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.

Coronary artery disease (CAD) is a chronic disease but causes the highest mortality and morbidity among the cardiovascular diseases worldwide. Correlations between CAD and gut microbiota have been observed. This suggests that the gut microbiota could become a vital diagnostic marker of CAD, and restoring the gut habitat may become a promising strategy for CAD therapy. The elevated level of trimethylamine-N-oxide (TMAO), a gut microbiota-derived metabolite, was found to be associated with the increased risk of cardiovascular disease and the all-cause mortality. Preclinical studies have shown that it has pro-arteriosclerosis properties. It is likely that regulating the production of TMAO by gut microbiota may become a promising strategy for anti-atherosclerosis therapy. This review summarizes the clinical and preclinical researches on the intervention of CAD by regulating the gut microbiota and the microbiota-derived metabolite TMAO, with the aim to provide new target for the therapy of CAD.
Coronary Artery Disease ; Gastrointestinal Microbiome ; Humans ; Methylamines ; Oxides

Objective:To analyze the pathological patterns, clinical features, and prognosis in patients with human immunodeficiency virus (HIV) infection complicated with kidney disease.Methods:A retrospective analysis of 21 renal damage cases in HIV-infected patients undergoing renal biopsy from June 2016 to November 2019 in Shanghai Public Health Clinical Center, Fudan University was conducted. The clinical features, renal pathological patterns, therapies and outcomes were summarized and analyzed.Results:The age of 21 patients was (45.4±11.0) years. There were 19 men and two women. The CD4 + T lymphocyte count was (473.7±218.4) cells/μL. The HIV RNA levels were measured in 20 patients, and 13 cases (65.0%) were less than 40 copies/mL. A total of 18 cases (85.7%) had initiated antiretroviral therapy before renal biopsy, and the treatment time was 12 (1, 47) months. As for the clinical diagnosis, 14 cases (66.7%) were nephrotic syndrome and seven cases (33.3%) were nephritic syndrome. Renal pathology reports showed that HIV immune-complex kidney disease was the most common pathology pattern, accounting for 42.9% (9/21), followed by podocytopathy and diabetic nephropathy, both accounting for 23.8% (5/21), respectively. The IgA nephropathy (23.8%, 5/21) was the most common subtype of HIV immune-complex kidney disease, while minimal change disease (19.0%, 4/21) was the most common one of podocytopathy. However, classic HIV-associated nephropathy was not found in the study. The follow-up period was (12.5±9.2) months. During this period, the nephropathy conditions of nine patients were improved, eight were stable, two deteriorated, and two died. Conclusions:IgA nephropathy, minimal change disease and diabetic nephropathy are the top three patterns of renal pathology in patients with HIV infection. Most cases have good prognosis after treatments. For HIV-infected patients with serious renal damage, timely kidney biopsy is vital to determine pathological pattern, and to subsequently guide the clinical treatment and evaluate the prognosis.

Alkali-salinity exerts severe osmotic, ionic, and high-pH stresses to plants. To under-stand the alkali-salinity responsive mechanisms underlying photosynthetic modulation and reactive oxygen species (ROS) homeostasis, physiological and diverse quantitative proteomics analyses of alkaligrass (Puccinellia tenuiflora) under Na2CO3 stress were conducted. In addition, Western blot,real-time PCR, and transgenic techniques were applied to validate the proteomic results and test the functions of the Na2CO3-responsive proteins. A total of 104 and 102 Na2CO3-responsive proteins were identified in leaves and chloroplasts, respectively. In addition, 84 Na2CO3-responsive phospho-proteins were identified, including 56 new phosphorylation sites in 56 phosphoproteins from chloro-plasts, which are crucial for the regulation of photosynthesis, ion transport, signal transduction, and energy homeostasis. A full-length PtFBA encoding an alkaligrass chloroplastic fructose-bisphosphate aldolase (FBA) was overexpressed in wild-type cells of cyanobacterium Synechocystis sp. Strain PCC 6803, leading to enhanced Na2CO3 tolerance. All these results indicate that thermal dissipation, state transition, cyclic electron transport, photorespiration, repair of pho-tosystem (PS) Ⅱ, PSI activity, and ROS homeostasis were altered in response to Na2CO3 stress, which help to improve our understanding of the Na2CO3-responsive mechanisms in halophytes.

Objective:To investigate the clinical characteristics and causes of serotonin syndrome induced by tramadol in order to provide references for rational drug use in clinical practice. Methods:The relevant literatures published in domestic medical journals from the building of database to 2016 were retrieved in PubMed, EMbase, CNKI and WanFang database and statistically analyzed in respects of types and relevance evaluation of adverse drug reactions, the age and gender distribution of patients, the application of drugs,occurrence time of serotonin syndrome,clinical manifestations,treatment and outcome. Results:A total of 21 cases of seroto-nin syndrome induced by tramadol were collected. Totally 19 cases were caused by combined drug use, among which 12 cases were combined with selective serotonin reuptake inhibitors. The results of relevance evaluation showed 19 cases of possible relevance and 2 cases of probable relevance. Totally 10 cases of severe adverse drug reactions were reported and 11 cases of common adverse drug reac-tions were exhibited. One patient was heterozygous for CYP2D6 polymorphisms(CYP2D6?1/?4) causing decreased metabolizing a-bility to tramadol. Totally 28.6% of patients developed symptoms in 24h after the addition of new serotonergic agents or increase the dosage of serotonergic agents. In most cases,the patients' syndrome resolved with discontinuation of at least one serotonergic drug and symptomatic treatment,usually in less than one week. Conclusion:When prescribing tramadol,physicians should be aware of seroto-nin syndrome induced by drug-drug interactions and possible pharmacogenetic factors. It is important that safety monitoring should be carried out in patients during the application of drugs to reduce the harm of adverse drug reactions.

Objective To compare the efficacy of four different methods to locate tracheal tube in the tracheal:modified transillumination method,21/23 cm rule,marked the intubation at a distance,and fiberoptic bronchoscope.Methods A prospective randomized controlled trial was conducted.120 endotracheally intubated adult patients with American Society of Anesthesiologists (ASA) classification Ⅰ-Ⅱ and admitted to Central Hospital of Fengxian in Shanghai from January to March 2015 were enrolled.The patients were randomly divided into four groups (n =30) and located by 21/23 cm rule,marked the intubation at a distance,fiberoptic bronchoscope and modified transillumination method (using homemade locator guided by a red laser fiber to position the depth of tube) respectively.An endotracheal tube was inserted and measured the distance of the tube tip to the carina (TTC),vocal cords to tracheal tube cuff (VC-TC) in three different neck positions,i.e.neck in flexion,neutral,and extension position.The number of improper position in four groups was recorded.Results There were no significant differences in gender,age,and body mass index among the four groups.Six of the 30 patients using marked tracheal tuba method failed to find vocal cords with laryngoscope,while the other three methods all completed successfully.① From neck flexion to extension,TTC was gradually increased,while VC-TC was gradually decreased.In neck flexion and extension positions,TTC distance in the 21/23 cm rule group was significantly shorter than that in the fiberoptic bronchoscope group (cm:1.44 ± 1.14 vs.2.11 ±0.54,3.01 ±1.18 vs.3.80±0.71,both P ＜ 0.05),and the distance was also shorter than that in modified transillumination method group (cm:1.44 ± 1.14 vs.1.93 ± 0.81,3.01--1.18 vs.3.45 ± 0.91,both P ＞ 0.05).VC-TC distance in the 21/23 cm rule group was significantly longer than that in the modified transillumination,the marked intubation,and the fiberoptic bronchoscope groups in neck neutral and extension positions,respectively (cm:3.07 ± 1.08 vs.2.28±0.76,2.29±0.90,2.49±0.86;2.64±0.94 vs.1.82±0.72,1.81-0.94,2.02±0.91,all P ＜ 0.05).TTC and VC-TC distances in three neck positions in the modified transiflumination group were shorter than those in the fiberoptic bronchoscope group without statistical significance.② If TTC was too short,an accidental bronchus intubation could happen,while if VC-TC was too short,an accidental damage of the vocal cord inducing by the cuff press could happen.In the 21/23 cm rule group,there were 7 cases that the tube wrongly inserted to bronchus in neck flexion,and 1 case in neutral and extension positions respectively.In the marked intubation group,there were 4 cases that the tube wrongly inserted into bronchus in neck flexion,and 1 case in neck neutral position,and there were 4 cases that the vocal cords were pressed by the cuffs in extension position.In the modified transillumintion and the fiberoptic bronchoscope groups,there was only 1 case that the tube wrongly inserted to bronchus in neck flexion respectively.Conclusions When neck position changed during trachea intubation,it was easier that the tube wrongly inserted to bronchus for 21/23 cm rule method to locate the position.Bronchus intubations and cuff press vocal cords could happen using the marked tube method,which was less be found using modified transillumination or fiberoptic bronchoscope methods.Finally,the modified transillumination methods can be used to locate with satisfactory effect.

OBJECTIVE:To study the induction effect of paeoniflorin on the apoptosis of lung adenocarcinoma A549 cells. METHODS:MTT method was used to detect the viability of A549 cells 48 h after the cells were cultured with paeoniflorin of 0 (negative control),5,10,20 and 40μmol/L. 24 h after A549 cells were cultured with paeoniflorin at the above-mentioned concen-trations,enzyme-linked immunosorbent assay was employed to detect the viability of cysteinyl aspartate specific proteinase 3(Cas-pase-3),and Western blot to determine the protein expression of Bcl-xl,Bax,nuclear factor κB p65(NF-κB p65)and phosphory-lated nuclear factorκB p65(NF-κB pp65). RESULTS:Compared to the negative control group,A549 cells cultured with paeoniflo-rin of 5-40 μmol/L for 48 h showed lower cell viability;A549 cell cultured with paeoniflorin of 5-40 μmol/L for 24 h showed high-er activity of Caspase-3 and the expression of Bax;A549 cell cultured with paeoniflorin of 10-40 μmol/L for 24 h showed lower protein expression of Bcl-xl and NF-κB pp65. There were statistically difference(P<0.01 or P<0.05). CONCLUSIONS:Paeoni-florin induces the apoptosis of A549 cells by a mechanism which may be related to the activation of NF-κB signaling pathway and regulation related gene expression.

ObjectiveTo evaluate the effect of auscultation, partial pressure of carbon dioxide in end-expiration (PETCO2), transillumination technique to judge whether the endotracheal tube is misplaced into the esophagus. Methods A blinded randomized controlled trial was conducted. Sixty patients with American Society of Anesthesiology (ASA) gradeⅠ-Ⅱundergoing endotracheal intubation in Fengxian Central Hospital admitted from September 2014 to February 2015 were enrolled. Two endotracheal tubes with the same size were respectively inserted into the trachea and esophagus for the same depth after general anesthesia by the same person. Two blinded anesthetists with different experience checked the tube position using three methods including auscultation, PETCO2, and transillumination technique, respectively. The order of the tubes tested (trachea or esophagus) and the method used were randomized according to randomise numbers table. The experienced anesthetists conducted the test first, followed by an inexperienced anesthetist conducting the same methods. The numbers of right and wrong determinations with different methods by different anesthetists were recorded.Results Sixty patients underwent the procedures for 180 times, with intratracheal intubation for 90 times, and esophageal intubation for 90 times. It was shown that the results were not different in two groups [96.7% (174/180) vs. 92.2% (166/180),χ2 = 3.500,P = 0.057]. By using auscultation, the correct rate of experienced anesthetist was higher than that of inexperienced (95.0% vs. 78.3%,χ2 = 5.786,P = 0.013). Using PETCO2, both anesthetists were correct in all cases, and the accuracy was 100%. Using transillumination, the experienced anesthetist was mistaken in 3 cases (accuracy was 95.0%), while the inexperienced mistook in 1 case (accuracy was 98.3%), and no significant difference was found between two groups (χ2 = 0.500,P = 0.250). The correct rate of using transilluminaion was significantly higher than that of using auscultation (χ2 = 7.563,P = 0.004). The sensitivity and specificity of the auscultation was 70.0% and 80.0%, that of transillumination technique was 96.7% and 93.3%,and PETCO2 was 100%, respectively, for two groups.ConclusionsPETCO2 is the most reliable method for determining tube position, and it is superior to auscultation and transilluminaion. Transillumintaion technique is superior to auscultation, irrespective of anesthetists' experience, while the accuracy of auscultation showed an obvious relationship with the anesthetists' experience.

Objective To compare the dosimetric differences of fixed field intensity-modulated radiation therapy(IMRT),volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC) patients.Methods Eighteen NPC patients previously treated with VMAT were retrospectively included and re-planned using HT and IMRT (7 fields) techniques utilizing the same dose prescription and optimization objectives.The following parameters were compared across the three types of plans:homogeneity index (HI),conformity index (CI),maximum dose (Dmax) and mean dose (Dmean) of targets ; the Dmax and Dmean of organs at risk (OARs) ; the doses and volumes of volume of interest; the treatment delivery time and monitor units (MU).Results Clinically acceptable target coverage could be achieved by IMRT,VMAT and HT plans.The HT plans were the best yet IMRT plans were the worst in HI and CI of targets.IMRT imposed highest doses to OARs while HT deposited least doses to the spinal cord,brainstem and parotid.However,the VMAT plans displayed the lowest doses on optic nerves,chiasma and lens while highest doses were found in IMRT plans.The average delivery time per fraction of IMRT (8.0±0.5) min were more than that of HT (7.4 ±0.9) min and VMAT (3.9 ±0.1) min plans.The MUs of IMRT plans (711.4 ±78.7) were larger than that of VMAT plans (596.4 ±33.7).Conclusions Three types of plans can all achieve the clinical dosimetric demands,but HT has the best performance on CI and HI.VMAT is most efficient regarding the delivery time and total MUs.