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.

At present,in medical academic circle there is no consensus on the optimal diameter of the stent used in transjugular intrahepatic portosystemic shunt(TIPS).In 2021,the Advancing Liver Therapeutic Approaches Consortium(ALTAC)recommended the use of controllable diameter TIPS covered stent system in the performance of TIPS,the stent diameter of this system can be adjusted within the range of 8 mm to 10 mm,and its stability can be maintained for a long time.This system carries several advantages such as accurately regulating portal venous pressure gradient(PPG),optimizing hemodynamic target,protecting liver blood perfusion,reducing shunt-related complications,etc.,indicating that this system has a promising clinical application prospect.Through reviewing the relevant literature,this paper summarizes the research progress of controllable diameter TIPS covered stent system,aiming to better help clinicians engaged in related fields to gain a further understanding of this new technology.

Objective:To analyze the clinicopathological features of de novo early colorectal cancer and to evaluate the efficacy of endoscopic treatment.Methods:Patients with de novo early colorectal cancer who underwent endoscopic resection in Beijing Friendship Hospital, Capital Medical University from June 2020 to May 2022 were enrolled. The baseline data, endoscopic manifestations, treatment methods, postoperative pathological results and prognosis of the patients were collected retrospectively.Results:A total of 33 patients with de novo early colorectal cancer were enrolled with the age of 62.67 ± 8.62 years, and the male to female ratio was 7.25∶1. The long diameter of lesions was 0.96 ± 0.36 cm. The lesion morphology was mainly superficial phenotype (type 0-Ⅱ), accounting for 72.7% (24/33). Endoscopic submucosal dissection (ESD) was performed in 29 cases and endoscopic mucosal resection (EMR) was performed in 4 cases. Postoperative pathology showed that 11 cases (33.3%) were well differentiated tubular adenocarcinoma, of which the superficial submucosal layer was invaded in 2 cases. Twenty cases (60.6%) were moderately differentiated tubular adenocarcinoma, of which the superficial submucosa layer was invaded in 5 cases and the deep submucosa layer in 15 cases. Two cases (6.1%) were moderately-poorly differentiated tubular adenocarcinoma, where the deep submucosa layer was invaded in both. There was significant correlation between the depth of invasion and the degree of differentiation ( P<0.001), and moderately and moderately-poorly differentiated lesions were more likely to invade the deep submucosa layer. The en bloc resection rate was 100.0% (33/33), the complete resection rate was 97.0% (32/33), and the curative resection rate was 42.4% (14/33). Among the 19 patients who did not achieve curative resection, 13 patients received supplementary surgical treatment. No tumor residue or lymph node metastasis was found in the postoperative pathology. All patients were followed up for 3-25 months, and no signs of local recurrence or metastasis were found. Conclusion:Most de novo early colorectal cancers are superficial phenotype under endoscopy. The pathology is mainly moderately differentiated tubular adenocarcinoma. Endoscopic resection of de novo early colorectal cancer shows encouraging short-term efficacy.

Objective:To evaluate the effect of stellate ganglion block on nighttime sleep quality in the patients with primary sleep disorders.Methods:Sixty patients of both sexes with primary sleep disorders, of American Society of Anesthesiology physical status Ⅰ or Ⅱ, aged 18-64 yr, weighing 40-75 kg, were randomized to 2 groups ( n=30 each): control group (group C) and stellate ganglion block group (group S). In group S, 0.2% ropivacaine 5 ml was injected into the surface of the right longus colli muscle where the the stellate ganglion was located under ultrasound guidance once a day for 7 consecutive days starting from 1 h before bedtime.While the equal volume of normal saline was given instead in group C. Patients′ Subjective Sleep Quality was assessed using the Pittsburgh Sleep Quality Index Questionnaire before treatment (T 0) and 1-7 days after treatment.The objective sleep quality was evaluated with polysomnography.A bispectral index(BIS)monitor and a cerebral and regional blood oxygen monitoring system were used to monitor the BIS value and regional cerebral oxygen saturation (rSO 2) during sleep, which were recorded once every 30 min, and the 7-day average was calculated.The patients′ daytime advanced cognitive function was assessed for 3 consecutive days after the end of treatment (T 8-10), including the Continuous Attention Test and the Behavioral Test for Performing Defect Syndrome, and the 3-day average value was calculated.Venous blood samples were collected at T 0 and T 8 to measure the plasma noradrenaline, cortisol, and serotonin concentrations by high-performance liquid chromatography. Results:Compared with group C, the individual and total scores of Pittsburgh Sleep Quality Index were significantly decreased, the sleep latency, awakening time and fast wave sleep latency were shortened, the number of awakening was increased, the total sleep time was prolonged, the sleep efficiency and proportion of fast wave sleep were increased, S 1-S 2 ratio in slow-wave sleep was decreased, S 3-S 4 ratio was increased, BIS value was decreased, rSO 2 was increased, each parameter of Continuous Attention Test was decreased and each parameter of Behavioral Test for Performing Defect Syndrome was increased after treatment, and plasma noradrenaline level was decreased at T 8 in group S ( P<0.05). Conclusion:Stellate ganglion block can improve nighttime sleep quality in patients with primary sleep disorders.

Shuyu Pill is the representative prescription for treating deficiency-essence. This article discussed the consistency of diabetes and deficiency-essence from TCM syndromes and etiology and pathogenesis, and probed into the correlation between Shuyu Pill and diabetic Western medicine of pathomechanism diabetes from the modern pharmacological research on Shuyu Pill. Therefore, it proposed that diabetes has the essence of deficiency-essence;the pathogenesis of diabetes should meet the efficacy of Shuyu Pill; pharmacological effects of Shuyu Pill can affect various pathological mechanism of diabetes, with a purpose to provide new ideas for the clinical treatment of diabetes.

Objective To observe the effect and adverse effect of ultrashort wave combined with Etroricox-ib in treatment of periarthritis of shoulder. Methods 80 cases with periarthritis of shoulder from March 2015 to March 2016 were randomly assigned into treatment group and control group. Etroricoxib therapy was provided in control group while ultrashort wave plus Etroricoxib therapy in treatment group. VAS ,ROM and MBI were applied for the evaluation before and after the treatment. The differences of clinical cure rate ,recurrence rate and adverse reactions were observed between 2 groups. Results There were higher cure rates ,lower recurrence rates and less adverse reactions in 2 groups after the treatment. The shoulder joint pain ,rang of should motion and BI of both groups were improved with significant differences after the treatment ,but treatment group witnessed more improve-ment(P<0.05). Conclusions Ultrashort wave combined with Etroricoxib therapy can relieve shoulder pain ,and further improve the function of shoulder joint activity in the treatment of periarthritis of shoulder. It is recommended for clinical application.

Systemic vasculitis is a rare disease, and the diagnosis is very difficult when patient shows atypical symptoms. We experienced an unusual case of dysphagia caused by Churg-Strauss syndrome with lower cranial nerve involvement. A 74-year-old man, with a past history of sinusitis, asthma, and hearing deficiency, was admitted to our department for evaluation of dysphagia. He also complained of recurrent bleeding of nasal cavities and esophagus. Brain magnetic resonance imaging did not show definite abnormality, and electrophysiologic findings were suggestive of mononeuritis multiplex. Dysphagia had not improved after conventional therapy. Biopsy of the nasal cavity showed extravascular eosinophilic infiltration. All these findings suggested a rare form of Churg-Strauss syndrome involving multiple lower cranial nerves. Dysphagia improved after steroid therapy.
Aged ; Asthma ; Biopsy ; Brain ; Churg-Strauss Syndrome* ; Cranial Nerve Diseases ; Cranial Nerves ; Deglutition Disorders* ; Diagnosis ; Eosinophils ; Esophagus ; Hearing ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Mononeuropathies ; Nasal Cavity ; Rare Diseases ; Sinusitis ; Systemic Vasculitis

Objective: To investigate the role of miR-455 in cardiac hypertrophy with its potential cellular and molecular mechanism in mice. Methods: The mice model of cardiac hypertrophy was established by transverse aorta constriction (TAC), and 18 male kunming TAC mice were randomly divided into 3 groups:①TAC + miR-455 group,②TAC + GFP (green lfuorescence protein) group and③Sham group (sham operation + GFP).n=6 in each group and all animals were treated for 2 weeks. The hemodynamic and echocardiographic indexes were examined, histo-pathological changes of myocardial tissue were observed by HE and Masson staining. The hypertrophic and ifbrosis gene expressions were measured by RT-PCR, the apoptosis protein level was detected by Western blot analysis. The expressions of miR-455 targeting gene and protein were also determined. Results: Upon 2 weeks modeling, compared with Sham group, TAC+GFP group had increased ratio of heart weight/ body weight (9.78 ± 0.20) mg/g vs (8.25 ± 0.22) mg/g,P<0.01, increased left ventricular diastolic (LVD) wall thicknesses (1.782 ± 0.058) mm vs (1.457 ± 0.050) mm,P<0.05, decreased LVD diameter (3.027 ± 0.052) mm vs (3.142±0.050) mm,P<0.05, increased LVEF (84.167 ± 4.167) % vs (77.000 ± 3.347) %,P<0.05; increased gene expressions of cardiac hypertrophy and ifbrosis, allP<0.05, decreased anti-apoptosis protein and increased promoting apoptosis protein, allP<0.05. Compared with TAC+GFP group, TAC+miR-455 group presented increased ratio of heart weight/body weight (12.04 ± 0.11) mg/g vs (9.78 ± 0.20) mg/g,P<0.01, increased LVD wall thicknesses (1.908 ± 0.062) mm vs (1.782 ± 0.058) mm,P<0.01, decreased LVD diameter (2.893 ± 0.069) mm vs (3.027 ± 0.052) mm,P<0.01, while LVEF was similar between 2 groups,P>0.05; increased gene expression of cardiac hypertrophy,P<0.05, while gene expression of cardiac ifbrosis was similar between 2 groups,P>0.05; the anti-apoptosis protein and promoting apoptosis protein expressions were similar between 2 groups. Compared with Sham group, TAC+GFP group had increased expressions of calreticulin (CALR) and glucose-regulated protein 78 (GRP78), allP<0.01. Compared with TAC+GFP group, TAC+miR-455 group had decreased mRNA and protein expressions of CALR, bothP<0.01, while GRP78 protein expression was similar between 2 groups,P>0.05. Conclusion: miR-455 may promote cardiac hypertrophy induced by short-term overload pressure via targeting CALR in experimental mice.

The impeller profile, which is one of the most important factors, determines the creation of shear stress which leads to blood hemolysis in the internal flow of centrifugal blood pump. The investigation of the internal flow field in centrifugal blood pump and the estimation of the hemolysis within different impeller profiles will provide information to improve the performance of centrifugal blood pump. The SST kappa-omega with low Reynolds correction was used in our laboratory to study the internal flow fields for four kinds of impellers of centrifugal blood pump. The flow fields included distributions of pressure field, velocity field and shear stress field. In addition, a fast numerical hemolysis approximation was adopted to calculate the normalized index of hemolysis (NIH). The results indicated that the pressure field distribution in all kinds of blood pump were reasonable, but for the log spiral impeller pump, the vortex and backflow were much lower than those of the other pumps, and the high shear stress zone was just about 0.004%, and the NIH was 0.0089.
Assisted Circulation ; Heart-Assist Devices ; Hemolysis ; Humans ; Models, Theoretical ; Stress, Mechanical

Objective To understand the distribution of inhaled allergens throughout Hainan province and explore effective preventive measures against allergen by examining the serum allergen of patients with chronic rhinosinusitis (CRS), which will provide evidence for specific immunotherapy for treating CRS. Methods Three hundred and eighteen CRS patients underwent Phadiatop blood test by using the UniCAP 100 , a completely automatic autoanalyser. Allergen-specific IgE of 7 common allergens were tested and the concentration of total immunoglobulin E (TIgE) was collected and evaluated. Results The positive rates of the serum TIgE and inhaled allergens were 64.15% and 37.74% respectively. The incidences of the positive serum SIgE is 33.96%. Among the positive cases, 28.30% of the inhaled allergens were dermatophagoides pteronyssinus, 27.36% for tropical mites, 21.07% for dermatophagoides farinae, 13.52% for cockroach, 11. 64% for house dust, 7. 86% for cat dander and 0.63% for dog dander. The incidences of positive TIgE and SIgE were not significantly different between patients with nasal polyps and sinusitis only. Conclusions Dermatophagoides pteronyssinus, tropical mites and dermatophagoides farinae are the main inhaled allergens for CRS patients in Hainan.