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.

Aim To observe the effect of corticotropin-releasing factor ( CRF) -expressing neurons on presympathetic neurons in hypothalamic paraventricular nucleus ( PVN) of normotensive Wistar Kyoto ( WKY) rats or spontaneously hypertensive rats (SHR) , and to elucidate the underlying neuronal circuit mechanism of central sympathetic hyperexcitability. Methods The expression levels of CRF protein in WKY rats and SHR PVN were determined by Western blot. Meanwhile, the WKY and SHR PVN CRF-expressing neurons and presympathetic neurons were observed by immunofluo-rescent staining. Adult WKY rats and SHR were used in this study. By microinjection of Cre-dependent ade-no-associated viruses ( AAV) that specifically recognized the CRF promoter and AAV of chemogenetics into the PVN, CRF-expressing neurons expressed designer receptors exclusively activated by designer drugs (DREADDs). Human M3 muscarinic DREADD coupled to Gq receptor ( hM3 Dq) was specifically expressed in PVN CRF-expressing neurons in WKY rats, while human M4 muscarinic DREADD coupled to Gi receptor ( hM4Di) was specifically expressed in PVN CRF-expressing neurons in SHR. Clozapine-N-oxide (CNO) , as a designer ligand, would couple to excitatory hM3Dq or inhibitory hM4Di to regulate the excitability of PVN CRF-expressing neurons. Then the PVN presympathetic neurons were retrogradely labeled by microinjection of fluosecent tracer into the intermedio-lateral column (IML) of spinal cord. Lastly, whole cell patch clamp was used to determine the effect of CNO (10 jjumol L~ ) on spontaneous excitatory postsynaptic currents ( sEPSCs) and current-evoked firing of PVN presympathtic neurons of WKY rats and SHR. Results The expression of CRF protein in the PVN of SHR was significantly higher than that of WKY rats, and the activity and number of CRF-expressing neurons in the PVN of SHR were increased. PVN CRF-expressing neurons were expressed with chemogenetic DREADDs and PVN presympathetic neurons were retrogradely labeled with fluorescent tracer in WKY rats and SHR. In SHR expressed with chemogenetic inhibitory hM4Di-mCherry of PVN CRF-expressing neurons, bath application of CNO to the brain slices resulted in a significant decrease in sEPSCs frequency, but no change in their amplitude of labeled PVN presympathetic neurons. In contrast, in WKY rats expressed with excitatory hM3Dq-eGFP of PVN CRF-expressing neurons, CNO had no obvious effect on the sEPSCs frequency and amplitude in PVN presympathetic neurons. Furthermore, bath application of CNO had no significant effect on current-evoked firing of PVN presympathetic neurons of either WKY rats with hM3Dq-eGFP expression in CRF neurons or SHR with hM4Di-mCherry expression in CRF neurons. Conclusions The activity and number of PVN CRF-expressing neurons are increased in SHR, and CRF-expressing neurons enhance the excitability of presympathetic neurons, which acts as a regulatory neuronal microcircuit between CRF neurons and presympathetic neurons in the PVN.

Estrogen impacts neural development; meanwhile, it has a protective effect on the brain. Bisphenols, primarily bisphenol A (BPA), can exert estrogen-like or estrogen-interfering effects by binding with estrogen receptors. Extensive studies have suggested that neurobehavioral problems, such as anxiety and depression, can be caused by exposure to BPA during neural development. Increasing attention has been paid to the effects on learning and memory of BPA exposure at different developmental stages and in adulthood. Further research is required to elucidate whether BPA increases the risk of neurodegenerative diseases and the underlying mechanisms, as well as to assess whether BPA analogs, such as bisphenol S and bisphenol F, influence the nervous system.
Receptors, Estrogen/metabolism* ; Estrogens ; Benzhydryl Compounds/pharmacology* ; Nervous System/metabolism*

Objective:To explore the medical costs and influencing factors of patients diagnosed with Brucellosis in Xinjiang Uygur Autonomous Region (Xinjiang).Methods:Information on demographics, medical visits, and costs of patients diagnosed with Brucellosis were collected between January 1,2017 and December 31,2019. The effects of different genders, age groups, clinical stages, and comorbidities on patients' health care utilization and medical costs were analyzed by nonparametric tests. The median was used to describe the outpatient and inpatient costs of patients with Brucellosis.Results:A total of 13 532 patients (8 113 outpatient and 5 419 inpatient cases) were included in the analysis. A total of 67.8% (9 176/13 532) were male, with an average age of (42.7±15.4 ) years; age between 18-44 years (46.6%, 6 304/13 532) and 45-59 years (34.2%,4 622/13 532) were the dominant groups. The mean age of inpatients [(43.3±15.7) years] was higher than that of outpatients [(42.3±15.1) years, Z=-3.85, P<0.001]. When hospitalized patients are treated,systemic symptoms were common with fever (36.9%, 1 997/5 419) and fatigue (36.6%, 1 983/5 419), and with joint/muscle pain (68.9%, 3 735/5 419) being the highest proportion of local symptoms. A total of 79.1% (4 289/5 419) of inpatients were diagnosed with acute Brucellosis. A total of 46.5% (2 519/5 419) of inpatients had complications;skeletal system complications ranked the highest. The average number of outpatient visits per outpatient was (1.6±1.4) times. The duration of hospitalization was (11.3±4.2) days, with longer days for patients in the chronic phase and with complications ( P<0.05). A total of 89.3% (4 840/5 419) of inpatients had outpatient records in the same year,and the average number of outpatient visits per patient was (3.6±2.6) times. Outpatient medical costs were dominated by laboratory and drug costs (75.1%), and inpatient costs were dominated by drug, laboratory, and other costs (74.4%). Outpatient medical expenses M( Q1, Q3) were 61(52, 497) Yuan, 61 (51, 346) Yuan and 58 (46, 318) Yuan,respectively. Inpatients' medical expenses M ( Q1, Q3) were 8 214 (6 355, 10 721) Yuan,9 095 (7 018, 12 155) Yuan and 9 492 (7 530, 12 351) Yuan, respectively. For patients, age, clinical stages,complications,and joint/muscle pain symptoms were influential factors for hospitalization costs ( P<0.001). Conclusions:The economic burden was higher for inpatients, especially those in the high age group, with chronic phases and skeletal and neurological complications. Improving patients' awareness of early treatment, standardized treatment, and reducing chronicity and complications are the main points in reducing the economic burden caused by Brucellosis diagnosis and treatment.

Objective:To analyze the compatibility rules of prescriptions containing Forsythiae Fructus based on data mining and explore the anti-inflammatory mechanism of Forsythiae Fructus based on network pharmacology，so as to provide reference for the rational clinical application of Forsythiae Fructus and the development of health foods and new Chinese medicines. Method:The prescriptions containing Forsythiae Fructus in the Dictionary of Traditional Chinese Medicine Prescriptions were collected，based on which a clinical prescription database was constructed. The Chinese herbs combined with Forsythiae Fructus and the corresponding indications were subjected to frequency statistics，association rule analysis，and complex network analysis using SPSS Statistics 26，IBM SPSS Modeler 18.0，and Gephi 9.2. The active components and targets of Forsythiae Fructus for anti-inflammation were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP），BATMAN-TCM，and SEA，and the targets related to anti-inflammation from GeneCards，Online Mendelian Inheritance in Man （OMIM），CTD，and GenCLiP3. Following the analysis of protein-protein interactions （PPI） with STRING，a PPI network was constructed. The enrichment analysis was performed using Metascape，and the active component-anti-inflammation target-signaling pathway network of Forsythiae Fructus was constructed by Cytoscape 3.8.2. Result:According to the inclusion and exclusion criteria，2 245 prescriptions containing Forsythiae Fructus were harvested，involving 512 Chinese herbs，with a total usage frequency of 27 314. The Chinese herbs that were most frequently combined with Forsythiae Fructus （>800 times） were Glycyrrhizae Radix et Rhizoma （1 483 times），Scutellariae Radix （964 times），and Angelicae Sinensis Radix （842 times）. Hence，the herbal pairs "Forsythiae Fructus-Scutellariae Radix" and "Forsythiae Fructus-Angelicae Sinensis Radix" were further explored. The prescriptions containing Forsythiae Fructus could be utilized for the treatment of 29 kinds of diseases，and three representative disease categories including "carbuncle，gangrene，sores and ulcers"，"ophthalmic diseases and syndromes" and "epidemic diseases" are selected for data mining. There were 19 association rules obtained with "Forsythiae Fructus-Glycyrrhizae Radix et Rhizoma-Lonicerae Japonicae Flos-Angelicae Sinensis Radix" as the core herb combination for "carbuncle，gangrene，sores and ulcers". The clustering analysis revealed one multi-herb clustering group，four herbal pairs，and single herb Lonicerae Japonicae Flos，the complex network analysis four herbal modules，and the factor analysis six common factors. There were 23 association rules obtained with "Forsythiae Fructus-Glycyrrhizae Radix et Rhizoma-Scutellariae Radix-Angelicae Sinensis Radix" as the core herb combination for "ophthalmic diseases and syndromes". The clustering analysis revealed two multi-herb clustering groups and four herbal pairs，the complex network analysis four herbal modules，and the factor analysis five common factors. There were 28 association rules obtained with "Forsythiae Fructus-Glycyrrhizae Radix et Rhizoma-Menthae Haplocalycis Herba-Lonicerae Japonicae Flos" as the core herb combination for "epidemic diseases". The clustering analysis revealed three multi-herb clustering groups，one herbal pair，and two single herbs Forsythiae Fructus and Glycyrrhizae Radix et Rhizoma，the complex network analysis four herbal modules，and the factor analysis five common factors. As demonstrated by network pharmacology-based analysis，the core anti-inflammation components of Forsythiae Fructus were quercetin，luteolin，and kaempferol，and the core targets were phosphoinositide-3-kinase regulatory subunit 1 （PIK3R1），protein kinase B 1 （Akt1），and epidermal growth factor receptor（EGFR）. The biological pathways were mainly concentrated in proteoglycans in cancer，pathways in cancer，and PI3K/Akt signaling pathway，with such functions as inhibition of transcription factors，regulation of enzyme activity，and inflammation-related gene expression involved. Conclusion:This study employed a variety of data mining techniques to objectively，intuitively，and scientifically uncover the compatibility rules of Forsythiae Fructus in the treatment of high-frequency diseases. It has been found that Forsythiae Fructus is often combined with heat-clearing herbs，tonifying herbs，exterior-releasing herbs，and blood-activating and stasis-resolving herbs for diverse diseases and syndromes. Under the premise of clearing heat and removing toxin，reinforcing healthy Qi and dredging stagnation are also emphasized. According to the degree of internal heat exuberance，the heat-clearing herbs with different merits are combined. This study has revealed the unique advantages of Forsythiae Fructus in the treatment of specific diseases and syndromes as well as its multi-component，multi-target，and multi-pathway mechanisms in anti-inflammation，breaking through the limitations in modern clinical and experimental research of Forsythiae Fructus. These findings are of great significance for guiding the rational clinical application of Forsythiae Fructus and the development of health foods and new Chinese medicines，thus better accelerating the development of Chinese medicine health industry.

Objective:To analyze the clinical and pathological features and gene mutations of pancreatic acinar cell carcinoma (PACC).Methods:Clinical data of 34 patients with PACC admitted to the Department of Pancreatic Surgery of the First Affiliated Hospital of Naval Medical University from December 2009 to July 2018 were retrospectively analyzed to summarize its clinical characteristics, and the expressions of α1-ACT, CaM5.2, Syn and CgA in pancreatic tumor tissues were detected by immunohistochemistry. Next-generation gene sequencing technology was used to detect gene mutations in tumor specimens.Results:Among the 34 PACC patients, 23(68%) were males and 11(32%) were females; the age ranged from 25 to 75 years, with an average age of 54 years. The first symptom was abdominal pain or distension in 21 cases (62%), skin or scleral yellow staining in 4 cases(12%), and 9 cases(26%) were found in routine physical examination. BMI was 17.6-34.0 kg/m 2, of which 3 cases (9%) were <18.5 kg/m 2, 23 cases (68%) were 18.5-24.0 kg/m 2, and 8 cases (23%) were >24.0 kg/m 2. Preoperative examination showed elevated CA19-9 in 7 cases (20.6%), elevated CEA in 3 cases (8.8%), and elevated AFP in 7 cases (20.6%). Blood amylase was 16-247 U/L, with an average of 80 U/L. Enhanced CT showed that the lesion was irregular in shape, showing inhomogeneity and slightly low density, with areas of cystic degeneration and necrosis. The tumor was located in the head of the pancreas in 14 cases (41%), the body and tail of the pancreas in 19 cases (56%), and the neck of the pancreas in 1 case (3%). The largest tumor diameter was 1.5-15.5 cm, with an average of 5.4 cm. Postoperative pathologic stage I was confirmed in 4 cases (12%), stage Ⅱ in 14 cases (41%), stage Ⅲ in 14 cases (41%) and stage Ⅳ in 2 cases (6%). Immunohistochemical results showed that both α1-ACT and CaM5.2 were positively expressed (100%). Syn was positive in 8 cases (23.5%) and CgA was positive in 6 cases (17.6%). Ki-67 index was from 9% to 70%, with an average of 41%. Gene sequencing of pancreatic tumor tissue from 6 patients showed BRCA2 mutation in 2 patients (7155C>G), K-ras mutation in 1 patient (35G>T), RET mutation in 1 patient (200G>A), and LKB1 mutation (234G>T) in 1 patient, and one double mutation of K-ras and RET (35G>A, 1 798C>T). 30 patients were followed up, and the median survival was 38.3 months. Conclusions:PACC was a rare pancreatic tumor with no specific clinical manifestations. The positive expression rates of α1-ACT and CAM5.2 in tumor tissues were 100%. BRCA2, K-ras, RET and LKB1 were common gene mutations.

OBJECTIVES: This study aims to investigate the diagnostic value of peripheral blood circulating tumor cells (CTCs) in oral squamous cell carcinoma (OSCC) and its correlation with the clinicopathological features of OSCC. METHODS: Ninety-three patients diagnosed as OSCC in the First Affiliated Hospital of Zhengzhou University from May 2019 to May 2020 were selected as the experimental group, and 20 healthy volunteers were employed as the control group. The CTCs value of peripheral blood of the patients were measured by CTCs detection technology, and its clinical significance was analyzed. RESULTS: The CTCs values in the experimental group were higher than those in the control group, and the difference was statistically significant ( CONCLUSIONS Peripheral blood CTCs has important clinical value for early screening, auxiliary diagnosis, evaluation of metastasis, and determination of malignant degree, progression, and pathological grade of OSCC and a relatively reliable tumor detection indicator.
Carcinoma, Squamous Cell/diagnosis* ; Head and Neck Neoplasms ; Humans ; Mouth Neoplasms/diagnosis* ; Neoplastic Cells, Circulating ; Squamous Cell Carcinoma of Head and Neck

OBJECTIVE: To Establish the shielding threshold value of TP antibody ELISA for unpaid blood donors, so as to shield true positive blood donors from returning to team management. METHODS: The real serological status of 517 samples with anti-TP ELISA reactivity was determined by confirmation test of Treponema pallidum particle agglutination (TPPA). The shielding threshold of TP antibody was preliminarily determined by using 99% specificity of ROC and 95% positive predictive value of percentile method, respectively. 283 TP antibody reactivity specimens routinely tested in our laboratory were selected to determine the applicability of the initial shielding values obtained by the two methods, and finally to determine the shielding threshold values of TP antibody donors. RESULTS: The specific S/CO values of reagent A 99% were 13.33-16.18, that of reagent B 99% was 6.34, that of reagent B 99% was 13.17-19.85, and that of 95% was 6.62. Empirical evidence: 99% specific threshold shielding true positive rates of reagents A and B were 100%, 95% positive expected value shielding true positive rates were 98.4%, 99%. Final determination of 99% specific shielding threshold as a low value of blood donors shielding threshold. The shielding limits of reagent A and B were 13.33 and 13.17. CONCLUSION The shielding threshold of TP antibody ELISA for blood donors established in this study can help to reduce the number of blood donors returning to team management.
Blood Donors ; Enzyme-Linked Immunosorbent Assay ; Humans ; Syphilis ; Syphilis Serodiagnosis ; Treponema pallidum

Objective: To analyze the quantitative features of coronary plaque and evaluate its diagnostic performance for myocardial ischemic injury in patient with coronary artery disease. Methods: Retrospectively enrolled 109 patients with suspected coronary artery disease, who successively underwent coronary CT angiography(CCTA) and coronary angiography in Shandong Provincial Hospital from June 2018 to September 2019. Elevated myocardial enzyme with segmental wall motion abnormalities (SWMA) in ultrasound was defined as myocardial ischemic injury, with which the subjects were divided into two groups, with and without myocardial ischemic injury (n=75,34) respectively. CCTA images of each target vessel were quantitatively analyzed by automated plaque analysis software to obtain the following indexes: minimal lumen area(MLA), plaque length(PL), total plaque volume(TPV), total plaque burden(TPB),calcified plaque volume(CPV), calcified plaque ratio(CPR), fibrous plaque volume(FPV), fibrous plaque ratio(FPR), lipid plaque volume(LPV), lipid plaque ratio(LPR), napkin-ring sign(NRS), spotty calcification(SC), remodeling index (RI) and eccentric index (EI). Chi-square, Mann-Whitney U tests, logistic regression and area under the receiver operating characteristics were determined. Results: For the degree of coronary artery stenosis, MAS% was 85.00% (80.00%, 92.00%) and 63.00% (60.00%, 65.00%) in myocardial ischemic group and without myocardial ischemic injury group, which was statistically significant (Z=-4.32, P=0.001). For the quantitative plaque features, TPV 150.13 (104.44,202.20) mm³, TPB (75.67%±9.90%), FPV 95.73 (66.57, 134.23)mm³, LPV 32.18 (18.93,54.55) mm³, LPR (25.13%±13.71%) in the group with myocardial ischemic injury were larger than those in group without myocardial ischemic injury 109.94 (79.39, 121.67) mm³, 65.37%±6.94%, 67.35 (57.67, 90.11) mm³, 16.64 (13.26, 24.73) mm³, 18.44%±7.09% respectively with statistically significant (Z=-2.59, P=0.010; t=3.11, P=0.003; Z=-2.16, P=0.031; Z=-2.18, P=0.029; t=2.19, P=0.037). In logistic regression analysis, MAS%(OR=1.55,P=0.021) was independent significant predictors of myocardial ischemic injury. The AUC of MAS%, LPV, LPR, TPV, TPB, FPV were 0.84, 0.82, 0.77, 0.72, 0.74, 0.67, respectively, which were all statistically significant (P<0.05). Conclusions In quantitative plaque analysis by coronary CT angiography, MAS%, TPV, TPB, FPV, LPV, LPR were affecting factors of myocardial ischemic injury, in which MAS% was independent predictors. MAS% and LPV have higher diagnostic accuracy in myocardial ischemic injury.

As a new direction of pancreatic cancer treatment, neoadjuvant therapy for pancreatic cancer has been confirmed to be able to improve the prognosis of the patients. Under multidisciplinary treatment (MDT) mode, neoadjuvant therapy combines multidisciplinary advantages to solve patients′ problems of diagnosis and treatment, provides accurate, comprehensive and individual treatments, and maximizes the clinical benefit for patients. In this article, we summarize the present problems of neoadjuvant therapy for pancreatic cancer in patient selection, treatment regimen selection, treatment response evaluation and surgical selection, and explore the direction of clinical research and neoadjuvant therapy for pancreatic cancer under MDT mode.