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 explore the clinical characteristics and prognostic factors of elderly patients with commu-nity-acquired bloodstream infection(CA-BSI),and provide basis for clinical treatment and prevention.Methods Medical records of elderly patients diagnosed with CA-BSI in a tertiary first-class hospital of Changsha from 2017 to 2021 were collected.Patients were divided into a survival group and a death group according to the prognosis after 30 days hospitalization.The differences in clinical data between two groups of patients were compared,and influen-cing factors for the prognosis in CA-BSI patients were analyzed.Results A total of 575 elderly CA-BSI patients were included in the analysis,with 535 cases in the survival group and 40 cases in the death group.Univariate ana-lysis results suggested that death of elderly CA-BSI patients was related to gender,age,history of hemodialysis,glucocorticoid usage,indwelling catheter,concomitant heart disease,albumin,creatinine,and sequential organ fai-lure assessment(SOFA)score(all P＜0.05).Multivariate logistic regression analysis results suggested that old age(OR=1.062,95％CI:1.016-1.109),high SOFA score(OR=1.161,95％CI:1.067-1.262),glucocorti-coid usage(OR=6.006,95％CI:2.441-14.774)were independent risk factors for the death of elderly CA-BSI patients,while normal albumin(OR=0.942,95％CI:0.891-0.995)was a protective factor.Conclusion Elderly CA-BSI patients have high risks of death.It is necessary to improve the immunity of patients as well as use antimi-crobial agents and glucocorticoids rationally,so as to reduce the risk of death in patients.

BACKGROUND: LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer. METHODS: We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels. RESULTS: On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs . 1.4% [2/145]). CONCLUSION: LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile. TRIAL REGISTRATION ClinicalTrials.gov, NCT04563936.
Humans ; Male ; Antineoplastic Agents, Hormonal/therapeutic use* ; East Asian People ; Gonadotropin-Releasing Hormone/agonists* ; Goserelin/therapeutic use* ; Prostate-Specific Antigen ; Prostatic Neoplasms/drug therapy* ; Testosterone

The current study was designed to explore the brain protection mechanism of Xinglou Chengqi Decoction (XCD) based on gut microbiota analysis and network pharmacology. A transient middle cerebral artery occlusion (MCAO) model of mice was established, followed by behavioral evaluation, TTC and TUNEL staining. Additionally, to investigate the effects of gut microbiota on neurological function after stroke, C57BL/6 mice were treated with anti-biotic cocktails 14 days prior to ischemic stroke (IS) to deplete the gut microbiota. High-throughput 16S rDNA gene sequencing, metabonomics technique, and flow multifactor technology were used to analyze bacterial communities, SCFAs and inflammatory cytokines respectively. Finally, as a supplement, network pharmacology and molecular docking were applied to fully explore the multicomponent-multitarget-multichannel mechanism of XCD in treating IS, implicated in ADME screening, target identification, network analysis, functional annotation, and pathway enrichment analysis. We found that XCD effectively improved neurological function, relieved cerebral infarction and decreased the neuronal apoptosis. Moreover, XCD promoted the release of anti-inflammatory factor like IL-10, while down-regulating pro-inflammatory factors such as TNF-α, IL-17A, and IL-22. Furthermore, XCD significantly increased the levels of short chain fatty acids (SCFAs), especially butyric acid. The mechanism might be related to the regulation of SCFAs-producing bacteria like Verrucomicrobia and Akkermansia, and bacteria that regulate inflammation like Paraprevotella, Roseburia, Streptophyta and Enterococcu. Finally, in the network pharmacological analysis, 51 active compounds in XCD and 44 intersection targets of IS and XCD were selected. As a validation, components in XCD docked well with key targets. It was obviously that biological processes were mainly involved in the regulation of apoptotic process, inflammatory response, response to fatty acid, and regulation of establishment of endothelial barrier in GO enrichment. XCD can improve neurological function in experimental stroke mice, partly due to the regulation of gut microbiota. Besises, XCD has the characteristic of "multi-component, multi-target and multi-channel" in the treatment of IS revealed by network pharmacology and molecular docking.
Animals ; Drugs, Chinese Herbal/pharmacology* ; Gastrointestinal Microbiome ; Mice ; Mice, Inbred C57BL ; Molecular Docking Simulation ; Network Pharmacology ; Stroke/drug therapy*

Objective    To explore the mechanism of volume-related mitral regurgitation (MR) from the anatomy of mitral valve. Methods    A total of 32 patients with ventricular septal defect (VSD) combined MR meeting inclusion criteria in West China Hospital from September 2018 to November 2019 were enrolled in this study. The direction relative to the cardiac axis: the deviation of the MR bundle along the left atrial wall was eccentric, otherwises it was central. There were 23 patients of VSD and eccentric MR (EMR, a VSD-EMR group), including 10 males and 13 females aged 21 (10, 56) months, and 9 patients of VSD and central MR (CMR, a VSD-CMR group), including 4 males and 5 females aged 26 (12, 87) months. Besides, 9 healthy children were enrolled in a control group, including 4 males and 5 females aged 49 (15, 72) months. All patients underwent transthoracic echocardiography (TTE) examination at 2 weeks before surgery and 6 months after surgery, respectively, The MR degree, end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), antero-posterior diameter (AP), annulus circumference (AC), commissural diameter (CD) were assessed. Results    Before operation, EDV, ESV, SV, AP, AC and CD in the VSD-EMR and VSD-CMR groups were significantly larger or longer than those in the control group (P<0.05); after operation, EDV, ESV, SV, AP and CD decreased compared with those before operation (P<0.05), but there was no significant difference compared with the control group (P>0.05). Compared with the control group, AC was slightly decreased (P<0.05). There was no significant difference in EF between and within groups before and after operation (P>0.05). The improvement rate of MR was 78.9%(15/19) in the VSD-EMR group and 100.0% (9/9) in the VSD-CMR group. Conclusion    After unloading of volume, the valve structure is back to normal except AC. The improvement rate of MR in the VSD-EMR group is lower than that in the VSD-CMR group, which may indicate that the mechanism of VSD-EMR is more complicated.

Objective:To explore national standard of occupational skills for assistive technology consultants in China based on the study of relevant international standards. Methods:After analyzing the international and some other national job content, work requirements, professional education and vocational training, and vocational standards of assistive technology consultants, the national occupational skills standard for assistive technology consultants in China was established referring to the compiling rules of national occupational skills standard. Results:According to the compiling rules of national occupational skills standard, the national occupational skills standard for assistive technology consultants in China included career situation, basic requirements, job requirements, and weight table, etc. Conclusion:The vocational development, structural framework and content of professional capacity for assistive technology consultants are studied. The draft of national occupational skills standard for rehabilitation assistive technology consultants has been compiled.

Objective:To investigate the value of anal swabs positive for 2019-nCoV in patients with COVID-19 and the clinical features of the patients.Methods:Throat swabs, sputum and blood samples, and anal swabs were collected from 104 patients with COVID-19 at admission to test for 2019-nCoV nucleic acid. Clinical characteristics and hematological indexes were compared between viral nucleic acid-positive and -negative groups of different sample types. Fifteen patients whose anal swabs were positive for viral nucleic acid were selected to analyze the length of time before the nucleic acid turned negative in different specimens.Results:Compared with the patients having negative anal swab test results, those having positive test results showed decreased lymphocytes, increased lactate dehydrogenase (LDH) and high-sensitivity C-reactive protein (HsCRP), and higher incidence of severe COVID-19. The levels of HsCRP and IL-6 and the incidence of severe COVID-19 were significantly higher in patients with positive throat swab test results than in those with negative results. No significant difference in hematological indexes or the proportion of severe cases was detected between the patients with positive and negative sputum test results. Only 1.92% of the patients had positive blood test results, but all of them were severe patients. The positive rate of sputum test was the highest, which was 46.15%. Patients with positive results of both throat and anal swab test had significantly decreased lymphocytes, increased HsCRP and IL-6 levels, and higher incidence of critical COVID-19. It took longer time for patients to have negative anal swab and sputum test results. Moreover, it should be noticed that the viral nucleic acid in sputum might become positive again after it turned negative.Conclusions:Patients with positive anal swab test results had reduced lymphocytes, enhanced inflammatory response and higher incidence of severe COVID-19, suggesting that a positive anal swab test might be an indicator of severe COVID-19. Moreover, the time of 2019-nCoV nucleic acid turning negative in anal swabs was longer than that in throat swabs. The combined detection of throat swabs and anal swabs would help to predict the occurrence of severe COVID-19.

Objective: To evaluate the association between NLRP2(NLR Family Pyrin Domain Containing 2) gene polymorphisms and classical type 1 diabetes mellitus(T1DM) in Chinese Han population. Methods: A case-control study was conducted in 510 classical T1DM patients from the Department of Metabolism and Endocrinology in the Second Xiangya Hospital affiliated to Central South University and 531 healthy controls in this region. The polymorphisms of rs1043673 in NLRP2 gene were analyzed by MassARRAY. Mann-Whitney U test and χ² test were used to compare the differences between patients and controls. Logistic regression analysis and χ² test were performed to compare the distributions of the alleles and genotypes between T1DM patients and controls. Kruskal-Wallis H test was used to compare the clinical characteristics of different genotypes in T1D patients. Results: The differences of the allele and genotype distributions in rs1043673 of NLRP2 gene were not significant between patients and controls. The polymorphisms of rs1043673 were associated with fasting C-peptide(P=0.029), postprandial 2-h C-peptide(P=0.017), and titer of GADA(P=0.043) in T1DM patients. Conclusion The polymorphisms of NLRP2 gene were associated with the characteristics of T1DM patients.

Objective:To explore the clinical characteristics and establish a corresponding prognostic scoring model in patients with early-stage clinical features of hepatitis B-induced acute-on-chronic liver failure (HBV-ACLF).Methods:Clinical characteristics of 725 cases with hepatitis B-related acute-on-chronic hepatic dysfunction (HBV-ACHD) were retrospectively analyzed using Chinese group on the study of severe hepatitis B (COSSH). The independent risk factors associated with 90-day prognosis to establish a prognostic scoring model was analyzed by multivariate Cox regression, and was validated by 500 internal and 390 external HBV-ACHD patients.Results:Among 725 cases with HBV-ACHD, 76.8% were male, 96.8% had cirrhosis base,66.5% had complications of ascites, 4.1% had coagulation failure in respect to organ failure, and 9.2% had 90-day mortality rate. Multivariate Cox regression analysis showed that TBil, WBC and ALP were the best predictors of 90-day mortality rate in HBV-ACHD patients. The established scoring model was COSS-HACHADs = 0.75 × ln(WBC) + 0.57 × ln(TBil)-0.94 × ln(ALP) +10. The area under the receiver operating characteristic curve (AUROC) of subjects was significantly higher than MELD, MELD-Na, CTP and CLIF-C ADs( P < 0.05). An analysis of 500 and 390 cases of internal random selection group and external group had similar verified results. Conclusion:HBV-ACHD patients are a group of people with decompensated cirrhosis combined with small number of organ failure, and the 90-day mortality rate is 9.2%. COSSH-ACHDs have a higher predictive effect on HBV-ACHD patients' 90-day prognosis, and thus provide evidence-based medicine for early clinical diagnosis and treatment.

Objective:To explore patients and nurses' attitude and willingness of "Internet + nursing services", and provide a reference for better "Internet + nursing services".Methods:In July 2019, totally 579 inpatients and 1 176 nurses from The First Affiliated Hospital of Sun Yat-sen University were selected by convenient sampling. A self-designed Questionnaire on the Status Quo of Patients and Nurses' Attitude and Willingness "Internet + Nursing Services" was used to explore the current status of these patients and nurses' willingness and costs of "Internet + nursing services". χ 2 test was employed to compare the differences between the two. Results:Among respondents, totally 73.40% (425/579) patients and 71.09% (836/1 176) nurses agreed to carry out "Internet + nursing services". A total of 45.08% (261/579) patients and 50.26% (591/1 176) nurses thought that the most needed on-site service items were catheter replacement and wound dressing change. Both patients and nurses believed that on-site services were most helpful to patients with immobility, accounting for 56.18% (325/579) and 52.98% (623/1 176) , respectively. The willingness of nurses to provide on-site services was lower than that of patients to receive on-site services. The cost of nurses' on-site services was higher than the patients' willingness to pay. Patients' concerns about medical risks were higher than those of nurses, while their personal safety concerns were lower than those of nurses. Nurses hoped that the time spent on on-site services was shorter than the needs of patients, and the differences were statistically significant ( P<0.05) . Conclusions:Patients and nurses support the development of "Internet + nursing services". Most patients accept nurses to provide on-site services, while some nurses hold a wait-and-see attitude towards on-site services. Moreover, there is a big gap between the two parties in terms of service costs, risks and duration. Therefore, when carrying out "Internet + nursing services", it is necessary to balance the needs of patients and nurses, formulate practical service plans, and satisfy both nurses and patients to achieve a win-win situation.