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.

OBJECTIVETo compare the effects of moxibustion combined with highly active antiretroviral therapy (HAART) and simple HAART for human immunodeficiency virus (HIV) infected patients.

METHODSA total of 100 patients with HIV receiving HAART were randomized into an observation group and a control group, 50 cases in each one. In the observation group, moxibustion was used at Zusanli (ST 36), Guanyuan (CV 4) and Sanyinjiao (SP 6), etc. combined with HAART of zidovudine, lamivudine, nevirapine and efavirenzone, etc. Simple HAART was used in the control group. The patients were observed for 18 months. The indexes were CD, CD/CD, interleukin 2 (IL-2), interleukin 7 (IL-7), the incidence of side effects and the score of quality of life.

RESULTSAfter treatment, CD, CD/CD, serum IL-2 and the scores of quality of life (physiological, psychological, social relation fields and comprehensive score) increased and serum IL-7 decreased compared with those before treatment in the two groups (<0.01,<0.05), with better results except CDin the observation group (<0.01,<0.05). The incidences of gastrointestinal side effects and total side effects in the observation group were lower than those in the control group (14% (7/50) vs 32% (16/50), 58% (29/50) vs 80% (40/50), both<0.05).

CONCLUSIONMoxibustion combined with HAART for HIV infected patients could reduce the incidence of side effects, improve medication compliance, CD/CD, IL-2, IL-7 and the quality of life.

Objective To discuss the safety and short-term efficacy of MR-guided focused ultrasound surgery (MRgFUS) for pain palliation of bone metastases patients.Methods Fourteen patients with painful bone metastases were recruited in this prospective study.The treating efficacy was characterized by numerical rating scale (NRS),the brief pain inventory quality of life (BPI-QOL) survey,and Karnosky performance status scale (KPS).Adverse events occurred pre-and post-treatment were analyzed.Normal distributed statistics was analyzed by using paired-samples t test or Wilcoxon rank sum test.Results Fourteen patients were treated with MRgFUS,2 patients dropped out of the study.The NRS ratings are 6.50(4.00),5.00 (5.25),2.50(5.00),2.50(4.75),2.00 (6.00) for pre-treatment,one week,one month,two months,and three months,respectively.Such variances of NRS ratings were statistically significant (Z=-2.773,-2.740,-2.769,-2.675;P＜0.05).The BPI-QOL ratings were (42.42± 8.27),(30.67 ± 12.29),(29.17±15.38),(29.92± 17.67) and (35.67± 19.28),respectively.The BPI-QOL ratings decreased in the first two months after the treatment which is statistically significant (t=3.231,2.820 and 2.453;P＜0.05);whereas for the third month,the BPI-QOL rating was statistically insignificant compared with the one before the treatment (P＞0.05).The KPS ratings were 80(28),80(20),65(45) for pre-treatment,one week and three months after treatment,respectively.Three months after the treatment,the KPS ratings decreased which was statistically significant compared with the one before the treatment (Z=-2.204,P＜0.05).After the treatment,one patient developed deep venous thrombosis,three patients reported lower extremities numbness,two patients had soft tissue edema around the lesions.Conclusions MRgFUS is effective for short-term pain palliation of bone metastases.Such noninvasive technique is safe and can improve patients' living condition.

Objective To investigate the pattern of nodal recurrence after curative resection in adenocarcinoma of the gastroesophageal junction ( AGE ) , and to provide a basis for delineation of the radiation range in the high-risk lymphatic drainage area.Methods A retrospective analysis was performed in 78 patients with locally advanced AGE who were newly treated in our hospital from January 2009 to December 2013 and had complete clinical data.All patients received curative resection and were pathologically diagnosed with stage T3/T4 or N (+) AGE.Those patients were also diagnosed with SiewertⅡor Ⅲ AGE by endoscopy, upper gastroenterography, macroscopic examination during operation, and pathological specimens.None of the patients received preoperative or postoperative radiotherapy.All patients were diagnosed by imaging with postoperative nodal recurrence.The computed tomography images of those
patients were accessible and had all the recurrence sites clearly and fully displayed.Results The median time to recurrence was 10 months ( 1-48 months) , and 90%of the recurrence occurred within 2 years after surgery.The lymph nodes with the highest risk of recurrence were No.16b1( 39%) , No.16a2( 37%) , No.9 (30%), and No.11p (26%), respectively.There was no significant difference in the recurrence rate within each lymphatic drainage area between patients with SiewertⅡandⅢAGE ( P=0.090-1.000) .The lymph nodes with the most frequent recurrence were No.16b1, No.16a2, No.9, No.16b2, No.11p, and No.7 in patients with stage N3 AGE and No.11p, No.16b1, No.16a2, No.9, No.8, and No.7 in patients with stage non-N3 AGE.Patients with stage N3 AGE had a significantly higher recurrence rate in the para-aortic regions (No.16a2-b2) than those with stage non-N3 AGE (67%vs.33%, P=0.004, OR=4.00, 95% CI=1.54-10.37) .Conclusions The lymph nodes with the highest risk of recurrence are located in the celiac artery, proximal splenic artery, and retroperitoneal areas ( No.16a2 and No.16b1) in patients with SiewertⅡorⅢlocally advanced AEG.Moreover, patients with stage N3 AGE have a higher risk of retroperitoneal recurrence.The above areas should be involved in target volume delineation for postoperative radiotherapy.

Voltage-gated sodium channels (VGSCs) in primary sensory neurons play a key role in transmitting pain signals to the central nervous system. BmK I, a site-3 sodium channel-specific toxin from scorpion Buthus martensi Karsch, induces pain behaviors in rats. However, the subtypes of VGSCs targeted by BmK I were not entirely clear. We therefore investigated the effects of BmK I on the current amplitude, gating and kinetic properties of Nav1.8, which is associated with neuronal hyperexcitability in DRG neurons. It was found that BmK I dose-dependently increased Nav1.8 current in small-sized (<25 μm) acutely dissociated DRG neurons, which correlated with its inhibition on both fast and slow inactivation. Moreover, voltage-dependent activation and steady-state inactivation curves of Nav1.8 were shifted in a hyperpolarized direction. Thus, BmK I reduced the threshold of neuronal excitability and increased action potential firing in DRG neurons. In conclusion, our data clearly demonstrated that BmK I modulated Nav1.8 remarkably, suggesting BmK I as a valuable probe for studying Nav1.8. And Nav1.8 is an important target related to BmK I-evoked pain.
Aniline Compounds ; pharmacology ; Animals ; Cell Size ; Cells, Cultured ; Electrophysiological Phenomena ; drug effects ; Furans ; pharmacology ; Ganglia, Spinal ; cytology ; Kinetics ; Male ; NAV1.8 Voltage-Gated Sodium Channel ; metabolism ; Rats ; Rats, Sprague-Dawley ; Scorpion Venoms ; antagonists & inhibitors ; pharmacology ; Scorpions ; Sensory Receptor Cells ; drug effects ; metabolism ; physiology ; Sodium Channel Blockers ; pharmacology ; Voltage-Gated Sodium Channel Agonists ; pharmacology

Objective To investigate the efficacy of relaparoscopic common bile duct exploration in choledocholithiasis.Methods 50 patients who underwent LC/OC/LCBDE/OCBDE for biliary surgery with choledocholithiasis were randomized into two groups:Group A (n ＝25) laparoscopic approach and Group B (n =25) open approach.The operation time,hospital stay,cost of hospitalization and postoperative complications were compared.Results There was no significant difference in the operation time,liver functional index,postoperative bile leakage rate and cost of hospitalization between the two groups.The postoperative hospital stay in group A was shorter than that in group B (7.1 ± 1.5 vs 12.4 ±4.3 days,P ＜0.05),as was the volume of intraoperative blood loss (58.3 ± 24.2 ml vs 108.6 ± 35.7 ml,P ＜ 0.05),recovery of gastrointestinal function (26.3 ±3.6 vs 58.2 ±6.3 hours,P ＜0.05),postoperative analgesia (7/25 vs 17/25,P＜0.05) and wound infection rate (1/25 vs 6/25,P＜0.05).Conclusions Relaparoscopic commonbile duct exploration for recurrent choledocholithiasis appeared to be a safe,feasible,and efficacious procedure when carried out by expert laparoscopic surgeons.The procedure is worth promoting.

Objective To investigate the feasibility of labeling mice spleen lymphocytes with superparamagnetic iron oxide(SPIO)and in vitro MR imaging of the labeled cells.Methods Spleen lymphocytes of 5 mice were isolated and then labeled with SPIO of 100,50,25,15,10,5 μg/ml,which was previously prepared with PLL.Prussian blue staining was performed to show the intracellular iron.Cell viability was compared among fresh,labeled and unlabeled cells.Different concentrations of mice spleen lymphocytes were screened using 3.0 T MR on T2WI,T2 * WI and SWI sequences in vitro.Cell viability was compared using independent-sample t test between groups.The MRI values among different groups were compared using one-way ANOVA.Results SPIO prepared with PLL could successfully label mice spleen lymphocytes,the optimum concentration of SPIO was 5 μg/ml.The Prussian blue staining showed intracellular blue spots and a labeling efficiency of(93.6 ± 2.1)％.Three groups of fresh,labeled and unlabeled cells showed a Trypan blue staining result of(94.8 ± 3.1)％,(88.7 ± 2.7)％,and(88.9 ±3.2)％,respectively; no statistically significant difference was found in cell viability between labeled and unlabeled lymphocytes(t =0.281,P ＞ 0.05); however,the cell viability of fresh cells were statistically significant higher than the labeled and unlabeled lymphocytes(t =8.125 and 7.253 respectively,P ＜0.05for all).Among the T2 WI,T2 * WI and SWI sequences under the same concentrations of cells,the SWI sequence was the most sensitive.Conclusions The mice spleen lymphocytes can be effectively labeled with SPIO with no impact on cell viability,and MR can be used to track these labeled cells in vitro.The SWI sequence is the most sensitive.

OBJECTIVE: We wanted to differentiate between transient ischemic attack (TIA) and minor stroke using fractional anisotropy and three-dimensional (3D) fiber tractography. MATERIALS AND METHODS: The clinical data, conventional magnetic resonance imaging (MRI), diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) were obtained for 45 TIA patients and 33 minor stroke patients. The fractional anisotrophy ratio (rFA) between the lesion and the mirrored corresponding contralateral normal tissue was calculated and analyzed. The spatial relationship between the lesion and the corticospinal tract (CST) was analyzed and the lesion sizes in the minor stroke patients and TIA patients were compared. RESULTS: Twenty-two of the 45 TIA patients (49%) revealed focal abnormalities following DWI. The rFA was significantly lower (p < 0.05) in the stroke patients (0.71 +/- 0.29) compared to that of the TIA patients (1.05 +/- 0.37). The CST was involved in almost all stroke lesions, but it was not involved in 68% of the TIA lesions. The TIA patients had significantly lower CST injury scores (3.25 +/- 1.75) than did the stroke patients (8.80 +/- 2.39) (p = 0.004). CONCLUSION: Our data indicate that TIA and minor stroke can be identified by analyzing the rFA and the degree of CST involvement, and this may also allow more accurate prediction of a patient's long-term recovery or disability.
Aged ; Anisotropy ; Area Under Curve ; Chi-Square Distribution ; Diagnosis, Differential ; Diffusion Tensor Imaging/*methods ; Female ; Humans ; Image Interpretation, Computer-Assisted ; *Imaging, Three-Dimensional ; Ischemic Attack, Transient/*pathology ; Male ; Middle Aged ; ROC Curve ; Sensitivity and Specificity ; Stroke/*pathology

Objective To detect the effect of olfactory bulb(OB)lesion on proliferation,migration and differentiation of the neural stem cells(NSCs)in the subventricular zone(SVZ).Methods Forty-two healthy female SD rats were enrolled and randomly divided into normal control group,isotonic saline group and OB lesion at day 3,at weeks 1,2,3 and 4 groups,six rats per group.OB lesion was induced by N-methyl-D-aspartic acid(NMDA)injection.Bromodeoxyuridine(BrdU)was injected intraperitoneally to label NSCs.Immunohistochemical staining was used to detect the proliferation of SVZ NSCs.In addition,another 18 rats were randomly divided into normal control group,isotonic saline group and lesion group,six rats per group.BrdU was injected intraperitoneally one week after OB lesion and then the animals were sacrificed four weeks after BrdU injection to detect the migration and differentiation of NSCs with immunohistochemistry and immunofluorescence.Results Three days after OB lesion,BrdU-positive cells in SVZ began to increase(26.33 ± 2.58,P ＜0.01),reached the maximum at week 1 (35.33 +3.01,P＜0.01)and still sustained a high level at week 4(19.50+ 2.26,P＞0.05).Five weeks after the OB lesion,the rostral migratory-stream(RMS)and the BrdU-positive cells in OB were significantly increased(86.50 + 5.09,P ＜ 0.01)and(52.83 + 3.87,P ＜ 0.01),respectively.By using fluorescence double staining,most of the BrdU-positive cells were co-localized with the neuronal nuclear antigen(Neun),with a portion of BrdU-positive cells expressing the glial fibrillary acidic protein (GFAP).Conclusions OB lesion can improve the proliferation of NSCs in SVZ and migration of NSCs to OB.The newborn cells can differentiate into not only neurons,but also gliocytes and may be involved in lesion repair.

Objective To investigate the diagnosis value of the tissue strain imaging in myocardial dysfunction in systemic lupus erythematosus (SLE). Methods Sixty-two patients and sixty controls underwent conventional and tissue Doppler echocardiography. Peak strain and strain rate value during systolic and diastolic phases as well as E/A, left ventricular fraction shortening (LVFS), left ventricular ejection fraction(LVEF) were measured in both SLE and the control groups. Results ①E/A,LVFS and LVEF did not differ between SLE patients and controls( P ＞0.05). The systolic peak strain and strain rate of SLE patients were lower than those of controls but without significant differences( P ＞0.05). ②The diastolic peak strain and strain rate of SLE patients were significantly lower than those of controls (P ＜0.01). ③ The diastolic peak strain and strain rate of antiheart antibody (AHA) positive patients were significantly lower than those of negative ones( P ＜0.05). Conclusions Strain and strain rate combining with AHA can sensitively detect myocardial dysfunction of SLE.