Objective To construct a nomogram to predict the prognosis of patients with gallbladder cancer(GBC).Methods The clinicopathological data of GBC patients were extracted from the SEER database,and the independent prognostic factors of GBC patients were analyzed by Cox regression,and a nomogram was constructed.Finally,the column diagrams in the training queue and validation queue are verified.Results Age,T stage,M stage,histological grade,radiotherapy,surgery and tumor size were independent prognostic factors in GBC patients,and the differences were statistically significant(P＜0.05).In the training cohort,the C index was 0.735(95％CI=0.721～0.749),and the AUC values at 1,3 and 5 years were 0.821,0.820 and 0.833,respectively.In the verification group,the C index was 0.733(95％CI=0.711～0.755),and the AUC values for 1,3 and 5 years were 0.816,0.807 and 0.827,respectively.The calibration curve shows that the predicted values of the nomogram are in good agreement with the observed values.The decision curve shows that the nomogram model has better prediction ability than TNM staging system.Conclusion The constructed dynamic prognosis nomogram of GBC patients has high accuracy and reliability.

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 prevalence and influencing factors of falls among elderly patients with comorbidity of chronic diseases in Chongqing Municipality, so as to provide insights into preventing measures of falls. Methods: Elderly patients with comorbidity of chronic diseases admitted to a level A tertiary hospital of Chongqing Municipality from July 2022 to December 2022 were recruited. Participants' demographics, physical component and fall condition were collected using a questionnaire survey. Incidence of falls was descriptively analyzed, and factors affecting falls among elderly patients with comorbidity of chronic diseases were identified using a multivariable logistic regression model. Results: A total of 344 questionnaires were allocated, and 338 valid questionnaires were recovered, with an effective rate of 98.26%. There were 195 men (57.69%) and 143 women (42.31%), with a mean age of (77.10±7.29) years. There were 171 (50.59%), 115 (34.02%), 38 (11.24%) and 14 (4.14%) patients suffering from 2, 3, 4 and 5 chronic diseases, respectively. The incidence of falls during recent six months was 22.49%. Multivariable logistic regression analysis identified history of vertigo in last 6 months (OR=2.720, 95%CI: 1.409-5.249), fear of falling (OR=8.725, 95%CI: 4.572-16.653) and adaptation of living environments to ageing (OR=0.257, 95%CI: 0.130-0.509) as factors affecting elderly patients with comorbidity of chronic diseases. Conclusion The Elderly patients with comorbidity of chronic diseases who have a history of vertigo, fear of falling, and living environments that are not age-adapted are at higher risks of falls.

Objective:The epidemiological characteristics of occupational pneumoconiosis in Gansu Province from 2010 to 2018 were analyzed to provide a theoretical basis for the development of prevention and control strategies for pneumoconiosis in Gansu Province.Methods:In March 2019, the data of newly diagnosed occupational pneumoconiosis in 2010 -2018 and the data of occupational pneumoconiosis as of December 31, 2018 in Gansu Province were collected by the Occupational Disease and Occupational Health Information Monitoring System. The stage, type of disease, time, enterprise information of newly diagnosed pneumoconiosis and the region, type of disease, enterprise information of existed pneumoconiosis were analyzed. Results:From 2010 to 2018, a total of 1269 new cases of occupational pneumoconiosis were reported in Gansu Province, including 818 cases (64.46%) of stage I pneumoconiosis, 284 cases (22.38%) of stage II pneumoconiosis, 167 cases (13.16%) of stage III pneumoconiosis. Silicosis, coal worker's pneumoconiosis and cement pneumoconiosis ranks the top 3, accounting for 55.71% (707/1269) , 37.67% (478/1269) and 3.78% (48/1269) of the total number, respectively. The new cases of stage III pneumoconiosis were mainly distributed in private economy (58.09%, 79/136) and small -sized (59.88%, 97/162) enterprises. As of December 31, 2018, Gansu Province had reported a total of 12211 cases of occupational pneumoconiosis, of which 58.16% (7102/12211) were coal worker's pneumoconiosis and 28.15% (3438/12211) were silicosis. Mainly distributed in Baiyin city (21.63%, 2641/12211) , Lanzhou city (17.79%, 2172/12211) and Wuwei city (13.73%, 1676/12211) . The existed cases of pneumoconiosis are mainly distributed in state -owned economy (76.95%, 9396/12211) and large -sized (54.23%, 6622/12211) enterprises. Conclusion:Silicosis and coal worker's pneumoconiosis are the main type of pneumoconiosis in Gansu Province. And the number of silicosis reported is on the rise, which should be taken seriously. Pneumoconiosis in Gansu Province is mainly distributed in state -owned economy and large -sized enterprises. However, pneumoconiosis patients in private economy and small -sized enterprise is generally serious, so it should be the focus of supervision.

Objective:The epidemiological characteristics of occupational pneumoconiosis in Gansu Province from 2010 to 2018 were analyzed to provide a theoretical basis for the development of prevention and control strategies for pneumoconiosis in Gansu Province.Methods:In March 2019, the data of newly diagnosed occupational pneumoconiosis in 2010 -2018 and the data of occupational pneumoconiosis as of December 31, 2018 in Gansu Province were collected by the Occupational Disease and Occupational Health Information Monitoring System. The stage, type of disease, time, enterprise information of newly diagnosed pneumoconiosis and the region, type of disease, enterprise information of existed pneumoconiosis were analyzed. Results:From 2010 to 2018, a total of 1269 new cases of occupational pneumoconiosis were reported in Gansu Province, including 818 cases (64.46%) of stage I pneumoconiosis, 284 cases (22.38%) of stage II pneumoconiosis, 167 cases (13.16%) of stage III pneumoconiosis. Silicosis, coal worker's pneumoconiosis and cement pneumoconiosis ranks the top 3, accounting for 55.71% (707/1269) , 37.67% (478/1269) and 3.78% (48/1269) of the total number, respectively. The new cases of stage III pneumoconiosis were mainly distributed in private economy (58.09%, 79/136) and small -sized (59.88%, 97/162) enterprises. As of December 31, 2018, Gansu Province had reported a total of 12211 cases of occupational pneumoconiosis, of which 58.16% (7102/12211) were coal worker's pneumoconiosis and 28.15% (3438/12211) were silicosis. Mainly distributed in Baiyin city (21.63%, 2641/12211) , Lanzhou city (17.79%, 2172/12211) and Wuwei city (13.73%, 1676/12211) . The existed cases of pneumoconiosis are mainly distributed in state -owned economy (76.95%, 9396/12211) and large -sized (54.23%, 6622/12211) enterprises. Conclusion:Silicosis and coal worker's pneumoconiosis are the main type of pneumoconiosis in Gansu Province. And the number of silicosis reported is on the rise, which should be taken seriously. Pneumoconiosis in Gansu Province is mainly distributed in state -owned economy and large -sized enterprises. However, pneumoconiosis patients in private economy and small -sized enterprise is generally serious, so it should be the focus of supervision.

Objective: To analyze the epidemiological characteristics of occupational diseases in Gansu Province, China in 2010-2017, and to provide a scientific basis for the prevention and control of occupational diseases. Methods: The cluster sampling method was adopted to make statistical analysis of 1339 cases of occupational disease reported by "occupational disease and occupational health information monitoring system" in Gansu province from 2010 to 2017, to investigate the diseases, regions and industries of occupational diseases in June 2018. Results: A total of 1339 cases of occupational diseases (39 types, 8 classes) were diagnosed and reposed in 2010-2017. The three most frequent diseases were pneumoconiosis (87.53%, 1172/1339), occupational poisonings (5.83%, 78/1339), and occupational ear, nose, and throat (ENT) diseases (3.14%, 42/1339). The cases of silicosis accounted for 54.61% (640/1172) of all cases of pneumoconiosis, the second was coalworker pneumoconiosis, which accounted for 38.57% (452/1172). In the cases of occupational poisonings, 32.05% (25/78) suffered from carbon monoxide poisoning. Patients with occupational diseases were reported in 14 districts of Gansu, mostly in Lanzhou (27.52%, 347/1261), Jinchang (16.57%, 209/1261), and Baiyin (14.20%, 179/1261). The reported cases are mainly concentrated in mining (71.56%, 468/654) and manufacturing (21.87%, 143/654), the types of state-owned economy (55.63%, 692/1244) and private economy (33.68%, 419/1244), large (43.41%, 540/1244) and small enterprises (35.21%, 438/1244) in 2010-2017 in Gansu. Conclusion The pneumoconiosis caused by silicious and coal dust and the occupational poisonings caused by carbon monoxide seem to be the main occupational hazards in Gansu province. Occupational diseases occur in all districts of Guangzhou and in various industries. The state-owned economy and private sector, large and small enterprises should be the focuses of occupational health supervision.

OBJECTIVE:Taking metoprolol succinate sustained-release tablets as an example,to explore the value of speckle tracking imaging in therapeutic efficacy evaluation of CHF drugs. METHODS:68 CHF patients who had never underwent regular treatment were given Metoprolol succinate sustained-release tablets and anti-heart failure agents for 3 months. NYHA classification, resting heart rate(RHR),6 min walk distance(6MWD)and conventional echocardiographic measurements were tested before and 1 and 3 months after treatment. Dynamic image were collected in the apical 2-chamber view,apical 4-chamber view and left ven-tricular long axis plane for speckle tracking imaging offline analysis. The left ventricular global longitudinal strain (LVGLS) were measured. After 3 months of treatment,CHF patients were divided into standard group(group A,RHR 55-60 times/min)and non-standard group (group B,RHR>60 times/min) according to resting heart rate. The improvement of above indicators were com-pared between 2 groups,and that of LVGLS was also compared. RESULTS:After 1 month of treatment,RHR,LVEDd,LVEF and LVGLS of group A were improved significantly,compared with group B,with statistical significance (P<0.05). After 3 months of treatment,there was statistical significance in above indicators between 2 groups(P<0.05). In group A,RHR,6MWD and LVGLS improved significantly after 1 month of treatment,there was statistical significance,compared with before treatment (P<0.05);there was statistical significance in above indicators after 3 months of treatment,compared with before treatment and after 1 month of treatment (P<0.05). In group B,RHR and 6MWD improved significantly after one month of treatment;there was statistical significance,compared with before treatment(P<0.05);there was statistical significance in significant improvement of each indicator between after 3 months of treatment and before treatment (P<0.05);only there were statistical significance in RHR and NYHA grading,compared with after one month of treatment(P<0.05). CONCLUSIONS:Speckle tracking imaging can early reflect the left ventricular function improvement of CHF patients after anti-heart failure treatment,especially in patients with RHR control standard earlier and more significant. Speckle tracking had good clinical application value in the follow-up treatment of heart failure as routine evaluation index.

BACKGROUND:The mechanisms of mesenchymal stem cells directional y homing to infarcted myocardium post myocardial infarction are stil unclear.
OBJECTIVE:To investigate the role of stromal cellderived factor-1 (SDF-1)/C-X-C chemokine receptor 4 (CXCR4) axis on mesenchymal stem cellmigration promoted by mononuclear cells after myocardial infarction.
METHODS:Cardiomyocytes and mesenchymal stem cells were respectively isolated from suckling and adult Sprague-Dawley rats. Twelve healthy Sprague-Dawley rats were selected (six rats for myocardial infarction models and six for sham models), then circulating mononuclear cells were isolated. 4,6-Diamino-2-phenyl indole-labeled mesenchymal stem cells, cardiomyocytes and mononuclear cells were cultured into the upper, middle and lower layers of the tri-chamber coculture system, respectively. In this experiment, there were four groups:myocardial infarction group, AMD3100 (CXCR4 inhibitor) group, sham group and blank control group. After 48 hours, the number of migrating mesenchymal stem cells with blue-lighting nucleus was calculated under fluoroscope. Immunocytochemistry and immunofluorescent staining was used to detect SDF-1 expression in cardiomyocytes and CXCR4 expression in mesenchymal stem cells, respectively.
RESULTS AND CONCLUSION:Migrating mesenchymal stem cells with positive expression of CXCR4 were observed in each group other than the blank control group. The number of migrating mesenchymal stem cells was higher in the myocardial infarction group than in the other groups. Tumor necrosis factor-αneutralizing antibody and CXCR4 inhibitor AMD3100 could obviously reduce the number of migrating mesenchymal stem cells (P<0.05). Cardiomyocytes in each group expressed SDF-1 positively. The gray values of SDF-1 expression in the myocardial infarction and AMD3100 groups were significantly higher than those in the sham and blank control groups (P<0.05). SDF-1/CXCR4 axis plays a certain role in mesenchymal stem cells migration promoted by mononuclear cells after myocardial infarction.

Objective To observe the effect of astragaloside IV (A) and SB203580 antagonize cadmium (Cd) toxicity on expression of associated protein and blood-testis barrier(BTB) in rats and to study the protective mechanism of A on it.Methods Totally 21 SD male rats were randomly divided into 7 groups, 3 rats per group:Cd [ intraperitoneally injected with 0.1%CdCl2,1mg/(kg?d)],Cd+A [at the above dose of CdCl2,at the same time with A,10mg/(kg?d)], and Cd +SB203580 [at the above dose of CdCl2,at the same time with SB203580,100μg/(kg?d)], each of the above groups was further divided into continuous five and ten days treatment groups .The control group was intraperitoneally injected with equal dosage of normal saline .The testes were studied by light , electron microscopy , immunohistochemistry and Western blotting .Results In the control group ,irregular and lightly stained nuclei of Sertoli cell ( Sc) in seminiferous tubules were observed by HE staining .A continuous electron density line of tight junction ( TJ) and normal ultrastructure of BTB were observed .After Cd treatment ,the vesicular formation in the Sc was observed .The ultrastructural damage of Sc and TJ was observed .Compared with the corresponding time point of Cd group ,these were weakened in morphology of testis and ultrastructure of TJ after Cd +A or Cd +SB203580 treatment .The positive products of zonula occludens-1 ( ZO-1 ) and claudin-11 were localized mainly in the base of the seminiferous tubule .After Cd treatment , the average absorbance (AA) of ZO-1 and Claudin-11 was decreased significantly compared with that of the control group (P<0.05).After Cd +A or Cd +SB203580 treatment,AA of ZO-1 and Claudin-11 were increased significantly compared with that of the Cd group(P<0.05),though lower than that of the control group .The result of Western blotting showed that phosphorylation-p38MAPK in Cd group was increased significantly compared with that of the control group (P<0.05).After Cd +A or Cd+SB203580 treatment, it was decreased significantly compared with that of the Cd group (P<0.05).Conclusion Cd decreases ZO-1 and Claudin-11 expression and damages ultrastructure of TJ in BTB , asⅣhas protective effect on it , and is related to inhibiting activation of p 38 MAPK pathway .

Objective To investigate the toxic effect of cadmium (Cd) on the ultrastructure ,expression of related protein and the signal molecule phosphrylated P38 mitogen-actived protein kinase(P-P38MAPK) of primary cultured rat sertoli cell(Sc) ,and the protective effect of astragaloside (A ) on it .Methods The primary cultured rat Sc were divided into the control group ,Cd (50 mol/L)group and Cd(50 mol/L) plus A(10 mg/L) group ,they were used for the electron microscope observation and the im-munohistochemistry detection of vimentin ,E-cadherin ,-catenin and P-P38MAPK .Results The Sc ultrastructural changes included that the swelled mitochondria ,abundant lipid droplets and dilated endoplasmic reticulum were found in the Cd group .Further ,apop-tosis occurred in some Sc .However these ultrastructure changes above mentioned were slighter in the Cd plus A group ;the immu-nohistochemistry showed that the positive products of vimentin ,E-cadherin and-catenin were obviously decreased in the Cd group (P<0 .05) ,and those in the Cd plus A group were higher compared with the Cd group(P<0 .05);the expression of P-P38MAPK in cytoplasm was increased in the Cd group ,and showed the trend to move from cytoplasm to nucleus ,meanwhile ,the positive prod-ucts expression in the Cd plus A group was lower than that in the Cd group (P<0 .05) .Conclusion Cadmium can cause the injury of the Sc ultrastructure ,damage of cytoskeletal protein and fibronectin ,and increase of P-P38MAPK level ;astragaloside can antago-nize the toxicity of cadmium on Sc ,the protective effect maybe related with the decrease of P-P38MAPK in Sc .