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:Hereditary neuropathy with liability to pressure palsy(HNPP)is a rare autosomal dominant peripheral neuropathy,usually caused by heterozygous deletion mutations in the peripheral myelin protein 22(PMP22)gene.This study aims to investigate the clinical and molecular genetic characteristics of HNPP. Methods:HNPP patients in the Department of Neurology at Third Xiangya Hospital of Central South University from 2009 to 2023 were included in this study.The general clinical data,nervous electrophysiological and molecular genetic examination results were collected and analyzed.Molecular genetic examination was to screen for deletion of PMP22 gene using multiplex ligation-dependent probe amplification(MLPA)after extracting genomic DNA from peripheral blood;and if no PMP22 deletion mutation was detected,next-generation sequencing was used to screen for PMP22 point mutations.The related literatures of HNPP were reviewed,and the clinical and molecular genetic characteristics of HNPP patients were analyzed. Results:A total of 34 HNPP patients from 24 unrelated Chinese Han families were included in this study,including 25 males and 9 females.The average age at illness onset was 22.0 years.Sixty-two point five percent of the families had a positive family history.Among them,30 patients had symptoms of peripheral nerve paralysis.Patients often presented with paroxysmal single limb weakness with(or)numbness(25/30),and some patients had paroxysmal unilateral recurrent laryngeal nerve(vagus nerve)paralysis(2/30).Physical examination revealed muscle weakness(23/29),hypoesthesia(9/29),weakened or absent ankle reflexes(20/29),distal limb muscle atrophy(8/29)and high arched feet(5/29).Most patients(26/30)could fully recover to normal after an acute attack.Thirty-one patients in our group underwent nervous electrophysiological examination,and showed multiple demyelinating peripheral neuropathies with both motor and sensory nerves involved.Most patients showed significantly prolonged distal motor latency(DML),mild to moderate nerve conduction velocity slowing,decreased amplitude of compound muscle action potential(CMAP)and sensory nerve action potential(SNAP),and sometimes with conduction block.Nerve motor conduction velocity was(48.5±5.5)m/s,and the CMAP amplitude was(8.4±5.1)mV.Nerve sensory conduction velocity was(37.4±10.5)m/s,and the SNAP amplitude was(14.4±15.2)μV.There were 24 families,23 of whom had the classical PMP22 deletion,the last one had a heterozygous pathogenic variant in the PMP22 gene sequence(c.434delT).By reviewing clinical data and genetic testing results of reported 1 734 HNPP families,we found that heterozygous deletion mutation of PMP22 was the most common pathogenic mutation of HNPP(93.4%).Other patients were caused by PMP22 small mutations(4.0%),PMP22 heterozygous gross deletions(0.6%),and PMP22 complex rearrangements(0.1%).Thirty-eight sorts of HNPP-related PMP22 small mutations was reported,including missense mutations(10/38),nonsense mutations(4/38),base deletion mutations(13/38),base insertion mutations(3/38),and shear site mutations(8/38).HNPP patients most often presented with episodic painless single nerve palsy.Common peroneal nerve,ulnar nerve,and brachial plexus nerve were the most common involved nerves,accounting for about 75%.Only eighteen patients with cranial nerve involved was reported. Conclusion:Heterozygous deletion mutation of PMP22 is the most common pathogenic mutation of HNPP.Patients is characterized by episodic and painless peripheral nerve paralysis,mainly involving common peroneal nerve,ulnar nerve,and other peripheral nerves.Nervous electrophysiological examination has high sensitivity and specificity for the diagnosis of HNPP,which is manifested by extensive demyelinating changes.For patients with suspected HNPP,nervous electrophysiological examination and PMP22-MLPA detection are preferred.Sanger sequencing or next generation sequencing can be considered to detect other mutations of PMP22.

Objective To discuss the effects of hospital-family transition period exercise management on respiratory function and exercise tolerance in elderly patients with chronic obstructive pulmonary disease (COPD)based on project management. Methods By convenient sampling method,a total of 89 elderly patients with COPD in stable stage were selected in Department of Respiration of Xinxiang Center Hospital from January 2017 to December 2018. According to the admission time,all subjects were divided into the intervention group(n=47)and control group(n=42). Patients in control group received standardized treatment and routine discharge guidance for COPD,while based on the intervention for control group,patients in the observation group developed exercise management model based on project management. The related indicators of respiratory function and exercise tolerance in the two groups were collected and compared on the day of discharge and 3 months after discharge at the outpatient visit. Results After intervention for 3 months,the levels of vital capacity(VC),forced vital capacity(FVC),forced expiratory volume in the first second(FEV1)and mean maximum expiratory flow(MMEF)in the control group were all higher than those on the day of discharge(t=6.228, 7.836,10.995,4.180;P<0.05),and the levels of VC,FVC,FEV1,peak expiratory flow(PEF),FEV1/FVC and MMEF were higher in the intervention group than those on the day of discharge(t=12.189,14.583,30.723, 6.352,6.166,12.420;P<0.05). After discharge for 3 months,the levels of VC,FVC,FEV1,PEF,FEV1/FVC and MMEF were higher in the intervention group than those in the control group(t=6.063,7.234,16.902, 5.596,2.640,7.295;P< 0.05). After discharge for 3 months,the 6-minute walking distance in two groups were both improved than those on the day of discharge(t=5.574,10.389;P<0.01),and the intervention group was better than control group(t=5.244,P< 0.01). Conclusions Hospital-family transition period exercise management based on project management can improve the respiratory function,and improve exercise tolerance in elderly patients with COPD,which helps patients recover early.

Objective To evaluate the efficacy of general anesthesia combined with ultrasoundguided epidural block for laparoscopic surgery in neonates.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ neonates,aged 20-60 days,scheduled for elective radical operation for Hirschsprung's disease,were divided into 2 groups (n=30 each) using a random number table:general anesthesia group (group Ⅰ) and general anesthesia combined with ultrasound-guided epidural block group (group Ⅱ).Anesthesia was induced by inhaling 8％ sevoflurane.Anesthesia was maintained with Ⅳ sufentanil 0.2 μg/kg,cisatracurium 0.1 mg/kg and then with additional sufentanil 0.1 μg/kg and cisatracurium 0.05 mg/kg every hour and 2％-3％ sevoflurane was simultaneously inhaled in group Ⅰ.In group Ⅱ,anesthesia was maintained by inhaling 2％-3％ sevoflurane,epidural block was performed at L1.2 interspace,the catheter was caudally advanced into the epidural space under ultrasound guidance,0.8％ lidocaine was injected at a loading dose of 6 mg/kg,the local anesthetic diffusion in the epidural space was observed,and additional 0.8％ lidocaine 3 mg/kg was given every 30 min.Heart rate and mean arterial pressure were recorded at 5 min before pneumoperitoneum,during pneumoperitoneum,at extubation and after extubation.The extubation time,duration of recovery room stay and development of assisted ventilation after extubation were recorded.Pain was assessed and scored at 5 min before discharge from recovery room.The development of epidural block-related complications was recorded in group Ⅱ.Results Operation was smoothly completed with stable anesthesia in two groups.Compared with group Ⅰ,the mean arterial pressure was significantly decreased during pneumoperitoneum and after extubation,the extubation time and duration of recovery room stay were shortened,and the requirement for assisted ventilation after extubation and pain scores were decreased in group Ⅱ (P＜0.05 or 0.01).No epidural block-related complications were found in group Ⅱ.Conclusion General anesthesia combined with ultrasound-guided epidural block is safe and effective for laparoscopic surgery and is helpful for postoperative recovery in neonates.

Objective To analyze the relationships of high mobility group box 1 protein (HMGB1) with regulatory T cells (Treg), T helper 17 cells (Th17) and cytokine secrtion in peripheral blood of gravidas with preeclampsia(PE),and to investigate the mechanism of HMGB1 in regulating Th17/Treg ratio via receptor for advanced glycation end products (RAGE)-IL-6 pathway. Methods Forty gravi-das with mild(20 cases) and severe(20 cases) PE were recruited as experimental groups,20 heathy gravi-das in the third trimester of pregnancy were enrolled as control group. Concentrations of HMGB1,IL-6,IL-17 and TGF-β in peripheral blood of all subjects were determined by enzyme-linked immunosorbent assay (ELISA). Real-time quantitative PCR(RT-PCR) was used to detect the expression of RAGE at mRNA lev-el in peripheral blood mononuclear cells(PBMCs). The percentages of Treg and Th17 cells were determined by flow cytometry. RT-PCR was performed to analyze changes in the expression of RAGE,IL-6,Foxp3 and RORγt at mRNA level after the PBMCs isolated from 20 garvidas with PE were cultured in vitro and stimula-ted with recombinant human HMGB1 (rhHMGB1). Results The levels of HMGB1,IL-6,Th17 and IL-17 in peripheral blood of gravidas with PE were significantly higher than those in the normal pregnancy group. Moreover,HMGB1 level was positively correlated with IL-6 level and ratios of Th17/Treg and IL-17/TGF-β in preeclamptic pregancies. In vitro stimulation of PBMCs with rhHMGB1 significantly enhanced the expres-sion of RAGE,IL-6 and RORγt at mRNA level, but suppressed the expression of Foxp3 at mRNA level. Conclusion Enriched HMGB1 in plasma shifts the Th17/Treg balance towards Th17 dominance via the RAGE-IL-6 pathway, which exacerbates inflammation and participates in the onset of preeclampsia during pregnancy.

Objective To detect the protein expression changes of mitochondrial apoptotic pathway during the reverse effects of lipid emulsion on bupivacaine cardiotoxicity, so as to investigate the probable mechanism concerning the reverse effect of lipid emulsion on bupivacaine cardiotoxicity.Methods The ventricular muscles of 15 healthy SD neonatal mice (1-3 d) were chosen to conduct primary culture in vitro.And the cardiomyocytes were cultivated in a medium containing bupivacaine for 24 hours to establish its bupivacaine poisoning model.The cultured cardiomyocytes were divided into three groups: control group (group C);bupivacaine group (group B);and bupivacaine+lipid emulsion group (group BL).Flow cytometry was applied to examine the apoptosis of cardiomyocytes, and the Western blot was employed to detect the protein expression variation of cytochrome C (Cyto-C) and cleaved casepase-3.Results Compared with group C, the apoptosis rate was remarkably increased in both group B and group BL and that of the group B was dramatically higher than that of the group BL, with a statistical significance (P<0.05).Compared with group C, the protein expression levels of both Cyto-C and cleaved casepase-3 were significantly increased in groups B and BL (P<0.05), and the protein expression levels of both Cyto-C and cleaved casepase-3 in group B were significantly higher than those in group BL (P<0.05).Conclusion Lipid emulsion can regulate apoptosis through inhibiting the release of mitochondrial Cyto-C and reducing casepase-3 activation, thus it protects cardiomyocytes.

Objective To investigate the vasodilatation effects of total flavonoid from polygonum aviculare on rat thoracic aorta and its underlying mechanisms. Methods Total flavonoid from polygonum aviculare was gotten by extracted with 65% alcohol, gathered with polyamide, and eluted with 75% alcohol.The content of flavone was determined with rutoside as standard preparation. Normal rats thoracic aorta in vitro used as sample, BL-420E biological functional experiment system was utilized to record dilatation effect of total flavonoid on PE affecting pre-contracting blood vessel and the relation between dilatation effect of total flavonoid on blood vessel and calcium influx. Results Total flavonoids from polygonum aviculare can diastole contractions of thoracic aorta caused by PE. In calcium-free perfusion, gradually adding CaCl2 induced calcium influx. Clinical data showed dose-effect relation between drug and blood vessel contraction decreased in the total flavonoids from polygonum aviculare incubation rats than normal rats. Besides, total flavonoids from polygonum aviculare can obviously inhibit contraction of blood vascular circle induced by calcium releasing.Conclusion FP exerted a dose-dependent vasodilatation effect on rat isolated aorta rings by inhibiting Ca2+influx via L-type voltage-gated Ca2+ channels and Ca2+ release from sarcoplasmic reticulum, consequently decrease Ca2+ in vascular smooth muscle cells.

Objective To screen the mutations of MYOC gene in a Chinese primary open angle glaucoma (POAG) family from Cbengqing and investigate the relationship between the mutations in MYOC/TIGR gene and POAG.Methods In a large 4-generation glaucoma family, myocilin gene (MYOC) was screened in 39 family members, 8 of which were confirmed patients. Normal controls included 100 normal Chinese subjects.The known mutations of MYOC gene ( including G34C, C136T, G144T, G227A, C624G,G736A, C1009G, A1036G, C1081T, G1099A, G1138A, A1139C, T1430A, C1441A and C1442T) were detected by single strand conformation polymorphism(SSCP) , po]ymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) analysis and DNA sequencing.Results G227A mutation was detected in 2 POAG patients and 1 asymptomatic patient, but not in the controls.Cl009del mutation was identified in all patients of the pedigree and an offspring member but not in the controls. No other mutations were detected.Since the C1009del mutation was revealed for the first time, a new GenBank number FJ237047 correponding to ACI62293 was applied.Conclusions The G227A mutation is a known site and there is no relationship between G227A mutation and glaucoma. But C1009del may be related to glaucoma which suggests that morbidity could be higher in the relatives of POAG than the controls.

To observe the effects of tetramethylpyrazine (TMP) on the proliferation and type I collagen synthesis of rat cardiac fibroblasts (CFBs) induced by angiotensin II (Ang II), and to explore the mechanism of TMP in treating myocardial fibrosis.

BACKGROUND: Chronic congestive heart failure occurs at the late stage of many heart diseases. Cognitive disability exists in chronic congestive heart failure which has been reported in most clinical studies, and measures that can successfully improve heart function can improve cognitive function.OBJECTIVE: To probe into the effect of chronic congestive heart failure after myocardial infarction on spatial learning and memory ability,and to observe the correlation between heart failure and cognitive function.DESIGN: A randomized controlled observation based on the experimental animals.SETTING: Key Laboratory of Traditional Chinese Medicine (Beijing University of Chinese Medicine), Ministry of Education.MATERIALS: This experiment was performed at the Key Laboratory of Traditional Chinese Medicine (Beijing University of Chinese Medicine),Ministry of Education. in November 2001. Totally 100 healthy male rats aged 10 to 12 weeks, weighing 200 g to 220 g purchased from Beijing Weitong Lihua Experimental animal Technical Co. Ltd were enrolled and randomly divided into the operation group (n=60) and sham-operation group (n=40).METHODS: Model rats in the operation group were infarcted by ligation of the left anterior descending coronary arteries to produce acute myocardial infarction models. Those in the sham-operation group left a loose tie without ligation. The rats that showed myocardial infarction-like changes through electrocardiogram were taken as the rats for operation (n=38), and those survived rats without abnormal changes and without ligation were taken as the sham-operation group (n=25). The two groups were subdivided into 10-day gro up, 30-day group and 60-day group. Morris water maze test was performed 10, 30 and 60 days after the operation followed by hemodynamic monitoring. Among the 10-day group, 30-day group and 60-day group, rats that did not complete the whole Morris swimming test due to heart failure with poor power and died 2 days after the operation or after hemodynamic monitoring were set as heart failure end period group.Rats in the same group as those died with similar body mass were set as the control group.MAIN OUTCOME MEASURES: ① Escape logarithm latency and the good rate if cognitive ability; ② stroke volume, cardiac output per minute,heart rate and cardiac index of hemodynamics, in which cardiac index was the main index for responding heart functionRESULTS: Totally 33 rats met the criteria in the operation group and 25rats in the sham-operation group. All the animals entered the stage of result analysis. ①Results of hymodynamic index: Stroke volume, cardiac output per minute and cardiac index of the rats in the 10-day group, 30-day group and 60-day group were significantly lower than those of the homochronous sham-operation group (P ＜ 0.01), and those indexes were significantly lower in the heart failure end period group than in the end period control group and each period of the operation (P ＜ 0.01-0.05). As compared with homochronous control group, the cardiac index in 10-day group, 30-day group, 60-day group and end period group was 51.21%,50.58%,55.84% and 33.91% respectively, and all were 60% lower than the normal value. ② Results of Morris water maze: Logarithm latency of 10-day operation group after training of 8 times was obviously longer than that of the 10-day sham-operation group [F(1,28) =5.997,P=0.021]. As for cognitive function, it was obviously worse in the 10-day operation group than that of the 10-day sham-operation group (x2=8.142 ,P ＜ 0.005). There was no significant difference between the 30-day operation group and the 30-day sham-operation group, and there was no significant difference in the logarithm latency as well between the 60-day operation group and the 60-day sham-operation group. As for searching strategies, the good rate of general cognitive ability in the 60-day operation group was worse than that in the 60-day sham-operation group (x2=4.988 ,P ＜ 0.05). Logarithm latency prolonged significantly in the heart failure end period group than in the end period control group [F( 1,6)=19.567 ,P=0.004], and the good rate of general cognitive ability was worse in the heart failure end period than that in the end period control group(x=1 1.82,P ＜ 0.01).CONCLUSION: Spatial learning and memory ability after heart failure in rats with myocardial infarction was injured obviously 10 days after the operation, and it recovered to the normal level 30 days after the operation.Cognitive injury occurred to some extent 60 days after the operation, and the cognitive function was obviously worse at the end period of congestive heart failure.