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 surgical effect of pedicled upper lip mucosal flap in repairing nasal septal mucosal defects after rhinoplasty.Methods:A retrospective analysis was performed from January 2016 to October 2022, the clinical data of patients with nasal septal mucosal defects after rhinoplasty were collected in the Department of Plastic and Aesthetic (Burn) Surgery at the Second Xiangya Hospital of Central South University. The pedicled upper lip mucosal flap was utilized for repair based on the patient’s medical history and wound condition. The pedicle of the flap was designed 1 cm adjacent to the frenulum of the upper lip, and an appropriate flap was incised based on the size of the wound, with dissection performed up to the superficial layer of the orbicularis oris muscle. The dissection establishes an upper lip tunnel that connects the gingival-buccal groove to the nasal cavity. The pedicled upper lip mucosal flap was elevated and transposed into the nasal cavity via the upper lip tunnel. The position of the flap was adjusted to ensure complete coverage and fixation of the nasal septal defect wound using 5-0 absorbable suture. The visual analogue scale (VAS) and the nasal obstruction symptom evaluation (NOSE) scale were utilized to facilitate patients’ satisfaction evaluation and assessment of nasal obstruction symptoms before surgery and at 6 months post-surgery. The VAS total score was 10 points, with higher scores indicating greater levels of patient satisfaction. The NOSE scale comprises of 5 items, each assigned a score ranging from 0 to 4, denoting absence of symptoms, very mild presence, moderate intensity, relatively severe manifestation, and highly severe indication respectively. The measurement data of VAS and NOSE scores before surgery and at 6 months post-surgery was expressed by Mean±SD, using paired t-test. The score distribution of the NOSE scale was represented by the number of cases, using Mann-Whitney U test. Results:The study included a total of 15 female patients, with an average age of (27.6±2.9) years (ranging from 23 to 33 years). Eleven cases presented with preoperative cartilage exposure, and the size of tissue defect ranged from 0.9 cm×0.5 cm to 1.5 cm×0.7 cm. Nine patients had a history of smoking. Skin grafting was performed in 9 patients, while nasal mucosal metastasis was observed in 8 patients. The dimensions of the flap varied from 4.0 cm×1.2 cm to 7.0 cm×1.5 cm. The postoperative recovery was satisfactory, with successful survival of the skin flaps and no occurrences of infection, hematoma, wound dehiscence, or flap necrosis. The average duration of follow-up was (8.2±2.1) months (ranging from 6 to 12 months). The postoperative VAS score (7.73±0.88) was significantly higher compared to the preoperative score (1.86±0.74) ( P<0.01). Additionally, the postoperative NOSE score (4.66±1.71) showed a significant decrease from the preoperative score (10.73±2.68), with a statistically significant difference ( P<0.01). Among them, after surgery items of stuffy or unbreathable nose (2 cases vs. 15 cases), nasal obstruction (1 case vs. 14 cases), and feeling that the nose was not enough to breathe during exercise or exertion (4 cases vs. 14 cases) scored≥2 points were significantly less than those before operation (all P<0.01). Conclusion:The utilization of pedicled upper lip mucosal flap in the reconstruction of severe nasal septal mucosal defects following rhinoplasty has proven to be highly effective. The postoperative satisfaction of patients is remarkably high, the ventilation function exhibits significant improvement, and no severe complications are observed.

Objective:To investigate the surgical effect of pedicled upper lip mucosal flap in repairing nasal septal mucosal defects after rhinoplasty.Methods:A retrospective analysis was performed from January 2016 to October 2022, the clinical data of patients with nasal septal mucosal defects after rhinoplasty were collected in the Department of Plastic and Aesthetic (Burn) Surgery at the Second Xiangya Hospital of Central South University. The pedicled upper lip mucosal flap was utilized for repair based on the patient’s medical history and wound condition. The pedicle of the flap was designed 1 cm adjacent to the frenulum of the upper lip, and an appropriate flap was incised based on the size of the wound, with dissection performed up to the superficial layer of the orbicularis oris muscle. The dissection establishes an upper lip tunnel that connects the gingival-buccal groove to the nasal cavity. The pedicled upper lip mucosal flap was elevated and transposed into the nasal cavity via the upper lip tunnel. The position of the flap was adjusted to ensure complete coverage and fixation of the nasal septal defect wound using 5-0 absorbable suture. The visual analogue scale (VAS) and the nasal obstruction symptom evaluation (NOSE) scale were utilized to facilitate patients’ satisfaction evaluation and assessment of nasal obstruction symptoms before surgery and at 6 months post-surgery. The VAS total score was 10 points, with higher scores indicating greater levels of patient satisfaction. The NOSE scale comprises of 5 items, each assigned a score ranging from 0 to 4, denoting absence of symptoms, very mild presence, moderate intensity, relatively severe manifestation, and highly severe indication respectively. The measurement data of VAS and NOSE scores before surgery and at 6 months post-surgery was expressed by Mean±SD, using paired t-test. The score distribution of the NOSE scale was represented by the number of cases, using Mann-Whitney U test. Results:The study included a total of 15 female patients, with an average age of (27.6±2.9) years (ranging from 23 to 33 years). Eleven cases presented with preoperative cartilage exposure, and the size of tissue defect ranged from 0.9 cm×0.5 cm to 1.5 cm×0.7 cm. Nine patients had a history of smoking. Skin grafting was performed in 9 patients, while nasal mucosal metastasis was observed in 8 patients. The dimensions of the flap varied from 4.0 cm×1.2 cm to 7.0 cm×1.5 cm. The postoperative recovery was satisfactory, with successful survival of the skin flaps and no occurrences of infection, hematoma, wound dehiscence, or flap necrosis. The average duration of follow-up was (8.2±2.1) months (ranging from 6 to 12 months). The postoperative VAS score (7.73±0.88) was significantly higher compared to the preoperative score (1.86±0.74) ( P<0.01). Additionally, the postoperative NOSE score (4.66±1.71) showed a significant decrease from the preoperative score (10.73±2.68), with a statistically significant difference ( P<0.01). Among them, after surgery items of stuffy or unbreathable nose (2 cases vs. 15 cases), nasal obstruction (1 case vs. 14 cases), and feeling that the nose was not enough to breathe during exercise or exertion (4 cases vs. 14 cases) scored≥2 points were significantly less than those before operation (all P<0.01). Conclusion:The utilization of pedicled upper lip mucosal flap in the reconstruction of severe nasal septal mucosal defects following rhinoplasty has proven to be highly effective. The postoperative satisfaction of patients is remarkably high, the ventilation function exhibits significant improvement, and no severe complications are observed.

Objective:To investigate the iodine nutritional status of adults and pregnant women in Jianshui County and Zhenxiong County, Yunnan Province.Methods:From May to August 2021, one urban area and one rural area in Jianshui County and Zhenxiong County, Yunnan Province were selected as investigation sites. At least 100 adults (half male and half female) and 100 pregnant women were selected as survey subjects in each investigation site. Random urine samples were collected from all survey subjects once to detect urine iodine, creatinine and sodium contents. Venous blood samples of all pregnant women were collected to detect the serum iodine content, and the 95% medical reference range of serum iodine was established using the percentile method.Results:The medians urinary iodine, creatinine and sodium of adults in Jianshui County and Zhenxiong County were 184.7 μg/L ( n = 432), 12 355.0 μmol/L ( n = 431) and 156.5 mmol/L ( n = 420), respectively. The median urinary iodine of adults in Jianshui County was higher than that in Zhenxiong County (197.3 vs 170.2 μg/L), the difference was statistically significant ( Z = - 2.90, P = 0.003). The median serum iodine of pregnant women in Jianshui County and Zhenxiong County was 92.1 μg/L ( n = 412), with a 95% medical reference value ranged from 45.3 to 183.5 μg/L; the medians urinary iodine, creatinine and sodium of pregnant women were 138.6 μg/L ( n = 413), 12 173.0 μmol/L ( n = 408) and 152.2 mmol/L ( n = 409), respectively. The urinary iodine (154.1 vs 115.8 μg/L), urinary creatinine (13 216.0 vs 11 376.0 μmol/L) and urinary sodium (161.8 vs 141.8 mmol/L) of pregnant women in Jianshui County were higher than those in Zhenxiong County, with statistical differences ( Z = - 5.12, - 2.29, - 4.30, P < 0.05). Conclusion:Adults in Jianshui County and Zhenxiong County are at an appropriate level of iodine, but pregnant women in Zhenxiong County are at an iodine deficiency level.

Objective:To investigate the effect of right stellate ganglion block (RSGB)-serratus anterior plane block (SAPB) combined with general anesthesia in thoracoscopic radical resection of lung cancer.Methods:A total of 90 patients who planned to undergo thoracoscopic radical resection of lung cancer in Xiangya Changde Hospital from March 2020 to September 2021 were prospectively selected and divided into 3 groups by random number table method: general anesthesia group (G group), (SAPB)+ general anesthesia group (SG group), RSGB+ SAPB+ general anesthesia group (RSG group), 30 cases in each group. The SG group received SAPB on the operative side before general anesthesia, and the RSG group received RSGB+ SAPB on the operative side before general anesthesia. After the blocking effect was determined, all patients were given general anesthesia in the same scheme according to their weight, and patients were given patient-controlled intravenous analgesia (PCIA) after surgery. The mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia (T 0), before intubation (T 1), 1 min after intubation (T 2), 5 min after intubation (T 3), at extubation (T 4) and 5 min after extubation (T 5). The intraoperative dosage of remifentanil, incidence of nausea and vomiting (PONV) within 24 hours after surgery, number of additional PCIA within 24 hours, the Visual Analogue Scale (VAS) of static and dynamic pain, the Bruggrmann Comfort Scale (BCS) and Richard Campbell Sleep Questionnaire (RSCQ) 24 hours after surgery were recorded. Results:Compared with T 0, the MAP and HR in 3 groups were increased 1 min after intubation (T 2) and at extubation (T 4), but the increases in RSG group were significantly less than those in G and SG groups (all P<0.05). The remifentanil dosage, PONV incidence and PCIA supplemental times in SG and RSG groups were less than those in G group, and the BCS score and RSCQ score were higher than those in G group (all P<0.05); the BCS score and RSCQ score in RSG group were higher than those in SG group (all P<0.05). Conclusions:RSGB+ SAPB combined with general anesthesia in thoracoscopic radical resection of lung cancer has little circulation fluctuation, good postoperative analgesia effect, less adverse reactions and high comfort level.

Objective:To evaluate the efficacy and safety of azacytidine (AZA) combined with homoharringtonine (HHT) and low-dose cytarabine (LDAC) in the treatment of acute myeloid leukemia (AML) patients with 3+ 7 conventional regimen intolerance.Methods:A retrospective analysis was conducted on the clinical characteristics, efficacy, prognosis, and adverse events of 33 AML patients (15 initially diagnosed and 18 relapsed/refractory) admitted to the Second Xiangya Hospital of Central South University.Results:Among the 33 AML patients treated with this regimen, the median age was 55 years old, 9 patients had a moderate cytogenetic risk, and 18 patients had a high cytogenetic risk. Among the 33 patients, 3 were lost to follow-up and 1 had incomplete data. Among the remaining 29 patients who received AZA+ HHT+ LDAC treatment, the total complete response (CR) rate was 69.0%(20/29), and the total response rate (ORR) was 79.3%(23/29); The median progression free survival (PFS) was 7.0 months. Among the subgroup analysis, including age, gender, Eastern Cooperative Oncology Group (ECOG) score, disease classification, bone marrow progenitor cells, peripheral blood leukocytes, risk stratification, and epigenetic abnormalities, only CR rates and PFS differences were statistically significant among different ECOG scoring groups ( P=0.048; P=0.021). A total of 29 patients underwent 69 AZA+ HHT+ LDAC chemotherapy cycles. Retrospective grading was performed on 69 cycles based on common toxicity criteria for adverse events (CTC AE version 5.0). The most common grade Ⅲ-Ⅳ hematological adverse events were thrombocytopenia (54/69, 78.3%) and granulocytopenia (48/69, 69.6%). Common non hematological adverse events included nausea (19/69, 27.5%), infection (17/69, 24.6%), and hypokalemia (18/69, 26.1%). Conclusions:AZA combined with HHT and LDAC has a good therapeutic effect in the treatment of acute myeloid leukemia, and adverse reaction events are controllable.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

Objective:To evaluate the structural features, stability and postoperative effect of integrated framework, 1+ 1 framework, 2+ 1 framework, 4+ 1 framework, and Y-shaped nasal framework.Methods:A retrospective analysis was performed based on the clinical data of patients underwent in Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital, Central South University from February 2019 to November 2020. According to rhinoplasty framework, the patients were divided into integrated framework group, 1+ 1 framework group, 2+ 1 framework group, 4+ 1 framework group, and Y-shaped framework group. Based on the principle of plane photography, the stability of the nasal framework was evaluated by measuring the nasal tip projection and the nasolabial angle 1 month after surgery, and 12 months after surgery. The satisfaction of patients and the incidence of postoperative complications were collected. The difference in nasolabial angle and nasal tip projection data of postoperation 1 month and postoperative 12 months among each group were analyzed by one-way analysis vaniance or Kruskal-Waliis H test.Bonferroni test or Nemenyi test was used for pairwise comparison between groups. P< 0.05 was considered statistically significant. Results:A total of 201 patients (18 males and 183 females, aged 18-46 years, average aged 26.6±5.9 years)were included in this study and followed up for 12-21 months. There were 45 patients in the integrated framework group, 45 patients in the 1+ 1 framework group, 34 patients in the 2+ 1 framework group, 35 patients in the 4+ 1 framework group, and 42 patients in the Y-shaped framework group. Four patients with Y-shaped framework had significant nasal tip supination 12 months after surgery. Among the patients with 1+ 1 framework, 1 patient showed slight columella distortion 6 months after surgery, and 3 patients showed significant nasal tip subrotation 12 months after surgery. One patient in 2+ 1 framework group developed nasal infection 92 days after surgery. No complications were found in other groups during follow-up. In terms of nasal tip projection during postoperative follow-up, the median difference of nasal tip projection between 12 months and 1 month after surgery in 2+ 1 framework group, integrated framework group, 1+ 1 framework group, and 4+ 1 framework group, and Y-shaped framework group was -0.08 cm, -0.09 cm, -0.20 cm, -0.10 cm and -0.17 cm, respectively. The difference of nasal tip projection among the five groups was statistically significant ( P<0.01). The difference between 2+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant( P<0.05). The difference between 4+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between integrated nasal framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between Y-shaped framework group and 1+ 1 framework group was statistically significant ( P<0.05). In terms of nasolabial angle during postoperative follow-up, the median difference of nasolabial angle between 12 months and 1 month after surgery in 2+ 1 framework group, integrated framework group, 1+ 1 framework group, and 4+ 1 framework group, and Y-shaped framework group was -4.20°, -3.80°, -6.50°, -4.10° and -6.35°, respectively. The difference of nasolabial angle among the five groups was statistically significant ( P<0.01). The difference between 2+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant( P<0.05). The difference between 4+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between integrated nasal framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). Patient satisfaction evaluation, 2+ 1 framework group had the highest satisfaction(34/34, 100.00%), followed by 4+ 1 framework group (34/35, 97.14%), integrated framework group(42/45, 93.33%), Y-shaped framework group(36/42, 85.71%), 1+ 1 framework group(37/45, 82.22%). Conclusion:The changes of nasolabial angle and nasal tip projection in 2+ 1 framework, integrated framework, and 4+ 1 framework were smaller than those in Y-shaped framework and 1+ 1 framework.2+ 1 framework was convenient and had good postoperative stability and high patient satisfaction.

Objective:To evaluate the structural features, stability and postoperative effect of integrated framework, 1+ 1 framework, 2+ 1 framework, 4+ 1 framework, and Y-shaped nasal framework.Methods:A retrospective analysis was performed based on the clinical data of patients underwent in Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital, Central South University from February 2019 to November 2020. According to rhinoplasty framework, the patients were divided into integrated framework group, 1+ 1 framework group, 2+ 1 framework group, 4+ 1 framework group, and Y-shaped framework group. Based on the principle of plane photography, the stability of the nasal framework was evaluated by measuring the nasal tip projection and the nasolabial angle 1 month after surgery, and 12 months after surgery. The satisfaction of patients and the incidence of postoperative complications were collected. The difference in nasolabial angle and nasal tip projection data of postoperation 1 month and postoperative 12 months among each group were analyzed by one-way analysis vaniance or Kruskal-Waliis H test.Bonferroni test or Nemenyi test was used for pairwise comparison between groups. P< 0.05 was considered statistically significant. Results:A total of 201 patients (18 males and 183 females, aged 18-46 years, average aged 26.6±5.9 years)were included in this study and followed up for 12-21 months. There were 45 patients in the integrated framework group, 45 patients in the 1+ 1 framework group, 34 patients in the 2+ 1 framework group, 35 patients in the 4+ 1 framework group, and 42 patients in the Y-shaped framework group. Four patients with Y-shaped framework had significant nasal tip supination 12 months after surgery. Among the patients with 1+ 1 framework, 1 patient showed slight columella distortion 6 months after surgery, and 3 patients showed significant nasal tip subrotation 12 months after surgery. One patient in 2+ 1 framework group developed nasal infection 92 days after surgery. No complications were found in other groups during follow-up. In terms of nasal tip projection during postoperative follow-up, the median difference of nasal tip projection between 12 months and 1 month after surgery in 2+ 1 framework group, integrated framework group, 1+ 1 framework group, and 4+ 1 framework group, and Y-shaped framework group was -0.08 cm, -0.09 cm, -0.20 cm, -0.10 cm and -0.17 cm, respectively. The difference of nasal tip projection among the five groups was statistically significant ( P<0.01). The difference between 2+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant( P<0.05). The difference between 4+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between integrated nasal framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between Y-shaped framework group and 1+ 1 framework group was statistically significant ( P<0.05). In terms of nasolabial angle during postoperative follow-up, the median difference of nasolabial angle between 12 months and 1 month after surgery in 2+ 1 framework group, integrated framework group, 1+ 1 framework group, and 4+ 1 framework group, and Y-shaped framework group was -4.20°, -3.80°, -6.50°, -4.10° and -6.35°, respectively. The difference of nasolabial angle among the five groups was statistically significant ( P<0.01). The difference between 2+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant( P<0.05). The difference between 4+ 1 framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). The difference between integrated nasal framework group and 1+ 1 framework group or Y-shaped framework group was statistically significant ( P<0.05). Patient satisfaction evaluation, 2+ 1 framework group had the highest satisfaction(34/34, 100.00%), followed by 4+ 1 framework group (34/35, 97.14%), integrated framework group(42/45, 93.33%), Y-shaped framework group(36/42, 85.71%), 1+ 1 framework group(37/45, 82.22%). Conclusion:The changes of nasolabial angle and nasal tip projection in 2+ 1 framework, integrated framework, and 4+ 1 framework were smaller than those in Y-shaped framework and 1+ 1 framework.2+ 1 framework was convenient and had good postoperative stability and high patient satisfaction.

The Coronavirus disease 2019 (COVID-19) has spread globally. Although mixed liver impairment has been reported in COVID-19 patients, the association of liver injury caused by specific subtype especially chronic hepatitis B (CHB) with COVID-19 has not been elucidated. In this multi-center, retrospective, and observational cohort study, 109 CHB and 327 non-CHB patients with COVID-19 were propensity score matched at an approximate ratio of 3:1 on the basis of age, sex, and comorbidities. Demographic characteristics, laboratory examinations, disease severity, and clinical outcomes were compared. Furthermore, univariable and multivariable logistic and Cox regression models were used to explore the risk factors for disease severity and mortality, respectively. A higher proportion of CHB patients (30 of 109 (27.52%)) developed into severe status than non-CHB patients (17 of 327 (5.20%)). In addition to previously reported liver impairment markers, such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin, we identified several novel risk factors including elevated lactate dehydrogenase (⩾ 245 U/L, hazard ratio (HR) = 8.639, 95% confidence interval (CI) = 2.528-29.523; P < 0.001) and coagulation-related biomarker D-dimer (⩾ 0.5 µg/mL, HR = 4.321, 95% CI = 1.443-12.939; P = 0.009) and decreased albumin (< 35 g/L, HR = 0.131, 95% CI = 0.048-0.361; P < 0.001) and albumin/globulin ratio (< 1.5, HR = 0.123, 95% CI = 0.017-0.918; P = 0.041). In conclusion, COVID-19 patients with CHB were more likely to develop into severe illness and die. The risk factors that we identified may be helpful for early clinical surveillance of critical progression.
COVID-19 ; Cohort Studies ; Hepatitis B, Chronic/epidemiology* ; Humans ; Retrospective Studies ; Risk Factors