Objective:To explore the CT manifestations and pathological features of pneumonia-type lung cancer, and to improve the diagnosis capability of pneumonia-type lung cancer. Methods:CT and pathologic features of 23 cases ofsurgical pathology or biopsy confirmed pneumonia-type lung cancer patients were retrospectively analyzed and classified according to the new pulmonary adenocarcinoma classification. Results:Among the 23 pneumonia-type lung cancer subjects, CT showed 12 cases with lung pulmonary consolidation shadows, for sheets or diffuse distribution of density increase, combined with cysts or honeycomb lung symptom in 7 cases. 5 cases as inflatable bronchial symptoms within the consolidation, 3 cases bronchial stiffness, narrowed lumen to uneven thickness of 2 case, combine with circuity twigs with change.7 cases of nodular for grinding glass, including 4 cases of mixed ground glass nodules, around with focal nodular. 3 case of the lumps, fibrosis and consolidation of mixed picture. 3 case of pure grinding glass nodules and fibrosis. Results:Pathology results revealed 13 cases of adenocarcinoma, bronchioloalveolar carcinoma in 5 cases, 4 cases were squamous carcinoma, papillary adenocarcinoma in 1 case. Conclusion: CT features of pneumonia-type lung cancer are single or multiple opacities, within which inflatable bronchial symptoms can be observed, with multiple nodules andground glass shadowing, cysts or honeycomb symptom can also be found concomitant, thelesions expand, increase and spread to both lungs, taking its dynamic change features intoconsideration will also help to improve the diagnostic accuracy.

Objective: To analyze the clinical value of 16-slice CT angiography techniques in cerebral artery lesions. Methods:Forty three cases in our hospital with suspected cerebrovascular disease who performed computed tomography angiography were retrospectively analyzed. Volumetric imaging, maximum intensity projection and multi-planar reconstruction technique for three-dimensional reconstruction process were used in post-processing. Results:There were 27 cases with no abnormal blood vessels, 6 cases with aneurysm, 1 with arteriovenous malformation, 8 with arterial stenosis and 1 with congenital abnormalities. The image quality analysis of cerebral vascular trunk and main branches was 100%performed in 43 cases. The location, shape, size, and the relationship with the surrounding blood vessels and skull of the aneurysm have been clearly shown, and the nidus, feeding arteries and draining veins have also been clearly shown. Conclusion:With the features of safe, fast, non-invasive and clarity in images, 16-slice CT angiography imaging technology can be used as the first choice of screening cerebral arterial disease.

Objective To evaluate effects and safety of mixed solution of sodium hyaluronate, normal saline and indicarmine during endoscopic submucosal dissection(ESD). Methods A total of 233 patients with gastric, esophageal and colonic lesions diagnosed by endoscopy in the digestive endoscopy center of the First Affiliated Hospital of Soochow University between September 2015 and November 2016 were randomly divided into the experimental group(173 patients)and the control group(50 patients). The experimental group was injected with sodium hyaluronate 100 mg+normal saline 60 mL+0.2% indicarmine 4 mL, and the control group with normal saline 70 mL+0.2% indicarmine 4 mL. The solutions were used for multi-point injection in submucosa outside markers of lesions, respectively, and ESD was performed until lesions were effectively lifted up. The location and size of lesions, operation time, dose of injection and the incidence of complications were compared between the two groups. Results The diameter of resected specimen was 1.9± 1.3 cm in the experimental group, slightly less than that in the control group(2.0 ± 1.8 cm,P>0.05). The operation time from lesion mark to the end of ESD in the experimental group was 59.5±26.7 min,significantly less than that in the control group(68.6±29.0 min, P<0.05). The dose of injection in the experimental group(55.5 ± 31.8 mL)was obviously lower than that in the control group (66.7±35.1 mL,P<0.05). The rate of delayed bleeding in the experimental group was 1.16%(2/173),which was significantly lower than that in the control group[12.00%(6/50), P<0.05]. No delayed perforation occurred in the experimental group,while 3 cases(6.00%)occurred in the control group(P<0.05). Conclusion ESD shows better effects and high safety after the submucosal injection of mixed solution of sodium hyaluronate,normal saline and indicarmine.

【Objective】 To learn more about the role of therapeutic plasma exchange in the management of cytokines release syndrome(CRS) after chimeric antigen receptor T(CAR-T) infusion by reviewing and analyzing the diagnosis and treatment of one case. 【Methods】 The diagnosis and treatment of lymphoma patients with CAR-T infusion related CRS were described, and case analysis was carried out by searching PubMed, Elsevier, Wiley, CNKI, and other databases for relevant guidelines, clinical trials, and case reports. 【Results】 The patient was diagnosed with follicular cell lymphoma. Progressive disease(PD) was assessed after multiple courses of treatment, and anti-CD19/20 CAR-T cell therapy was administered.The patient developed a high fever and chills, secondary dyspnea and hypotension at night on the day of infusion, and the inflammatory factors such as C-reactive protein(CRP) and interleukin-6(IL-6) increased sharply, suggesting the occurrence of cytokines release syndrome(CRS). After the patient was given symptomatic antipyretic, broad-spectrum anti-infection, tumor necrosis factor(TNF) antibody and three occasions of plasma exchange, the clinical manifestations of CRS gradually relieved. Three months after discharge, the patient was in complete response(CR). 【Conclusion】 CAR-T-associated CRS is a serious cellular immunotherapy-related toxicity that can result in multiple organ failure or even death in patients. Therapeutic plasma exchange may be a potential treatment for some patients with severe CRS.

【Objective】 To evaluate common laboratory items in a large-dose blood loss model in vitro using thromboelastogram (TEG), to provide a reasonable infusion solution for clinical massive transfusions. 【Methods】 On March 2nd, 2017, eight healthy blood donors who participated in voluntary blood donation in the Department of Blood Transfusion Medicine of the First Medical Center of the PLA General Hospital were selected to undergo phlebotomy, and an in vitro dilution model of massive blood loss was established based on the previous research, namely Model 1 (M1, given massive transfusion protocol) and Model 2 (M2, given packed red blood cells and plasma) were established. Then blood routine, routine coagulation function, clotting factor activity, TEG of each model were tested. 【Results】 The platelet count in the M1 model was 61.00±10.24 (×10⁹/L), and reduced to 28.83±10.36(×10⁹/L) in M2 (P<0.01). The MA value (mm) of two groups detected by TEG was 29.35±2.37 vs 20.53± 2.76 (P<0.01). In M1 and M2 model, The activities of primary clotting factors respectively decreased to about 40% and 30% to original in M1 and M2. The R value of TEG prolonged to (6.32±0.85) min and (7.27±0.63) min respectively, still within the normal range(baseline 4.97±1.04). The fibrinogen concentration in the M1 and M2 model decreased to (1.10±0.08) g/L and (0.81±0.10) g/L(P<0.01), which had the same variation tendency to Alpha angle of TEG (25.65±4.95 vs 16.63±3.94, P>0.05). 【Conclusion】 MTP with blood components supplemented such as platelet and cryoprecipitate in time has effectively improved the Plt and Fib in vitro large-dose blood loss/transfusion model.

OBJECTIVE To investigate the mechanism of Yifei xuanfei jiangzhuo formula （YFXF） against vascular dementia （VD）. METHODS The differentially expressed genes of YFXF （YDEGs） were obtained by network pharmacology. High-risk genes were screened from YDEGs by using the nomogram model. The optimal machine learning models in generalized linear， support vector machine， extreme gradient boosting and random forest models were screened based on high-risk genes. VD model rats were established by bilateral common carotid artery occlusion， and were randomly divided into model group and YFXF group （12.18 g/kg， by the total amount of crude drugs）， and sham operation group was established additionally， with 6 rats in each group. The effects of YFXF on behavior （using escape latency and times of crossing platform as indexes）， histopathologic changes of cerebral cortex， and the expression of proteins related to the secreted phosphoprotein 1 （SPP1）/phosphoinositide 3-kinase （PI3K）/protein kinase B （aka Akt） signaling pathway and the mRNA expression of SPP1 in cerebral cortex of VD rats were evaluated. RESULTS A total of 6 YDEGs were obtained， among which SPP1， CCL2， HMOX1 and HSPB1 may be high-risk genes of VD. The generalized linear model based on high-risk genes had the highest prediction accuracy （area under the curve of 0.954）. Compared with the model group， YFXF could significantly shorten the escape latency of VD rats， significantly increase the times of crossing platform （P＜0.05）； improve the pathological damage of cerebral cortex， such as neuronal shrinkage and neuronal necrosis； significantly reduce the expressions of SPP1 protein and mRNA （P＜0.05）， while significantly increase the phosphorylation levels of PI3K and Akt （P＜0.05）. CONCLUSIONS VD high-risk genes SPP1， CCL2， HMOX1 and HSPB1 may be the important targets of YFXF. YFXF may play an anti-VD role by down-regulating the protein and mRNA expressions of SPP1 and activating PI3K/Akt signaling pathway.

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.