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.

With the rapid increase of the microbiome samples and sequencing data,more and more knowledge about microbial communities has been gained.However,there is still much more to learn about microbial communities,including billions of novel species and genes,as well as count-less spatiotemporal dynamic patterns within the microbial communities,which together form the microbial dark matter.In this work,we summarized the dark matter in microbiome research and reviewed current data mining methods,especially artificial intelligence(AI)methods,for different types of knowledge discovery from microbial dark matter.We also provided case studies on using AI methods for microbiome data mining and knowledge discovery.In summary,we view microbial dark matter not as a problem to be solved but as an opportunity for AI methods to explore,with the goal of advancing our understanding of microbial communities,as well as developing better solu-tions to global concerns about human health and the environment.

【Objective】 To explore the effect of repeated use of situational dialogues in the process of blood donation of voluntary blood donors. 【Methods】 From September to November 2019, blood donors in the center were investigated in the form of questionnaire, and the influencing factors of blood donation experience were analyzed by regression analysis.The direction of blood donation service should be improved according to the influencing factors.Compared with the survey data before and after the improvement, the effectiveness of the new blood donation service measures, centering on the situation dialogue, on improving blood donation experience was evaluated. 【Results】 A total of 304 and 187 valid questionnaires were returned from the two surveys. Regression analysis of the data from the first study revealed that the main factors affecting the blood donation experience were emotion, value, body and service. The regression coefficient for emotional experience was 2.587 (OR=13.292). Based on this evidence, improvements were implemented to the blood donation service, and the core strategy was to increase emotional communication with blood donors through multiple situational dialogues to achieve psychological support for blood donors. The results of the comparison of the data before and after the measure were as follows: emotional experience 3.490±0.879 vs. 3.754±0.771, value experience 3.461±0.957 vs. 3.722±0.854, and service experience 3.355±0.908 vs. 3.663±0.909; all were improved (F=9.365~23.025, P<0.01 for all). The control analysis illustrated that the improved orientation of the blood donation service was effective in improving the donor experience (χ²=4.776, P<0.05). 【Conclusion】 Increasing verbal situational dialogues with blood donors is an effective way for blood centers to improve donors′ donation experience, which helps donors to develop a positive evaluation of blood donation and leads to an increased intention to return.

OBJECTIVE: To explore the relationship between dry weight setting and the related parameters of PEW of multicenter hemodialysis patients in Guizhou. in order to provide the basis for setting dry weight in patients. METHODS: We conducted the research in patients of 11 hemodialysis center in Guizhou province. We collected demographic data(age, gender, nationality, marital status, education level, income status and so on) by questionnaire; are collected dry weight, ECW, ICW, fat mass,lean body mass and so on by bioelectrical impedance analysis, and then we also collected physical measurement indexes, such as waist circumference, hip circumference, medium arm circumference(MAC), tricep fold thickness(TSF)and crus diameter. The data is divided into three groups according to the dry weight setings. Group 1: dry weight setting was slightly lower(dry weight setted by doctors was slightly lower than bioelectrical impedance analysis results,withen 1 kg); group 2: dry weight setting was normal; group 3: dry weight setting slightly higher group(dry weight setted by doctors was slightly higher than bioelectrical impedance analysis results,withen 1 kg). We used Chi-square analysis to analyze PEW prevalence, compared differences of the PEW indications by variance analysis, and then we used Spearman correlation analysis to analyze the correlation between PEW and the indications. Influence of various factors on the PEW was analyzed by logistic regression analysis. RESULTS: The PEW morbidity of group 3 was higher than the other two groups. PEW indicators such as upper arm midpoint diameter, tricep fold thickness, hip circumference, fat mass, BMI, Hb, Alb and prealbumin were lower than the other two groups, the difference being statistically significant(P<0.05). Correlation analysis results show that the degree of the factors associated with the PEW was as follows in turn BMI(r=-0.677, P<0.05), dry weight(r=0.636, P<0.05), upper arm midpoint diameter(r=-0.589, P<0.05), albumin(r=-0.562, P<0.05) and hip circumference(r=-0.475, P<0.05). Logistic regression showed that the factors affecting PEW were albumin(OR = 0.883, 95%CI: 0.782-0.997, P<0.05), BMI(OR = 0.671, 95%CI: 0.509-0.884, P<0.05), upper arm midpoint diameter(OR = 0.457, 95% CI: 0.318-0.655, P<0.05) and dry weight(OR = 1.191, 95%CI: 1.041-1.363, P<0.05). CONCLUSION: The dry weight setting too high, insufficient amount of ultrafiltration and inadequate dialysis can increase the occurrence of PEW.

Objective To compare efficacy and complications of endoscopic sphincterotomy(EST) and limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD) for choledocholithiasis.Methods A total of 120 choledocholithiasis patients (stone diameter ≤ 2 cm)underwent endoscopic treatment,including 60 cases of EST,60 ESBD.The stone-free rate,complication rate of postERCP pancreatitis,hemorrhage,perforation and recurrence rate of stones were compared between two groups.Results Success rates of one-time removal were 90.0％ (54 cases) and 93.3％ (56 cases) in group EST and ESBD (x2 =0.436,P =0.743).Eleven case (18.3％) and 4 case (6.7％) underwent mechanical lithotripsy(x2=3.733,P =0.053).There were 4 cases of hemorrhage,6 post-ERCP pancreatitis and 1 perforation in EST group,while in ESBD group,there was 1 case of hemorrhage,4 pancreatitis and no perforation.The total rates of early complications were 18.3％ (11/60) and 8.3％ (5/60) in two groups (x2 =3.322,P =1.422) and recurrence rate of stones were 21.7％ (13/60) and 6.7％ (4/60) respectively (x2=5.551,P =0.034).Conclusion There are no significant differences between EST group and ESBD group in treatment of choledocholithiasis,in success rate of one-time removal and the occurrence of early complications,but the recurrence rate of late complications in ESBD group is lower than that in EST group.ESBD shows high efficacy and safety for younger patient of choledocholithiasis.

[Objective]To investigate the efficacy of total hip arthroplasty(THA)on the treatment of traumatic arthritis that caused by internal fixation failures of intertrochanteric fractures.[Methods]During January 2009 and March 2016,35 cases of trau?matic arthritis(male:18 cases;female17 cases;49 ~ 86 years old,with an average age of 68.5 years)caused by internal fixation failures or malunion of intertrochanteric fractures,were undergo THA. Among 35 cases,13 cases were performed with the proximal femoral fixation stems,10 cases were with distal fixation stems,and 12 cases were with extended stems.[Results]With 3~65 months follow-up,the hip joint HSS score was elevated from 44.1(31 ~ 65)preoperative to 82.5(58 ~ 94)postoperative without obvious loosening. No postoperative deep infectionwas found. The femoral stems in 2 cases were found to sink 5 mm and 10 mm,respectively. No obvious prosthesis loosening was found. Taken together ,the satisfaction rate of THA on the joint function of traumatic arthritis was 91.4%.[Conclusion]Total hip arthroplasty is recommended as an effective approach for treating traumatic arthritis caused by internal fixation failures of intertrochanteric fractures. Distal fixed prosthesis was recommended due to bone sclerosis or defects of proximal femur. Coupled with emphasis on reconstruction of the greater trochanter ,good therapeutic effects could be achieved.

Objective To develop the clinical practice guidelines for the management of medication adherence to highly active antiretroviral therapy (HAART) in China. Methods The development methods included qualitative interview of 31 stakeholders, questionnaire survey of 423 PLHIV, adaptation of 30 clinical practice guidelines related to AIDS care, and overviews of reviews of 44 systematic reviews/Meta-analysis. Results 10 clinical practice guidelines and 10 systematic reviews/Meta-analysis were included. The clinical practice guidelines for the management of HAART were formed. Conclusions The formed clinical practice guidelines showed better applicability and higher general quality. It is recommended to use the guidelines in AIDS care.

BACKGROUND:Correlation between subchondral bone and articular cartilage in the process of osteoarthritis has not been fuly elucidated. Degeneration of cartilage is the focus of attention, and the subchondral bone also plays an important role in the process of osteoarthritis. OBJECTIVE: To observe the differences between experimental osteoarthritis models in rabbit knees established by two kinds of surgical methods and two kinds of proteases inducing methods, and to explore the correlation between subchondral bone mass and degeneration of cartilage. METHODS:Thirty-two New Zealand rabbits were randomly and averagely divided into four groups: Hulth group (group A), anterior cruciate ligament transaction group (group B), colagenase type II group (group C) and papain group (group D). The right knees of rabbits were established as osteoarthritis models, and the left knees served as controls. Bone mineral density of the knee joint was evaluated by dual-energy X-ray absorptiometry scanning at 0, 4 and 8 weeks after modeling. The rabbits were sacrificed at 8 weeks after MRI scanning, bilateral knee joints were harvested for general and histological observation. Quantitative analysis was done according to Mankin scores. RESULTS AND CONCLUSION: Bone mineral density of the right knees decreased at 0, 4 and 8 weeks after modeling, and the rank was as folows: group A > group B > group C > group D. MRI scanning showed that the articular cartilage thickness of the medial and lateral femoral condyle on the right knees became thinner compared with the left side, and the rank was as folows: group A < group B < group C < group D. Observation by specimens and pathological slices showed that the articular cartilage degeneration of the surgery groups worsened, group A was the most serious one, and group 1D was the lightest. Both surgery and proteases inducing methods can successfuly establish osteoarthritis models in rabbit knees. Surgery inducing models resemble the advanced or intermediate stage of osteoarthritis, while the proteases inducing models resemble the early stage of osteoarthritis. Degeneration of the articular cartilage and changes of subchondral bone are related in progressive development.

OBJECTIVETo detect the clinical value of the ECT bone scan in evaluating of the situation of infection control after hip knee arthroplasty.

METHODSThe clinical data were retrospectively analyzed in 62 patients, including 34 males and 28 females with an average age of 68.8 years old ranging from 65 to 74 years. The results of ECT bone scan, erythrocyte sedimentation rate, C-reactive protein were used to assess periprosthetic infection. The patients with positive ECT and ESR on CRP were considered to have periprosthetic infection; however, the patients with two or more negative, indexes were considered to have no infection.

RESULTSThe sensitivity, specificity, accurate rate of ECT were 75.0%, 88.9%, 87.1% respectively; ESR 50.0%, 72.2%, 69.4%; CRP 62.5%, 81.4%, 79.0%. The combination of the three methods were 87.5%, 96.3% and 95.2%,

CONCLUSIONCompared with ESR and CRP, ECT is a more effective way in the diagnosis of periprosthetic infection, which has great value and is worth popularizing.

Aged ; Arthroplasty, Replacement ; adverse effects ; Blood Sedimentation ; Bone and Bones ; diagnostic imaging ; C-Reactive Protein ; analysis ; Female ; Humans ; Male ; Prosthesis-Related Infections ; diagnostic imaging ; Retrospective Studies ; Tomography, Emission-Computed ; methods

OBJECTIVETo investigate the etiology of posttraumatic elbow stiffness and distinguish features of the patients by retrospective analyzing their records.

METHODSThis was a retrospective analysis of 553 patients with posttraumatic elbow stiffness who underwent arthrolysis performed in Beijing Jishuitan Hospital from January 1997 to December 2013. The patients' clinical and radiographic results were collected, and encoded into a survey database.

RESULTSTotal 366 male and 189 female patients were treated by the same treating team. The average age of 553 cases was 35 years (12-76 years). And the largest number of >30-40 years old group was 166 (30.8%). There were 301 cases (54.4%) causing by low-energy injury and 227 cases (41.1%) by high-energy injury. The patients of extra-articular fractures and injuries were 60 cases (10.8%) with average 6.1 weeks' immobilization, and the patients of intra-articular fractures or dislocations were 493 cases (89%) with average 4.9 weeks' immobilization. The mean range of motion of extension and flexion was 30° (0°-110°). Four hundreds and fifty-seven patients (82.6%) were diagnosed with Heterotopic Ossification (HO), the other 96 patients without HO.

CONCLUSIONSElbow stiffness commonly occurs following trauma. More attention needs to pay on the treatment procedures for minor injuries, extra-articular fractures and simple intra-articular fractures. It is not appropriate to immobilize the elbow more than 3 weeks, even for those complicated elbow fracture and dislocation. Heterotopic ossification has significant negative impact on the function of elbow. However its pathogenesis is still not clear, which need more fundamental research.

Elbow ; Elbow Joint ; injuries ; physiopathology ; Female ; Fractures, Bone ; Humans ; Intra-Articular Fractures ; Joint Diseases ; Joint Dislocations ; Male ; Orthopedic Procedures ; Ossification, Heterotopic ; Range of Motion, Articular ; Retrospective Studies ; Treatment Outcome