There has been a growing amount of evidence that a balanced blood component transfusion with roughly equal ratio of units of packed red blood cells,fresh frozen plasma,and platelets leads to better outcomes in massive transfusion re-suscitation of trauma victims.Therefore,the great interest of massive transfusion protocol(MTP)with whole blood was a-roused.Low titer group O whole blood(LTOWB)is implemented in routine use for civilian prehospital ambulance services in large trauma centers of most European and American countries nowadays.There is a growing body of evidence to date to support that early use of LTOWB in patients with life-threatening bleeding improve their survival.In view of the current situ-ation of whole blood supply in our country,most trauma resuscitation guidelines still recommend balanced component trans-fusion for MTPs in the early stage of resuscitation.The research and application of LTOWB abroad will be introduced in this article.

Objective To explore the mechanisms of Buyang Huanwu Decoction(BYHWD)in reducing oxidative stress levels to protect the blood-brain barrier(BBB)in cerebral ischemia/reperfusion injury(CIRI)rats.Methods A middle cerebral artery occlusion/reperfusion(MCAO/R)model in rats was established via wire embolization method.PeriCam PSI laser speckle flow imaging was applied to detect whether the model was successfully established.Neurological deficits in the rats were evaluated by Zea Longa score,and histopathological changes in the rat brain were observed by HE staining.The degree of brain edema was detected by the dry and wet weight method.BBB permeability was detected by Evans blue staining,and ultrastructural changes to the BBB were observed by transmission electron microscopy.The levels of ROS,MDA and SOD activities,which are related to oxidative stress,were detected using kits.The expression levels of matrix metalloproteinase-9(MMP-9)were detected by immunohistochemical staining and Western blot.The expression levels of Occludin,ZO-1,and Claudin-5 tight junction proteins were determined via immunofluorescence and Western blot.Results BYHWD reduced neurological deficit scores,alleviated brain histopathological damage,alleviated BBB structural disruption,prolonged the appearance of dense regions in the tight junction structure,attenuated edema of the brain on the ischemic side,and reduced BBB permeability in MCAO/R rats.BYHWD decreased the levels of ROS and MDA,increased the activity of SOD,decreased the expression levels of MMP-9,and increased the expression levels of Occludin,Claudin-5 and ZO-1.Conclusions BYHWD can increase BBB tight junction protein expression levels,reduce the permeability of the BBB,protect the ultrastructure of the BBB,and reduce brain edema,and its mechanisms may be related to its antioxidant activity and inhibition of MMP-9 activation.

Objective To investigate the differences in the influencing factors for acute necrotizing pancreatitis (ANP) and infectious pancreatic necrosis (IPN) between Eastern and Western countries, and to provide a theoretical basis for the prediction and prevention of ANP. Methods Databases including PubMed, Embase, the Cochrane Library, and Web of Science were searched for articles on the influencing factors for ANP and IPN published up to January 21, 2021, and a Meta-analysis was performed. Results A total of 59 studies were included, with 22 studies from Eastern countries and 37 studies from Western countries.The Meta-analysis showed that in Eastern countries, male sex (odds ratio[ OR ]=1.51, 95% confidence interval[ CI ]: 1.18-1.91, P < 0.01), C-reactive protein (CRP)(standardized mean difference[ SMD ]=1.39, 95% CI : 1.06-1.71, P < 0.01), D-dimer ( SMD =0.44, 95% CI : 0.07-0.81, P =0.02), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score (mean difference[ MD ]=3.51, 95% CI : 1.38-5.64, P < 0.01), alcoholic etiology ( OR =3.57, 95% CI : 2.68-4.75, P < 0.01), and biliary etiology ( OR =0.60, 95% CI : 0.46-0.77, P < 0.01) were the influencing factors for ANP, and in Western countries, male sex ( OR =1.63, 95% CI : 1.30-2.05, P < 0.01), CRP ( SMD =2.09, 95% CI : 1.12-3.05, P < 0.01), APACHE-Ⅱ score ( MD =4.28, 95% CI : 2.73-5.83, P < 0.01), Ranson score ( MD =2.99, 95% CI : 2.50-3.47, P < 0.01), and organ failure ( OR =10.87, 95% CI : 2.62-45.04, P < 0.01) were the influencing factors for ANP.In Eastern countries, age ( MD =2.16, 95% CI : 0.43-3.89, P =0.01), body mass index (BMI)( MD =1.74, 95% CI : 1.23-2.25, P < 0.01), albumin level ( SMD =-0.43, 95% CI : -0.75 to-0.12, P < 0.01), CRP ( SMD =0.58, 95% CI : 0.04-1.11, P =0.03), procalcitonin ( SMD =0.80, 95% CI : 0.56-1.04, P < 0.01), D-dimer ( MD =0.23, 95% CI : 0.15-0.31, P < 0.01), APACHE-Ⅱ score ( MD =2.47, 95% CI : 0.73-4.22, P < 0.01), Ranson score ( MD =1.60, 95% CI : 1.46-1.73, P < 0.01), and extent of necrosis ≥30%( OR =2.52, 95% CI : 1.26-5.06, P < 0.01) were the influencing factors for IPN, while in Western countries, age ( MD =4.07, 95% CI : 1.82-6.31, P < 0.01), APACHE-Ⅱ score ( MD =3.28, 95% CI : 1.39-5.17, P < 0.01), Ranson score ( MD =2.18, 95% CI : 1.75-2.62, P < 0.01), SIRS score ( OR =3.88, 95% CI : 1.58-9.51, P < 0.01), alcoholic etiology ( OR =0.61, 95% CI : 0.42-0.87, P < 0.01), and organ failure ( OR =3.63, 95% CI : 1.11-11.92, P =0.03) were the influencing factors for IPN. Conclusion Current evidence shows that biliary etiology and alcoholic etiology are unique influencing factors for ANP in the Eastern population, while Ranson score is a unique influencing factor in the Western population.BMI and extent of necrosis ≥30% are unique influencing factors for IPN in the Eastern population, while alcoholic etiology is a unique influencing factor in the Western population.

Objective : To analyze interacting proteins of tropomodulin1 (TMOD1 ) in Raw264．7 mouse monocyte macrophage line by mass spectrometry and GeneCards database． Methods : Immunoprecipitation combined with mass spectrometry was used to find interacting proteins of TMOD1 after overexpress TMOD1 in Raw264．7 cells. GeneCards database was used to search for known genes for macrophage migration．Bioinformatics ＆ Systems Biolo- gy was used to analyze correlation between known targets and mass spectrometry proteins to find common differenti- ally expressed proteins( CO-DEPs) ．WoLF PSORT was used to predict subcellular localization of CO-DEPs．Egg- NOG databasewas used to analyze eukaryotic orthologous group(KOG) of CO-DEPs．DAVID database was used to analyze gene ontology( GO) enrichment kyoto encyclopedia of genes and genomes( KEGG) pathway of CO-DEPs. String database was used to analyze protein interaction network and CytoScape software drawing. Results : There were 41 CO-DEPs in mass spectrometry and GeneCards database．Subcellular localization of CO-DEPs was mainly distributed in cytoplasm，nucleus and mitochondria．KOG notes were mainly O : post-translational modification，Z : cytoskeleton and J : translation．GO enrichment found that CO-DEPs was mainly involved in poly (A) RNA bind- ing，protein folding and focal adhesion．KEGG was mainly enriched in arrhythmogenic right ventricular cardiomyop- athy (ARVC) and tight junction．ACTB was a protein with large protein interaction． Conclusion The proteins in- teracting with TMOD1 in macrophages mainly include myosin heavy chain-9 (MYH9) ，α-actinin 1 (ACTN1) and β-actin (ACTB) ，etc，suggesting that TMOD1 is related to macrophages migrate.

Objective: To study the epidemiological characteristics of tsutsugamushi disease, and to confirm the existence of the disease's epidemic foci in Taizhou. Methods: From 2013 to 2014, Dongxing town hospital and Xingqiao town hospital were selected as specimen collection sites in Jingjiang city. Blood samples (5 ml) were collected from 40 patients with acute tsutsugamushi disease. A total of 59 rodents were captured with cage night method in the survey sites at 5, 7, 9, 10, and 11 months in 2013, from which, the spleen, liver, and kidney specimens were selected. Chigger mites were captured by small blackboard method and from the ears of the captured rodents. A total of 226 small blackboards were laid, 27 mites were captured, and the samples were grounded into suspension. Nested-polymerase chain reaction and cell and tissue culture techniques were used to test the specimen from the probable patients, host animals and chigger mites. Results: Among the 40 acute tsutsugamushi disease blood samples, 29 were found to meet the test requirements, 17 were positive for orientia tsutsugamushi nucleic acid with 59% of the positive rate, and 1 stran orientia tsutsugamushi was isolated. 59 rats were captured and the density of mice was 5.5%. Among them, there were 26 Mus musculus (2.4%), 18 Rattus flavipectus (1.7%) and 15 Smelly shrew (density 1.4%). 1 Smelly shrew was tested positive for orientia tsutsugamushi nucleic acid, and the negative results were found in the other rodent specimens. 27 Chigge mites were collected by small blackboard method and the density of mites was 0.12 for each blackboard, among which 3 larvae and 24 nymphs were found. 33 Chigger mites were collected from the ears of 3 Smelly shrew, and the density of the mite was 11 per mouse. All the captured Chigger mites were identified as Leptotrombidium scutellare and 1 group of specimens of Chigger mites from the external environment were positive for orientia tsutsugamushi nucleic acid. Conclusion There was a high density of mice in the epidemic area from May to November and the species of the chigger mites were Chigger mites in Taizhou. The nucleic acid of the oriental tsutsugamushi was detected in the patients with acute scrub typhus, rodents and vectors. According to the above-mentioned results, it was considered that the scrub typhus epidemic area of Taizhou city has the natural foci of scrub typhus.

Objective To explore the risk factors of esophageal gastric varices in patients with primary biliary cirrhosis (PBC ) .Methods From January 2008 to November 2014 ,112 PBC patients underwent gastroscopy examination and among them 24 received liver biopsy .The correlation between esophageal gastric varices and histological stage ,age ,gender ,anti‐centromere antibodies (ACA) ,platelet (PLT ) , albumin (Alb ) , total bilirubin (TBil ) , alkaline phosphatase (ALP ) , γ‐glutamyl‐transferase (GGT ) ,aspartate‐aminotransferase (AST ) ,alanine‐aminotransferase (ALT ) ,prothrombin time (PT ) and Mayo score was analyzed .Logistic regression analysis was used to identify independent risk factors predicting esophageal gastric varices in PBC patients .Results Among 112 patients with PBC ,varices was found in 62 patients (51 pure esophageal varices ,nine esophageal gastric varices and two pure gastric varices) .Among 24 patients with liver biopsy ,15 had varices (two at early histological stage Ⅰ and Ⅱ , 13 at later histological stage Ⅲ and Ⅳ ) .The ACA positive rate ,PT ,TBil and Mayo score of patients with varices were higher than those of patients without varices ;while Alb ,GGT and PLT were lower than those of patients without varices , and the differences were statistically significant (all P < 0 .01) . Multivariate Logistic regression analysis revealed that positive ACA (odds ratio (OR) = 8 .759 ,95%cofidence interval (CI) :1 .308 to 58 .637) ,Mayo score over 4 .52 (OR = 8 .941 ,95% CI :1 .145 to 69 .809) ,PLT count less than 96 .5 × 109 /L (OR = 10 .410 ,95% CI :2 .344 to 46 .224) ,TBil level over 26 .62 μmol/L(OR = 14 .348 ,95% CI :2 .945 to 69 .913) were independent risk factors predicting varices . Conclusion ACA positive ,PLT count less than 96 .5 × 109 /L ,TBil level over 26 .62 μmol/L and Mayo score over 4 .52 can help to predict esophageal gastric varices in patients with PBC .

Objective To compare the effects of selenium nanoparticles (Nano-Se) and sodium selenium (Na2SeO3) on apoptosis and reactive oxygen species (ROS) of articular chondrocytes from patients with Kashin-Beck Disease (KBD) in vitro,and provide a scientific basis for preventing KBD.Methods The subjects with KBD were diagnosed on National Clinical Diagnostic Criteria of KBD (WS/T207-2010),articular cartilage from 8 patients undertaken joint replacement operation were collected.In vitro,chondrocytes were treated with concentration of 0,25,50,100,200,300,400 and 500 μg/L of Nano-Se and Na2SeO3 for 5 d,respectively.Cell growth was detected by MTT assay,and the highest concentration and time corresponding to the highest survival rate of Nano-Se and Na2SeO3 were used in the following experiment.KBD chondrocytes were treated with Nano-Se and Na2SeO3,and divided into control group,Na2SeO3 group,Nano-Se group according to the randomized design.Each group had 8 cases.The cell apoptosis and ROS were detected by flow cytometry.Results The optimal intervention concentration of Nano-Se and Na2SeO3 was 100 and 400 μg/L,respectively.The optimal intervention time of NanoSe and Na2SeO3 both was 3 days.There was a significant decrease in the total and terminal apoptosis,ROS level of chondrocytes in Nano-Se group [(4.67 ± 0.89)％,(1.51 ± 0.48)％,(56.04 ± 4.81)％] and Na2SeO3 group [(7.07 ±0.25)％,(4.37 ± 0.37)％,(87.13 ± 6.60)％] compared with those of control group [(9.95 ± 0.38)％,(6.93 ± 0.42)％,(125.17 ± 16.60)％,all P ＜ 0.01].The difference of early apoptotic rate among control group,Na2SeO3 group,NanoSe group [(3.02 ± 0.41)％,(2.7 ± 0.46)％,(3.16 ± 0.56)％] was not statistically significant (F =2.11,P =0.35).Conclusion Appropriate concentration of Nano-Se can significantly decrease oxidative stress of KBD chondrocytes and inhibit apoptosis compared to Na2SeO3.

Objective To explore the risk factors of meningoencephalitis with hand-foot-mouth disease (HFMD) for predictive evaluating and providing evidence for nursing measures. Methods According to the presence of meningoencephalitis, 998 cases with hand-foot-mouth disease were divided into the meningoencephalitis and non meningoencephalitis group. The difference of clinical manifestations, signs and laboratory test resultsbetween two groups were discussed by retrospective analyzing from the perspective of nursing, and we used single factor analysis method to reveal the risk factors of meningoencephalitis. Results The statistical analysis showed that there was a statistical significance in using frequently myoclonicjerk,limbjitter, vomiting,limb weakness, continued highfever, abnormal breathing, circulation dysfunction, blood WBC count and elevatedblood glucoseto predict meningoencephalitis with hand-foot-mouth disease ( P < 0. 05 ). The sensitivity respectively were frequently myoclonic jerk (95. 05% ),blood WBC count (90. 10% ),continued high fever (89. 11% ),abnormal breathing (77. 24% ), elevated blood glucose (63. 37% ),vomiting (42. 57% ), limb jitter (12. 38% ), circulation dysfunction ( 6. 93% ) and limb weakness ( 6. 93% ). The specificity respectively were circulation dysfunction (99. 87% ), limb weakness (99. 75% ), limb jitter (99. 75% ), frequently myoclonic jerk (99. 62% ),vomiting (91. 46% ),abnormal breathing (66. 33% ),continued high fever (65. 33% ), elevated blood glucose (47. 61% ) and blood WBC count (47. 24% ). Conclusions The nurses should strengthen the nursing observation on children with myoclonicjerk, limbjitter, vomiting, limbweakness, continued high fever, abnormal breathing, circulation dysfunction, blood WBC count and elevatedblood glucose. The corresponding nursing intervention measures are also formulated and timely finding meningoencephalitis with HFMD for reducing the developments of severe disease and the mortality.

OBJECTIVETo provide basic data for the prevention of oral diseases in minorities by investigating the oral health status and behavior related to oral health knowledge of individuals aged 35 to 44 years in Dongxiang, Bonan, and Yugur.

METHODSThe caries and periodontal health of 445 individuals aged 35 to 44 years were examined according to the method and criterion prescribed by the World Health Organization and the Third National Oral Health Epidemiologic Investigation. A questionnaire survey on related oral health knowledge and behavior was conducted.

RESULTSThe crown caries prevalence rate in Dongxiang, Baoan, and Yugur were 48.28%, 79.47%, and 67.11%, respectively; the root caries prevalence rates were 38.62%, 69.54%, and 42.95%, respectively. The rates of gum bleeding in Dongxiang, Bonan, and Yugur were 86.90%, 90.07%, and 65.77%, respectively. The rates of dental calculus in Dongxiang, Bonan, and Yugur were 99.31%, 100.00%, 99.33%, respectively, and the rates of periodontal bags were 68.97%, 67.55%, and 43.62%, respectively. Only 69.84% of the respondents brush their teeth every day; 94.90% of the respondents do not floss. Only 20.19% of the respondents contact a doctor for a toothache, and 42.23% of the respondents have never seen a dentist.

CONCLUSIONCaries morbidity is high among the respondents aged 35 to 44 years from Dongxiang, Bonan, and Yugur. The periodontal health status and oral hygiene of the respondents are poor, and behavior related to oral health knowledge is insufficient. Thus, more attention must be provided to the prevention and control of caries and periodontal diseases among middle-aged people in the area.

Adult ; DMF Index ; Dental Calculus ; Dental Caries ; Female ; Health Knowledge, Attitudes, Practice ; Health Status ; Humans ; Male ; Oral Health ; Oral Hygiene ; Periodontal Diseases ; Prevalence

Objective To observe the effect of intelligent trunk intensive training on motor and balance for patients with stroke. Methods 80 stroke patients were divided into treatment group (n=40) and control group (n=40) randomly. Both groups accepted routine rehabilitation,and the treatment group accepted intelligence trunk intensive training in addition for 6 weeks. They were assessed with Rivermead Movement Index (RMI), the Berg Balance Scale (BBS), Sheikh trunk control ability evaluation before and after treatment. Results All the scores improved after treatment in both groups (P<0.001), and improved more in the treatment group than in the control group (P<0.001).The score of trunk control positively correlated with the score of RMI and BBS respectively (r=0.576, r=0.592, P<0.05). Conclusion Intelligent trunk intensive training can further improve the motor and balance of patients with stroke.