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 physical activity (PA) and sedentary behavior (SB) variables on weekdays and weekends, the study aims to cluster the physical activities inside and outside kindergartens and to explore the cluster characteristics of different children using physical fitness indicators, so as to provide new strategies and methods for early childhood education and health. Methods: From March to June 2019, 291 children aged 3-6 years from 6 kindergartens in Nanchang were recruited by a stratified cluster random sampling method. The ActiGraph GT3X-BT triaxial accelerometer was used to measure and analyze the PA and SB levels inside and outside the kindergarten. A twostep clustering algorithm model was employed for cluster analysis. Physical fitness were measured and evaluated according to the "National Physical Fitness Measurement Standard Manual (Preschool Section)". Differences in physical fitness among different clusters of children were compared, and the cluster characteristics of different children were analyzed. Results: The clustering algorithm model indicated that based on six indicators, including PA and SB inside the kindergarten on weekdays, and PA and SB outside the kindergarten on both weekdays and weekends, children could be divided into three categories:active inside (high PA, low SB inside), active outside (high PA outside), and inactive (low PA, high SB both inside and outside). The average silhouette coefficient of the model was 0.3, indicating good clustering results. Both the active inside and active outside children showed significantly higher PA inside on weekdays, PA outside on weekdays and weekends, daily low intensity physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) than the inactive children ( F=157.91, 80.79 , 95.86, 95.52, 124.74, P <0.05). After adjusting for gender and age, the physical fitness scores of both active outside ( 19.03 ±0.47) and active inside (19.11±0.40) were significantly higher than those of the inactive children (17.94±0.31). Additionally, active inside children (3.91±0.14) also showed significantly better performance in continuous double-leg jumps, compared to inactive children (3.45±0.11) ( P <0.05). Conclusion Children active inside and those active outside perform well in PA. Future research should focus on the proportion of structured and unstructured PA time to enhance the overall physical fitness of children.

Objective:To evaluate laparoscopic choledocholithotomy in patients with cholecystolithiasis and normal sized common bile duct(CBD) with choledocholithiasis.Methods:The clinical data of 393 patients with cholecystolithiasis and choledocholithiasis treated by LC combined with LCBDE at the Department of General Surgery of Hefei Second People's Hospital from Mar 2014 to Jul 2021 were retrospectively analyzed.Results:There were 280 CBD calculi cases in which CBD diameter >8 mm which was included into CBD dilated group, and 113 cases of CBD calculi with normal diameter (5 mm≤CBD diameter ≤8 mm). There was no difference in operative time and postoperative complications in the small diameter group. During the follow-up period, 1 case in the dilated group experienced biliary tract stenosis and treated by stenting. There was no statistical significance in biliary tract stenosis in both groups ( P>0.05).Stone recurrence occurred in 3 cases (2.7%) in the normal diameter group, all of which were removed by ERCP lithotomy. Stone recurrence occurred in 8 cases (2.9%) in the CBD dilated group, 7 were removed by ERCP stone extraction and 1 refused further treatment. Conclusion:It is safe and feasible to perform LC+LCBDE in patients with cholecystolithiasis complicating normal sized CBD stones.

Objective: To understand the present situation of physical activity and its influencing factors, and to provide a reference for improving the level of physical activity and making the intervention measures. Methods: The method of random stratification was used to select 4 740 pre school children aged 3-6 from 17 kindergartens in 12 counties and districts of Nanchang City, The questionnaire of physical activities of young children and the questionnaire of parents of physical activities of young children were applied to conduct a survey. Results: Compared with weekday PA and MVPA, preschool children’s weekends decreased, SB increased. The differences in PA, MVPA and SB on weekdays and weekends were statistically significant( P <0.01). The proportion of PA and MVPA reaching the recommended amount during the working day of preschool children were 44.9%-59.2%, 45.4%- 61.7%.The proportion reaching the recommended amount of PA and MVPA on weekends were 24.7%-27.8%, 24.5%-29.9%, and the proportion reaching the recommended amount on weekdays was higher than that on weekends. Conclusion There is still gap between actual amount of physical activity and the recommended amount. There are different modes of activity on weekdays and weekends, and weekends are the least active periods. Parents and teachers should pay enough attention to the establishment of "social campus family" model to improve the lack of physical activity of preschool children.

Objective:To evaluate the effect of imatinib on growth impairment in children with chronic myeloid leukemia (CML-CP) in the chronic phase.Methods:From July 2018 to July 2019, questionnaires were distributed to CML children aged <18 years at the time of diagnosis who were receiving imatinib for at least 3 months or to their parents in China. The height-for-age standard deviation score (HtSDS) and the difference of standard deviation integral (△HtSDS) were used to explore the change in height with imatinib therapy.Results:The data of 238 respondents were included; 138 (58.0% ) respondents were men. The median age at the first diagnosis of CML was 11.0 years (range, 1.4-17.9 years) , and 93 (39.0% ) respondents were at the prepuberty stage. At the time of completing the questionnaires, the median age was 15.0 years (range, 2.0-34.0 years) . The median duration of imatinib therapy was 28 months (range, 3-213 months) . Among all the respondents, the mean HtSDS when completing the questionnaires (-0.063±1.361) was significantly lower than that at the time of starting imatinib treatment (0.391±1.244) ( P<0.001) . Total 71.0% respondents showed growth impairment that was more common in those starting imatinib therapy at prepubertal age than in those starting at pubertal age. Multivariate analysis showed that younger at the start of imatinib therapy ( P<0.001) and longer duration of imatinib therapy ( P<0.001) were significantly associated with severe growth impairment on imatinib therapy. Conclusions:Imatinib induced growth impairment in children with CML-CP. Younger the age of initiation and longer the duration of imatinib therapy, more obvious the effect of imatinib on growth impairment.

The mammalian central nervous system (CNS) is considered an immune privileged system as it is separated from the periphery by the blood brain barrier (BBB). Yet, immune functions have been postulated to heavily influence the functional state of the CNS, especially after injury or during neurodegeneration. There is controversy regarding whether adaptive immune responses are beneficial or detrimental to CNS injury repair. In this study, we utilized immunocompromised SCID mice and subjected them to spinal cord injury (SCI). We analyzed motor function, electrophysiology, histochemistry, and performed unbiased RNA-sequencing. SCID mice displayed improved CNS functional recovery compared to WT mice after SCI. Weighted gene-coexpression network analysis (WGCNA) of spinal cord transcriptomes revealed that SCID mice had reduced expression of immune function-related genes and heightened expression of neural transmission-related genes after SCI, which was confirmed by immunohistochemical analysis and was consistent with better functional recovery. Transcriptomic analyses also indicated heightened expression of neurotransmission-related genes before injury in SCID mice, suggesting that a steady state of immune-deficiency potentially led to CNS hyper-connectivity. Consequently, SCID mice without injury demonstrated worse performance in Morris water maze test. Taken together, not only reduced inflammation after injury but also dampened steady-state immune function without injury heightened the neurotransmission program, resulting in better or worse behavioral outcomes respectively. This study revealed the intricate relationship between immune and nervous systems, raising the possibility for therapeutic manipulation of neural function via immune modulation.

Objective To explore the expressions of costimulatory molecules OX40 and OX40L in peripheral blood (PB) samples of multiple sclerosis (MS) patients,and reveal their clinical significance.Methods PB samples of 39 MS patients and 37 health control subjects (HC) were collected from June 2013 to October 2018.OX40 expressions on CD4+ T cells,OX40L expressions on CD14+ monocytes and CD19+ B cells were detected by immunofluorescent labeling and flow cytometer.The correlations between expanded disability status scale (EDSS) scores and OX40 and OX40L expressions were analyzed,and the influences of different clinical typing and gender in OX40 and OX40L expressions were analyzed.The changes of OX40 and OX40L expressions before and after methylprednisolone shock therapy in 8 patients with recurrent MS were observed.Results (1) As compared with those in the HC group,the expressions of CD4+OX40+ and CD 14+OX40L+ in the peripheral blood of patients in the MS group were significantly increased (P＜0.05).(2) The OX40 expression on the surface of CD4+ T cells was positively correlated with EDSS scores of MS patients (r=0.684,P=0.000).(3) As compared with that in the MS patients at remission phase,the OX40 expression in the CD4+ T cells of MS patients at recurrence phase was significantly increased (P＜0.05);there were no significant differences in the expressions of OX40 and OX40L between male and female MS patients (P＞0.05).(4) EDSS scores of 8 patients with relapsed MS after intravenous infusion of methylprednisolone were significantly lower than those before treatment (P＜0.05);the OX40 expression on the surface of CD4+ T cells after intravenous infusion of methylprednisolone was significantly decreased as compared with that before treatment (P＜0.05).Conclusion Abnormal OX40 expression is closely correlated to neurologic impairment and clinical characteristics,and distinctly responded to corticosteroid therapy in MS patients,which suggests that OX40 may be a promising biomarker and is involved in the pathogenesis of MS.

Objective To explore the expression and change of ski-interacting protein (SKIP) in rats after spinal cord injury. Methods A total of 60 adult female Sprague-Dawley rats were randomly divided into sham group (n=30) and spinal cord injury (SCI) group (n=30), each group was further divided into five time points including one day, three days, five days, seven days, and 14 days with six rats in each time points. The model was established at T10 with modified Allen's technique, and the sham group only bit the lamina of rats. The hindlimbs behavior was assessed with Basso-Beattie-Bresnahan (BBB) score at each time point. The pathological changes of spinal cord neurons were detected with Nissl staining. The expression of SKIP were observed with immunofluorescence staining. Results The BBB scores were signif-icantly lower in each time point in SCI group than in the sham group (t>48.267, P<0.001). Compared with the sham group, Nissl bodies in the cytoplasm of spinal cord neurons began to disintegrate, coalesce and irregularly distribute, the neurons began to degenerate and die on the fifth day, and the damage deteriorated on the 14th day. Immunofluorescence staining showed that SKIP expression was mainly expressed in the gray matter of the spinal cord and little expressed in the white matter. The expression of SKIP gradually increased after SCI, and reached a peak on the fifth day (t=-17.035, P<0.001) and decreased significantly on the 14th day (t=3.853, P<0.05). Conclusion SKIP may be a new signaling molecule, which play an important role in neuronal apoptosis after SCI.

Objepctive To explore the protective effect of modified recombinant human aFGF ( Mrh-aFGF) on the neurons in ventral tegmental area of rats with Parkinson’ s disease ( PD) . Methods The 54 SD rats were ramdomly divided into the control group,the model group and the treatment group,and there were 18 rats in each group. PD rats of the model group and the treatment group were induced by in-jecting 6-OHDA into the left substantia nigra compacta ( SNC) and ventral tegmental area ( VTA) to build the PD model. Rats in the treat-ment group were given Mrh-aFGF injection after lateral ventricle injection,and the behavioral changes of the rats were detected after apomor-phine injection. The morphologic features and pathological changes of neurons in the ventral tegmental area were observed by Nissl’ s staining and electronic microscope. Results Compared to the right VTA of PD rats,the number of neurons in left side ( the injured side) decreased significantly in the model group(P<0. 05). In the treatment group,the structure of left (the injured side) VTA was markedly improved and the number of neurons was increased one week,two weeks and four weeks after operation compared with the model group (P<0. 05). The neurons in the VTA of the model group were found to have karyopyknosis,endoplasmic reticulum,degranulation,mitochondria swelling,cristae disappear,pre-synaptic and post-synaptic membranes swelling,and synaptic cleft disappear. In the treatment group,the ultrastructure of the neurons in the VTA,such as nuclei,mitochondria,synaptic structure,kept well compared to the model group. Conclusion Mrh-aFGF could protect the neurons in the ventral tegmental area from the loss and improve the ultrastructure of the neurons of PD rats.

Objective To observe the effect of astragalus polysaccharide on motor function and pathology after spinal cord injury in rats. Methods Seventy adult Sprague-Dawley rats were selected as normal group (n=10), injury group (n=30) and treatment group (n=30), and the injury group and the treatment group were divided into 7 days, 14 days, 28 days subgroups. The injury group and the treatment group were modeled with Allen's mode at T10 (10 g×25 mm). The treatment group was injected with astragalus polysaccharide 10 mg/kg per day after injury. They were rated with Basso-Beattie-Bresnahan (BBB) scores 7 days, 14 days and 28 days after injury, while the morphology was observed with HE staining, Nylon body was observed with Nissl staining, and myelin sheath was observed with eriochrome cyanine staining. Results The BBB score was significantly higher in the treatment group than in the injury group at each time point (P<0.05). There was a large number of necrotic tissue in the injured cords and cystic cavity began to form 7 and 14 days after injury. Cystic cavity formed basically and surrounded with dense scar 28 days after injury. The necrosis and cystic cavity alleviated in the treatment group at each time point. Demyelination and myelin sheaths loose were found 7 days after injury, and aggravated with the time. There was a cystic cavity in trauma center 28 days after injury. The demyelination and myelin sheaths loose relieved at each time point in the treatment group. Nissl bodies began to coalesce 7 days after injury, and aggravated 14 days after injury, coalesced completely 28 days after injury. Nissl body coalesced alleviatively in the treatment group at each time point. Conclusion Astragalus polysaccharide may reduce the damage and promote the recovery of motor function after spinal cord injury in rats.