[Objective] To analyse and predict the tendencies of using erythrocyte blood in Changsha based on the autoregressive integrated moving average (ARIMA) model, long short-term memory (LSTM) and ARIMA-LSTM combination model, so as to provide reliable basis for designing a feasible and effective blood inventory management strategy. [Methods] The data of erythrocyte usage from hospitals in Changsha between January 2012 and December 2023 were collected, and ARIMA model, LSTM model and ARIMA-LSTM combination model were established. The actual erythrocyte consumption from January to May 2024 were used to assess and verify the prediction effect of the models. The extrapolation prediction accuracy of the models were tested using two evaluation indicators: mean absolute percentage error (MAPE) and root mean square error (RMSE), and then the prediction performance of the model was compared. [Results] The RMSE of LSTM model, optimal model ARIMA(1,1,1)(1,1,1)12 and ARIMA-LSTM combination model were respectively 5 206.66, 3 096.43 and 2 745.75, and the MAPE were 18.78%,11.54% and 9.76% respectively, which indicated that the ARIMA-LSTM combination model was more accurate than the ARIMA model and LSTM model, and the prediction results was basically consistent with the actual situation. [Conclusion] The ARIMA-LSTM model can better predict the clinical erythrocyte consumption in Changsha in the short term.

Objective:To evaluate the efficacy and safety of high-dose injectable dexlansoprazole in the treatment of acute upper gastrointestinal ulcer hemorrhage.Methods:This study was a randomized, double-blind, positive drug parallel controlled, multicenter clinical trial led by the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), with participation from 43 hospitals such as Yichun People′s Hospital, Army Medical Center of PLA (Chongqing Daping Hospital), etc. From August 31, 2019 to May 25, 2020, 346 patients with upper gastrointestinal hemorrhage caused by acute gastric and (or) duodenal ulcer were selected. The subjects were randomly divided into experimental group and control group according to a 2 to 1 stratification scheme using the SAS 9.4 software. The medication regimen for the experimental group was intravenous injection of dexlansoprazole 30 mg/times, once every 12 h, while the medication regimen for the control group was intravenous injection of lansoprazole and dexlansoprazole mimetics, 30 mg/times, once every 12 h; the treatment course was 5 days. The primary efficacy indicator (72 h effective hemostasis rate), the secondary efficacy indicator(clinical hemostasis rate at 24, 48, and 120 h, and the proportion of subjects who underwent endoscopic treatment or surgical procedures again due to hemorrhage within 5 days), and the incidence of adverse reactions were compared between the 2 groups. Binomial distribution normal approximation method was performed to calculate the 95% confidence interval (95% CI) of the difference in hemostasis rate between the experimental group and the control group. Fisher′s exact test was used for statistical analysis. Results:A total of 329 patients (219 cases in the experimental group and 110 cases in the control group) were enrolled. The 72 h effective hemostasis rate (95% CI) of the experimental and control group was 95.9%(210/219, 92.3% to 98.1%) and 93.6%(103/110, 87.3% to 97.4%), respectively, and the difference was not statistically significant ( P>0.05). The difference in the 72-hour effective hemostasis rate(95% CI) between the experimental and the control group was 2.3% (-3.0% to 7.5%). The clinical hemostasis rates at 24, 48, and 120 h of the treatment were 82.2% (176/214), 99.1%(210/212), and 100.0%(210/210) in the experimental group, and 85.2%(92/108), 98.1%(104/106), and 100.0%(105/105) in the control group, respectively, and the differences were not statistically significant (all P>0.05). The proportion of subjects who underwent endoscopic treatment and surgical procedure again within 5 days (95% CI)of the experimental group and control group was 0 (0 to 1.7%) and 1.9% (0.2% to 6.5%), respectively, and the difference was not statistically significant ( P>0.05). The result of safety evaluation showed that the overall incidence of adverse reactions of the experimental group and the control group was 6.4% (14/219) and 11.8% (13/110), respectively, and the difference was not statistically significant ( P>0.05). Conclusion:High dose injectable dexlansoloprazole is an effective and safe treatment for upper gastrointestinal ulcer hemorrhage, and suitable for clinical application.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

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 To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective:To evaluate the efficacy and safety of high-dose injectable dexlansoprazole in the treatment of acute upper gastrointestinal ulcer hemorrhage.Methods:This study was a randomized, double-blind, positive drug parallel controlled, multicenter clinical trial led by the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), with participation from 43 hospitals such as Yichun People′s Hospital, Army Medical Center of PLA (Chongqing Daping Hospital), etc. From August 31, 2019 to May 25, 2020, 346 patients with upper gastrointestinal hemorrhage caused by acute gastric and (or) duodenal ulcer were selected. The subjects were randomly divided into experimental group and control group according to a 2 to 1 stratification scheme using the SAS 9.4 software. The medication regimen for the experimental group was intravenous injection of dexlansoprazole 30 mg/times, once every 12 h, while the medication regimen for the control group was intravenous injection of lansoprazole and dexlansoprazole mimetics, 30 mg/times, once every 12 h; the treatment course was 5 days. The primary efficacy indicator (72 h effective hemostasis rate), the secondary efficacy indicator(clinical hemostasis rate at 24, 48, and 120 h, and the proportion of subjects who underwent endoscopic treatment or surgical procedures again due to hemorrhage within 5 days), and the incidence of adverse reactions were compared between the 2 groups. Binomial distribution normal approximation method was performed to calculate the 95% confidence interval (95% CI) of the difference in hemostasis rate between the experimental group and the control group. Fisher′s exact test was used for statistical analysis. Results:A total of 329 patients (219 cases in the experimental group and 110 cases in the control group) were enrolled. The 72 h effective hemostasis rate (95% CI) of the experimental and control group was 95.9%(210/219, 92.3% to 98.1%) and 93.6%(103/110, 87.3% to 97.4%), respectively, and the difference was not statistically significant ( P>0.05). The difference in the 72-hour effective hemostasis rate(95% CI) between the experimental and the control group was 2.3% (-3.0% to 7.5%). The clinical hemostasis rates at 24, 48, and 120 h of the treatment were 82.2% (176/214), 99.1%(210/212), and 100.0%(210/210) in the experimental group, and 85.2%(92/108), 98.1%(104/106), and 100.0%(105/105) in the control group, respectively, and the differences were not statistically significant (all P>0.05). The proportion of subjects who underwent endoscopic treatment and surgical procedure again within 5 days (95% CI)of the experimental group and control group was 0 (0 to 1.7%) and 1.9% (0.2% to 6.5%), respectively, and the difference was not statistically significant ( P>0.05). The result of safety evaluation showed that the overall incidence of adverse reactions of the experimental group and the control group was 6.4% (14/219) and 11.8% (13/110), respectively, and the difference was not statistically significant ( P>0.05). Conclusion:High dose injectable dexlansoloprazole is an effective and safe treatment for upper gastrointestinal ulcer hemorrhage, and suitable for clinical application.

Novel coronavirus Omicron variant infection can cause severe illness and even death in certain populations. Omicron variant infection may lead to systemic inflammatory response, coagulation disorder, multi-organ dysfunction and other pathophysiological changes, which are different from other Novel coronavirus variants to a certain extent, so therapeutic strategies should not be the same. The National Medical Center for Major Public Health Events invited experts in fields of infectious diseases, respiratory medicine, intensive care, pediatrics and fever clinic to develop this quick guideline based on the current best evidence and extensive clinical practices. This quick guideline aims to standardize the diagnosis and treatment of novel coronavirus Omicron infection, and to improve the disease management abilities of clinicians.

Objective:To compare 3D-printing-assisted surgery and conventional surgery in the treatment of Schazker type Ⅵ tibial plateau fractures.Methods:A retrospective study was conducted to analyze the clinical data of 50 patients with type Ⅵ tibial plateau fracture who had been treated from January 2019 to December 2021 at the 5 Departments of Orthopedics in The First Affiliated Hospital of Nanchang University, The First People's Hospital of Jiujiang, Pingkuang General Hospital, Ganzhou People's Hospital, and Nanchang Hongdu Hospital of Traditional Chinese Medicine. The patients were divided into 2 groups according to their different treatment methods. In the 3D printing group of 25 cases treated by 3D-printing-assisted surgery, there were 14 males and 11 females, with an age of (42.5±9.1) years; in the conventional group of 25 cases treated by conventional surgery, there were 13 males and 12 females with an age of (42.2±9.3) years. The 2 groups were compared in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, fracture healing time, postoperative complications, the Rasmussen radiological scores and the American Hospital for Special Surgery (HSS) knee function scores at 6 and 12 months after operation.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The operation time [(125.4±10.6) min], intraoperative blood loss [(206.2±16.3) mL], intraoperative fluoroscopy frequency [(9.2±2.7) times] and fracture healing time [(3.0±0.7) months] in the 3D printing group were all significantly less than those in the conventional group [(168.2±14.1) min, (303.2±20.4) mL, (15.5±3.5) times and (4.1±0.8) months] while the Rasmussen radiological scores (17.6±1.2 and 17.9±0.6) and HSS knee scores (90.8±6.4 and 91.5±5.6) at 6 and 12 months after operation in the 3D printing group were all significantly higher than those in the conventional group (16.2±2.6 and 16.7±2.2; 84.5±9.2 and 87.6±8.0) (all P<0.05). In the 3D printing group, there were 1 case of wound infection and 1 case of wound dehiscence after operation. In the conventional group, there were 2 cases of wound skin necrosis, 3 cases of wound dehiscence, 1 case of traumatic arthritis, 2 cases of wound infection, and 1 case of screw loosening. The incidence of complications in the 3D printing group (8.0%, 2/28) was significantly lower than that in the conventional group (36.0%, 9/25) ( P<0.05). Conclusion:In the treatment of Schatzker type VI tibial plateau fractures, compared with conventional surgery, 3D-printing-assisted surgery can lead to better curative outcomes, because it is conducive to lowering surgical difficulty, reducing postoperative complications, and promoting fracture union and functional recovery of the knee.

Objective To explore the effect of low molecular weight heparin calcium on coagulation function and platelet(PLT)in patients before and after anterolateral thigh flap transplantation.Methods Fifty patients with skin and soft tissue defects of hands and feet treated in Wuxi Ninth Hospital and Jiujiang No.1 People's Hospital from January to December 2022 were selected as the study objects.They were divided into observation group(26 cases)and control group(24 cases)according to random number table method.Patients in observation group received low molecular weight heparin calcium 12h before surgery,and continued to receive routine treatment once a day after surgery.Patients in control group began to use low molecular weight heparin calcium routinely 4h after surgery,once a day.The coagulation function and PLT before and after surgery were compared between two groups.Results There were no significant differences in incidences of vascular crisis and skin flap necrosis between two groups(P>0.05).Five patients in observation group received intraoperative or postoperative blood transfusion,which was excluded in further analysis.On first day and third day after surgery,fibrinogen(FIB)and PLT in two groups were significantly higher than those before surgery,and thrombin time(TT)was significantly shorter than that before surgery(P<0.05).On third day after surgery,activated partial thromboplastin time(APTT)and prothrombin time(PT)in observation group were significantly longer than those before surgery(P<0.05).Before surgery,first day and third day after surgery,there were no significant differences in FIB,APTT,PT and TT between two groups(P>0.05).On third day after surgery,PLT of observation group was significantly higher than that of control group(P<0.05).Conclusion Both FIB and PLT were higher after surgery regardless of the use of low molecular weight heparin calcium before and after surgery,and FIB and PLT were more significantly higher in patients treated 12h before surgery.

Objective:To investigate the clinical application value of enhanced recovery after surgery using the LEER model in patients subjected to laparoscopic cholecystectomy in basic hospitals of Yi nationality area.Methods:Twenty-six patients who underwent laparoscopic cholecystectomy based on the concept of enhancing recovery after surgery using the LEER model in People's Hospital of Jinkouhe District of Leshan from January to October 2021 were included in the observation group. An additional 20 patients who concurrently underwent laparoscopic cholecystectomy and conventional intervention were included in the control group. Clinical efficacy, postoperative complications and postoperative pain were compared between the two groups.Results:Postoperative fasting time, length of hospital stay, and total hospital days in the observation group were 6 (6, 6) hours, 2 (2, 3) days and 4 (4, 6) days respectively, which were significantly shorter than 24 (24, 36) hours, 5 (5, 6) days, 7 (7, 9) days in the control group ( H = 351.00, 407.50, 458.00, all P < 0.05). Hospitalization cost in the observation group was 5 454.58 (5 014.11, 6 016.58) yuan, which was significantly lower than 6 611.91 (6 192.68, 7 841.73) yuan in the control group ( H = 420.00, P < 0.05). There were no significant differences in operative time and postoperative complications between the two groups (both P > 0.05). At postoperative 6 hours, Visual Analogue Scale score in the observation group was 3 (3, 4) points, and patients with mild pain accounted for 73.07% (19/26). At postoperative 24 hours, Visual Analogue Scale score in the observation group was 2 (2, 3) points, and patients with mild pain accounted for 92.31% (24/26). Overall pain was well controlled after surgery. Patient satisfaction rate in the observation was 96.15% (25/26). All patients recovered and were discharged. Conclusion:Application of enhanced recovery after surgery using the LEER model in patients subjected to laparoscopic cholecystectomy in basic hospitals of Yi nationality area can promote postoperative recovery, contribute to changing the theory of diagnosis and treatment, and improve overall medical quality. The enhanced recovery after surgery protocol using the LEER model has a good application value.