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.

Objective:Based on multi-parametric prostate magnetic resonance imaging (mpMRI) and related clinical indicators, a nomogram model for patients with PI-RADS ≥3 and PSA 4-20ng/ml was developed and validated, and the predictive value of the model in diagnosing clinically significant prostate cancer was evaluated.Methods:The clinical and pathological data of 865 patients who underwent ultrasound-guided transperineal prostate biopsy for the first time at the Department of Urology, Second Hospital of Tianjin Medical University from January 2020 to August 2023, with PI-RADS scores ≥3 and PSA levels between 4-20 ng/ml were retrospectively analyzed. These 865 patients were included in Cohort A, and from them, 437 patients with PHI were selected in Cohort B. In Cohort A, the median age was 68(64, 73); the median f/tPSA was 14.36 (10.63, 19.74); the median PSAD was 0.17(0.11, 0.25); 375 cases (43.35%) with PV≤50 ml and 490 cases (56.65%) with PV>50 ml; PSA fluctuation <-50% 84 cases (9.71%), -50%--20% in 206 cases (23.82%), and >-20% in 575 cases (66.47%); PI-RADS v2.1 3 scores 546 cases (63.12%), 4 in 230 cases (23.59%), and 5 in 89 cases (10.29%); localization of suspicious lesions on mpMRI in the peripheral zone in 619 cases (71.56%), transitional zone in 181 cases (20.92%), others in 42 cases (4.86%), and both peripheral and transitional zones in 23 cases (2.66%). In Cohort B, the median PSAD was 0.17 (0.12, 0.25); the median D-dimer was 310.00 (230.00, 411.48); the median PHI was 49.75 (35.90, 73.27); with 198 cases (45.31%) with PV≤50 ml and 239 cases (54.69%) with PV>50 ml; PSA fluctuation<-50% was in 40 cases (9.15%), -50%--20% in 107 cases (24.49%), and>-20% in 290 cases (66.39%); PI-RADS v2.1 scores 3 was in 289 cases (66.13%), 4 in 103 cases (23.57%), and 5 in 45 cases (10.30%).Patients in cohorts A and B were randomly assigned to the training set and validation set using R language with " 123" as the random number seed, at a ratio of 7∶3.There was no statistically significant difference between the clinical data of the training and validation sets for both groups ( P>0.05).Univariate and multivariate logistic regression analyses were used to identify independent risk factors for CsPCa, and a nomogram model was constructed using R. The diagnostic performance of the prediction model was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis(DCA).External validation of the model was conducted in the validation set. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and missed diagnosis rate analyses were performed on nomogram models A and B, as well as PSAD and PHI, under different thresholds. Results:Cohort A training set has 608 cases, and the validation set has 257 cases.The results of multivariate backward regression analysis in the training set show that age( OR=1.06, P=0.001), f/tPSA( OR=0.96, P=0.008), prostate volume (PV)>50ml( OR=0.36, P<0.01), prostate-specific antigen density(PSAD)( OR=145.19, P<0.01), PSA fluctuation(-50%--20%: OR=1.97, P=0.234; >-20%: OR=6.81, P<0.01), PI-RADS v2.1 score(4: OR=10.65, P<0.01; 5: OR=21.20, P<0.01), and localization of suspicious lesions on mpMRI(TZ: OR=0.57, P=0.074; Others: OR=0.26, P=0.022) were all risk factors for CsPCa. Nomogram A was developed based on these risk factors and had an area under the ROC curve (AUC) of 0.905 (95% CI 0.881-0.928) for the training set and 0.893 (95% CI 0.854-0.931) for the validation set. Cohort B training set developed based on age( OR=1.05, P=0.053), PV>50ml( OR=0.18, P<0.01), PSAD( OR=54.14, P=0.021), PSA fluctuation(-50%--20%: OR=4.78, P=0.100; >-20%: OR=20.37, P=0.001), PHI( OR=1.02, P=0.002), D-Dimer( OR=1.00, P=0.031), and PI-RADS scores(4: OR=11.35, P<0.01; 5: OR=57.61, P<0.01) as risk factors for CsPCa. Nomogram B had an AUC of 0.933(95% CI 0.906-0.959) for the training set and 0.908 (95% CI 0.859-0.958) for the validation set.The two nomogram models mentioned above both have excellent discrimination, and the calibration curves also indicated that the calibration of the two models were good.Moreover, both nomogram A and nomogram B demonstrate good clinical net benefits in the DCA curves of the training and validation sets, especially when applying nomogram B to predict CsPCa, with an accuracy rate of up to 85.82%. Conclusions:The two nomogram models developed in study, based on mpMRI and related clinical indicators, both have excellent predictive value for the diagnosis of clinically significant prostate cancer prior to prostate biopsy in patients with PI-RADS≥3 and PSA 4-20ng/ml.

Objective To evaluate the noise hazard level of a coal mining enterprise, and identify high-risk operation types and people, and to provide a basis for preventing and controlling the health damage caused by noise. Methods A large coal mining enterprise in Shaanxi Province was selected as the research object. The noise monitoring data of the coal mine over the years was used to calculate the noise exposure matrix of each post in the enterprise, and the classification of occupational hazards at workplaces (GBZ/T 229.4-2012) was used to assess the occupational health risk levels. Results Among the 22 noise-exposed positions in the enterprise, the 8-hour working day equivalent sound level in positions of shearer driver, horseshoe driver, crusher driver, shuttle driver, relaxation screen driver, and grading screen driver were all higher than the occupational exposure limit of noise. In 2021, the noise exposure levels of shearer drivers, crusher drivers, and coal-selecting workers were all higher than 90 dB (A), and the occupational hazard level was moderate hazard level. In addition, the noise exposure levels of most other jobs also exceeded the occupational exposure limit. Conclusion The noise hazards in the coal mine industry are mainly concentrated in the posts of the coal mining system, tunneling system, and screening workshop. Among them, the shearer driver, the crusher driver, and the coal preparation workers have higher noise exposure levels. It is recommended to take corresponding noise reduction measures and strengthen the protection level to reduce the noise exposure risk of workers.

Objective To investigate the relationship between serum mannan binding lectin(MBL),histi-dine rich glycoprotein(HRG),interleukin(IL)-23/IL-17 inflammatory axis and cerebral vasospasm(CVS)and prognosis in patients with aneurysmal subarachnoid hemorrhage(aSAH)after interventional emboliza-tion.Methods A total of 195 patients with aSAH who underwent interventional embolization treatment in the hospital from March 2019 to February 2022 were selected and were divided into no CVS group(126 cases),mild CVS group(18 cases),moderate CVS group(39 cases),and severe CVS group(12 cases)according to the occurrence and severity of CVS detected by digital subtraction angiography at the 4th postoperative day.The levels of serum MBL,HRG,IL-23 and IL-17 among the four groups before and 3 d after surgery were compared.The patients were followed up for 6 months and divided into good prognosis group(137 cases)and poor prognosis group(58 cases)according to their prognosis.Factors influencing poor prognosis in aSAH pa-tients were analyzed by multivariate Logistic regression model.The predictive value of serum MBL,HRG,IL-23,IL-17 levels and their combined application models for poor prognosis in patients with aSAH was analyzed by receiver operating characteristic(ROC)curve.Results The incidence rate of CVS after interventional em-bolization was 35.38%in 195 patients with aSAH.3 d after surgery,the serum levels of MBL,IL-23 and IL-17 in the mild,moderate,and severe CVS groups were higher than those in the no CVS group,those in the severe CVS group were higher than those in the moderate CVS group,those in the moderate CVS group were higher than those in the mild CVS group(P<0.05).The serum HRG levels in the mild,moderate,and severe CVS groups were lower than those in the non CVS group,those in the severe CVS group were lower than those in the moderate CVS group,those in the moderate CVS group were lower than those in the mild CVS group(P<0.05).3 d after surgery,the levels of serum MBL,IL-23 and IL-17 in the four groups were higher than that before surgery,while the levels of serum HRG were lower than that before surgery(P<0.05).The pro-portions of patients with aneurysm diameter≥6 mm,number of aneurysms>1,surgery time>24 h,Hunt-Hess grade Ⅲ/Ⅳ and postoperative CVS,and serum levels of MBL,IL-23,and IL-17 on the 3rd day after sur-gery in the good prognosis group were lower than those in the poor prognosis group,and serum HRG levels at 3 d after surgery in the good prognosis group were higher than that in the poor prognosis group(P<0.05).Multivariate Logistic regression analysis showed that aneurysm diameter≥6 mm,Hunt-Hess grade Ⅲ/Ⅳ and postoperative CVS,elevated serum levels of MBL,IL-23,and IL-17 and decreased HRG level at 3 d after sur-gery were independent risk factors for poor prognosis in aSAH patients(P<0.05).ROC results showed that serum levels of MBL,HRG,IL-23,and IL-17 at 3 d after surgery had certain predictive power for poor progno-sis in patients with aSAH.The predictive model with the combined application of four indicators had relatively high efficiency(the area under the curve was 0.853).Conclusion Elevated levels of MBL,IL-23,IL-17,and decreased HRG levels in aSAH patients after interventional embolization could increase the risk of CVS and are associated with poor prognosis in aSAH patients after interventional embolization.The above indicators have a certain predictive power for poor prognosis in aSAH patients.

Objective To investigate the predictive value of serum soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)and Netrin-1 combined with acute physiology and chronic health evaluationⅡ(APACHE Ⅱ)score for poor prognosis in patients with severe craniocerebral injury after surgery.Methods Totally 120 patients with severe craniocerebral injury admitted to a hospital from June 2020 to June 2022 were divided into good prognosis group and poor prognosis group according to the prognosis 30 days af-ter surgery.The serum levels of sTWEAK,Netrin-1 and APACHE Ⅱ score were compared between the two groups.Univariate and multivariate Logistic regression were used to analyze the influencing factors of poor prognosis in patients with severe craniocerebral injury,and the prediction model of serum sTWEAK,Netrin-1 and APACHE Ⅱ score combined was constructed.The predictive value of serum sTWEAK,Netrin-1 level and APACHE Ⅱ score in patients with severe craniocerebral injury after surgery was analyzed by receiver operat-ing characteristic(ROC)curve.Results The duration of intensive care unit stay in the poor prognosis group was longer than that in the good prognosis group,and the albumin level,Glasgow Coma scale and serum Ne-trin-1 level at admission were lower than those in the good prognosis group.The proportion of multiple brain contusion and laceration,the proportion of mechanical ventilation,APACHE Ⅱ score at admission and the lev-els of serum sTWEAK,blood creatinine and blood urea nitrogen were higher than those in the group with good prognosis,and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that multiple brain contusion and laceration,decreased Netrin-1 level,increased APACHE Ⅱscore and increased sTWEAK level at admission were risk factors for poor prognosis in patients with severe craniocerebral injury(P＜0.05).ROC curve analysis showed that the area under the curve and 95％CI of ser-um sTWEAK,Netrin-1 and APACHE Ⅱ scores were 0.742(0.552-0.925),0.731(0.488-0.963),0.714(0.502-0.911)and 0.882(0.795-0.947)respectively when the three indexes were used alone and in com-bination.Conclusion Serum sTWEAK and Netrin-1 combined with APACHE Ⅱ score have good predictive value for the poor prognosis of patients with severe craniocerebral injury after surgery,and can provide refer-ence for the formulation of clinical treatment.

Objective:To investigate whether it is by regulating interleukin 1β ( IL-1β) gene expression that androgen receptor (AR) in macrophages affects hyperphosphate-induced vascular smooth muscle cell calcification. Methods:The chromatin immunoprecipitation (ChIP) experiment was used to determine whether AR was bound to the androgen receptor element (ARE) sequence of IL-1β promoter in THP-1 cells. Whether the AR regulated IL-1β gene expression was detected by luciferase assay experiments. AR of THP-1 cells was silenced and transfected by lentivirus with vector or shRNA. Flow cytometry was used to select positive transfected cells THP-1ARsc (control) and THP-1ARsi (AR silencing) with fluorescent markers. Western blotting was used to detect AR protein levels of THP-1ARsc (control) and THP-1ARsi cells (AR silencing in monocytes). Macrophages MФARsc (control) or MФARsi (AR silencing) were induced by 50 ng/ml phorbol ester. Enzyme-linked immunosorbent assay was used to detect IL-1β expression levels of MФARsc or MФARsi conditioned medium. The human aortic smooth muscle cells (HASMC) were cultured in MФARsc or MФARsi conditioned medium with phosphate (2.5 mmol/L final concentration of sodium dihydrogen phosphate), and Alizarin red S staining was used to analyze HASMC calcification degree. Western blotting was used to detect the expression levels of RUNX2 (osteoblast marker) and SM22α (HASMC marker), and neutralization assay was performed to test IL-1β-mediating effect of macrophages AR on HASMC calcification. Results:AR was bound to ARE sequence of IL-1β promoter and regulated IL-1β gene expression. The expression level of IL-1β protein in conditioned medium of MФARsi cells decreased significantly compared to MФARsc cells ( P<0.001). Compared with MФARsc conditioned medium group, HASMC calcium deposition in MФARsi conditioned medium group decreased significantly, RUNX2 protein decreased and SM22α protein increased (all P<0.05). The degree of HASMC calcification in the MФARsi conditioned medium+IgG antibody group decreased than that in the MФARsc conditioned medium+IgG antibody group significantly, and the degree of HASMC calcification in the MФARsc conditioned medium+IL-1β antibody group decreased significantly than that in the MФARsc conditioned medium+IgG antibody group; while the degree of HASMC calcification in the MФARsi conditioned medium+IgG antibody group and MФARsi conditioned medium+IL-1β antibody group decreased than that in the MФARsc conditioned medium+IL-1β antibody group (all P<0.05). Conclusions:Macrophage AR regulates IL-1β expression by binding to ARE sequence within IL-1β promoter, and IL-1β mediates the effect of macrophage AR on hyperphosphate-induced HASMC calcification.

Objective:To investigate the clinical characteristics of SARS-CoV-2 Omicron variant BA.2.2 infection in children with different basic diseases.Methods:A total of 76 children with different basic diseases admitted to Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine from March 2 to June 10, 2022 were retrospectively analyzed in terms of clinical manifestations, supplementary examination, treatment and prognosis.These children were divided into hematologic tumor group and non-hematologic tumor group which included cardiopulmonary disease group, neurological disease group and congenital malformation group.The clinical characteristics and prognosis of SARS-CoV-2 Omicron variant infection in children with basic diseases were analyzed.Results:Among 76 children with basic diseases, 61 patients were newly diagnosed with fever and 15 patients were asymptomatic.There were 26, 22, 20, and 8 cases with hematologic tumor diseases, cardiopulmonary diseases, neurological diseases and congenital malformation, respectively.The average fever time was 3-7 days.There was no significant difference in the clinical manifestations among each group ( P>0.05). However, children with hematological tumors were more prone to single organ or multiple organ dysfunction.The level of C-reactive protein was higher than that in the non-hematologic tumor group, while the white blood cell count, neutrophil count, lymphocyte count and hemoglobin were lower than those in the non-hematologic tumor group.The time of virus negative transformation and the duration of fever were higher than those in the non-hematologic tumor group, with statistical significance ( P<0.05). Among the children in the hematologic tumor group, the blood routine and inflammation indexes of children infected with SARS-CoV-2 after chemotherapy within 2 weeks were worse than those in the non-chemotherapy group, and the duration of fever and the time of virus negative transformation were significantly longer ( P<0.05). Three children with hematologic tumor showed virus positive recovery after chemotherapy and surgical treatment after virus negative transformation. Conclusion:Omicron variant BA.2.2 of SARS-CoV-2 has no serious impact on children with cardiopulmonary diseases, nervous system diseases and congenital malformations.However, the duration of fever and virus positive time in hematologic tumor group extended, especially after chemotherapy.It has an important impact on the formulation of epidemic prevention and timing selection of chemotherapy for children with hematological tumors.

Objective:To investigate the clinical efficacy of neoadjuvant chemo-hormonal therapy(NCHT)followed by radical prostatectomy(RP) plus extended pelvic lymphadenectomy for very-high-risk locally advanced prostate cancer.Methods:The data of 327 cases of very-high-risk locally advanced prostate cancer treated in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, The Second Hospital of Tianjin Medical University, and The Third Affiliated Hospital of Sun Yat-sen University from December 2014 to July 2019 were retrospectively analyzed. Patients were divided into two groups according to treatment regimens: the RP group (direct RP + extended pelvic lymphadenectomy 4-6 weeks after the biopsy of prostate) and the NCHT group (4-6 cycles of NCHT prior to RP). There were 171 cases in RP group and 156 cases in NCHT group, respectively. In the RP group, the median age was 67 (ranging 44-83)years. The median PSA at diagnosis was 27.24 (ranging 4.55-207.00) ng/ml. Patients’numbers of clinical T 2, T 3a, T 3b, T 4 stage were 13, 85, 57, 16, respectively, and clinical N 1, N 0 stage were 33 and 138, respectively. Patients’numbers of ISUP grade groups of 1, 2, 3, 4, 5 were 5, 35, 41, 51, 39, respectively. In the NCHT group, The median age was 67 years, ranging 46-78 years. The median PSA at diagnosis was 72.09(ranging 4.08-722.95)ng/ml. Patients’ numbers of clinical T 2, T 3a, T 3b, T 4 stage were 11, 47, 58, 40, respectively, and clinical N 1, N 0stage were 76 and 80, respectively. Patients’numbers of ISUP grade groups of 1, 2, 3, 4, 5 were 1, 11, 33, 43, 68, respectively. At baseline, the NCHT group showed higher PSA, higher ISUP grade, and more advanced clinical stage at diagnosis( P<0.05). The PSA, pathological down-staging rate, and positive surgical margin rate as well as the biochemical recurrence free survival(bRFS)were compared between the two groups. Results:After radical prostatectomy, compared with the RP group, the NCHT group had a higher proportion of patients achieving PSA<0.2 ng/ml at 6-week postoperative follow-up ( P<0.001), a higher pathologic tumor stage down-staging rate ( P<0.001), a higher ISUP down-grading rate ( P<0.001), and a lower positive surgical margins rate ( P<0.001). In addition, 10.9% of the NCHT group achieved pT 0 or minimal residual disease in postoperative pathology exams. Eighty-three patients (48.5%) in the RP group and 125 patients (80.1%) in the NCHT group achieved undetectable PSA after surgery and entered further analysis for bRFS, which showed NCHT group had significantly longer bRFS (19.46 months vs. 6.35 months). NCHT significantly reduced the risk for biochemical recurrence in locally advanced prostate cancer patients( HR=0.278, 95% CI 0.198-0.390, P<0.001). Such a reduce in risk for biochemical recurrence was seen in all subgroups( P<0.001). Conclusions:NCHT might improve surgical outcomes as well as bRFS in very-high-risk locally advanced prostate cancer patients.

Objective:To investigate the value of serum programmed cell death molecule 5 (PDCD5) protein expression in early prediction of gastric cancer and its clinical significance.Methods:A total of 103 patients with gastric cancer who were treated in Yuechi County People′s Hospital in Sichuan Province from March 2014 to March 2016 and 80 healthy people who underwent physical examinations (control group) in the same period were selected as subjects. The serum level of PDCD5 protein were detected by enzyme-linked immunosorbent assay. The diagnostic performance of serum PDCD5 protein on gastric cancer was evaluated by receiver operating characteristic curve. The patients with gastric cancer were divided into low-level group (50 cases) and high-level group (53 cases) according to serum PDCD5 protein level. The relationship between serum PDCD5 protein level and clinical data in patients with gastric cancer was analyzed by χ2 test. Univariate and multivariate Cox regression models were used to analyze independent risk factors for survival and prognosis of gastric cancer. Kaplan-Meier method was used to map survival curves of gastric cancer patients with different levels of serum PDCD5 protein. Results:Serum PDCD5 protein level in gastric cancer group was significantly lower than that in control group: (0.82 ± 0.30) mg/L vs. (1.26 ± 0.39) mg/L, and there was statistical difference ( t=8.628, P<0.01). Serum PDCD5 protein level in patients with gastric cancer was related to tumor TNM stage and tumor invasion ( P<0.05), but not related to gender, age, body mass index (BMI), tumor size, lymph node metastasis, tumor type and tumor differentiation ( P<0.05). The area under curve (AUC) of serum PDCD5 protein in the diagnosis of gastric cancer was 0.810 (95% CI 0.747 to 0.873), with a sensitivity of 71.8%, and a specificity of 76.3% ( Z=9.641, P<0.01). Serum PDCD5 protein level was an independent risk factor for poor prognosis in patients with gastric cancer ( P<0.05). The 5-year survival rate in low-level group was significantly lower than that in high-level group: 32.0% vs. 62.3%, and there was statistical difference ( χ2=18.422, P<0.01). Conclusions:The serum PDCD5 protein level in patients with gastric cancer is significantly decreased. Low serum PDCD5 protein level is independent risk factors for poor prognosis of patients with gastric cancer.

Betacoronavirus ; Coronavirus Infections ; Humans ; Pandemics ; Pneumonia, Viral ; Single-Cell Analysis