Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

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 application of patient-based real-time quality control (PBRTQC) using exponentially weighted moving average (EWMA) method in internal quality control (IQC) procedures of thyroid function tests.Methods:The serum thyroid function test results of outpatients and inpatients in the Second Hospital of Shandong University from December 1, 2022 to April 30, 2023 were collected. Based on the PBRTQC professional intelligent software system, normality correction, parameter setting, program preparation and real-time operation of test data were carried out. The results of all patients who underwent thyroid function testing between May 1, 2023 and August 31, 2023 were used as the validation dataset. The estimated EWMA value of thyroid function test results and the cumulative coefficient of variation ( CV) over 4 months were calculated. The cumulative CV was compared with the criteria of precision quality standard (1/3TEa) and the CV of IQC. Westgard 2-2s and 1-3s rules were used for alarm setting. The early warning information of the EWMA quality control program were recorded and the potential causes of performance changes were analyzed. DxLab Mind software was used to conduct normal distribution statistics for all data, and the Kolmogorov-Smirnov test was performed on the test results. Results:The items related to serum thyroid function of the patients were all positively skewed. After data correction by Box-Cox method, the PBRTQC data of free triiodothyronine (FT3) and free thyroxine (FT4) were normally distributed, and their cumulative precisions ( CV) of EWMA within 4 months were 6.26% and 2.86%, respectively, both of which were lower than the precision quality target of 8.33%. However, the data of thyroid-stimulating hormone (TSH), thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibody (TgAb) were still positive skewed after modification. The EWMA cumulative CV of TSH, TPOAb and TgAb were 13.16%, 15.31% and 16.77%, which were higher than the precision quality targets of 8.33%, 10% and 10%, respectively. The EWMA QC program can detect different out-of-control alarms, including FT4 false alarms due to sample source concentration and TSH result bias caused by changes in reagent performance. In addition, the EWMA QC program can also detect differences in FT3 results between different DXI800 fully automated chemiluminescence instrument instruments. Conclusions:The EWMA program based on PBRTQC professional intelligent software tools can monitor the patient data of the detection system in real time and continuously, dynamically identify and monitor the errors generated during the analysis process and give early warning. It can be used as a useful supplement for the daily IQC of thyroid function items, especially FT3 and FT4, and has good clinical application value.

Purpose: This study aimed to investigate the changes in microRNA-130a (miR-130a) and its correlation with cardiotoxicity during epirubicin/cyclophosphamide followed by docetaxel plus trastuzumab (EC-D+T) adjuvant chemotherapy in human epidermal growth factor receptor-2-positive (HER2+) breast cancer patients. Methods: A total of 72 HER2+ breast cancer patients who underwent resection and were scheduled to receive EC-D+T adjuvant therapy were consecutively enrolled. The expression of miR-130a and cardiotoxicity (defined as any of the following situations: 1) absolute decline of left ventricular ejection fraction (LVEF) ≥ 10% and LVEF < 53%; 2) heart failure; 3) acute coronary artery syndromes; and 4) fatal arrhythmia) were assessed every 3 months throughout the 15-month EC-D+T treatment. Results: The accumulating cardiotoxicity rate was 12 (16.7%), of which the incidence of heart failure, acute coronary syndrome, life-threatening arrhythmias, ΔLVEF ≥ 10%, and LVEF < 53% was 0 (0.0%), 1 (1.4%), 0 (0.0%), and 12 (16.7%), respectively. Baseline miR-130a expression was negatively correlated with LVEF (%) and positively correlated with cardiac troponin I. The expression of miR-130a gradually increased in both cardiotoxicity and noncardiotoxicity patients during EC-D+T treatment, while the increment of miR-130a was more obvious in cardiotoxicity patients compared with non-cardiotoxicity patients. Further logistic regression and receiver operating characteristic curve analysis indicated that miR-130a was an independent predictive factor for increased cardiotoxicity risk. Conclusion MiR-130a increases constantly and predicts high cardiotoxicity risk during ECD+T adjuvant chemotherapy in HER2+ breast cancer patients.

Purpose: This study aimed to investigate the changes in microRNA-130a (miR-130a) and its correlation with cardiotoxicity during epirubicin/cyclophosphamide followed by docetaxel plus trastuzumab (EC-D+T) adjuvant chemotherapy in human epidermal growth factor receptor-2-positive (HER2+) breast cancer patients. Methods: A total of 72 HER2+ breast cancer patients who underwent resection and were scheduled to receive EC-D+T adjuvant therapy were consecutively enrolled. The expression of miR-130a and cardiotoxicity (defined as any of the following situations: 1) absolute decline of left ventricular ejection fraction (LVEF) ≥ 10% and LVEF < 53%; 2) heart failure; 3) acute coronary artery syndromes; and 4) fatal arrhythmia) were assessed every 3 months throughout the 15-month EC-D+T treatment. Results: The accumulating cardiotoxicity rate was 12 (16.7%), of which the incidence of heart failure, acute coronary syndrome, life-threatening arrhythmias, ΔLVEF ≥ 10%, and LVEF < 53% was 0 (0.0%), 1 (1.4%), 0 (0.0%), and 12 (16.7%), respectively. Baseline miR-130a expression was negatively correlated with LVEF (%) and positively correlated with cardiac troponin I. The expression of miR-130a gradually increased in both cardiotoxicity and noncardiotoxicity patients during EC-D+T treatment, while the increment of miR-130a was more obvious in cardiotoxicity patients compared with non-cardiotoxicity patients. Further logistic regression and receiver operating characteristic curve analysis indicated that miR-130a was an independent predictive factor for increased cardiotoxicity risk. Conclusion MiR-130a increases constantly and predicts high cardiotoxicity risk during ECD+T adjuvant chemotherapy in HER2+ breast cancer patients.

Objective To investigate a creative breast augmentation of autologus fat in combination with implant in reconstruction of normal breast and prevention of implant related contracture.Methods The autologous fat was harvested and purified for use.A 3.0 to 4.0 cm long incision was made in the axillary crease.The implant placement cavity was created underlying the pectoralis major after subcutaneous blunt dissection through the incision.The properly selected silicone breast implant of certain type and volume was inserted into the previously created cavity through the subcutaneous tunnel.The autologous fat was transplanted overlying the pectoralis major in multiple planes and the fat was located over the implant in an umbrella form.Results A total of 12 cases obtained obvious breast increase,reconstruction of breast,fullness of breast and softness of breast without obvious contracture after the autologous fat in combination with implant in reconstruction of normal breast.The result was satisfactory during a follow-up between 6 months and 3 years.Conclusions The transplanted fat overlying the silicone implant can augment the breast,increase breast,promote regeneration of breast,reduce or resist immune response of silicone breast implant,and then prevent breast implant related contracture.The newly built breast is soft and natural.The procedure is safe and effective.

Objective To analyze medical care delivered to orthopaedic cases during " Mission Harmony-2014" and explore features of orthopaedic diseases in the South Pacific region.Methods General medical data of orthopaedic patients from Tonga,Fiji,Vanuatu and Papua New Guinea in the South Pacific region were classified and summarized,by using the hospital ship information system,and general medical conditions and features of those orthopaedic patients from the 4 island countries were analyzed statistically.Results During "Mission Harmony-2014",there were 3 872 person-times for orthopaedic patients accounting for 17.3％ of all the patients,of whom 2 211 person-times were male patients accounting for 57.1％,and 1 661 person-times were female patients accounting for 42.3％.Of all the orthopaedic cases,there were 1 932 person-times delivered to the patients due to osteoarthritis (accounting for 49.9％) and 1 153 person-times delivered to the patients due to spinal disorders (accounting for 29.8％).Also during this medical mission,CT and radiologic scanning was delivered to 798 cases,of which 680 were positive cases,with the positive rate of detection accounting for 85.2％.Conclusions There is a great demand for medical service in orthopaedics in South Pacific region.The high rate of osteoarthritis is the significant feature in the distribution of orthopaedic diseases in this region,which might be closely associated with the overweight of local residents.

Objective To analyze medical care delivered to orthopaedic cases during " Mission Harmony-2014" and explore features of orthopaedic diseases in the South Pacific region.Methods General medical data of orthopaedic patients from Tonga,Fiji,Vanuatu and Papua New Guinea in the South Pacific region were classified and summarized,by using the hospital ship information system,and general medical conditions and features of those orthopaedic patients from the 4 island countries were analyzed statistically.Results During "Mission Harmony-2014",there were 3 872 person-times for orthopaedic patients accounting for 17.3％ of all the patients,of whom 2 211 person-times were male patients accounting for 57.1％,and 1 661 person-times were female patients accounting for 42.3％.Of all the orthopaedic cases,there were 1 932 person-times delivered to the patients due to osteoarthritis (accounting for 49.9％) and 1 153 person-times delivered to the patients due to spinal disorders (accounting for 29.8％).Also during this medical mission,CT and radiologic scanning was delivered to 798 cases,of which 680 were positive cases,with the positive rate of detection accounting for 85.2％.Conclusions There is a great demand for medical service in orthopaedics in South Pacific region.The high rate of osteoarthritis is the significant feature in the distribution of orthopaedic diseases in this region,which might be closely associated with the overweight of local residents.

Objective To investigate the value and effects of lipoinjection into the subperiosteal and overlying multiple planes for correction of facial depression.Methods The lateral and posterolateral areas of the thigh and infragluteal areas were selected as donor sites of autologous fat.The fat was rinsed and purified after liposuction.The collected fat was injected into the subperiosteal and overlying multiple planes to correct facial depression.Results 96 patients received lipoinjection of volume between 0.5 to 22 ml for each unilateral depression each time.Secondary injection was performed after 4 to 8 months after operation if necessary.The depression was corrected,the skin texture was improved,the wrinkles were also improved after fat transplantation.The follow-up period was between 6 and 24 months.3 patients had sclerosis after lipoinjection.The sclerosis disappeared after 6 months through local massage,hot compress,and traditional medicine treatment in two of them.The sclerosis was resolved by excision in the rest one.There were no complications of hematoma,infection,liquefaction,and calcification.Conclusions Lipoinjection into the subperiosteal and overlying multiple planes can correct facial depression with fat.Fat survival rate is high.The method is suitable for correction of facial depression in aesthetic plastic surgery.