Objective To investigate the effect of L-carnitine combined with psychological intervention on nutritional status and inflammatory status in maintenance hemodialysis patients. Methods 75 cases of maintenance hemodialysis patients treated in our hospital from September 2016 to December 2016 were randomly divided into control group(n=37) and study group(n=38)by single and double number method (hospital visit order). The control group in the hemodialysis treatment combined with Levocarnitine; the study group in the use of L-carnitine combined with psychological intervention. Results There were no significant differences in ALB, Hb, BMI, IL-6 and CRP between the two groups before treatment. After the corresponding treatment, the improvement of ALB, Hb, BMI, IL-6, CRP and other inflammatory indexes and nutritional indexes in the study group were better than those in the control group(P<0.05). Conclusion The application of L-carnitine in maintenance hemodialysis patients combined with psychological intervention can significantly improve the body's Micro inflammatory status and nutrition indicators, has positive significance to protect the patients' quality of life and physical and mental health.

Objective To explore the interaction of calcitonin receptor (CTR) gene polymorphisms and environmental factors in the population lived in coal-burning-borne endemic fluorosis areas in Chongqing.Methods A 1 ∶ 1 case-control study was carried out and Duping Township of Wushan County and Xinglong Township of Fengjie County of Chongqing were chosen as the endemic fluorosis areas.The observation subjects were divided into case group 121 cases and internal control group 130 cases.The Alu I polymorphism in the CTR gene was genotyped using the PCR-RFLP procedure.Logistic regression model was used to analyze the environment and genetic factors,and the interaction between genes and environment was determined according to interaction indicators.Results The rate of CC genotype in case group was lower than that of the control group [60.33％ (73/121) vs.74.62％ (97/130)],while the TT genotype was higher than that of the control group[9.09％ (11/21) vs.3.85％(5/130)].Significant differences in Alu I genotypes were observed between groups(x2 =6.57,P =0.037 ＜ 0.05; 95％CI:0.029-0.036).Allele frequencies of CTR genotypes differed significantly between groups(x2 =7.67,P =0.006 ＜ 0.01 ; OR =0.53,95 ％ CI:0.338-0.834).Urinary fluoride level (≥ 1 mg/L) was demonstrated to be a risk factor of fluorosis(OR =1.814,P =0.041 ＜ 0.05).There was a positive interaction(OR =5.530,γ =2.457) between CT + TT genotypes in CTR and the fluorosis environment of the people (urinary fluoride level ≥ 1 mg/L).Conclusions There is a certain type of interaction between CTR gene C/T polymorphism and environmental fluorine content (urinary fluoride ≥ 1 mg/L) in Chongqing population lived in coal-burning-borne fluorosis areas,and the onset of fluorosis is the result of interaction between heredity and environment.

Objectives To investigate the efficacy of the shear wave velocity (SWV) based on acoustic radiation force impulse (ARFI) elastography in the differentiation of normal population with chronic kidney disease (CKD) and acute kidney injury (AKI) in middle aged and elderly patients.Methods Sixty-four middle aged and elderly patients referred to China-Japan Friendship Hospital and Zhejiang Provincial People's Hospital with AKI or CKD were enrolled in this study from February 2015 to December 2016 (kidney disease group).Among them,43 patients were CKD (CKD group),and 21 patients were AKI (AKI group,15 patients combined with prior CKD,6 patients without prior CKD).Twenty-nine middle aged and elderly healthy volunteers from China-Japan Friendship Hospital were enrolled at the same time (healthy control group).The SWV values of the renal middle pole cortex were acquired using the ARFI elastography.The differences of the kidney length,cortical thickness and SWV values among healthy control group,AKI and CKD group were compared by variance analysis.The LSD-t analysis was used for the advanced comparison between any two groups.The differences of cortical SWV values among healthy control group,AKI combined with prior CKD group,AKI without prior CKD group and CKD group were compared by variance analysis.The LSD-t analysis was used for the advanced comparison between any two groups.The receiver operating characteristic (ROC) curves of the cortical SWV values for diagnosing kidney disease was drawn.Results The mean cortical SWV values of healthy control group,AKI and CKD groups were (2.88±0.63),(2.42±0.83) and (2.06±0.72) m/s,respectively.The SWV values of AKI and CKD groups were significantly lower than that of healthy control group (t=2.158,P=0.033;t=5.234,P ＜ 0.001).The SWV values of CKD group were lower than that of AKI group,but there were no significant differences.The SWV values of AKI without previous CKD group and AKI combined with prior CKD group were (2.60±0.84) and (1.80±0.45) m/s,respectively.The SWV values of AKI combined with prior CKD group and CKD group were significant lower than that of healthy control group and AKI without prior CKD group (compared with healthy control group:t=2.916,P=0.004 and t=5.318,P ＜ 0.001;compared with AKI without prior CKD group:t=2.054,P=0.043 and t=-2.517,P=0.013).But there were no significant differences between AKI combined with prior CKD group and CKD group,so as to the AKI without prior CKD group and healthy control group.The cutoff value of cortical SWV for diagnosing kidney disease was 2.40 m/s,with an area under ROC curve was 0.767 (95％ CI 0.689-0.898,P=0.000).The sensitive and specificity were 57.1％ and 81.9％,respectively.Conclusions The SWV values of kidneys in middle aged and elderly CKD and AKI patients were significantly lower than those of apparently normal kidneys.The SWV values of AKI patients combined with prior CKD were lower than AKI patients without prior CKD.Determining cut-off SWV values based on ARFI elastography between normal and damaged renal parenchyma can help in the diagnosis of kidney disease in middle aged and elderly patients.

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.