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.

Background::Cardiovascular disease (CVD) has emerged as the leading cause of death from prostate cancer (PCa) in recent decades, bringing a great disease burden worldwide. Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy (ADT). The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China.Methods::Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling. CVD was defined as myocardial infarction, arrhythmia, heart failure, stroke, ischemic heart disease, and others. CVD risk was estimated by calculating Framingham risk scores (FRS). Patients were accordingly divided into low-, medium-, and high-risk groups. χ2 or Fisher’s exact test was used for comparison of categorical variables. Results::A total of 4253 patients were enrolled in the present study. A total of 27.0% (1147/4253) of patients had comorbid PCa and CVD, and 7.2% (307/4253) had two or more CVDs. The enrolled population was distributed in six regions of China, and approximately 71.0% (3019/4253) of patients lived in urban areas. With imaging and pathological evaluation, most PCa patients were diagnosed at an advanced stage, with 20.5% (871/4253) locally progressing and 20.5% (871/4253) showing metastasis. Most of them initiated prostatectomy (46.6%, 1983/4253) or regimens involving ADT therapy (45.7%, 1944/4253) for prostate cancer. In the present PCa cohort, 43.1% (1832/4253) of patients had hypertension, and half of them had poorly controlled blood pressure. With FRS stratification, as expected, a higher risk of CVD was related to aging and metabolic disturbance. However, we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT. This was in accordance with clinical practice, i.e., aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery. Among patients who underwent medical castration, only 4.0% (45/1118) received gonadotropin releasing hormone antagonists, in stark contrast to the grim situation of CVD prevalence and risk.Conclusions::PCa patients in China are diagnosed at an advanced stage. A heavy CVD burden was present at the initiation of treatment. Patients who accepted ADT-related therapy showed an original higher risk of CVD, but the awareness of cardiovascular protection was far from sufficient.

Humans ; Triple Negative Breast Neoplasms/genetics* ; MicroRNAs/genetics* ; Oncogenes ; Cell Line, Tumor ; Cell Proliferation ; Gene Expression Regulation, Neoplastic ; Cell Movement

OBJECTIVE: To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children. METHODS: Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria. RESULTS: All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up ( P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up ( P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up ( P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%. CONCLUSION The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.
Male ; Female ; Humans ; Child ; Child, Preschool ; Calcium Sulfate ; Humerus ; Humeral Fractures/surgery* ; Plastic Surgery Procedures ; Fracture Fixation, Internal/methods* ; Bone Wires ; Fracture Healing ; Treatment Outcome ; Range of Motion, Articular

Objective:To determine the efficacy of treatment of refractory lymphatic anomalies with celecoxib.Methods:The authors retrospectively analyzed the characteristics, treatments and complications of patients treated with celecoxib in Children’s Hospital of Nanjing Medical University from September 2020 to January 2022. Treatment was started after poor response to other method or pain, which consisted of a continuous dosing schedule of oral celecoxib at 5 mg.kg -1.d -1, twice daily, for 6 months. Efficacy and safety were evaluated according to radiologic assessment, quality of life and incidence of adverse events. The efficacy was divided into complete response, partial response, stablizing response and non-responsive. SPSS 21.0 was used for data analysis. The data were expressed by M( Q1, Q3). Wilcoxon test was used to compare the lesion volume and PedsQL score before and after treatment. P<0.05 indicated that the difference was statistically significant. Results:A total of 12 patients with lymphatic malformation were enrolled, including 7 males and 5 females aging from 1 year and 5 months to 9 years and 9 months. Eight patients kept stable disease while two patients achieve partial response and two patients presented progressive disease. The median volume of lesions before treatment was 59.13(38.19, 107.15) cm 3 and was 66.08(37.37, 119.98) cm 3 after the treatment. There was no significant difference in volume changes ( Z=0.40, P=0.686). The PedsQL score was 30.5 (29.0, 32.0) before and 29.0(28.0, 30.0) after the treatment. There was no significant difference in the change of PedsQL score( Z=1.73, P=0.084). The side effects occurred in one patient as poor sleeping. Conclusion:Celecoxib can not reduce the lesion but may be helpful for improving life quality in lymphatic malformations.

Objective:To study the effects and potential mechanisms of Notch signaling pathway on the adipogenic differentiation of infantile hemangioma-derived mesenchymal stem cells.Methods:From January 2021 to June 2021, 10 infantile hemangioma specimens (6 males and 4 females, aged 2 months to 6 months, average age 3.5 months) were collected from the Department of Burns and Plastic Surgery of the Children’s Hospital of Nanjing Medical University. Hem-MSCs were isolated from hemangioma in the proliferating phase by adherent screening and identified by flow cytometry. Adipogenic induction was performed after successful identification. Real-time quantitative fluorescence PCR was used to detect the expression of Notch1, Jagged1 and Hes1 genes after 14 days of adipogenesis induction of Hem-MSCs. The Notch signaling pathway inhibitor DAPT, PI3K/Akt signaling pathway agonist 740Y-P and solvent DMSO were added to Hem-MSCs, and adipogenesis induction was performed. The cells were divided into six groups: control group, adipogenic induction group, adipogenic induction+ DMSO group, adipogenic induction+ DAPT group, adipogenic induction+ 740Y-P group, and adipogenic induction+ 740Y-P+ DAPT group. After 14 days of adipogenic induction, real-time quantitative fluorescence PCR was used to detect the expression of PPARγ and C/EBPα genes in the key transcription factors of adipogenic differentiation in the above six groups. Oil red O staining was applied to identify the adipogenic differentiation capabilities; after adipogenic induction for 7 days, the expression levels of p-PI3K, PI3K, p-AKT, and AKT proteins in the adipogenic induction+ DMSO group, adipogenic induction+ DAPT+ 740Y-P group were detected by western blotting. In comparing the two groups, an unpaired Student’s t-test was used to assess the differences, and analysis of variance was applied for the analysis of the mean values among multiple groups. and P<0.05 was considered statistically significant. Results:The expression levels of Notch1, Jagged1 and Hes1 decreased gradually during the adipogenic induction of Hem-MSCs, and the differences were statistically significant ( tNotch1=8.99, PNotch1=0.008; tJagged1=9.49, PJagged1=0.007; tHes1=7.74, PHes1=0.015). After the addition of Notch signaling pathway inhibitor DAPT during the adipogenic induction of Hem-MSCs, the expression of proteins associated with PI3K/AKT signaling pathway decreased, and the difference was statistically significant ( qp-PI3K=4.78, Pp-PI3K=0.014; qp-AKT=5.04, Pp-AKT=0.010) and the expression of adipogenesis indexes increased( qOil red O=6.07, POil red O=0.003; qPPARγ=17.34, PPPARγ<0.001; qC/EBPα=14.8, PC/EBPα<0.001). There was no significant change in adipogenesis indexes after addition of PI3K/Akt signaling pathway agonist 740Y-P ( qOil red O=1.82, POil red O=0.786; qPPARγ=0.97, PPPARγ=0.981; qC/EBPα=1.98, PC/EBPα=0.654). The expression of adipogenesis indexes decreased after adding DAPT and 740Y-P( qOil red O=5.22, POil red O=0.013; qPPARγ=9.78, PPPARγ<0.001; qC/EBPα=16.74, PC/EBPα<0.001). Conclusion:The inhibition of Notch signaling pathway can promote the adipogenic differentiation of Hem-MSCs by reducing the activity of PI3K/Akt signaling pathway.

Objective:To determine the efficacy of treatment of refractory lymphatic anomalies with celecoxib.Methods:The authors retrospectively analyzed the characteristics, treatments and complications of patients treated with celecoxib in Children’s Hospital of Nanjing Medical University from September 2020 to January 2022. Treatment was started after poor response to other method or pain, which consisted of a continuous dosing schedule of oral celecoxib at 5 mg.kg -1.d -1, twice daily, for 6 months. Efficacy and safety were evaluated according to radiologic assessment, quality of life and incidence of adverse events. The efficacy was divided into complete response, partial response, stablizing response and non-responsive. SPSS 21.0 was used for data analysis. The data were expressed by M( Q1, Q3). Wilcoxon test was used to compare the lesion volume and PedsQL score before and after treatment. P<0.05 indicated that the difference was statistically significant. Results:A total of 12 patients with lymphatic malformation were enrolled, including 7 males and 5 females aging from 1 year and 5 months to 9 years and 9 months. Eight patients kept stable disease while two patients achieve partial response and two patients presented progressive disease. The median volume of lesions before treatment was 59.13(38.19, 107.15) cm 3 and was 66.08(37.37, 119.98) cm 3 after the treatment. There was no significant difference in volume changes ( Z=0.40, P=0.686). The PedsQL score was 30.5 (29.0, 32.0) before and 29.0(28.0, 30.0) after the treatment. There was no significant difference in the change of PedsQL score( Z=1.73, P=0.084). The side effects occurred in one patient as poor sleeping. Conclusion:Celecoxib can not reduce the lesion but may be helpful for improving life quality in lymphatic malformations.

Objective:To study the effects and potential mechanisms of Notch signaling pathway on the adipogenic differentiation of infantile hemangioma-derived mesenchymal stem cells.Methods:From January 2021 to June 2021, 10 infantile hemangioma specimens (6 males and 4 females, aged 2 months to 6 months, average age 3.5 months) were collected from the Department of Burns and Plastic Surgery of the Children’s Hospital of Nanjing Medical University. Hem-MSCs were isolated from hemangioma in the proliferating phase by adherent screening and identified by flow cytometry. Adipogenic induction was performed after successful identification. Real-time quantitative fluorescence PCR was used to detect the expression of Notch1, Jagged1 and Hes1 genes after 14 days of adipogenesis induction of Hem-MSCs. The Notch signaling pathway inhibitor DAPT, PI3K/Akt signaling pathway agonist 740Y-P and solvent DMSO were added to Hem-MSCs, and adipogenesis induction was performed. The cells were divided into six groups: control group, adipogenic induction group, adipogenic induction+ DMSO group, adipogenic induction+ DAPT group, adipogenic induction+ 740Y-P group, and adipogenic induction+ 740Y-P+ DAPT group. After 14 days of adipogenic induction, real-time quantitative fluorescence PCR was used to detect the expression of PPARγ and C/EBPα genes in the key transcription factors of adipogenic differentiation in the above six groups. Oil red O staining was applied to identify the adipogenic differentiation capabilities; after adipogenic induction for 7 days, the expression levels of p-PI3K, PI3K, p-AKT, and AKT proteins in the adipogenic induction+ DMSO group, adipogenic induction+ DAPT+ 740Y-P group were detected by western blotting. In comparing the two groups, an unpaired Student’s t-test was used to assess the differences, and analysis of variance was applied for the analysis of the mean values among multiple groups. and P<0.05 was considered statistically significant. Results:The expression levels of Notch1, Jagged1 and Hes1 decreased gradually during the adipogenic induction of Hem-MSCs, and the differences were statistically significant ( tNotch1=8.99, PNotch1=0.008; tJagged1=9.49, PJagged1=0.007; tHes1=7.74, PHes1=0.015). After the addition of Notch signaling pathway inhibitor DAPT during the adipogenic induction of Hem-MSCs, the expression of proteins associated with PI3K/AKT signaling pathway decreased, and the difference was statistically significant ( qp-PI3K=4.78, Pp-PI3K=0.014; qp-AKT=5.04, Pp-AKT=0.010) and the expression of adipogenesis indexes increased( qOil red O=6.07, POil red O=0.003; qPPARγ=17.34, PPPARγ<0.001; qC/EBPα=14.8, PC/EBPα<0.001). There was no significant change in adipogenesis indexes after addition of PI3K/Akt signaling pathway agonist 740Y-P ( qOil red O=1.82, POil red O=0.786; qPPARγ=0.97, PPPARγ=0.981; qC/EBPα=1.98, PC/EBPα=0.654). The expression of adipogenesis indexes decreased after adding DAPT and 740Y-P( qOil red O=5.22, POil red O=0.013; qPPARγ=9.78, PPPARγ<0.001; qC/EBPα=16.74, PC/EBPα<0.001). Conclusion:The inhibition of Notch signaling pathway can promote the adipogenic differentiation of Hem-MSCs by reducing the activity of PI3K/Akt signaling pathway.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Research progress and clinical achievements of pediatric lymphatic malformations management in recent years were reviewed. Comprehensive development had been promoted because of both clinical and basic research progress. It highlighted profound discoveries and innovations in the field of classification, basic research, diagnosis and treatment. Besides, the authors elaborated their insights into the further developments of lymphatic malformations management in children.