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.

Glomus tumor of kidney is very rare in clinic. One case with glomus tumor of the kidney was reported. CT demonstrated a well-defined mass located at the lower pole of the left kidney. The mass densely enhanced in arterial phase and constantly enhanced in venous and portal phase. Laparoscopic enucleation of left renal tumor was successfully performed. The pathological diagnosis was glomus tumor of the kidney. Recurrence and metastasis were not seen after 35 months follow-up.

This paper aims to explore the main points of diagnosis， treatment and misdiagnosis of conversion disorder characterized by paroxysmal abdominal pain. The general hospitals had a high misdiagnose rate and no effective symptomatic treatment for conversion disorder patients with physical discomfort as main symptoms， which leading to heavy physical and mental burden of patients and waste of medical resources， so this paper retrospectively analyzed the etiology， diagnostic process， treatment and therapeutic effect of a case of conversion disorder with paroxysmal abdominal pain as the main symptom. Case analysis showed that the physical discomfort as chief complain of conversion disorder patients affected the rate of early correct diagnosis and treatment， so clinicians' ability of diagnosis and differential diagnosis of conversion disorder needs to be strengthened. At the same time， cognitive behavioral therapy （CBT） is effective in the clinical treatment and recurrence prevention of conversion disorder.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

We report a critically ill pregnant woman in the third trimester with severe pneumonia due to COVID-19 who presented to Xiaolan People's Hospital of Zhongshan in February 2020. The 32-year-old patient was admitted at 35 +2 gestational weeks with a 4-day history of a sore throat and a fever for three hours. The patient had been to Xiaogan City, Hubei Province, and the symptoms occurred during a period of self-isolation after back home. The condition of the patient deteriorated rapidly, with left-sided chest and back pain, shortness of breath, dizziness, progressing to respiratory failure and septic shock 7 hours after her admission. In view of her critical condition and a history of two previous cesarean sections, an emergency cesarean section was performed. Blood gas analysis of the mother before the operation suggested respiratory failure, respiratory acidosis, and metabolic acidosis. During the operation, a baby boy was born. The Apgar score of the boy, birth weight of 2 700 g, was one at 1, 5 and 10 minutes despite the resuscitation efforts. The neonate died after withdrawing treatment. The patient was treated with tracheal intubation ventilator and other supportive treatments after the operation. The result of the new coronavirus nucleic acid test, taken on admission, but which was reported after delivery, was positive. The patient was transferred to the designated hospital for further treatment and was recovering with the withdrawal of extracorporeal membrane oxygenation and ventilation support at 26 and 36 days after surgery, respectively.

Objective: In order to improve the accuracy of preoperative diagnosis, the value of MRI in the diagnosis and differential diagnosis of the mediastinal neuroganglionic tumors in children was explored. Methods: A retrospective analysis of 41 cases of pathologically proven mediastinal neuroganglionic tumors[GN 19 cases, 6 cases of ganglion neuroblastoma (GNB), 16 cases of neuroblastoma (NB)]was conducted.The MRI characteristics and clinicopathological features were analyzed, including age, size, shape and boundary of tumor, MRI plain scan and enhanced signal characteristics, compared with postoperative pathology. Results: The average age of the 19 cases of GN was 3.9 years, the maximum diameter of the tumor was 7.3 cm, 12 cases of tumor morphology, 18 cases of clear border, 11 cases of tumor interlinking with vertebral canal, 0 case with multi nodular fusion, 12 cases with lengthwise tumor, 11 cases with low signal in T₁WI, 12 cases of uniform high signal in T₂WI, and 2 cases with hemorrhagic necrotic cysts and cystic degeneration.In 6 cases of GNB and 16 cases of NB, the above-mentioned signs were 4.1 years old, 1.9 years old, 6.8 cm, 6.4cm, 2, 6; 5, 12; 3, 15; 2, 10; 3, 12; 0, 4; 3, 9; 2, 11; 1, 2; 5, 9; 0, 7, there were statistically significant differences in age of onset(F=4.145; P=0.024), relationship between tumors and vertebral canal(P=0.023), hemorrhagic necrosis and cystic degeneration(P=0.001), multiple nodule fusion(P=0.000), plain T₁WI signal(P=0.015), and associated metastasis(P=0.000). There were no statistically significant differences in tumor size(F=0.363; P=0.698), tumor shape(P=0.277), boundary(P=0.221), lengthwise growth(P=0.401), plain scan T₂WI signal(P=0.835), intensifying degree(P=0.338), whether the tumor had capsule(P=0.423). Conclusion The onset age of benign GN is significantly larger than that of NB, T₁WI plain scan is mostly low signal, after enhancement, mainly with mild strengthening, GNB and NB tumor shape is irregular, NB is mainly multi nodular fusion, which easy to occur hemorrhage and necrosis cystic change, T₂WI is mainly mixed high signal, mostly moderate or clear uneven enhancement, NB is prone to invasion of the spinal canal and distant metastasis.

Objective To investigate the clinicopathological and magnetic resonance imaging (MRI)characteristics of mediastinal neuroblastoma (NB) in children,and to improve the preoperative diagnosis accuracy of NB.Methods The clinicopathological characteristics and imaging data of 16 patients with pediatric NB confirmed by pathology in Children's Hospital of Chongqing Medical University from January 2012 to December 2016 were retrospectively analyzed,including the onset age,lesion size,shape and boundary of the tumors,and MRI scan,and the characteristics of the enhanced signals,which were compared with the postoperative pathology,then the data were also analyzed.Results The age of onset was from 30 d to 11 years old,with the median age of 1.98 years old;all cases occurred in the posterior mediastinum,including 7 cases in left superior posterior mediastinum,4 cases in right superior posterior mediastinum,3 cases in left posterior mediastinum,1 case in right posterior mediastinum,1 case in right posterior mediastinum,1 case in neck and 2 cases in adrenal area;the maximum diameter of tumor was 3-10 cm,with the average of 6.4 cm;the tumor morphology and boundary:10 cases were irregular and 6 cases were regular;I0 cases had multiple nodular fusion,12 cases were lengthwise,12 cases had clear border,1 case had crossing the midline of the tumor,2 cases had multiple tumors,and 15 cases had tumor and spinal canal.MRI signal:plain scan T1WI showed low signals in 4 cases,equal signals in 12 cases.Plain scan T2WI showed uniform high signals in 9 cases,mixed high signals in 7 cases;hemorrhagic necrotic cysts of tumors in 11 cases,slight enhancement in 2 cases,moderate enhancement in 5 cases,and strengthened enhancement in 5 cases.Postoperative pathology showed that there were 9 cases of complete capsule and 5 cases of incomplete capsule or without capsule,including,2 cases of surrounding organs invasion;and 7 cases transferred from other parts,including 5 cases of bone metastasis,2 cases of bone marrow,2 cases of lymph nodes,1 case of left lung,and 1 case of bone and soft tissue.The cut surface of the tumors showed gray in 4 cases,grey brown in 6 cases,gray white and brown in 4 cases;hemorrhage in 2 cases,calcification in 2 cases,necrosis in 3 cases,cystic degeneration in 1 case,hemorrhage and necrosis in 2 cases,necrotic calcification in 2 cases,and hemorrhagic calcification in 2 cases.There were 4 cases combined with pleural effusion,and 4 cases combined with pneumonia,4 cases of Horner syndrome,and 1 case of lung consolidation or atelectasis.Conclusion The MRI manifestations of pediatric NB patients have some characteristics.Combination with their clinical characteristics can provide an important basis for the early diagnosis and accurate diagnosis of NB.

Objective To analyze the value of serum Treg cell related factors and chemokines in patients with tuberculous pleurisy .Methods From July 2015 to December 2016 ,92 cases of tuberculous pleurisy in our hospital were selected as the observation group ,and 92 healthy persons at the same time were selected as the control group .The levels of Treg cell related factors[monocyte chemoattractant protein (MCP)-1 ,IP-10 ,CCL-3 and CCL-16] and IL-10 ,TGF-βand IL-35] were detected and compared in the two groups ,and the levels of these indexes were compared in different classifications and stages of tuberculous pleuritis .Results The ser-um Treg cell related factors and chemokine levels in the observation group were significantly higher than those in the control group (P<0 .05) .The expression level of tuberculous empyema was higher than that of dry pleuritis and exudative pleuritis ,the patients with exudative pleuritis were higher than those of dry pleuritis , and the patients with multiple pleuritis were higher than those with idiopathic and concomitant pleuritis ,the difference was statistically significant (P<0 .05) .Conclusion The serum Treg cell related factors and chemo-kines in patients with tuberculous pleurisy are highly expressed ,and the classification and staging of the dis-ease have great influence on the expression ,and the above indexes have high detection value in the patients with tuberculous pleurisy .

Objective To explore the folate receptor alpha(FRA)expression in different types and stages of in endometrial carcinoma(EC). The sensitivity and specificity of FRA testing were compared with CA125 to evaluate its diagnostic performance.Methods Serum from 50 cases of EC patients and 30 cases of normal patients was collected.Tissue from 83 cases of typeⅠEC and 30 cases of normal endometrium and typeⅡEC were collected. The expression of serum FRA was detected by ELISA.The expression ofserum CA125 was detected by electrochemi-luminescence.The expression of FRA and CA125 in tissues was detected by immunohistochemistry. Results The rate of elevated FRA expression of in typeⅠEC tissue was higher than that in typeⅡEC(P < 0.05). The rate of elevated FRA expression in type I EC was higher than that in the early stage(P < 0.05). The ROC curve showed that the sensitivity and specificity of FRA was higher than these of CA125′s. Further,they are higher in the com-bined serum FRA and CA125.Conclusions This study shows that the FRA expression level in endometrial carci-noma varies in different subtypes,indicating the potential different pathogeneses. The rate of elevated FRA expression in type I endometrial carcinoma was higher than that in the early stage. This provides the possibility for the application of FRA targeted fluorescent developer in advanced endometrial carcinoma meticulous surgery. Combination of FRA and CA125 have better diagnostic value in detecting EC.

Objective To investigate the clinical effects of different urinary diversion regimens after minimally invasive resection of bladder cancer. Methods 127 patients with muscular infiltrating bladder cancer from January 2010 to June 2015 were enrolled in this study. According to the patients' condition, they were divided into orthotopic ileal cystectomy group (58 cases), Bricker bladder surgery group (33 cases), ureteral skin ostomy group (36 cases), then compare the clinical data, postoperative complications and quality of life of the three groups. Results There was no significant difference in the ratio of sex, the distribution of age and tumor staging among the three groups. The operation time and postoperative hospital stay in orthotopic ileal cystectomy group were longer than those in the other two groups. The operation time and postoperative hospital stay of the Bricker bladder surgery group were longer than that in ureteral skin ostomy group, the difference was statistically significant; the bleeding in orthotopic ileal cystectomy group was more than the other two groups, and in Bricker bladder surgery group was more than ureteral skin ostomy group, the difference was statistically significant. There was no significant difference in the recovery time of intestinal function among the three groups. The recovery time of intestinal function in ureteral skin ostomy group was shorter than that in the other two groups, the difference was statistically significant. There was no significant difference in the incidence of short-term complications of the three groups of patients. The incidence of long-term complications of orthotopic ileal cystectomy group was significantly higher than the other two groups, the difference was statistically significant. The social function scores, and overall health score of orthotopic ileal cystectomy group were higher than the other two groups, the difference was statistically significance. Conclusion Without external device, closer to the characteristics of physiological urination, orthotopic ileal cystectomy holds higher postoperative quality of life, and higher incidence of long-term complications. With advantages of quick recovery and less complications, ureteral skin ostomy is best for patients who can not stand for long time surgery. It should choose the appropriate surgical approach for patients according to individuals' conditions.