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.

ObjectiveTo analyze the fingerprint of six pungent herbs based on the molecular connectivity index（MCI）and the matching frequency total statistical moment method， and to study the division and integration of the "imprinting template" of their volatile components， so as to find the common "imprinting template" characteristics of the pungent herbs. MethodThe volatile components of six pungent herbs were extracted by steam distillation， and their fingerprints were established by gas chromatography-mass spectrometry（GC-MS） with a programmed temperature increase（80 ℃ for 5 min， 5 ℃·min^-1 to 200 ℃ for 5 min， 2 ℃·min^-1 to 230 ℃ for 10 min）， a splitting ratio of 20∶1， an electron bombardment ion source（EI） and the detection range of m/z 35-650， and the average MCI and total statistical moment parameters of the fingerprints were calculated. Then the matching frequency method was used to classify， integrate and confirm the chromatographic peaks of the fingerprints of six pungent herbs. ResultThe average zero order， first-order and second-order MCI values of the volatile components of Pogostemonis Herba， Artemisiae Argyi Folium， Atractylodis Rhizoma， Asari Radix et Rhizoma， Magnoliae Flos and Schizonepetae Herba were 9.02， 5.28 and 5.05， respectively. The average values of peak number， total zero-order moment， total first-order moment and total second-order moment were 60， 169×10⁷， 22.49 min and 36.82 min²， respectively. The 20 integrated imprinting templates were obtained by the matching frequency method for the six pungent herbs， among which three were common imprinting templates with the retention times of （25.97±0.21），（26.90±0.20），（31.64±1.24） min， respectively， and the representative components were valencene，β-elemene， caryophyllin， etc. ConclusionMCI combined the matching frequency total statistical moment can divide and integrate the characteristics of imprinting templates of six pungent herbs， and find their common chromatographic imprinting characteristics， which can provide a reference for the determination of effective substances of pungent herbs.

The rapid spread of carbapenemase-producing Klebsiella pneumoniae(cpKP)poses seri-ous threats to public health;however,the underlying genetic basis for its dissemination is still unknown.We conducted a comprehensive genomic epidemiology analysis on 420 cpKP isolates col-lected from 70 hospitals in 24 provinces/autonomous regions/municipalities of China during 2009-2017 by short-/long-read sequencing.The results showed that most cpKP isolates were categorized into clonal group 258(CG258),in which ST11 was the dominant clone.Phylogenetic analysis revealed three major clades including the top one of Clade 3 for CG258 cpKP isolates.Additionally,carbapenemase gene analysis indicated that blaKPC was dominant in the cpKP isolates,and most blaKPC genes were located in five major incompatibility(Inc)groups of blaKPC-harboring plasmids.Importantly,three advantageous combinations of host-blaKPC-carrying plasmid(Clade 3.1+3.2-IncFⅡpHN7A8,Clade 3.1+3.2-IncFⅡpHN7A8:IncR,and Clade 3.3-IncFⅡpHN7A8:InCpA1763-KPC)were identified to confer cpKP isolates the advantages in both genotypes(strong correlation/coevolution)and phenotypes(resistance/growth/competition)to facilitate the nationwide spread of ST11/CG258 cpKP.Intriguingly,Bayesian skyline analysis illustrated that the three advanta-geous combinations might be directly associated with the strong population expansion during 2007-2008 and subsequent maintenance of the population of ST11/CG258 cpKP after 2008.We then examined drug resistance profiles of these cpKP isolates and proposed combination treatment regimens for CG258/non-CG258 cpKP infections.Thus,the findings of our systematical analysis shed light on the molecular epidemiology and genetic basis for the dissemination of ST11/CG258 cpKP in China,and much emphasis should be given to the close monitoring of advantageous cpKP-plasmid combinations.

Objective:To evaluate the diagnostic value of exercise stress echocardiography combined with left ventricular two-dimensional speckle tracking layer-specific strain technique in evaluating subclinical myocardial damage and reserve function in patients with hypertension.Methods:A total of 51 healthy subjects(control group) and 55 hypertensive patients (hypertension group) were enrolled in the treadmill exercise stress test in Sichuan Provincial People′s Hospital from October 2018 to January 2020. According to the European Guidelines for the Prevention and Treatment of Hypertension, the inclusion criteria for patients with hypertension were: blood pressure≥140/90 mmHg or who explicitly took antihypertensive drugs, and related cardiovascular diseases were excluded. The conventional parameters of resting and peak exercise, including left ventricular mass index, left ventricular end-diastolic volume index and left ventricular ejection fraction et al, were analyzed by speckle tracking software in two groups. According to the standard images in the resting and peak exercise, the endocardium /mid-myocardium /epicardium of left ventricular (three-, two-, four-chamber and global) longitudinal strain and circumferential strain (papillary muscle level) were compared respectively in two groups. The characteristics of strain differences and the systolic function reserve between the resting and peak exercise were evaluated.Results:There were significant differences in conventional ultrasound parameters between resting and peak exercise period in hypertension group, except E/A and e/a ratio (all P<0.05), and E/e value increased significantly(12.1±0.38) during peak exercise, indicating impaired diastolic reserve function. The longitudinal and circumferential layer-specific strain values from endocardial to epicardial were gradually decreased in both two groups. Compared with the control group, the resting longitudinal and circumferential endocardial strain values in hypertensive group were decreased, and the differences were more obvious at peak status, for instance global longitudinal endocardium strain at rest[control group (24.4±1.5)%, hypertension group (20.4±2.3)%], peak status[control group (30.8±2.8)%, hypertension group (22.8±2.9)%]( P<0.05). There were no significant differences of the partial layer-specific strain values between the peak exercise and resting status in hypertension group, while peak layer-specific strain of the control group were all significantly increased, suggesting that the left ventricular systolic reserve function of hypertension patients was lower than that of the control group. Conclusions:Left ventricular layer-specific strain can effectively evaluate the myocardial function in patients with hypertension, especially the endocardial strain can be used as an indicator parameter, and the peak exercise stress state is more sensitive. The systolic and diastolic reserve function of the left ventricle in patients with hypertension at the peak period are reduced to different degrees. Exercise stress echocardiography combined with left ventricular layer-specific strain technique can be used as a new method for detection of myocardial function impairment in patients with hypertension.

Major obstetric hemorrhage (MOH) may endanger the life of maternal during the perioperative period. Its highly efficient management involves multidisciplinary co-operation and is a complex clinical emergency situation which needs teamwork to complete. Anesthesiologist, as the key member of the obstetric MOH management team, should actively cooperate with the obstetricians once they decide to perform an emergency procedure for the parturient. They should possess perfect skill in resuscitation and rich experiences for assessment of MOH. They also should be professional in monitoring and caring for the critically ill patient. Constantly simulation training also should be actively carried out for MOH. In this review, the definition and etiology of MOH, drug and surgical treatment, anesthesia management (including preparation before anesthesia, hemorrhagic shock assessment, choice of anesthesia methods, blood transfusion, blood cell salvage, coagulation function and hemodynamic monitoring) were reviewed, and the conclusions were just for references.

Objective:To investigate the effect of preventive use of antiemetic drugs on postoperative nausea and vomiting (PONV) in patients with cesarean section(CS) under multi-mode analgesia.Methods:The clinical data of 5530 patients with cesarean section in the University of Hong Kong-Shenzhen Hospital (HKU-SZH) from February 1, 2016 to January 31, 2020 were retrospectively collected and divided into four groups: Ondansetron 4 mg group (group A, n=2 712), Dexamethasone 5 mg group (group B, n=39), Ondansetron 4 mg combined with Dexamethasone 5 mg group (Group C, n=413), and blank group (Group D, n=2 366). All drugs were given before the end of theoperation. The prophylactic effectiveness with different antiemetic prescription has been compared in this study. Results:There were no significant differences in height, weight, age, the ratio of NRs≥6 at 24 h and oxycodone usage among the four groups ( P>0.05). The incidence of postoperative nausea and vomiting was 2.29%(62/2 712), 0(0/39), 1.45%(6/413) and 1.90%(45/2 366), respectively. There was no significant difference between the four groups ( P=0.463). Conclusions:Prophylaxis antiemetic administration seems do not reduce the incidence of PONV after CS under this strategy of multi-mode analgesia.

BACKGROUNDLupus nephritis (LN) is one of the most serious manifestations of systemic lupus erythematosus. Although there have been substantial improvements in LN treatment over the last decade, the outcome remains unoptimistic in a considerable percentage of patients. The aim of this study was to evaluate the efficacy and safety of mizoribine (MZR), a novel selective inhibitor of inosine monophosphate dehydrogenase, as induction treatment for active LN in comparison with mycophenolate mofetil (MMF) and intravenous cyclophosphamide (CYC).

METHODSNinety patients with active LN were observed. Thirty patients were given MZR orally at the dose of 300 mg every other day. Thirty patients took MMF at 2 g per day in two divided doses. Thirty patients received CYC intravenously 0.5 g every 2 weeks. Therapeutic effects and adverse events (AEs) were evaluated at the end of 24-week treatment. One-way analysis of variance (ANOVA) followed by Dunn's test was applied to compare the difference among the groups. For comparing categorical data between two groups, χ(2) test was employed.

RESULTSEarly responses at week 12 were achieved by 73.3%, 90.0%, and 96.7% in MZR, MMF, and CYC groups, respectively. There was no significant difference in the complete remission rates (22.7%, 24.0%, and 25.0%, respectively) or overall response rates (68.2%, 72.0%, and 75.0%, respectively) among the three groups at week 24. The most prominent drop-down of Systemic Lupus Erythematosus Disease Activity Index scores was observed in MMF or CYC group, and the decline of health assessment questionnaire scores in MZR or MMF group was more prominent than that in the CYC group at week 12. Serum complement 3 (C3) or C4 levels were elevated in all groups after the treatments. CYC was more effective in inhibiting anti-double-stranded DNA antibody, while MZR was more effective in inhibiting antinuclear antibody. The incidences of AEs in patients treated with CYC were significantly higher than those in patients treated with MZR or MMF (24.2% for CYC vs. 3.3% for MZR, and 2.6% for MMF, P = 0.01).

CONCLUSIONSMZR is well tolerated and has an effect similar to MMF in the induction therapy of active LN. MZR may serve as an alternative approach for LN patients.

Administration, Intravenous ; Adolescent ; Adult ; Aged ; Cyclophosphamide ; administration & dosage ; therapeutic use ; Enzyme Inhibitors ; administration & dosage ; therapeutic use ; Female ; Humans ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Lupus Nephritis ; drug therapy ; Male ; Middle Aged ; Mycophenolic Acid ; administration & dosage ; therapeutic use ; Ribonucleosides ; administration & dosage ; therapeutic use ; Treatment Outcome ; Young Adult

Objective To clarify the anatomical and pathlogical implications of Denonvilliers' fascia.Method In this study,thirty pelvic specimens (17 males and 13 females) were incised through the median sagittal plane and carried for regional anatomy study; Denonvilliers' fascia was identified by immunohistochemistry.Results Denonvilliers' fascia could be found in all male specimens:it had an anterior leaf and a posterior leaf,with the anterior one attaching to seminal vesicle,seminiferous duct,prostate and the bottom of bladder firmly.The fascia originated at the fold of the peritoneum and ended at the perineum fascia,fusing into the pelvic parietal fascia laterally.It was not obvious in females,only to find a thin and transparent membrane between vagina and rectum.The maximum height of Denonvilliers' fascia in left pelvis was (3.2 ± 0.3) cm,compared with (3.3 ± 0.3) cm in the right pelvis (t =0.965,P ＞ 0.05).Immunohistochemistry study revealed that there was no lymph node in the fascia and its lateral parts were enriched of nerve fibers,which were few in its middle part.Conclusions The unique anatomical and pathlogical characteristics of Denonvilliers' fascia are of vital importance to the avoidance of nerve injury during rectal surgery.

Objective To study the reactive changes of normal nasal mucosa in rabbit under photodynamic therapy (PDT) and to make a preliminary research for the treatment of allergic rhinitis (AR) with PDT.Methods Twenty-four New Zealand rabbits were divided into 2 groups,an experimental group and a control group with 12 rabbits in each group.PDT was applied to the experimental group,while the control group was given no treatment.The nasal mucosa was sampled separately from the same position of the rabbits from the 2 groups on 1st,3rd,7th,14th,21st,28th day.Histomorphological changes of the sampled nasal mucosa were observed under light microscope and transmission electron microscope (TEM).The damage of three tachykinins:substance P (SP),neurokinin A (NKA) and neurokinin B (NKB) of nerve fibers was observed after immunohistochemical staining.Results Compared with the control group,the nasal mucosa tissues from the experimental group had serious inflammatory reaction with basal layer damaged on the 1st and 3rd day after PDT application,the epithelial cells of nasal mucosa were arranged in disorder,and part of cilium shortened and became abnormal or even disappeared,each organelles damaged obviously; on the 7th,14th,21st day,it could be seen that ciliated cell,columnar cell and goblet cell started regeneration,basal cell and lamina propria glands proliferated,and the glands appeared secretion phenomenon; on the 28th day,ciliated columnar epithelium took back the nasal mucosas with small amount of microvilli,and mucous granules were found in the column cells.Nasal immunohistochemical staining of the experimental group from various stages showed that three kinds of neuropeptides were not expressed.Conclusions Normal rabbit nasal mucosas will be temporarily damaged after PDT application,the damaged nasal mucosa begin to recover in one week,and return to normal in about four weeks.Most structure and functions have recovered at the fourth week except some nerve endings.

Background Lupus nephritis (LN) is one of the most serious manifestations of systemic lupus erythematosus.Although there have been substantial improvements in LN treatment over the last decade,the outcome remains unoptimistic in a considerable percentage of patients.The aim of this study was to evaluate the efficacy and safety of mizoribine (MZR),a novel selective inhibitor of inosine monophosphate dehydrogenase,as induction treatment for active LN in comparison with mycophenolate mofetil (MMF) and intravenous cyclophosphamide (CYC).Methods Ninety patients with active LN were observed.Thirty patients were given MZR orally at the dose of 300 mg every other day.Thirty patients took MMF at 2 g per day in two divided doses.Thirty patients received CYC intravenously 0.5 g every 2 weeks.Therapeutic effects and adverse events (AEs) were evaluated at the end of 24-week treatment.Oneway analysis of variance (ANOVA) followed by Dunn's test was applied to compare the difference among the groups.For comparing categorical data between two groups,X2 test was employed.Results Early responses at week 12 were achieved by 73.3％,90.0％,and 96.7％ in MZR,MMF,and CYC groups,respectively.There was no significant difference in the complete remission rates (22.7％,24.0％,and 25.0％,respectively) or overall response rates (68.2％,72.0％,and 75.0％,respectively) among the three groups at week 24.The most prominent drop-down of Systemic Lupus Erythematosus Disease Activity Index scores was observed in MMF or CYC group,and the decline of health assessment questionnaire scores in MZR or MMF group was more prominent than that in the CYC group at week 12.Serum complement 3 (C3) or C4 levels were elevated in all groups after the treatments.CYC was more effective in inhibiting anti-double-stranded DNA antibody,while MZR was more effective in inhibiting antinuclear antibody.The incidences of AEs in patients treated with CYC were significantly higher than those in patients treated with MZR or MMF (24.2％ for CYC vs.3.3％ for MZR,and 2.6％ for MMF,P=0.01).Conclusions MZR is well tolerated and has an effect similar to MMF in the induction therapy of active LN.MZR may serve as an alternative approach for LN patients.