Based on the concept of environmental factors of ICF, together with the practice of environmental assessment and reform in the recent years, this paper discussed the principle, specification, procedures and content of environmental assessment.

Objective To analyze the relationship between needs of assistive devices and the three other factors (age, disability categories, severity levels of disability) in order to scientifically formulate subsidy policy on assistive devices.MethodsThe assessment of rehabilitation needs for 928 Shenzhen citizens with new disability certificates in its six districts was performed by professionals, and the data was recorded into ACCESS database and analyzed.ResultsThe sequence of demand rates on assistive devices among disability categories was vision disability (78%), hearing disability (76%) and physical disability (74%); but speech, mental retardation and psychological disabilities had a low demand. The demand rates of assistive devices were dissimilar among four age groups for persons with vision, hearing and physical disabilities; for severity levels of three disability categories of vision, hearing and physical disabilities: the milder the vision disability was, the greater demand rates of assistive devices were; the demand rate of those with the second level of hearing disability was the highest; the demand rates of persons with the first and second levels of physical disability were relatively higher.ConclusionWhen drawing up subsidy policy on assistive devices for persons with disability, the disability categories, ages of persons with disability and severity levels of disability should be considered; the different types of assistive devices should be supplied according to rehabilitation goals at different age group; and necessary assistive devices should be provided according to severity levels of disability.

Objective To survey the current status of human resources of the Anesthesiology in Chi-na and investigate the reform direction of human resources allocation of Chinese medical and health system. Methods Chinese Society of Anesthesiology organized the investigation from March 1, 2015 to June 30, 2015.All the hospitals in which clinical anesthesia was carried out were investigated only in mainland Chi-na.The questionnaires contained hospital general information, anesthesia-related information and surgery-re-lated information.Results A total of 16 280 questionnaires were released and 14 076 questionnaires (86.462%)were retrieved.There were 13 489 questionnaires(82.856%)identified as qualified anesthesia-related information ones and 7 026 questionnaires(43.157%)identified as qualified surgery-related informa-tion ones.Qualified anesthesia-related information questionnaires showed that there were 77 926 anesthesiolo-gists in total in China, 27 660 000 patients in whom anesthesia was completed inside operating room(OR)and 11 470 000 cases outside OR, one attending anesthesiologist completed anesthesia in 634 cases inside OR and in 263 cases outside OR on average; the number of per capita anesthesiologists was 5.7 per 100 000 pop-ulation in 2014.The number of per capita physicians per 10 000 population(r=0.735, P<0.05), the num-ber of anesthesiologists per 100 000 population(r=0.537, P<0.05)and the number of per capita patients requiring anesthesia per 100 000 population(r=0.571, P<0.05)were all positively correlated with GDP per capita in various provinces and cities nationwide and autonomous regions.The area having the highest num-ber of per capita anesthesiologists per 10 000 and per 100 000 population was Beijing, the area having the lowest number was Tibet; the area having the highest number of per capita patients requiring anesthesia per 100 000 population was Beijing, the area having the lowest number was Shanxi. The qualified surgery-related information questionnaires showed that the ratio of attending surgeons to attending anesthesiologists was 7.5:1.0 in China in 2014.Conclusion Although China has a huge number of anesthesiologists, the Anesthesiolo-gy is still shortage of anesthesiologists; the imbalanced distribution of human resources exists in different provinces and cities, in hospitals of different scales and between different medical specialties, and economics is one of the important influencing factors.

OBJECTIVE: To identify and analysis three ABO variant Bw subtypes. METHODS: Serological assays were carried out to identify the ABO blood group of the proband. ABO gene was identified by Sanger sequencing. RESULTS: The genotype of three individuals are ABO*Bw.11/0.01.02, ABO*Bw.12/0.01.01, ABO*Bw.34/A1.02, receptively. Sequencing results showed that there were c.695T>C, c.278C>T, c.889G>A, resulting in variants in Leu232Pro, Pro93Leu and Glu297Lys, receptively. CONCLUSION Bw11, Bw12 and Bw34 subgroups were identified, and gene testing can be used as a supplement to determine the ABO blood group subtypes.
ABO Blood-Group System/genetics* ; Alleles ; Blood Grouping and Crossmatching ; Exons ; Genotype ; Humans ; Phenotype ; Sequence Analysis

Objective:To analyze the genetic sequences of two patients with a rare Ael blood subgroup.Methods:Two female patients undergoing treatment respectively for adenomyoma of the uterus and gastritis at the Second Affiliated Hospital, Yuying Children′s Hospital of Wenzhou Medical University in June 2019 and September 2020 were selected as the study subjects. Their Ael subtypes were identified with a saline tube agglutination assay and absorption-emission assay. Sequence of the ABO gene Ael subtypes was determined by the Sanger method. The impact of genetic variants on the structural stability of N-acetylgalactosaminyl transferase (GTA) was analyzed with PyMOL software by constructing a structure predicted model. Results:Both patients were determined as Ael blood subgroup. Sequencing result of patient 1 was ABO* O.01.02/ ABO* O.01.02, which has resulted in a p. Thr88Profs*31 amino acid substitution. The sequencing result of patient 2 was ABO* Ael.06/ ABO* O.01.02, in which c. 425C>T and c. 467C>T variants in exon 7 have led to p. Met142Thr and p. Pro156Leu substitutions. Prediction of the protein model speculated that the p. Met142Thr not only can change the binding of GTA protein with water molecules, but also the local hydrogen bond network of GTA, which may lead to decreased enzymatic activity. By contrast, the p. Pro156Leu variant has trivial effect on the structural stability of GTA. Conclusion:The molecular structure of Ael subtypes can be diverse. The genotypes of the two patients have been respectively determined as ABO* O.01.02/ ABO* O.01.02 with a G261 deletion and ABO* Ael.06/ ABO* O.01.02.

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of aggressive lymphoma. The relapsed/refractory DLBCL patients have poor outcomes and DLBCL is still lack of effective treatment standard regimens. How to effectively treat relapsed/refractory DLBCL patients has become a research hotspot, and the current treatment methods include bispecific antibody therapy, chimeric antigen receptor T-cell (CAR-T) therapy, antibody-drug conjugates (ADC) therapy. This paper reviews the progress of targeted drugs/cell treatment for DLBCL at the 64th American Society of Hematology annual meeting.

Objective:To explore the molecular mechanisms of a Chinese pedigree with hereditary factor Ⅺ (FⅪ) deficiency.Methods:All of the 15 exons, flanking sequences of the FⅪ gene and the corresponding mutation sites of family members were analyzed by the Sanger sequencing, followed by the extraction of the peripheral blood genomic DNA. And all the results were verified by the reverse sequencing. The conservation of the mutated sites was analyzed by the ClustalX-2.1-win. Three online bioinformatics software tools, including Mutation Taster, PolyPhen2 and the PROVEAN, were used to assess the possible impact of the mutations. Swiss-pdbviewer software was used to analyze the effects of mutant amino acids on protein structure.Results:Genetic analysis revealed that the proband had compound heterozygous mutations including a nonsense mutation of c. 1107C>A (Tyr369stop) in exon 10 and missense mutation of c. 1562A>G (Tyr521Cys) in exon 13. The same c. 1107C>A (Tyr369stop) was present in her father, the same c. 1562A>G (Tyr521Cys) was present in both her mother and daughter. Conservation analysis indicated that Tyr521 was a highly conserved site during evolution. The prediction of pathogenicity showed that both c. 1107C>A and c. 1562A>G were pathogenic mutations. Protein structure prediction showed that in the wild type FⅪ protein structure, Tyr521 formed a hydrogen bond with the Lys572 and Ile388, respectively. When Tyr521 was replaced by Cys521, the original benzene ring structure disappeared, and side chains of Lys572 added a hydrogen bond with the Cys521, which may chang protein catalytic domain structure. When Tyr369 was mutated to a stop codon, resulting in the truncated protein.Conclusion:The compound heterozygous mutations including the c. 1107C>A heterozygous missense variant in exon 10 and the c. 1562A>G heterozygous nonsense mutation in exon 13 may be responsible for the hereditary factor Ⅺ deficiency in this Chinese pedigree.

OBJECTIVE： To explore the effects of different primary processing methods on quality change of Polygonatum sibiricum， and to optimize primary processing method of P. sibiricum with different grades and shapes. METHODS： After processed with different drying methods， boiling method and steaming method， sulfuric acid-phenol method was used to determine the contents of indicator component P. sibiricum polysaccharide in samples. The contents of ethanol-soluble extract， water-soluble extract and total ash were investigated. The optimal primary processing methods were screened. RESULTS： After processed with different methods， the contents of polysaccharide （≥7％）， ethanol-soluble extract （≥45％） and total ash （≤4％） of samples at all levels conformed to the requirements of the 2015 edition of Chinese Pharmacopoeia （part Ⅰ）； from aspect of drying method， microwave drying method was better than oven drying method；for P. sibiricum with different morphologies （individual and lamellar）， the quality of lamellar samples of P. sibiricum was better than that of individual P. sibiricum. As primary processing method， steaming was better than boiling. The contents of P. sibiricum polysaccharide were in relatively high level， when the steaming and boiling time of gradeless and uniformly-priced goods of P. sibiricum were 20 and 15 minutes respectively. CONCLUSIONS： By discussing the different primary processing methods， high-efficient primary processing method for the individual and lamellar samples of P. sibiricum as well as gradeless and uniformly-priced goods of P. sibiricum are preliminarily obtained， which can provide a scientific basis for the effective utilization of P. sibiricum resources.

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.