanted successfully. One patient died from multi-organ disorder due to paravalvular leak (PVL) during perioperative period. There was no acute myocardial infarction, stroke or coronary obstruction during the perioperative period. The median follow-up time was 725 days (range: 6 to 1 082 days). There were 5 patients died during the 2 years, follow-up, 2 patients had stroke, 2 patients had permanent pacemaker implanted. Three patients had valve related reinterventions: One for intraoperative valve embolism into the aortic arch followed by a conversion to SAVR which was mentioned above. One patient underwent SAVR on the postoperative day 6 due to moderate PVL and ventricular dysfunction. One patient underwent SAVR 6 months after primary procedure due to prosthesis thrombosis and severe aortic valve stenosis.Thirty-six patients with J-valve™ implanted survived to the latest echocardiogram follow-up, 25 patients had trivial or less PVL, 9 patients had mild PVL, and the transvalvular gradient after valve implantation was favorable at (9.8±5.8) mmHg (1 mmHg=0.133 kPa). Conclusions Transapical implantation of domestic made J-Valve™ transcatheter heart valve system for patients with predominant aortic regurgitation has a excellent early outcome. This novel technology is safe and effective.

The aim of this paper is to investigate the effect of patchouli alcohol in enhancing Helicobater pylori's action in eradicating macrophages and its mechanism. H. pylori was co-cultured with macrophages at a ratio of MOI=100 in different concentrations of patchouli alcohol. The effect of patchouli alcohol in eradicating macrophages was detected by agar dilution method. The effect of patchouli alcohol on NO and myeloperoxidase (MPO) levels in macrophages were measured by H. pylori by biochemical methods. Patchouli alcohol effect on H. pylori-induced pro-inflammatory gene expression and protein secretion in macrophages were detected by RT-qPCR and ELISA method. The eradication of H. pylori has significantly enhanced, and the destabilization of lysosomes has been reversed. Meanwhile, patchouli alcohol has an effect in inhibiting pro-inflammation and oxidation. The mechanism of patchouli alcohol in eradicating H. pylori and resisting oxidative stress may be associated to the blocking of bacteria escape lysosome combination procedures.

Objective To determine whether endovascular simulation training in medical students may increase technical proficiency,enhance interest in vascular surgery. Methods We recruited 30 medical students from Pe-king Union Medical College prospectively. We gave these students an eight-week course with a structured curricu-lum comprised of weekly simulator sessions and theoretical lessons. A test of iliac artery balloon dilatation was con-ducted in pre-and post-course. Performance was assessed. Demographics and subjective survey data,including in-terest in vascular surgery were obtained pre-and post-course from the students too. Results Parameters measured on the standardized global endovascular rating scale,including angiography skills,wire handling and interventional criteria as well as simulator-generated metrics such as fluoroscopy time and volume of contrast used significantly im-proved from pre-to post-course values for the medical students(P<0.05) All the students agreed or strongly agreed that the simulation course increased their interest in vascular surgery. Conclusions A simulation-based endovascu-lar course improves technical performance with interest in vascular surgery training of medical students. The simula-tor is quite potential in the medical students training.

Objective:To accumulate the clinical experience of one-stage revascularization of concomitant carotid artery disease by stenting and coronary artery disease by coronary artery bypass grafting (CABG).Methods:In the center, two patients with coronary disease and carotid artery disease,underwent same-day CABG and carotid artery stenting (CAS). The perioperative treatments,procedures of surgery and postoperative results were recorded.Results:The cardiac function of patients were improved.The carotid artery CTA after 6 months of operative indicated the unobstructed stenting,and nosyncope and amaurosis occured.Conclusions:One-stage CABG and CAS is a good choice for patients with coronary disease and carotid artery disease,but the hybrid theatre and good surgical technique were essential.