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 develop and validate a three-year risk prediction model for new-onset cardiovascular diseases (CVD) among female patients with breast cancer. METHODS: Based on the data from Inner Mongolia Regional Healthcare Information Platform, female breast cancer patients over 18 years old who had received anti-tumor treatments were included. The candidate predictors were selected by Lasso regression after being included according to the results of the multivariate Fine & Gray model. Cox proportional hazard model, Logistic regression model, Fine & Gray model, random forest model, and XGBoost model were trained on the training set, and the model performance was evaluated on the testing set. The discrimination was evaluated by the area under the curve (AUC) of the receiver operator characteristic curve (ROC), and the calibration was evaluated by the calibration curve. RESULTS: A total of 19 325 breast cancer patients were identified, with an average age of (52.76±10.44) years. The median follow-up was 1.18 [interquartile range (IQR): 2.71] years. In the study, 7 856 patients (40.65%) developed CVD within 3 years after the diagnosis of breast cancer. The final selected variables included age at diagnosis of breast cancer, gross domestic product (GDP) of residence, tumor stage, history of hypertension, ischemic heart disease, and cerebrovascular disease, type of surgery, type of chemotherapy and radiotherapy. In terms of model discrimination, when not considering survival time, the AUC of the XGBoost model was significantly higher than that of the random forest model [0.660 (95%CI: 0.644-0.675) vs. 0.608 (95%CI: 0.591-0.624), P < 0.001] and Logistic regression model [0.609 (95%CI: 0.593-0.625), P < 0.001]. The Logistic regression model and the XGBoost model showed better calibration. When considering survival time, Cox proportional hazard model and Fine & Gray model showed no significant difference for AUC [0.600 (95%CI: 0.584-0.616) vs. 0.615 (95%CI: 0.599-0.631), P=0.188], but Fine & Gray model showed better calibration. CONCLUSION It is feasible to develop a risk prediction model for new-onset CVD of breast cancer based on regional medical data in China. When not considering survival time, the XGBoost model and the Logistic regression model both showed better performance; Fine & Gray model showed better performance in consideration of survival time.
Humans ; Female ; Adult ; Middle Aged ; Adolescent ; Breast Neoplasms/epidemiology* ; Cardiovascular Diseases/etiology* ; Proportional Hazards Models ; Logistic Models ; China/epidemiology*

Aim To investigate the differences in the role of different purinergic receptor subtypes at different sites in postoperative-hyperalgesic priming in mice. Methods A postoperative-hyperalgesic priming model was constructed by injecting PGE

AIM:To identify the reasons for not improving visual acuity of patients with diabetic macular edema(DME)and its correlation with optical coherent tomography(OCT)imaging characteristics. They were treated with anti-vascular endothelial growth factor(VEGF)again after an interruption of treatment due to the COVID-19 pandemic.METHODS: Retrospective cases study. A total of 31 patients(40 eyes)with DME and treated with anti-VEGF drugs in the Department of Ophthalmology of the First Affiliated Hospital of Xi'an Jiaotong University between December 2019 and July 2020 were selected. All patients had an treatment history of interruption due to COVID-19. Based on the behavioral standard of best corrected visual acuity(BCVA)at 1mo after re-treatment, they were divided into improved visual acuity group(14 eyes)and non-improved visual acuity group(26 eyes). All patients received comprehensive ophthalmic examinations, including BCVA, intraocular pressure, OCT, fundus photography, and fundus fluorescein angiography(FFA). The central retinal thickness(CRT), hyper-reflective retinal dots(HRD), subretinal fluid(SRF), intraretinal fluid(IRF), disorganization of the inner retinal layers(DRIL)and ellipsoid zone disruption(EZD)were quantified by Image J. The correlation between BCVA and CRT, the number of HRD, the diameter of SRF and IRF, and the height of DRIL and EDZ width at 1mo after treatment were analyzed by Spearman correlation.RESULTS: The proportion of HRD in OCT was significantly higher in the non-improved visual acuity group than that in the improved visual acuity group(χ2=5.43, P=0.0072); There was a positive correlation between the difference of BCVA(LogMAR)and CRT change in DME patients after treatment(rs=0.406, P=0.009); There was a positive correlation between BCVA(LogMAR)and EZD width after treatment(rs=0.358, P=0.023). There was no correlation between BCVA(LogMAR)after treatment and the number of CRT(rs=-0.086,P=0.600)and HRD(rs=-0.115,P=0.482), the diameter and height of SRF(rs=0.102,P=0.530; rs=0.100,P=0.538)and IRF(rs=0.134,P=0.410; rs=-0.014,P=0.932), and the width of DRIL(rs=0.089,P=0.587).CONCLUSION:The probability of retinal HRD was significantly higher in patients with no visual improvement than that in patients with visual improvement after the re-treatment with anti-VEGF due to the treatment interruption during COVID-19. EZD width was also closely correlated to the prognosis of visual acuity. As for these patients, HRD manifestations in OCT should be comprehensively considered, taking intravitreal injection of glucocorticoid as an auxiliary strategy if necessary.

AIM: To evaluate the efficacy of modified folding intraocular lens(IOL)suspension surgery in treatment of traumatic dislocation of lens surgery technique.METHODS: Prospective randomized controlled study. A total of 15 patients underwent the modified folding IOL suspension surgery. Among them, 9 patients chose Akreos AO IOL, and polypropylene sutures were used to thread the haptics of IOL. After guided to puncture out through the sclera, the ends of sutures were thermal expanded and fixed in the sclera. And 6 patients chose Tecnis ZA9003 IOL and no sutures were used. After guided the haptics to puncture out through the sclera, the ends of haptics were thermal expanded and fixed in the sclera. The best corrected visual acuity(BCVA, LogMAR)of all patients and postoperative complication were observed. RESULTS: This study included 15 patients, among them, 7 were male and 8 were female, the mean age was 64.00±9.85 years old, the mean course of diseases was 5.80±3.17 wk. There were no significant differences between the demographic and baseline clinical characteristics. After underwent the modified folding IOL suspension surgery, visual acuity of all patients were obviously improved. After 3mo of the surgery, the BCVA(LogMAR)of patients were improved from 1.28±0.56 to 0.52±0.30. More specifically, the BCVA(LogMAR)of patients who chose Akreos AO IOL were improved from 1.39±0.62 to 0.59±0.25, and those who chose Tecnis ZA9003 IOL of the BCVA(LogMAR)were improved from 1.12±0.45 to 0.42±0.35. Furthermore, there was no severe postoperative complication observed in our study. Only one patient suffered IOL dislocation and the IOL optical surface was mild oblique.CONCLUSION: Modified folding IOL suspension surgery technique resulted in good visual and outcomes with no severe complication, making it an effective option for IOL suspension surgery.

Qixuehe Capsules is a compound Chinese patent medicine developed for treating the disorder of Qi and blood(a common etiology of gynecological disease), which has remarkable effects on smoothing liver and regulating Qi, activating blood circulation, and relieving pain. However, due to its complex prescriptions(15 herbs) and multiple effects, the quality control of Qixuehe Capsules has always been a bottleneck problem limiting its sustainable development. Therefore, this study adopted the traditional Chinese medicine Q-markers quantitative identification system established previously by our research group based on the combination of analytic hierarchy process and entropy weight methods. With the different effects of Qixuehe Capsules as the entry point, the comprehensive scores of chemical ingre-dients in Qixuehe Capsules under the items of effectiveness(smoothing liver and regulating qi, activating blood circulation, and relieving pain), testability and specificity were calculated and integrated, respectively. Subsequently, through the analysis of compatibility relationship of Qixuehe Capsules, 15 active ingredients with high comprehensive scores were found to be the top Q-mar-kers of Qixuehe Capsules, including ferulic acid, quercetin, caffeic acid, kaempferol, rutin, Z-ligustilide, senkyunolide Ⅰ, vanillic acid, protocatechuic acid, chlorogenic acid, rosmarinic acid, senkyunolide A, gallic acid, tetrahydropalmatine and eugenol. Collectively, this study not only provided scientific evidence for further research on the improvement and standardization of quality standards of Qixuehe Capsules but also provided methodological references for the quantitative identification of Q-markers of multi-effect traditional Chinese medicine formulae.
Analytic Hierarchy Process ; Capsules ; Drugs, Chinese Herbal ; Entropy ; Medicine, Chinese Traditional

Pneumonia caused by SARS-CoV-2 has seriously threatened human life and health worldwide and caused a large number of deaths. Viral infection and acute inflammation are important causes of death, so it is particularly important to combine antiviral therapy with anti-inflammatory therapy. Glycyrrhizic acid, the main component of the glycyrrhizic root extract, has a wide range of pharmacological effects as well as high efficiency and low toxicity, its preparation has been widely used in the treatment of chronic hepatitis and other diseases. Glycyrrhizic acid can regulate the expression and release of a variety of cytokines and play a significant anti-inflammatory effect. At the same time, glycyrrhizic acid also showed significant inhibition towards a variety types of viruses. Therefore, the potential application of glycyrrhizic acid as COVID-19 treatment should be explored.

In this paper, the micro-video teaching mode was explored in the course construction of . The micro-video teaching contents include the academic thought, experience in diagnosis and treatment, characteristic technology and clinical manipulation of famous acupuncture experts in the Henan University of CM. Each micro-video film is designed within 15-18 min, including three sections of knowledge, i.e. basic theory, technological application and clinical manipulation. Each section is designed within 5-6 min. The construction of the teaching course of is the innovation of practice mode of TCM and the new approach to the inheritance of the experience of experts. The construction of micro-video teaching course propels the reform of teaching mode, improves the learning initiative of students and clinical manipulative ability so as to improve the teaching effect and quality.
Acupuncture Therapy ; Humans ; Learning ; Moxibustion ; Students ; Teaching

Objective To investigate the clinical features of elderly patients with stage 3-4 chronic kidney disease ( CKD ) and to analyze the risk factors of the kidney function progression. Methods This was a cross-sectional study. The clinic data of elderly patients (≥60 years) with stable clinical manifestation in Beijing Hospital from January ,2014 to December ,2015 was collected.Based upon the eGFR derived from Cockcroft-Gault (CG) equation ,all patients were divided into groups of CKD 3a group ,CKD 3b group and CKD 4 group ,respectively. Moreover ,patients were separated into the old group (＜ 80 years) and the very old group (≥80 years) based on the age. The demographic features ,primary diseases history ,body mass index (BMI) ,blood routine ,urine routine , blood biochemistry ,Cystatin C and iPTH were recorded.Logistic regression analysis of kidney function progression was also conducted. Results One-hundred and eighty-three cases were enrolled with a mean age of(80 ± 9)years.Along with the descent of kidney function ,the age ,levels of proteinuria and iPTH gradually ascended (F＝ 12.352 ,5.910 ,5.910 ;P＝ 0.000 ,0.003 ,0.003 ,respectively) and the BMI and serum albumin gradually descended (F＝9.758 ,11.088 ;P＝0.000 ,0.000 ,respectively).In addition ,compared to the old group ,very old group was associated with decreased level of eGFR [(37.1 ± 9.9) ml·min－1·1.73 m －2vs. (44.0 ± 12.0) ml·min－1·1.73 m －2,t＝ －4.280 ,P＝0.000] and increasedlevelofCystatinC[(1.71±0.84)mg/L vs. (1.40±0.69)mg/L ,t＝3.484 ,P＝0.001].The Logistic regression analysis indicated that the proteinuria was an independent risk factor for the progression of kidney function ( OR ＝3.856 ,P＝0.004). Conclusions As the gradually descended of the eGFR level in elderly patients with stage 3-4 CKD ,age ,proteinuria and iPTH gradually ascended ,BMI and serum albumin descended ,respectively. The level of eGFR decreased and CystatinC increased significantly with the increasing age. Proteinuria was an independent risk factor for progression of the kidney function.

BackgroundIdiopathic pulmonary fibrosis (IPF) is an age-related and progressive interstitial lung disease. Up to 20% of cases of IPF cluster in families, genetic factors contribute significantly to the pathogenesis of the disease. This study aimed to explore the association between rare genetic variants and IPF in Chinese Han families.

MethodsA Han family, comprising three IPF patients and five unaffected their first-degree relatives, and 100 ethnically matched control individuals from North China were enrolled in this study. Peripheral blood was collected, and genomic DNA was extracted. To elucidate if rare genetic variants are associated with the familial IPF, we performed whole-exome sequencing of affected members from a Chinese Han IPF family. Candidate rare variants were then confirmed by Sanger sequencing.

ResultsWe identified a potentially damaging rare variant-a heterozygous mutation c.2146G>A in exon 6 of the gene encoding for telomerase reverse transcriptase (TERT), which results in an amino acid substitution (p.Ala716Thr). We confirmed the missense mutation by Sanger sequencing in all the affected family members but did not detect this mutation in 100 ethnically matched healthy controls. Patients carried this mutation were characterized by the frequently acute exacerbation of IPF phenotype, with poor prognosis. The mean time to death was 2.8 years after diagnosis.

ConclusionUsing next-generation sequencing technology in familial IPF patients, we identified the heterozygous rare variant in TERT gene, and strengthened the importance of genetic variants in telomere-related pathogenesis in Chinese IPF patients.

China ; Female ; Humans ; Idiopathic Pulmonary Fibrosis ; genetics ; Male ; Middle Aged ; Mutation ; Mutation, Missense ; Pulmonary Fibrosis ; Telomerase ; genetics ; Telomere