The number of patients with reduced blood volume due to haemorrhage, fractures, severe infections, extensive burns and tumours is increasing, and traditional blood products are no longer able to meet the increasing clinical demand. Therefore, plasma substitutes have become particularly important in fluid resuscitation, especially artificial colloidal solutions, which have a sustained volume expansion time and a good volume expansion effect, and can significantly improve the circulatory status of patients. This article aims to review the classification of artificial colloidal plasma substitutes and their research progress in clinical practice, in order provide a more rigorous, professional and standardized reference for medicine.

Based on the natures and flavors of herbal medicinals recorded in Shen Nong's Classic of the Materia Medica （《神农本草经》）； Miscellaneous Records of Famous Physicians （《名医别录》）， this study analyzed the characte-ristics of the natures， flavors and combination of medicinals of the two-herb compound formulas in Treatise on Cold Damage and Miscellaneous Diseases （《伤寒杂病论》）.Finally， 31 compound formulas were included， and it was found that the nature and flavor of the herbs in these two-herb compound formulas are closely related to the functions of the compound formulas， such as the common pairing of the acrid and the sweet herbs to warm yang and transform qi， the acrid and the bitter herbs in pairs to regulate and harmonize cold and heat， the sweet and the bitter in pairs to remove dampness and clear heat， the acrid and the acrid in pairs to arrest vomiting and direct qi downward， and the sour and the sweet in pairs to slow the urgent and relieve pain. Regardless of the deficiency or excess nature of the disease， the corresponding two-herb compound formulas often aim to reinforce healthy qi while eliminating pathogenic factors， with some formulas showcasing a unique correspondence between the disease pattern and the symptoms addressed.

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 evaluate the degree of liver injury and liver fibrosis in patients in the immune-tolerant phase of chronic HBV infection, and to provide a basis for judging the condition of patients in the immune-tolerant phase. Methods A total of 300 patients with HBV DNA ≥10 7 IU/mL, alanine aminotransferase (ALT) ≤40 U/L, and complete data who were treated in The Third People's Hospital of Kunming from January 2015 to December 2019 were enrolled as subjects, and related data were collected, including age, sex, duration of HBV infection, blood biochemistry, hepatitis B surface antigen (HBsAg) level, and HBV DNA. Liver pathological examination was performed for all patients, and the patients were divided into G < 2 and G ≥2 groups according to inflammation grade and S < 2 and S ≥2 groups according to the degree of fibrosis. The t -test was used for comparison of continuous data between two groups, and univariate and multivariate unconditional logistic regression analyses were used to investigate the influencing factors for G ≥2 liver inflammation and S ≥2 liver fibrosis. Results Among the 300 patients, 213 (71%) had G ≥2 liver inflammation and 120 (40%) had S ≥2 liver fibrosis, with a baseline age of 26.06±9.01 years; male patients accounted for 48%, and the duration of infection was 5.62±5.09 years. The univariate analysis showed that there were significant differences between the G < 2 and G ≥2 groups in ALT, alkaline phosphatase (ALP), albumin (Alb), platelet count (PLT), diameter of the portal vein, and spleen thickness ( t =-26.677, -11.612, 2.149, 5.410, -6.092, and -2.911, all P < 0.05), and there were significant differences between the S < 2 and S ≥2 groups in duration of infection, ALT, ALP, Alb, HBV DNA, PLT, diameter of the portal vein, and spleen thickness ( t =-6.320, -6.694, -7.880, 2.349, 4.552, 19.160, -5.782, and -5.622, all P < 0.05). The multivariate analysis showed that ALT (odds ratio [ OR ]=10.270, 95% confidence interval [ CI ]: 2.212-47.672, P =0.003) and ALP ( OR =1.097, 95% CI : 1.013-1.188, P =0.023) were independent risk factors for G ≥2 liver inflammation in patients in the immune-tolerant phase, and ALP ( OR =1.034, 95% CI : 1.015-1.054, P < 0.001), PLT ( OR =0.913, 95% CI : 0.886-0.938, P < 0.001), HBV DNA ( OR =0.198, 95% CI : 0.062-0.636, P =0.007), and duration of infection ( OR =1.176, 95% CI : 1.033-1.340, P =0.015) were independent influencing factors for S ≥2 liver fibrosis in patients in the immune-tolerant phase. Conclusion Most patients in the immune-tolerant phase have significant liver histological changes. ALT and ALP are the influencing factors for significant liver inflammation, and ALP, HBV-DNA, PLT, and infection time are the influencing factors for significant liver fibrosis in patients in the immune-tolerant phase.

Objective To investigate the effect of Ganshuang granule combined with entecavir on portal vein thrombosis (PVT) in patients with hepatitis B cirrhosis. Methods A total of 356 patients with hepatitis B cirrhosis who attended and were hospitalized in The Third People's Hospital of Kunming from January 1, 2018 to December 31, 2020 were enrolled and randomly divided into combination group with 191 patients and control group with 165 patients. The patients in the combination group received Ganshuang granule combined with entecavir, and those in the control group received entecavir alone. The course of treatment was at least 24 weeks. The t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to analyze the cumulative incidence rate of PVT in both groups, and the log-rank test was used for comparison between two groups. Univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for PVT in patients with hepatitis B cirrhosis. Results The 191 patients in the combination group were followed up for 296.25 person-years in total, with a mean follow-up time of 1.55±0.65 years, and there were 8 patients with PVT, with an incidence rate of 4.19% and an incidence density of 1.41 per ten-thousand person-years. The 165 patients in the control group were followed up for 253.25 person-years in total, with a mean follow-up time of 1.53±0.67 years, and there were 20 patients with PVT, with an incidence rate of 12.12% and an incidence density of 4.79 per ten-thousand person-years. There was a significant difference in the incidence rate of PVT between the two groups ( χ 2 =7.687, P =0.006). The cumulative incidence rate of PVT plotted by the Kaplan-Meier method showed that the combination group had a significantly lower cumulative incidence rate of PVT than the control group ( χ 2 =7.226, P =0.007), with a relative risk of 3.155 (95% confidence interval [ CI ]: 1.351-7.370). The univariate Cox analysis showed that hypertension, alanine aminotransferase, aspartate aminotransferase (AST), albumin (Alb), cholinesterase, estimated glomerular filtration rate, alpha-fetoprotein, D-dimer (D-D), Child-Pugh class, and Ganshuang granule combined with entecavir were influencing factors for PVT (all P < 0.05); the multivariate Cox analysis showed that AST (hazard ratio [ HR ]=1.002, 95% CI : 1.000-1.004, P =0.025), and D-D ( HR =1.907, 95% CI : 1.554-2.338, P < 0.001) were independent risk factors for PVT in patients with hepatitis B cirrhosis, while Alb ( HR =0.844, 95% CI : 0.755-0.944, P =0.003) and Ganshuang granule combined with entecavir ( HR =0.350, 95% CI : 0.144-0.851, P =0.021) were independent protective factors against PVT in patients with hepatitis B cirrhosis. Conclusion Ganshuang granule combined with entecavir can significantly reduce the incidence rate of PVT in patients with hepatitis B cirrhosis, thereby exerting a certain preventive effect against PVT.

The brain is the most advanced organ with various complex structural and functional microregions. It is often challenging to understand what and where the molecular events would occur for a given drug treatment in the brain. Herein, a temporo-spatial pharmacometabolomics method was proposed based on ambient mass spectrometry imaging and was applied to evaluate the microregional effect of olanzapine (OLZ) on brain tissue and demonstrate its effectiveness in characterizing the microregional pharmacokinetics and pharmacodynamics of OLZ for improved understanding of the molecular mechanism of drugs acting on the microregions of the brain. It accurately and simultaneously illustrated the levels dynamics and microregional distribution of various substances, including exogenous drugs and its metabolites, as well as endogenous functional metabolites from complicated brain tissue. The targeted imaging analysis of the prototype drug and its metabolites presented the absorption, distribution, metabolism, and excretion characteristics of the drug itself. Moreover, the endogenous functional metabolites were identified along with the associated therapeutic and adverse effects of the drug, which can reflect the pharmacodynamics effect on the microregional brain. Therefore, this method is significant in elucidating and understanding the molecular mechanism of central nervous system drugs at the temporo and spatial metabolic level of system biology.

Objective:To investigate the clinical effect of static staple in the treatment of metatarsal neck fracture.Methods:The clinical data of 34 patients with the 2 nd to 5 th metatarsal neck fracture admitted to the Department of Orthopaedic Surgery, Tianjin Fifth Central Hospital from January 2017 to December 2018 were retrospectively analyzed.Seventeen patients were treated with static staple and 17 with retrograde Kirschner wire.In solustaple group, there were 11 males, 6 females, aged 34.6 years (range: 21 to 50 years), 10 cases on the right side, 7 cases on the left side.In retrograde Kirschner wire group, there were 12 males and 5 females, aged 36.2 years (range: 23 to 53 years), 9 on the right and 8 on the left.The fracture healing time was recorded and the postoperative complications were counted.The American Orthopedic Foot and Ankle Society Score (AOFAS) forefoot score, visual analogue scale (VAS), and the active flexion and extension range of metatarsophalangeal joints were measured to compare the clinical efficacy of the two groups.The data were compaired by t test, non-parametric or χ 2 test. Results:All patients were followed up for 14.2 months (range: 12 to 17 months).All the fractures were healed and there was no statistically significant difference between solustaple group and retrograde Kirschner wire group in fracture healing time ((11.2±2.1) week vs.(11.5±3.1) week, t=0.030, P=0.743).There was no statistically significant difference between VAS (1.00 (1.00) vs.1.00 (1.50) M( QR), Z=-0.443, P=0.658) and AOFAS scores(90.9±5.3 vs. 88.6±6.1, t=1.174, P=0.249) at the last follow-up. The difference in active dorsiflexion((35.1±4.3)° vs.(31.2±6.4)°, t=2.055, P=0.048) and flexion range of motion ((34.7±4.5)° vs. (30.2±5.3)°, t=2.681, P=0.011) between the two groups was statistically significant. One case of open fracture in the Solustaple group had local skin necrosis, and three patients had metatarsal pain after weight-bearing walking. Four patients in the retrograde Kirschner wire group developed metatarsalgia after weight-bearing walking, and two patients developed mild dorsal extension contracture and joint pain. Conclusions:The treatment of the 2 nd to 5 th metatarsal neck fracture by static staple is minimally invasive and firmly fixed. It can effectively reduce the complications of tendon and joint adhesion, and is beneficial to the fracture healing and joint function recovery.

Objective:To investigate the clinical effect of static staple in the treatment of metatarsal neck fracture.Methods:The clinical data of 34 patients with the 2 nd to 5 th metatarsal neck fracture admitted to the Department of Orthopaedic Surgery, Tianjin Fifth Central Hospital from January 2017 to December 2018 were retrospectively analyzed.Seventeen patients were treated with static staple and 17 with retrograde Kirschner wire.In solustaple group, there were 11 males, 6 females, aged 34.6 years (range: 21 to 50 years), 10 cases on the right side, 7 cases on the left side.In retrograde Kirschner wire group, there were 12 males and 5 females, aged 36.2 years (range: 23 to 53 years), 9 on the right and 8 on the left.The fracture healing time was recorded and the postoperative complications were counted.The American Orthopedic Foot and Ankle Society Score (AOFAS) forefoot score, visual analogue scale (VAS), and the active flexion and extension range of metatarsophalangeal joints were measured to compare the clinical efficacy of the two groups.The data were compaired by t test, non-parametric or χ 2 test. Results:All patients were followed up for 14.2 months (range: 12 to 17 months).All the fractures were healed and there was no statistically significant difference between solustaple group and retrograde Kirschner wire group in fracture healing time ((11.2±2.1) week vs.(11.5±3.1) week, t=0.030, P=0.743).There was no statistically significant difference between VAS (1.00 (1.00) vs.1.00 (1.50) M( QR), Z=-0.443, P=0.658) and AOFAS scores(90.9±5.3 vs. 88.6±6.1, t=1.174, P=0.249) at the last follow-up. The difference in active dorsiflexion((35.1±4.3)° vs.(31.2±6.4)°, t=2.055, P=0.048) and flexion range of motion ((34.7±4.5)° vs. (30.2±5.3)°, t=2.681, P=0.011) between the two groups was statistically significant. One case of open fracture in the Solustaple group had local skin necrosis, and three patients had metatarsal pain after weight-bearing walking. Four patients in the retrograde Kirschner wire group developed metatarsalgia after weight-bearing walking, and two patients developed mild dorsal extension contracture and joint pain. Conclusions:The treatment of the 2 nd to 5 th metatarsal neck fracture by static staple is minimally invasive and firmly fixed. It can effectively reduce the complications of tendon and joint adhesion, and is beneficial to the fracture healing and joint function recovery.

Objective: Purpose To introduce the treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with endobutton CL bone-tendon-bone (BTB), and discuss its clinical effects. Methods: From January 2010 to August 2013, 21patients (male 15, female 6) with mallet finger deformity were retrospectively studied. The average age of patients was 31.3±5.3 years. The time from injury to surgery was 5.2±2.1 d. Extensor tendons were ruptured at the terminal insertion in all patients, and there were no avulsion fracture at the base of the distal phalanx.. the terminal extensor tendon insertion Awere surgical reconstructed with Endobutton CL BTB, via a dorsal S-shaped incision of distal interphalangeal joint. Dorsal base of the distal phalanx was drilled a hole and then the tendon suture line with Endobutton CL BTBwas inserted from the ventral finger to the dorsal base of the phalanx to suture the proximal extensor tendon. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up: the active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured, and the total active ranges of motion of the finger were recorded. Finger function was evaluated according to the total active range of motion (TAM) system of the American Association of hand Surgeons. Results: All 21 cases were followed up and the follow-up period was 8 to 24 months, with an average of 18.6±5.1 months. The operation time of the patients was 20-40 min, with an average of 29.6±10.3 min. The intraoperative blood loss was 5-10ml, with an average of 7.5±2.6 ml. Mallet finger deformities were all corrected postoperatively. One case presented with limited dorsal extension with elongation of -20°. According to the Crawford evaluation standard, there were 18 excellent patients and 2 good patients, with the excellent and good rate was 95.2% (20/21). The degrees of active joint activity were: 91°±7° of the metacar-pophalangeal joint, 92°±4° of the proximal interphalangeal joint, 82°±8° of the distal interphalangeal joint, and 259°±15° of total active activity. The TAMs of the healthy side were 259°±15°, and the TAMs of the affected side were 268°±12°, the difference was statistically significant (t=2.147, P=0.038). Accorrding to TAM system assessment criteria: excellent in 18 patients, good in 2 patients, and the excellent and good rate was 95.2% (20/21). One case presented with dorsal extension limitation, one case suffered from discomfort of grip because of scar in ventral side of the finger. The postoperative dorsal extension was limited in 3 cases, and the postoperative dorsal extension function was gradually restored 6 months later. Conclusion The treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with Endobutton CL BTB was effective and easy-operating. Postoperative patients can perform early finger function exercise, satisfactory results, worthy of clinical promotion and application.

Objective To investigate the protective effect and mechanism of serum containing Euonymus fortunei on the rat pancreatic islet cells. Methods Forty male SD rats were randomly divided into 5 groups (n=8 in each group), including the control group (normal rat islet cells were cultured with normal rat serum), ischemic preconditioning group (abdominal aorta was blocked first and then re-opened before the pancreas was obtained, and the pancreatic islet cells were cultured with normal rat serum), Euonymus fortunei treatment group (normal rat islet cells were cultured with rat serum containing Euonymus fortunei), Euonymus fortunei group and blank group (normal rats were administered orally with Euonymus fortunei extract or distilled water for the preparation of rat serum). Diphenylthiocarbazone (DTZ) staining was utilized to observe and calculate the quantity of islets. Acridine orange (AO)/propidium iodide (PI) staining was adopted to calculate the survival rate of islet cells. The insulin release experiment was performed to calculate the stimulation index (SI) and evaluate islet cell function. The concentration of glutathione (GSH) and nitric oxide (NO) in islet cells was detected using GSH and NO kits. The expression level of inducible nitric oxide synthase (iNOS) messenger RNA (mRNA) was quantitatively measured by reverse transcription polymerase chain reaction (RT-PCR). Results Islet cells were observed in specifically scarlet color after DTZ staining. The quantity of islet cells did not significantly differ among different groups (all P>0.05). Along with the prolongation of culture time, the activity of islet cells in each group was gradually decreased. At 72 h after isolation and culture, compared with the control group, the survival rate of the cells was significantly higher in the Euonymus fortunei treatment group (P<0.05). The insulin release test results demonstrated that compared with the control group, the SI of the ischemic preconditioning and Euonymus fortunei treatment groups was significantly increased (both P<0.05). Compared with the control group, the GSH contents of pancreatic islet cells in the ischemic preconditioning and Euonymus fortunei treatment groups were considerably enhanced, the NO content was significantly decreased, and the expression level of iNOS mRNA was significantly down-regulated (all P<0.05). Conclusions Euonymus fortunei can increase the survival rate of islet cells and enhance the function of pancreatic islets by increasing the level of GSH, down-regulating the expression of iNOS and decreasing the NO production.