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 investigate any effect of combining mirror visual feedback (MVF) training with robot-assisted gait training (RGT) in promoting the recovery of lower limb motor function among stroke survivors.Methods:Sixty stroke survivors were randomly divided into a combined treatment group, an RGT group and a control group, each of 20. In addition to traditional rehabilitation, the RGT group received 30min of RGT 5 days a week for 4 weeks, while the combined treatment group underwent 30min of RGT and also 20min of MVF training with the same frequency and duration. Before and after the treatment, the lower extremities motor functioning and walking ability of all of the patients were assessed using the Fugl-Meyer Assessment for the lower extremities (FMA-LE), the Berg Balance Scale (BBS) and Functional Ambulation Categories (FAC).Results:There were no systematic differences in any of the measurements before the treatment. After the 4 weeks, however, the average FMA-LE, BBS and FAC scores of the combined treatment and RGT groups were significantly better than the control group′s averages, and those of the combined treatment group were significantly superior to the RGT group′s. All of the groups had, however, improved significantly compared with before the treatment.Conclusions:Robot-assisted gait training is more effective in enhancing the motor functioning of the lower extremities and walking ability when it is combined with MVF.

ObjectiveTo study the effect of anodal transcranial direct current stimulation (atDCS) combined with mirror therapy (MT) on upper limb function for stroke patients. MethodsFrom July, 2018 to June, 2019, 54 stroke patients from the Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, were randomly divided into groups A, B and C, with 18 cases in each group. All the patients received routine medication and rehabilitation training, while group A accepted 60 minutes of MT, group B accepted 20 minuts of atDCS first and then 40 minuts of MT, and group C accepted 40 minutes of MT first and then 20 minuts of atDCS in addittion; for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT), Motor Assessment Scale (MAS) and modified Barthel Index (MBI) before and after treatment. ResultsThe main effect of time was significant in scores of FMA-UE (F = 159.811, P < 0.001), ARAT (F = 353.227, P < 0.001), MAS (F = 513.494, P < 0.001) and MBI (F = 85.982, P < 0.001), and all of them improved after treatment. The main effect of groups was significant in scores of FMA-UE (F = 12.502, P < 0.001), ARAT (F = 20.095, P < 0.001), MAS (F = 16.371, P < 0.001) and MBI (F = 11.882, P < 0.001). The interacted-effect between time and groups was significant in scores of FMA-UE (F = 37.659, P < 0.001), ARAT (F = 78.681, P < 0.001), MAS (F = 97.997, P < 0.001) and MBI (F = 48.015, P < 0.001); while all the scores were the best in group B (P < 0.01), and there was no significant difference between groups A and C (P > 0.05). ConclusionThe combination of atDCS first and then MT can promote the recovery of motor function of the affected limbs for stroke patients.

Seventy two patients with initial cerebral infarction admitted in the Second Hospital of Jiaxing from March 2017 to October 2017 were enrolled. Patients underwent conventional ultrasonography and contrast-enhanced ultrasonography for two-dimensional echo grading and neovascularization grading of carotid artery plaques respectively. There were 113 carotid plaques in 72 patients with cerebral infarction,27 cases recurred after 1 years with 44 patches. The echo grading of recurrence group was mainly grade Ⅰ and grade Ⅱ,the number of Ⅰ,Ⅱ,and Ⅲ plaques was 23,18,and 3,respectively. The echo grading of non-recurrence group was mainly grade Ⅲ,the number of Ⅰ,Ⅱ,and Ⅲ plaques was 36,23,and 40,respectively. The echo grading of carotid artery plaque between the two groups was significantly different (P<0.05). The grade of carotid neovascularization in recurrence group was mainly grade Ⅲ and grade Ⅳ,the number of Ⅰ,Ⅱ,Ⅲ and Ⅳ plaques was 2,5,27 and 10,respectively. The echo grading of non-recurrence group was mainly grade Ⅰ and grade Ⅱ,the number of Ⅰ,Ⅱ,Ⅲ and Ⅳ plaques was 24,52,14 and 9,respectively. There was significant difference in the grade of carotid neovascularization between the two groups (P<0.05). The area under curve(AUC) of echo grade<Ⅱ,echo grade<Ⅲ,neovascularization grade>Ⅰ,neovascularization grade>Ⅱ and neovascularization grade>Ⅲ in predicting the recurrence of cerebral infarction were 0.553,0.641,0.587,0.793 and 0.557,respectively,the AUC of neovascularization grade>Ⅱ was significantly higher than the other four criteria (P<0.01). The recurrence curves of carotid plaques with different neovascularization grades were significantly different (χ²=49.18,P<0.01). Carotid plaque vulnerability evaluated by contrast-enhanced ultrasonography is an effective indicator for predicting recurrence of cerebral infarction.

Objective To study spatial attention processing characteristics in patients with unilateral spatial neglect (USN)by comparing the patients with right USN and behavioral findings of event-related potential (ERP)in normal subjects and the amplitude and latency of P1,N1 and P300. Methods Ten consecutive patients with USN (USN group)after right-hemisphere stroke admitted to the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University from April 2012 to April 2013 were enrolled retrospectively. Age-and sex-matched 10 normal subjects with the USN group were selected. ERP was used to document the electroencephalogram changes of two groups of subjects when performing visual Oddball pattern tasks. The response time and accuracy of target stimuli in both groups appearing on the left (left target)and right (right target)were analyzed and compared. The amplitude and latency of all ERP components (P1,N1,P300)on the left and right target stimuli were analyzed by repeated measurement of multivariate analysis of variance. The pathogenesis of USN after stroke was investigated. Results In the USN group,the accuracy of target stimuli on left side and right side was lower than that in the normal group (left target:17. 7 ± 7. 5% vs. 98. 5 ± 7. 5%,P＜0. 01;right target:88. 5 ± 2. 0% vs. 99. 0 ± 2. 0 %,P＝0. 002). There was no significant difference in P1 amplitude between the two groups (F ＝1. 104,P ＝0. 307). When the target stimulus appeared on the left side,the N1 amplitude on the right hemisphere of the USN group was lower than that of the normal group (-0. 3 ± 1. 1 μV vs. -5. 8 ± 1. 1 μV;P＝0. 001), when the target stimulus appeared on the right side,the N1 amplitude of USN group was lower than that of the normal group (-1. 8 ± 1. 0 μV vs. -6. 0 ± 1. 0 μV;F＝9. 799,P＝0. 006). The P300 amplitude of left target of the USN group was lower than that of the normal group (1. 0 ± 1. 1 μV vs. 7. 2 ± 1. 1 μV;P＝0. 001). Compared with the normal group,the latency of each wave of P1 (right hemisphere)(136. 7 ± 3. 8 ms vs. 122. 1 ± 3. 8 ms;P ＝0. 013),N1 (179. 7 ± 2. 0 ms vs. 172. 8 ± 2. 0 ms;F ＝5. 775,P ＝0. 027),and P300 (490 ± 12 ms vs. 402 ± 12 ms;F＝27. 310,P＜0. 01]in the USN group was prolonged. Conclusion During the spatial attention processing in patients with USN,regardless of the stimuli from the left and right,its information processing had been damaged to a certain degree.

Objective To evaluate the clinical value of acetic acid with narrow-band imaging ( NBI ) and magnifying endoscopy ( ME ) on diagnosis of small colorectal polyps. Methods In this prospective study, 261 small colorectal polyps from 122 patients were observed by ME, NBI-ME, and acetic acid with NBI-ME, and then received endoscopic treatment. Endoscopic images were stored electronically and randomly allocated to 3 experts and 3 non-experts for diagnosis using Kudo pit pattern. The postoperative pathologic results acted as gold standard to evaluate the diagnostic accuracy of different endoscopic modes for small colorectal polyps. The image definition and interobserver agreement were compared among different endoscopic modes. Results The diagnostic accuracy of ME, NBI-ME, and acetic acid with NBI-ME for small colorectal polyps was 65. 5％ ( 171/261) , 90. 0％ ( 235/261) , and 94. 6％ ( 247/261) , respectively, in the experts group, and 57. 1％ ( 149/261) , 83. 1％ ( 217/261) , and 89. 3％ ( 233/261) , respectively, in the non-experts group. All experts and non-experts diagnosed small colorectal polyps more accurately by acetic acid with NBI-ME than by NBI-ME ( all P<0. 05 ) and ME ( all P<0. 001 ) . The image definition scores of acetic acid with NBI-ME in the experts group and non-experts group were significantly higher than those of NBI-ME and ME ( all P<0. 001) . The results of interobserver agreement showed that Kappa values (95％CI) of ME, NBI-ME, and acetic acid with NBI-ME diagnosis were 0. 578 (0. 508-0. 648), 0. 669 (0. 599-0. 739), and 0. 940 (0. 870-1. 010), respectively, for experts and 0. 476 (0. 406-0. 546), 0. 534 ( 0. 464-0. 604) , and 0. 830 ( 0. 760-0. 900 ) , respectively, for non-experts. Acetic acid with NBI-ME showed good interobserver agreement. Conclusion Acetic acid with NBI-ME has a higher diagnostic accuracy and good reproducibility for colorectal small polyps compared with ME and NBI-ME.

AIM: To study the suppressive effect of glycogen synthase kinase-3β( GSK-3β) knockdown by RNA interference on the formation of keloid .METHODS:Human keloid fibroblasts ( KFB) in vitro were transfected with 3 pairs of specific GSK-3βsmall interfering RNA (siRNA).The best siRNA to inhibit the GSK-3βexpression in human KFB was screen by RT-PCR and Western blot .The expression of GSK-3βand related proteins at mRNA and protein levels in the KFB was determined by RT-PCR and Western blot .RESULTS: The GSK-3βsiRNA1434 remarkably inhibited the expression of GSK-3βat mRNA and proteins levels in the human KFB .After transfection with GSK-3βsiRNA, the protein levels of β-catenin, p-GSK-3β, Wnt2 and cyclin D1 were all decreased.KFB growth became slow.With the extension of time, the inhibition of cell growth increased , and the cell doubling time was significantly delayed .CONCLUSION:siRNA targeting GSK-3βefficiently knocks down the expression of GSK-3βin the human KFB, and inhibits the activation of Wnt signaling pathway , thus inhibiting the growth of keloid .GSK-3βmay be a potential therapeutic target for keloid .

Objective To investigate the effect of transcranial direct current stimulation combined with motor relearning program on the recovery of upper limb motor function after stroke.Methods From September 2015 to June 2016,40 patients with first-ever stroke received rehabilitation therapy at the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University were enrolled prospectively.Their course of disease was 1 to 6 months.They were divided into either a combined treatment group or a control group according to the odd and even numbers in hospital (n =20 in each group).The patients of both groups received traditional rehabilitation training and motor relearning program for upper lindb recovery,2 times a day,once for 30 min,5 days a week for 6 weeks.The combined treatment group was also given transcranial direct current stimulation,2 times a day,once for 20 min,5 days a week,while the control group was only treated with sham stimulation treatment.The patients were assessed before treatment and at 6 weeks after treatment.Fugl-Meyer Assessment (FMA) scores and Action Research Arm Test (ARAT) were used to assess upper limb motor function.The modified Barthel index (MBI) was used to evaluate the activities of daily living.Results There was no significant difference in the observation indices before treatment between the 2 groups (P ＞ 0.05).Six weeks after treatment,the differences of the upper limb FMA score and ARAT score before treatment were superior to the control group,they were 13 ± 3,10 ± 3 and 10 ± 2,8 ± 2,respectively (t =3.503 and 3.244 respectively,all P ＜ 0.01).There was no significant difference in the MBI score between the 2 groups (P ＞ 0.05).Conclusion Transcranial direct current stimulation combined with motor relearning program may effectively improve the upper limb motor function in patients with stroke and promote the improvement of the activities of daily living.

Objective To explore the diagnostic and treatment value of serum B-type natriuretic peptide (BNP) levels for the chronic heart failure and its correlation with cardiac function classification.Methods 155 patients with heart failure were selected as treatment group.According to cardiac function,grade Ⅱ in 48 cases,grade Ⅲ in 56 cases,grade Ⅳ in 51 cases.122 healthy people during the same period were selected as the control group.Retrospectively detected serum BNP levels of the subjects,and the BNP levels of the treatment group were detected before and after treatment,and its correlation with heart function was analyzed.Results The serum BNP level of the treatmentgroup was (738.67 ± 61.32) pg/mL,which was higher than (22.36 ± 21.89) pg/mL of the control group,the difference was statistically significant (t =19.38,P ＜ 0.05).The serum BNP level of the treatment group after treatment was (329.58 ± 90.74) pg/mL,which was lower than (738.67 ± 161.32) pg/mL of the control group,the difference was statistically significant(t =19.38,P ＜ 0.05).The serum BNP levels of grade Ⅱ,grade Ⅲ and grade Ⅳ patients after treatment compared with pre-treatment,the differences were statistically significant (t =13.65,15.18,17.39,all P ＜ 0.05),from pre-treatment to pro-treatment,the serum BNP levels were gradually increased with increased grade,the differences were statistically significant (t =10.61,21.33,11.06,16.40,all P ＜ 0.05).Conclusion The serun BNP level of chronic heart failure patients significantly increases,and it increases with the increase of cardiac function classification,and shows correlation.As the objective indicators of chronic heart failure,it has better clinical diagnosis value and treatment and prognostic significance.

Objective To investigate the effect of lower limb rehabilitation training robot combined with task-oriented training on walking ability after stroke. Methods From February 2014 to August 2015,74 consecutive patients with post-stroke who received rehabilitation therapy and met the inclusion criteria admitted to the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University were collected prospectively. They were all the patients with the first-ever stroke for 1 to 12 months. They were divided into either an observation group (n = 39)or a control group (n = 35)according to whether they were treated with the lower-limb rehabilitation robot. The patients of both groups received task-oriented training,2 times a day,once for 20 min,5 days a week for 12 weeks. The observation group was also treated with the lower-limb rehabilitation training robot,1 time a day,once for 30 min,5 days a week. Berg balance scale,Fugl-Meyer assessment (FMA),timed up-and-go test (TUG)and knee flexion active range of motion (KFAROM)were used to assess the efficacy. Results (1)After treatment,the Berg scale and FMA scale scores were increased in the observation group and the control group compared with before treatment. There was significant difference (Berg scale:28 ±9 vs. 22 ±9,29 ±9 vs. 24 ±9;FMA scores:47 ± 8 vs. 36 ± 8,40 ± 6 vs. 36 ± 7;all P < 0. 01),however,there was no significant difference between the two groups (P <0. 05),and there was significant difference in FMA scores between the 2 groups (P < 0. 01 ). The differences of Berg scale scores in the observation group and the control group were 10. 75 + 0. 30 and 4. 71 + 0. 14 respectively before and after treatment. There was no significant difference between the 2 groups (t = 0. 95,P = 0. 345). The differences of FMA scores in the observation group and the control group were 5. 8 ±0. 6 and 4. 9 ±0. 8 before and after treatment (t =5. 16,P <0. 01). (2)After treatment,the tug test and KFAROM of the observation group and the control group were better than those before treatment. There were significant differences (TUG test:35 ± 13 s vs. 56 ± 18 s,53 ± 17 s vs. 58 ± 18 s;KFAROM:82 ± 24° vs. 60 ± 23°,63 ± 23° vs. 57 ± 26°;all P < 0. 01),and there were significant differences between the 2 groups (all P < 0. 01). The differences of the TUG test in the observation group and the control group before and after treatment were 21. 5 ± 5. 0 and 4. 6 ± 0. 6 s respectively. There was significant difference between the 2 groups (t = 9. 55,P < 0. 01);the differences of KFAROM in the observation group and control group before and after treatment were 5.8 ±0.6° vs. 4.9 ±0.8° respectively. There was significant differences between the 2groups (t =4.17,P <0. .01). Conclusion Lower limb rehabilitation training robot combined with task-oriented training may improve the lower extremity motor function,walking ability,knee flexion joint activity of the patients after stroke,but the improvement effect of the lower limb balance is not obvious.