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 derive the Chinese medicine (CM) syndrome classification and subgroup syndrome characteristics of ischemic stroke patients. METHODS: By extracting the CM clinical electronic medical records (EMRs) of 7,170 hospitalized patients with ischemic stroke from 2016 to 2018 at Weifang Hospital of Traditional Chinese Medicine, Shandong Province, China, a patient similarity network (PSN) was constructed based on the symptomatic phenotype of the patients. Thereafter the efficient community detection method BGLL was used to identify subgroups of patients. Finally, subgroups with a large number of cases were selected to analyze the specific manifestations of clinical symptoms and CM syndromes in each subgroup. RESULTS: Seven main subgroups of patients with specific symptom characteristics were identified, including M3, M2, M1, M5, M0, M29 and M4. M3 and M0 subgroups had prominent posterior circulatory symptoms, while M3 was associated with autonomic disorders, and M4 manifested as anxiety; M2 and M4 had motor and motor coordination disorders; M1 had sensory disorders; M5 had more obvious lung infections; M29 had a disorder of consciousness. The specificity of CM syndromes of each subgroup was as follows. M3, M2, M1, M0, M29 and M4 all had the same syndrome as wind phlegm pattern; M3 and M0 both showed hyperactivity of Gan (Liver) yang pattern; M2 and M29 had similar syndromes, which corresponded to intertwined phlegm and blood stasis pattern and phlegm-stasis obstructing meridians pattern, respectively. The manifestations of CM syndromes often appeared in a combination of 2 or more syndrome elements. The most common combination of these 7 subgroups was wind-phlegm. The 7 subgroups of CM syndrome elements were specifically manifested as pathogenic wind, pathogenic phlegm, and deficiency pathogens. CONCLUSIONS There were 7 main symptom similarity-based subgroups in ischemic stroke patients, and their specific characteristics were obvious. The main syndromes were wind phlegm pattern and hyperactivity of Gan yang pattern.
Humans ; Syndrome ; Ischemic Stroke ; Medicine, Chinese Traditional ; Liver ; Phenotype

Objective To investigate the immunoregulatory effect of sirolimus on the xenotransplantation with arterial patch. Methods The xenotransplantation of arterial grafts was taken from the wild-type Bama pigs to cynomolgus monkeys. The peripheral blood mononuclear cells of recipient monkeys at 14 days after xenotransplantation (POD14) were selected as subjects. Dimethyl sulphoxide (DMSO) was used in the control group (volume ratio of 1:1 000) and sirolimus was administered in the sirolimus experimental group (final concentration of 0.1 μmol/L and 0.5 μmol/L). The cells were cultured for 1.0 and 5.5 d, respectively. The activity of POD14 cells was evaluated. The DMSO control and sirolimus experimental groups (final concentration of 0.1 μmol/L) were established and cultured for 5.5 d. The quantity of T and B cells in POD14 cells was counted and the expression levels of cytokines and messenger RNA (mRNA) were quantitatively measured. Results Compared with the DMSO control group, the activity of POD14 cells was significantly decreased after sirolimus treatment at a final concentration of 0.1 and 0.5 μmol/L for 1.0 d (P<0.01-0.001). After sirolimus treatment at a final concentration of 0.1 and 0.5 μmol/L for 5.5 d, the activity of POD14 cells was significantly decreased (both P<0.001). Compared with the DMSO control group, the quantity of CD3+CD4+T cells and CD3+CD8+T cells in POD14 cells was significantly reduced after sirolimus treatment at a final concentration 0.1 μmol/L (P<0.05-0.01), whereas the quantity of CD3-CD20+B cells was considerably elevated (P<0.01). Compared with DMSO control group, the levels of interferon(IFN)-γ, interleukin(IL)-2, IL-4, IL-5 and IL-6 in the sirolimus experimental group were significantly down-regulated (P<0.05-0.001). The expression levels of IFN-γ, tumor necrosis factor(TNF)-α, IL-2, IL-4, IL-5 and IL-6 mRNA were significantly down-regulated (P<0.05-0.001). Conclusions Sirolimus inhibits the proliferation of POD14 cells in the recipient monkeys after xenotransplantation with arterial patch. The underlying mechanism is that the sirolimus can reduce the quantity of T cells and suppress the expression and secretion of immune rejection-related cytokines.

Objective To investigate the clinical distribution and antimicrobial resistance of carbapenem-resistant Enterobacteriaceae (CRE) in Dongguan.Methods CRE isolated from hospitalized patients in 22 secondary and above medical institutions which participated in bacterial monitoring in Dongguan between January 2015 and June 2016 were retrospectively analyzed,antimicrobial resistance was analyzed by WHONET 5.6 software.Results A total of 71 CRE isolates were detected,with a isolation rate of 0.34％ (71/20 713).53 strains(74.65％) of CRE were isolated from patients aged 15-60 years old;46 (64.79 ％) were from male patients;CRE were mainly isolated from patients in intensive care unit(36 strains,50.70 ％);the main specimen was sputum(34 strains,47.89 ％),followed by urine (11 strians,15.49 ％) and wound secretion(6 strains,8.45 ％);the main infection type was healthcare associated infection (64 strains,90.14 ％);CRE were mainly distributed in tertiary hospitals(56 strains,78.87 ％),the isolation rate of CRE in tertiary and secondary hospitals were 0.41 ％(56/13 677)and 0.21％(15/7 036) respectively.71 strains of CRE were all resistant to imipenem,resistance rate to meropenem was 81.12％,only amikacin and tobramycin had drug resistance rates of ＜40％ (21.38％ and 38.79％ respectively),resistance rate to trime thoprim/sulfamethoxazole was 48.23 ％,while resistance rates to fluoroquinolones,third-generation cephalosporins,and enzyme inhibitors were all＞60.Conclusion The isolation rate of CRE in Dongguan is lower than that of the whole nation and the other provinces,effective prevention and control measures should be taken according to the key population and departments that isolated CRE,antimicrobial use should be rational.

Objective To investigate the relationship between the levels of plasma adrenaline and norepinephrine and gene polymorphism of β1 adrenergic receptor G1165C in children with enterovirus 71 (EV71) infection in hand foot and mouth disease (HFMD). Methods The polymerase chain reaction (PCR) was used to detect the expression of gene polymorphism of β1 adrenergic receptor G1165C in vitro. The levels of plasma adrenaline and norepinephrine were measured by enzyme-linked immunosorbent assay (ELISA). Results The plasma norepinephrine level of severe group was significantly higher than the mild group in children with EV71 infection in HFMD (P < 0.05); however, the levels of plasma adrenaline in two groups had no statistical differences (P > 0.05); There was no significant difference in the distribution of β1 adrenergic receptor G1165C genotype and allele between EV71 infection group and healthy control group (P > 0.05). Further analysis of EV71 infection group by dividing it into mild and severe groups showed that there was no significant difference in the distribution of genotype and allele between these two groups as well (P > 0.05). There was no significant difference in the levels of epinephrine and norepinephrine in different genotypes of EV71 infection group (P > 0.05), and in the levels of plasma epinephrine and norepinephrine in the mild and severe groups (P > 0.05). Conclusions As the disease gets worse, the plasma norepinephrine level has a rising trend in children with EV71 infection in HFMD, which is an important indicator to evaluate the progress of the disease. However, the gene polymorphism of β1 adrenergic receptor G1165C have no significant correlation, not only with the susceptibility and severity of EV71 infection in hand, foot and mouth disease, but also with the levels of catecholamine.

Objective To study the disease trend of Keshan in Hubei Province and provide a basis for scientifically making control and prevention strategy.Methods According to Chinese Surveillance Plan of Keshan Disease,physical examination and electrocardiogram were done for surveillance subjects and suspected patients were filmed chest X-ray in Keshan disease areas.Results Totally 4 822 people were monitored from 2007-2014.The numbers of females (2 589,53.69％) were more than those of the males (2 233,46.31％).The group of people under the age of 15 accounted for 52.47％ (2 530/4 822) which was higher than that of the group over the age of 55 (19.14％,923/4 822).The rate of electrocardiographic abnormality was the highest in 2011 (61.33％,268/ 437) and the lowest in 2014 (5.61％,23/410).In the eight years,only potential type of Keshan disease patients were detected,and the incidences from 2007 to 2014 were all lower than 3％ and had a decreasing trend yearly.No Keshan patient was detected in 2012-2014.Ninety-one suspected cases were taken chest X-ray.Most of the suspected cases (63.74％,58/91) had normal cardiothoracic ratio.The cardiothoracic ratio increased,excepting one,other 32 were all potential type Keshan disease patients.Conclusions The disease trend of Keshan disease in Hubei Province is weak.Nevertheless,surveillance and health education are indispensable,in case the disease relapses.

BACKGROUNDThe decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS). But the gap between artery stenosis and the glomerular filtration ability is still unclear.

METHODSPatients with selective renal artery angiogram were divided by the degree of renal artery narrowing, level of estimated glomerular filtration rate (eGFR), respectively. The different levels of eGFR, renal microcirculation markers, and RAS severity were compared with each other, to determine the relationships among them.

RESULTSA total of 215 consecutive patients were enrolled in the prospective cohort study. Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50%) and no RAS group (RAS < 50%) or did not change correspondingly to RAS severity. The value of eGFR in RAS group was lower than that in the no RAS group, but it did not decline parallel to the progressive severity of RAS. The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency, especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration of eGFR, with strong (r = -0.713, P < 0.001) and moderate (r = -0.580, P < 0.001) correlations. In the subgroup analysis of severe RAS (RAS ≥ 80%), the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR, (r = -0.827, P < 0.001) and (r = -0.672, P < 0.001) correlations, respectively.

CONCLUSIONSSeverity of RAS could not accurately predict the value of eGFR, whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.

Aged ; Female ; Glomerular Filtration Rate ; physiology ; Humans ; Male ; Microcirculation ; physiology ; Middle Aged ; Prospective Studies ; Renal Artery Obstruction ; physiopathology ; Retrospective Studies

BACKGROUNDA multi-center large scale study is needed to confirm the efficacy and safety of domestic peritoneal dialysis (PD) solutions. Some researchers believe that 6 L/d is enough for adequate dialysis, but there is no multi-center prospective study on Chinese population to confirm this. In this study, we evaluated the efficacy and safety of domestic PD solution (Changfu) and its difference between 6 L and 8 L dosage.

METHODSAdult PD patients who had taken PD therapy for at least one month were selected and divided into four groups according to two dialysis solution brands and two dialysis dosages, i.e., 6 L dose with Changfu dialysis solution, 6 L dose with Baxter dialysis solution, 8 L dose with Changfu dialysis solution, and 8 L dose with Baxter dialysis solution. After 48 weeks, the changes of primary and secondary efficacy indices were compared between different types and different dosages. We also analyzed the changes of safety indices.

RESULTSChanges of Kt/V from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of creatinine clearance rate (Ccr). Normalized protein catabolic rate (nPCR) from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of net ultrafiltration volume (nUF) and estimated glomerular filtration rate (eGFR). Changes of nPCR from baseline to 48 weeks between 6 L and 8 L showed no statistical differences; so did those of nUF and eGFR. The decline of Kt/V from baseline to 48 weeks in 6 L group was more than that in 8 L group. Change of Ccr was similar. During the 48-week period, the mean Kt/V was above 1.7/w, and mean Ccr was above 50 L×1.73 m(-2)×w(-1). More adverse events were found in Changfu group before Changfu Corporation commenced technology optimization, and the statistical differences disappeared after that.

CONCLUSIONSThe domestic PD solution (Changfu) was proven to be as effective as Baxter dialysis solution. During 48-week period, a dosage of 6 L/d was enough for these patients to reach adequate PD. Clinical study promotes technological optimization, further helps to improve the safety indices of the medical products.

Adolescent ; Adult ; Aged ; Dialysis Solutions ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis ; methods ; Young Adult

Objective To analyze the prevalence rate of diabetic nephropathy (DN) and the related factors on DN among type 2 diabetic patients.Methods A total number of 1758 type 2 diabetic patients who were hospitalized in the Beijing Hospital from 2003 to 2010 were analyzed retrospectively.Three groups were divided according to the rate of urinary albumin excretion (UAER).Patients whose UAER＜20 μg/min belonged to normal albuminuria (NA) group.The ones whose UAER from 20 to 200 μ g/min belonged to microalbuminuria (MA) group,and the others whose UAER≥200 μg/min belonged to large albuminuia (LA) group.The clinical characteristics were then compared.The related factors of DN were analyzed.Results (1)There were 1246 patients in NA group,408 patients in MA group,and 104 patients in LA group.The constituent ratio of nephropathy was 29.1％ (2) The ages of NA group,MA group and LA group were (59.87± 12.77,62.52± 12.74,64.44 ± 12.74) years old,respectively,with body mass index ( BMI ) as (24.90 ± 3.42,25.53 ± 4.00,25.53 ± 3.91 )kg/m2 respectively; duration of diabetes as (8.39 ± 7.12,10.77 ± 8.02,12.84 ± 7.97)years; systolic blood pressure (SBP) as (133.42 ± 18.19,142.72 ± 20.21,151.12 ± 21.91 )mm Hg;diastolic blood pressure as (78.75 ± 10.66,80.79 ±12.21,83.33 ±13.61 )mm Hg; fasting blood suger (FBS) as (8.25±3.43,9.02±3.72,9.22±4.62)mmol/L; glycated hemoglobin(HbAlc) as (8.88±2.10,9.34 ± 2.36,9.10 ± 2.36)％ ; uric acid (UA) as (288.04 ± 90.41,307.23 ± 96.96,374.28 ±105.47) mmol/L; triglyceride as (1.72 ± 1.51,2.06 ± 1.88,1.94 ± 1.42) mmol/L,high density lipoprotein cholesterol as ( 1.08 ± 0.30,1.02 ± 0.29,1.07 ± 0.28) mmol/L; fasting insulin as (9.24 ±9.02,11.24 ± 9.74,11.06 ± 9.29) μU/ml; fasting C peptide as (462.31 ± 289.94,510.02 ± 350.08,595.93 ± 445.86) pmol/L.There were significant differences between NA,MA and LA groups in all above items ( P ＜ 0.01 or P＜ 0.05 ).( 3 ) Logistic regression analysis showed that DN were related with duration of diabetes,BMI,SBP,HbAlc,FBS,UA (OR values were 1.041,1.055,1.028,1.116,1.100,1.004 respectively,P＜0.05 or P＜0.01 ).Conclusion It would be helpful to prevent and retard progression of DN that comprehensively controlling high blood glucose,hypertension,hyperuricemia and body weight of type 2 diabetic patients.