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 investigate the effect of different timing of arterial -venous extracorporeal membrane oxygenation (VA-ECMO) on the prognosis of patients with acute myocardial infarction complicated with cardiogenic shock (AMICS).Methods:This study was a prospective cohort study. AMICS patients received VA-ECMO support primary percutaneous coronary intervention in Henan Provincial People's Hospital from May 2017 to July 2023 were divided into early VA-ECMO group and late VA-ECMO group. 64 AMICS patients who met the indications for VA-ECMO implantation, but did not revive VA-ECMO were included as control group. Demographic characteristics, coronary interventional (PCI) information and complications after VA-ECMO implantation were collected. The primary end points was 1-year survival, minor end point were in-hospital and perioperative death. Multivariate Logistic and Cox regression models were used to evaluate the effect of timing of VA-ECMO on prognosis of AMICS patients. Kaplan-Meier survival curve was used to analyze the 1-year survival outcome of the 3 groups.Results:A total of 143 AMICS patients were included, and materials of 136 patients entered in the final analysis, including 42 in the early VA-ECMO group, 34 in the late VA-ECMO group, and 60 in the non-VA-ECMO group. Compared with the late VA-ECMO group, the early VA-ECMO group had a higher ratio of PPCI after VA-ECMO, a longer D-to-B time, a shorter VA-ECMO support time, a higher success rate of VA-ECMO withdrawal, and a lower complication rate (all P<0.05). Compared with the early VA-ECMO group, the perioperative, in-hospital and 1-year mortality were significantly higher in Non-ECMO support (all P<0.05). There was no difference in perioperative and in-hospital mortality between the early VA-ECMO group and the late VA-ECMO group, but the 1-year mortality in the late VA-ECMO group was significantly higher ( P<0.05). Perioperative, in-hospital and 1-year mortality rates were lower in the late VA-ECMO group than in the no-VA-ECMO group, but the differences were not statistically significant. Multivariate Logistic and Cox regression analysis showed that after adjusting interference factors, early VA-ECMO was still a protective factor for in-hospital ( OR=0.244, P=0.015) and one year ( HR=0.308, P=0.001)mortality. Kaplan-Merier survival curve showed that compared with the late VA-ECMO group and the group without VA-ECMO, the early VA-ECMO group had the highest 1-year survival rate. Conclusion:Patients with AMICS may benefit more from early VA-ECMO than from late VA-ECMO support for PPCI.

Objective:To explore the feasibility and safety of remote programming technology based on 5G cloud technology support platform in postoperative follow-up of cardiovascular implantable electronic devices(CIED).Methods:This study was a multicenter cross-sectional study. CIED patients from 12 hospitals lacking full-time follow-up specialists in Sichuan Province were enrolled from June 2021 to October 2021. All patients′ devices received remote inspecting and programming by the follow-up specialist of the remote follow-up center of the Third People′s Hospital of Chengdu through 5G cloud technology support platform. The baseline data, device alarm events, device reprogramming events, adverse reactions and satisfaction questionnaire survey results were collected.Results:A total of 195 CIED implantation patients were included, with an age of (72.5±11.3) years, including 103 males (52.6%). All patients completed remote inspecting and programming successfully, with a duration of (5.8±4.0) min. Ninety-one patients′ CIED were reprogrammed, with a total of 104 parameter adjustments. No abnormal communication or adverse events occurred. The satisfaction questionnaire showed that 97.9%(191/195) of the patients trusted or relatively trusted remote follow-up and 86.7%(169/195) of the patients were willing to choose remote follow-up mode for device management.Conclusion:The remote programming based on 5G cloud technology support platform may be feasible and safe for postoperative follow-up of CIED patients.

ObjectiveA rapid enrichment and detection method for Escherichia coli O157∶H7 was developed by using multienzyme isothermal rapid amplification （MIRA） fluorescence method combined with metal organic frameworks immunomagnetic beads. MethodsUsing rfbE gene as the target， the primers， probes and reaction system were screened， and the specificity， sensitivity and practical application of this method were investigated. ResultsThe detection limit of Escherichia coli O157∶H7 was 1.18×10⁵ CFU‧mL^-1， and the detection limit of DNA concentration was 9 pg‧μL^-1. The detection process was completed in 20 minutes. The test results of 47 strains （24 target strains and 23 non-target strains） were consistent with real-time PCR （RT-PCR）. ConclusionA method based on metal-organic framework immunomagnetic beads enrichment combined with MIRA assay is developed in this study. The method is simple， rapid and suitable for rapid enrichment and detection of Escherichia coli O157∶H7 in food.

Objective:To explore the effect of drug metabolism gene polymorphisms on blood concentration and safety of tacrolimus (TAC) in children with refractory nephrotic syndrome (RNS).Methods:The study was designed as prospective observational clinical study. The subjects were selected from the children with RNS who were hospitalized in Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University from September 1, 2018 to August 31, 2019 and planned to receive TAC (first application) at the basis of glucocorticoids treatment. Clinical research files were formed and clinical conditions within 6 months of TAC treatment were recorded in detail for all subjects. The peripheral venous blood of all children was collected on the 7th day after TAC application for TAC blood trough concentration detection, and the TAC dose was adjusted according to the results. Blood samples were collected at the right time during hospitalization and gene polymorphisms of adenosine triphosphate binding cassette transporter B1 (ABCB1), cytochrome P450 (CYP) 2C19, CYP3A4, CYP3A5 and nuclear receptor subfamily 1, group I, member 2 (NR1I2) were detected. Children who completed 6 months of TAC treatment and follow-up were included. According to the genotype detection results, children were divided into wild-type group, heterozygous mutant group, and homozygous mutant group and first dose-adjusted blood trough concentration (C/D) of TAC were compared; they were divided into mutation carrier group (including heterozygous mutation carriers and homozygous mutation carriers) and wild-type group and the incidence of adverse reactions were compared.Results:A total of 39 children were included in the analysis, including 24 males and 15 females, aged 3 to 13 years with a median age of 8 years. The comparison results of the first C/D of TAC among various genotype groups showed that the TAC C/D in children of CYP2C19 homozygous mutant (*2*2) group was higher than that of wild-type (*1*1) group [3.65 (2.78, 7.43) μg/L vs. 1.53 (1.27, 3.33) μg/L, P=0.032], TAC C/D in children of CYP3A5 homozygous mutant (*3*3) group was significantly higher than those of the wild-type (*1*1) group and heterozygous mutation (*1*3) group [3.68 (3.05, 5.14) μg/L vs. 2.10 (0.77, 3.56) μg/L and 1.74 (1.47, 3.25) μg/L, P=0.046, P=0.009], and no significant differences were found in TAC C/D among different genotypes in CYP3A4, ABCB1, or NR1I2 (all P>0.05). A total of 7 children had adverse reactions within 6 months of TAC treatment (Naranjo′s assessment scale, "probable" in 2 children and "possible" in 5 children), including infection, rash, hypertensive encephalopathy, and convulsions in 4, 1, 1, 1 child, respectively. The incidence of adverse reactions in ABCB1 mutation carrying children (CT and TT) was significantly higher than that in children of wild-type (CC) group [30.4% (7/23) vs. 0 (0/16), P=0.033]. Conclusion:CYP2C19 and CYP3A5 gene polymorphisms have significant effects on TAC blood concentration, and ABCB1 gene polymorphisms have significant effects on the safety of TAC application, which should be noticed in clinic.

Objective:To explore the effect of drug metabolism gene polymorphisms on blood concentration and safety of tacrolimus (TAC) in children with refractory nephrotic syndrome (RNS).Methods:The study was designed as prospective observational clinical study. The subjects were selected from the children with RNS who were hospitalized in Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University from September 1, 2018 to August 31, 2019 and planned to receive TAC (first application) at the basis of glucocorticoids treatment. Clinical research files were formed and clinical conditions within 6 months of TAC treatment were recorded in detail for all subjects. The peripheral venous blood of all children was collected on the 7th day after TAC application for TAC blood trough concentration detection, and the TAC dose was adjusted according to the results. Blood samples were collected at the right time during hospitalization and gene polymorphisms of adenosine triphosphate binding cassette transporter B1 (ABCB1), cytochrome P450 (CYP) 2C19, CYP3A4, CYP3A5 and nuclear receptor subfamily 1, group I, member 2 (NR1I2) were detected. Children who completed 6 months of TAC treatment and follow-up were included. According to the genotype detection results, children were divided into wild-type group, heterozygous mutant group, and homozygous mutant group and first dose-adjusted blood trough concentration (C/D) of TAC were compared; they were divided into mutation carrier group (including heterozygous mutation carriers and homozygous mutation carriers) and wild-type group and the incidence of adverse reactions were compared.Results:A total of 39 children were included in the analysis, including 24 males and 15 females, aged 3 to 13 years with a median age of 8 years. The comparison results of the first C/D of TAC among various genotype groups showed that the TAC C/D in children of CYP2C19 homozygous mutant (*2*2) group was higher than that of wild-type (*1*1) group [3.65 (2.78, 7.43) μg/L vs. 1.53 (1.27, 3.33) μg/L, P=0.032], TAC C/D in children of CYP3A5 homozygous mutant (*3*3) group was significantly higher than those of the wild-type (*1*1) group and heterozygous mutation (*1*3) group [3.68 (3.05, 5.14) μg/L vs. 2.10 (0.77, 3.56) μg/L and 1.74 (1.47, 3.25) μg/L, P=0.046, P=0.009], and no significant differences were found in TAC C/D among different genotypes in CYP3A4, ABCB1, or NR1I2 (all P>0.05). A total of 7 children had adverse reactions within 6 months of TAC treatment (Naranjo′s assessment scale, "probable" in 2 children and "possible" in 5 children), including infection, rash, hypertensive encephalopathy, and convulsions in 4, 1, 1, 1 child, respectively. The incidence of adverse reactions in ABCB1 mutation carrying children (CT and TT) was significantly higher than that in children of wild-type (CC) group [30.4% (7/23) vs. 0 (0/16), P=0.033]. Conclusion:CYP2C19 and CYP3A5 gene polymorphisms have significant effects on TAC blood concentration, and ABCB1 gene polymorphisms have significant effects on the safety of TAC application, which should be noticed in clinic.

Objective To study the clinical characteristics of outpatients with hand,foot and mouth disease (HFMD) caused by different serotypes of enteroviruses.Methods This was a prospective study.From February 2017 to March 2018,563 outpatients with HFMD were enrolled by systematic sampling in the Department of Infectious Diseases,Henan Children's Hospital.Throat swabs were collected to determine the serotypes via PCR.Demographic,clinical,and laboratory data were collected by standard questionnaire.All cases were followed up twice at 2 and 9 weeks after the initial outpatient visit through telephone interview.A total of 563 cases were enrolled and 555 (98.6％) cases were positive for human enteroviruses,including 338 (60.9％) males.Analyses were stratified by enterovirus serotypes,Chi square test or Fisher's exact test,Rank sum test was used for comparison among different groups.Results The age of 555 cases was 24.2 (16.4,41.3) months.Among them 44.0％ (224 cases) were identified as coxsackievirus (CV)-A6,while 189 cases,35 cases,14 cases and 73 cases were identified as CV-A16,enterovirus (EV)-A71,CV-A10 and other serotypes,respectively.Fever (≥37.5 ℃C) was present in 51.4％(285/555) of laboratory confirmed cases.The proportions of fever in cases of CV-A6 (68.9％(168/244)) and CV-A10 (12/14) were significantly higher than those in cases of CV-A16 (31.7％(60/189),x2=57.344,14.313,both P=0.000),other serotypes (43.8％(32/73),x2=15.101 and 8.242,P=0.000 and 0.004) and EV-A71 (37.1％(13/35),x2=13.506 and 9.441,P=0.000 and 0.002) respectively.There was no significant difference between CV-A6 and CV-A10 in presentation of fever (x2=1.785,P=0.182).There were 359 cases (64.7％) with eruptions in mouth,hands,feet and buttocks.Cases infected with EV-A71 had the highest proportions (74.3％(26/35)) of rash emerging simultaneously in mouth,hands,feet,and buttocks.The proportion in cases of CV-A 16,CV-A6,CVA 10 and other serotype were 73.5％ (139/189),61.9％ (151/244),7/14 and 49.3％ (36/73),respectively.The proportion of rash on other parts of body,such as face,limbs or torso in cases infected with CV-A6 (16.8％ (41/244)) was the higherest and the proportion in cases of CV-A16,EV-A71,CV-A10 or other serotypes were 8.5％(16/189),5.7％(2/35),1/14,6.8％(5/73),respectively.None of these cases developed serious complications.Desquamation occurred in 45.5％ (179/393) cases 7.5 (5.0,9.0) days after disease onset and 13.5％ (53/393) cases showed onychomadesis 31.0 (18.0,33.5) days after disease onset.The proportion of desquamation and onychomadesis associated with CV-A6 (64.2％ (95/148) and 31.8％ (47/148)) was significantly higher than CV-A16 (31.8％ (49/154) and 1.3％ (2/154),x2=33.601 and 52.482,both P=0.000) and other serotypes (38.0％(19/50) and 6.0％(3/50),x2=10.236 and 12.988,P=0.001 and 0.000).Desquamation appeared more in cases of CV-A6 than in cases of CV-A10 (2/11,x2=9.386,P=0.002),with the proportion of onychomadesis higher in CV-A6 than in EV-A71 (3.3％ (1/30),x2=11.088,P=0.001).Conclusion Clinical manifestation such as fever,rash emerging parts,desquamation and onychomadesis are different among outpatient HFMD cases infected with CV-A16,CV-A6,EV-A71,CV-A10 and other enteroviruses.

Objective To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in treatment of IgA nephropathy. Methods The Cochrane library, PubMed, EMBASE, Wanfang Data Knowledge Service Platform, CNKI and VIP were searched from the time when the databases were established to March 31, 2018. Reports on randomized controlled trials (RCTs) on treating IgAN with MMF were collected. Data were extracted and assessed independently by three reviewers and the methodological quality of included RCTs was assessed by the Cochrane collaboration's tool for assessing risk of bias. The Meta analysis of homogeneous RCTs was managed by using Stata 12.0. Results Nine RCTs, of which two RCTs were assessed as A-level studies scoring from 4 to 7 points, six RCTs were assessed as B-level studies scoring from 2 to 3 points, and one RCT was assessed as C-level study with scores less than 2 points, were enrolled in the study. Important outcomes of this systematic review were described as follows: (1) Compared to placebo plus ACEI/ARB or ACEI/ARB monotherapy, MMF plus ACEI/ARB did not reduce the incidence of increased serum creatinine and ESRD, but increased the partial remission rate of urinary protein (OR=2.59, 95％CI 1.01-6.65, P=0.049. (2) No significant difference was detected in the efficacy of reducing urinary protein for MMF monotherapy or MMF plus glucocorticoid (GC) compared to GC monotherapy. (3) MMF showed no significant difference in the efficacy of reducing urinary protein compared to LEF or CTX, but lower incidence rate of serum creatinine increasing than that of CTX group (OR=0.21, 95％CI 0.04-1.07, P=0.043. (4) Different levels of adverse reactions occurred in each treatment group with MMF, but most symptoms were mild, and recovered gradually after reducing or withdrawing MMF. Conclusions MMF monotherapy shows a superiority in curing IgAN compared to ACEI/ARB, but no significant superiority compared to GC. MMF can replace a part of the effect of GC when used in combination with GC and can reduce the dosage of GC compared to GC monotherapy. Additionally, MMF displays no better short-term efficacy than LEF or CTX, but a better long-term efficacy and fewer side effects than CTX. And the side effects occurred in the treatment groups with MMF are mostly mild, and disappear gradually after reducing or stopping the use of the drug. MMF is a safe and effective drug for the treatment of IgAN.

Objective: To investigate the incidence and pathogen distribution of ventilator-associated pneumonia (VAP) among preterm infants admitted to level Ⅲ neonatal intensive care units (NICU) in China. Method: A prospective study was conducted in 25 level Ⅲ NICU, enrolling all preterm infants <34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016. Chi-square test, t test and Mann-Whitney U test were used for statistical analysis. Result: A total of 7 918 patients were enrolled, within whom 4 623(58.4%) were males. The birth weight was (1 639±415) g and the gestational age was (31.4±2.0) weeks; 4 654(58.8%) infants required non-invasive mechanical ventilation and 2 154(27.2%) required intubation. Of all the mechanically ventilated patients, VAP occurred in 95 patients. The overall VAP rate was 7.0 episodes per 1 000 ventilator days, varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers. The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children′s hospitals and maternity-infant hospitals respectively, without significant differences (t=1.002, P=0.327). Gram-negative bacilli (76 strains, 91.6%) were the primary VAP microorganisms, mainly Acinetobacter baumannii (24 strains, 28.9%), Klebsiella pneumonia (23 strains, 27.7%), and Pseudomonas aeruginosa (10 strains, 12.0%). Conclusion The incidence of VAP in China is similar to that in developed counties, with substantial variability in different NICU settings. More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.