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.

The nursing experience of a pregnant woman with stillbom fetus with a septic shock to cardiac arrest at 30 weeks of pregnancy was summarized.The critical points of nursing include first aid nursing of cardiac arrest during pregnancy,preparation of transport plan to ensure ECMO combined with CVVH to support cesarean section,anti-infection nursing of fetal death complicated with septic shock,precise implementation of target temperature management,individualized anti-coagulation nursing under multiple factors interference.After 31 days of careful treatment and nursing,the patient's condition was stable,discharged smoothly,and the patient recovered well after 5 months of follow-up.

Objective:To summarize the ultrasound characteristics of incarceration of gravid uterus (IGU) for improving the diagnostic accuracy of IGU.Methods:Three cases of IGU patients were diagnosed in Peking University Third Hospital from May 2018 to May 2020. CNKI, Wanfang Data, China Science and Technology Journal Database and PubMed were searched using the search terms "incarcerate uterus" or "uterine incarceration" and "gravid" through January 2000 to July 2020, 53 IGU cases were found. The ultrasound data and outcomes of the 56 IGU patients were retrospectively analyzed. The display rate of various ultrasonic features were counted. Relevant literatures were reviewed and the experience were summarized.Results:Of the 56 cases with IGU, 45 cases (80.4%) had positive results, of which 34 cases (60.7%) were found abnormal cervix(elongated anteriorly and superiorly displaced cervix or poorly visualized cervix), 27 cases (48.2%) were found retroversion of the gravid uterus, 12 cases (21.4%) were found that the fundus of the uterus lay deeply in the Douglas pouch, 4 cases (7.1%) were found anteriorly and superiorly displaced bladder. There was statistically significant difference between the displaying rates of abnormal cervix and retroversion of the gravid uterus(χ 2=5.452, P<0.05). Conclusions:Abnormal cervix was the most common feature of IGU by ultrasound. Correct identification of the cervix is helpful to improve the detection rate of IGU.

【Objective】 A framework to support nurses and midwives making the clinical decision and providing the written instruction for blood transfusion has been developed and implemented in the United Kingdom as a response to the changing needs of the patient and in recognition that blood transfusion services to patients could be improved by using the untapped knowledge and expertise of experienced nurses and midwives.Special education and training program for this role development are provided jointly by the national blood and nurse management authority, higher education institutions and transfusion societies.The British government has issued and implemented a compulsory professional indemnity which cover nurses and midwives as well.The development and implementation of the framework, policies and procedures for this role development is based on the regulatory compliance and the collaboration of, and beneficial to the multiple stakeholders, with the gaps left by doctors being fillled, work load of doctors reduced, nurses and midwives achieving professional development, hospitals performing more efficiently, and most importantly, the patients having a better transfusion services.At present, there is no similar policy or program for nurses and midwives in China.Therefore, this paper introduces the policy framework and implementation for this role development in UK, which would be a valuable reference for the role development and extension of nurses and the organization, education and training for transfusion professional teams as well in China in the near future.

OBJECTIVE: To compare the accuracy of five warfarin-dosing algorithms and warfarin stable dose model (2.5 mg/day) for Shandong population. METHODS: One hundred and twenty five patients who achieved stable warfarin dose were enrolled. Clinical and genetic data were used to evaluate the value of each algorithm by calculating the percentage of patients whose predicted warfarin dose was within 20% of the actual stable therapeutic dose and mean absolute error (MAE). RESULTS: The frequency of patients with CYP2C9*1/*1, CYP2C9*1/*3 and CYP2C9*1/*2 genotype was 92.00%, 7.20%, 0.80%, respectively. That of VKORC1-1639 AA, AG and GG genotype was 82.40%, 15.20%, 2.40%, respectively. CYP4F2*1/*1, *1/*3, *3/*3 genotype was 50.40%, 39.20%, 10.40%, respectively. With the same genotypes for other loci, patients who carried at least one VKORC1-16398G mutant allele had increased warfarin stable daily dose compared with VKORC1-1639AA. Compared with CYP4F2*1/*1, those carrying at least one CYP4F2*3 mutant allele had warfarin stable daily dose increased by 5.9%-13.00%. The percentage of ideal prediction calculated from IWPC model (59.20%), Huang model (57.60%) and Ohno model (52.80%) were higher than others. The MAE were 0.35 (95%CI: 0.11-0.49), 0.15 (95%CI: 0.10-0.32), 0.39 (95%CI: 0.12-0.51), respectively. CONCLUSION The polymorphisms of CYP2C9, VKORC1 and CYP4F2 genes can influence the stable dose of warfarin in Shandong population. IWPC algorithm is suitable for guiding the use of warfarin in this population.
Anticoagulants ; administration & dosage ; Aryl Hydrocarbon Hydroxylases ; Cytochrome P-450 CYP2C9 ; genetics ; Cytochrome P450 Family 4 ; genetics ; Dose-Response Relationship, Drug ; Genotype ; Humans ; Models, Theoretical ; Polymorphism, Genetic ; Vitamin K Epoxide Reductases ; genetics ; Warfarin ; administration & dosage

Objective To analyze the ultrasonic features of gynecological emergency and severe cases.Methods To analyze 431 cases in clinical,ultrasonic images and examination data of gynecological emergency and severe patients in Peking University Third Hospital from September 2014 to September 2015,and to study clinical pathological and ultrasonic imaging examination.Results In 431 severe cases of gynecologic emergency,the clinical symptom were shown as acute abdominal pain or and vaginal bleeding.They were divided into seven types by clinical examination,operation or conservative treatment under dynamic observation.There were 137 cases of fracture disease,accounting for 31.8％,with corpus luteum rupture in 67 cases,ectopic pregnancy burst in 59 cases and tumor rupture in 11 cases.There were 114 cases of pelvic inflammatory disease,accounting for 26.5％,with hemorrhagic disease of department of gynaecology in 67 cases (15.5％),dysfunctional uterine bleeding in 39 cases,cervical cancer in 11 cases,submucosal myoma in 7 cases,endometrial carcinoma in 6 cases,carcinosarcoma in 4 cases.There were 58 cases of early pregnancy related diseases,accounting for 13.5％.Among them,32 cases were incomplete abortion,and 21 cases were inevitable abortion and 5 cases were hydatidiform mole.Forty-six cases were torsion of pedicle (10.6％).Five cases were genital tract malformation,accounting for 1.2％,with vaginal septum obliquumevery 4 cases and cervical atresia in one case.There were damages after the operation in 4 cases (0.9％),uterus perforation in 2 cases,abdominal wall hematoma in 1 case after cesarean section,and false aneurysm in 1 case after cesarean section.In the 431 cases,there was emergency surgery oroperation after symptomatic treatment in 329 cases,interventional treatment in one case and non-operative treatment in 101 cases.Conclusions There are corresponding typical ultrasonographic characteristics in different diseases of emergency and severe gynaecologic cases,combined with clinical symptoms and medical history.The right diagnosis can be made.Therefore,there are important clinical values of ultrasound in the treatment of emergency and severe gynecologic cases.

Objective To explore the clinical significance of abnormal fetal genitalia detected by routine prenatal ultrasound. Methods In Peking University Third Hospital from January 2014 to January 2016, the ultrasonic diagnosis and sonographic features in 14 suspected cases of abnormal fetal genitalia were analyzed retrospectively and compared with postpartum morphological and pathological characteristics. Results The fetal ultrasound findings and clinical outcomes in 14 cases were: (1) There were 4 cases of partial penoscrotal transposition (28.6%, 4/14), in which all fetus hadshort penis and hypospadias. In 2 termination cases, unilateral hydronephrosis and anal atresia was found in one case, while ventricular septal defect was found in the other case. In 2 term-birth cases, there was one case of recessive spina bifida. In the 4 cases, prenatal ultrasonographic manifestation showed that the short penis was located between the division of the scrotum, named as ″tulip sign″. (2) There were 2 cases (14.3%, 2/14) of complete penoscrotal transposition, in which all the pregnancies were terminated. On prenatal ultrasound of external genitalia, the location of the penis and scrotum was reversed. In one case, anal atresia and small eye malformation were found. In one case, the tetralogy of Fallot, duodenal atresia and anal atresia were found. (3) There were 4 cases of the micropenis (28.6%, 4/14). On prenatal ultrasound, the penis was difficult to demonstrated and was shown merely as an echoic dot. Among 2 cases of FGR, one infant dies for unexplained reasons after birth, and one infant has hypospadias after birth. The pregnancy was terminated in two cases of 18-trisomia and microdeletion in chromosome 9. (4) There were 2 cases of penis absence (14.3%, 2/14), in which all pregnancies were terminated. The sonographic manifestations show the absence of penis and bladder eversion. (5) In 2 cases, sex couldn`t be identified (14.3%, 2/14). In one case, the 46 xy infant showed a female external genitalia appearance after birth. In one case, the clitorism and congenital adrenal cortical hyperplasia were found in a 46 xx infant after birth. Conclusions Prenatal ultrasonography is effective and feasible in detecting genitalia abnormalities, especially for penis scrotal transposition and penis absence. When the fetal gender cannot be identified on ultrasound, chromosome examination is warranted. For indeterminable cases, ultrasound follow-up in 2nd and 3rd trimester is necessary.

Purpose To establish normative reference ranges of fetal azygos vein between gestation 20.0 and 40.0 weeks and analyze the possible correlation between azygos vein diameter and gestational age.Materials and Methods Retrospectively analyzed the data which collected from pregnant women with singleton pregnancies,1375 fetuses with normal outcome were included.The gestation was from 20.0 weeks to 40.0 weeks.The research objects were divided into 5 groups according to their gestational age and were examined standardized.The fetal normal reference value of azygos vein and its correlation with gestational ages were analyzed.Results The normal reference value of the fetal azygos vein diameter was established.We found that a significant increase linear between the diameter of fetal azygos vein and the gestation age.There was no obvious correlation with sex.The ratio of azygos vein and descending aorta inner diameter was about 0.36.There was on obvious changes in different gestational ages.Conclusions Fetal echocardiography technology can accurately assess fetal cardiac structure,the establishment normal reference value of azygos vein diameter could provide guidance for fetal echocardiography examination.