177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

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 analgesic effect of intravenous anesthesia induction combined with anterior quadratus lumborum block (AQLB)and related hemodynamic changes in patients undergoing laparoscopic retroperitoneal partial nephrectomy (RPN).Methods:A total of 116 patients undergoing elective laparoscopic partial nephrectomy for renal tumors in Jinhua Central Hospital from August 2021 to February 2022 were randomly divided into two groups with 58 cases in each group. Patients in control group received intravenous anesthesia , while those in study group received intravenous anesthesia induction with AQLB. The analgesic effect was evaluated at 1, 6, 12, 24, and 48 h after the operation. The hemodynamics were monitored at the time of entering the operating room (T 0), 3 min after induction of anesthesia (T 1), at the beginning of the operation (T 2), after the operation (T 3), and leaving the operating room (T 4). Microcirculation was assessed at 1, 6, 12, 24, and 48 h after operation. Cognitive function was assessed 30min before anesthesia, 6 h, 24 h, and 72 h after operation. Results:At 1, 6, 12, 24 and 48 h after operation, the visual analogue scale (VAS) of the resting (quiet state) pain in the study group were 3.2±1.2, 2.6±0.3,2.0±0.4, 1.5±0.4 and 0.8±0.2, which were significantly lower than those in control group (4.0±1.7, 3.4±0.7, 2.9±0.5, 1.7±0.5 and 1.2±0.3) ( t=2.93, P=0.004; t=8.00, P<0.001; t=10.07, P<0.001; t=2.38, P=0.019; t=8.45, P<0.001). There was no significant difference in heart rate and mean arterial pressure (MAP) at T 0 between two groups ; no significant difference in the heart rate at T 1, T 2, T 3 and T 4. There were significant differences in MAP levels at T 1, T 2, T 3 and T 4 between study group [(80.0±8.0)mmHg (1 mmHg=0.133 kPa), (84.4±8.4)mmHg, (80.4±5.7)mmHg, (86.4±4.7)mmHg and control group (77.1±7.5)mmHg, (88.0±8.6)mmHg, (83.0±7.7)mmHg, (92.2±6.2) mmHg; t=2.01, P=0.046; t=2.28, P=0.024; t=2.07, P=0.041; t=5.68, P<0.001]. At 6, 12, 24 and 48 h after operation, the morphological scores of tube loops in the study group were 1.0±0.2, 0.8±0.2, 0.7±0.1 and 0.7±0.1, which were lower than those in the control group (1.1 ±0.2, 0.9±0.2, 0.8±0.2 and 0.8±0.1; t=2.69, P=0.008; t=2.69, P=0.008; t=3.41, P=0.001; t=5.39 , P < 0.001). The blood flow status scores of the study group were 1.1±0.2, 0.9±0.2, 0.8±0.2 and 0.6±0.1, which were lower than those of the control group (1.2±0.2, 1.0±0.2, 0.9±0.2 and 0.7±0.1; t=2.69, P=0.008; t=2.69, P=0.008; t=2.69, P=0.008; t=5.39, P<0.001). The cognitive function scores of the study group and the control group were 24.4±1.0, 27.1±0.9 and 23.5±0.9, 26.7±0.9 at 6 h and 24 h after operation ( t=5.10, P<0.001; t=2.39, P=0.018); while there were no significant at 72 h after operation between two groups (28.2±0.9 vs. 28.1±0.8, t=0.63, P=0.529). Conclusion:Intravenous anesthesia induction combined with anterior quadratus lumborum block has a good analgesic effect in patients undergoing RPN, with stable hemodynamics and microcirculation, and not affecting cognitive function of patients.

Objective:To investigate the clinical effects of retrograde anterolateral thigh perforator flaps assisted with computed tomography angiography (CTA) in repairing skin and soft tissue defects around the knee or in proximal lower leg.Methods:A retrospective cohort study was conducted. From May 2015 to October 2019, 17 patients with skin and soft tissue defects around the knee or in proximal lower leg were admitted to the Department of Orthopedics of Jizhong Energy Xingtai Mig General Hospital, including 12 males and 5 females, aged 16-65 years, with an average age of 35 years. The areas of skin and soft tissue defects after debridement ranged from 6.0 cm×3.0 cm to 15.0 cm×9.0 cm. The retrograde anterolateral thigh perforator flaps were designed according to the origin and distribution of the perforating branches in flaps and the length of the vascular pedicle examined with CTA and the condition of the wound to repair the wounds. The areas of resected flaps ranged from 6.5 cm×3.5 cm to 15.5 cm×9.5 cm. The wounds in donor sites of flaps were sutured directly or covered with medium-thickness skin grafts from healthy upper leg. The sources of the perforating branches in flaps were recorded. The lateral circumflex femoral artery, its branches, and the relative length of the vascular pedicle were compared between preoperative CTA detection and intraoperative observation. The survivals of the flaps were observed. At the last follow-up, the effects of flaps in repairing wounds were evaluated according to evaluation standard of efficacy satisfaction; the motion ranges of flexion and extension of the knee joint were measured, and the knee joint function was evaluated according to the Hohl knee joint function evaluation standard; the sensory function in the flap area was evaluated according to the sensory function evaluation standard formulated by the British Medical Research Council; the wound healing and the occurrence of complication affecting motor function of limb of flap donor sites was observed. Data were statistically analyzed with paired sample t test. Results:The perforating branches in flaps originated from descending branches, oblique branches, and rectus femoris branches of lateral circumflex femoral artery in 7, 6, and 4 patients, respectively. The flaps with blood supply from descending branches, oblique branches, and rectus femoris branches of lateral circumflex femoral artery were type 1, 2, and 3 retrograde anterolateral thigh perforator flaps, respectively. The preoperative CTA examination of lateral circumflex femoral artery and its branches were consistent with those observed during operation. The relative lengths of vascular pedicles of type 1, 2, and 3 retrograde anterolateral thigh perforator flaps calculated after CTA examination were 0.32±0.13, 0.56±0.07, and 0.56±0.15, which were close to 0.35±0.12, 0.52±0.10, and 0.53±0.12 measured and calculated during operation, respectively ( t=0.45, 0.80, 0.31, P>0.05). All flaps survived in 17 cases without vascular crisis. At the last follow-up, 16 patients were satisfied with effects of flaps in wound repair, with 1 patient feeling average about the effect; the flexion range of knee joint was 100-120°, and the extension range of knee joint was -2-0°; knee joint function was evaluated as excellent in 9 cases, good in 7 cases, and poor in 1 case; the sensory function of the flap area reached S 4 level in 2 cases, S 3 level in 8 cases, and S 2 level in 7 cases; the wounds in flap donor sites healed well; there was no adverse effect in motor function of limbs. Conclusions:Retrograde anterolateral thigh perforator flap is an effective method for repairing skin and soft tissue defects around the knee or in proximal lower leg. Preoperative CTA examination can fully show the anatomical characteristics of the branches of the lateral circumflex femoral artery and the perforating vessels of each branch, which can guide preoperative flap design and operation, thus shortening operation time and improving flap survival rate, with good clinical effects.

Objective: To comprehensively understand the disinfection quality of secondary and primary schools and kindergartens in Wuxi, so as to find out problems and to provide advice for improvement. Methods: Stratified random sampling method was applied in the investigation to select 73 schools and classes. The qualities of room air, surface of object, hand hygiene of staff, tableware, ultraviolet lamp and disinfectant in use (including bacterial contamination and concentration of chlorine-containing) were all tested. Results: A total of 2 563 samples were collected with the total disinfection qualified rate 88.02%. The qualified rates of kindergarten, primary and secondary schools were 87.89%, 90.67% and 85.83% respectively. The rates of Xishan and Jiangyin districts were 75.24% and 75.89% respectively. The quality of urban schools was better than the rural(χ 2=16.57, P<0.01). There was no statistical significance between public and private schools (χ 2=0.01, P=0.92). The rank of qualified rates of different objects was: bacterial contamination (100.00%) > room air (93.13%) > tableware (91.87%) > surface of object (89.40%) > ultraviolet lamp (84.00%) > concentration of chlorine-containing (73.68%) > hand hygiene of staff (73.53%). The quality of secondary schools was lower than kindergartens and primary schools in the aspects of room air and surface of object. Conclusion The disinfection quality of secondary and primary schools and kindergartens in Wuxi is good in general. More attention should be paid on hand hygiene, concentration of chlorine-containing and ultraviolet lamp. The qualities of room air and surface of object of secondary schools need to be improved.

Background: Porcine circovirus type 2 (PCV2) is an important infectious pathogen implicated in porcine circovirus-associated diseases (PCVAD), which has caused significant economic losses in the pig industry worldwide. Objectives: A suitable viral vector-mediated gene transfer platform for the expression of the capsid protein (Cap) is an attractive strategy. Methods: In the present study, a recombinant adeno-associated virus 8 (rAAV8) vector was constructed to encode Cap (Cap-rAAV) in vitro and in vitro after gene transfer. Results: The obtained results showed that Cap could be expressed in HEK293T cells and BABL/c mice. The results of lymphocytes proliferative, as well as immunoglobulin G (IgG) 2a and interferon-γ showed strong cellular immune responses induced by Cap-rAAV. The enzyme-linked immunosorbent assay titers obtained and the IgG1 and interleukin-4 levels showed that humoral immune responses were also induced by Cap-rAAV. Altogether, these results demonstrated that the rAAV8 vaccine Cap-rAAV can induce strong cellular and humoral immune responses, indicating a potential rAAV8 vaccine against PCV2. Conclusions The injection of rAAV8 encoding PCV2 Cap genes into muscle tissue can ensure long-term, continuous, and systemic expression.

The guidelines for standard nursing in the PET/MR imaging examination included preparation of examination,injecting drug,observing during scanning,post scanning care,management of adverse reaction of contrast agent and radiation protection.The purpose of these guidelines could were to provide the practical and effective management for nursing care in PET/MR imaging,and offer a framework for nurses that could provide useful and helpful in clinical practice and research.

The hybrid PET/MR has been gradually applied in clinical practice.However,the hybrid PET/MR is a com plex advanced technique,and it brings to the new challenges,especially regarding the workflow and scan protocols.The guidelines for hybrid PET/MR in brain imaging include information related to the indications and contraindications,preparation before examination,procedures of examination (PET imaging,conventional MRI brain imaging and special MRI imaging for brain disease),application of radiopharmaceutical and MRI contrast-enhanced agent.The purpose of the guidelines is to offer a framework that would be practical and helpful for clinical PET/MR brain imaging.In PET tracers,the guidelines only limit to the 18 F-FDG.

Objective To investigate the effects of ulinastatin(UTI)on the nerve regeneration of mice experimental allergic encephalomyelitis and the expression of related factors and protein.Methods Forty mice were randomly divided into four groups:ulinastatin group(U),atorvastatin group(A), empty control group(C)and normal control group(N).The experimental autoimmune encephalomyelitis(EAE)in mice was constructed by Freund's complete adjuvant and MOG35-55 polypeptide.Histopathological changes were observed by HE,LFB and Bielschowsky stained at the 3rd week and 4th week after immunized of each group.The expressions of CD4 +T cells were estimated by immunohistochemical method.The expression of myelin basic protein (MBP),brain-derived neurotrophic factor(BDNF),growth associated protein-43(GAP-43),2',3'-cyclic nucleotide-3'-phosphodiesterase(CNP)were detected by Western-blot.Results The largest neurological score of group U was lower than group C,and the difference was statistically significant(P<0.05 ).Pathological features showed that the inflammatory cells,demyelination of spinal cord and axonal injury of group U were lighter than group C.With the duration of treatment,nerve injury decreased.After UTI treatment,the expression of MBP,BDNF,GAP-43,CNP increased.They were statistically significant difference when compared with group C(P<0.05).There was no significant difference between ulinastatin and atorvastatin in the treatment of EAE.Conclusion Ulinastatin could reduce the extent of nerve damage effectively and promote its regeneration which provide a theoretical basis for the clinical treatment of MS.

Background and purpose: Itch protein is an established regulator of T cell immune response thresholds, belong to a class of E3 ubiquitin-transferring enzymes, widely involve in the ubiquitination of several key signaling molecules, such as ZAP70, P85, VAV, PLC-γ, PKC-θ, etc, plays a critical role in tumor induced immu-nosuppression. Itch ligase activity regulate T-cell anergy and development of regulatory T cells in the periphery by modulating key components of T-cell receptor and transforming growth factor-βsignaling. Therefore, manipulation of Itch activities may provide the opportunities to develop future therapies for immune disorders such as autoimmunity and cancer. speciifc small interfering RNA(siRNA) was utilized to silence the expression of Itch gene of T-lymphocytes and investigate the cytotoxicity activity of transfected T lymphocytes against MFC stomach neoplasms cells in vitro. Methods:T lymphocytes were isolated from the spleen of 615 mice and transfected by speciifc siRNA to silence the expression of Itch gene, The expression of Itch protein were examined by Western bolt in each group;72 hours after transfection, The secretion level of IL-2, INF-γwere measured by enzyme-linked immunosorbent assay (ELISA). At the end, the cytotoxicity activity changes against MFC stomach neoplasms cells was compared between transfected T lym-phocytes, negative control and blank control in vitro. Results:Compared with control group, the expression rate of Itch protein of transfected T-lymphocytes was decreased to 16%after transfection 48 hours;72 hours after transfection, the secretion level of IL-2 in transfection group, negative control and blank control respectively were (1 891.96±141.91)pg/mL, (1 241.69±91.67)pg/mL and (1 175.03±89.14)pg/mL (P<0.001), the secretion level of INF-γin transfection group, negative control and blank control respectively were (958.33±75.46)pg/mL, (683.33±66.67)pg/mL and (691.72±68.72) pg/mL (P<0.05). Transfected T lymphocyte also showed more efifcient killing ability against MFC stomach neoplasms cells than negative control and blank control in vitro, the highest killing rate has reached (54.18±2.96)%. Conclusion:Silencing Itch gene can signiifcantly promoted the secretion level of IL-2, INF-γof mice T lymphocyte, enhanced the cytotoxicity activity of T lymphocyte against MFC stomach neoplasms cells in vitro.