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 correlation between dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) quantitative parameters and pathological grading in esophageal squamous cell carcinoma(SCC). Methods Prospective analysis of esophageal squamous cell carcinoma confirmed by electronic gastrointestinal endoscopy was performed. Thirty nine patients who underwent radical resection of esophageal carcinoma with MRI examination one weeks before operation were included. All patients underwent routine chest MRI and DCE-MRI scans, and DCE-MRI quantitative parameters including volume transfer constant (Ktrans), exchange rate constant (Kep) and extravascular extracellular volume fraction(Ve)were measured.Pathological analysis of postoperative specimens,including pathological grading(highly differentiated,moderately differentiated,poorly differentiated,undifferentiated),gross tumor pathological type(ulcerative type,medullary type,fungating type,sclerotic type)and local infiltration degree (T staging) were performed. Kruskal-Wallis H test was used to compare the differences of quantitative parameters between different pathological T staging,gross tumor pathological types and pathological grades of DCE-MRI,and a Dunn-Bonferroni test for post hoc comparisons.Spearman rank correlation analysis was used to evaluate the correlation between DCE-MRI parameters and pathological grading of esophageal squamous cell carcinoma.The ROC curves was used to evaluate the efficiency of different parameters in the diagnosis of poorly differentiated esophageal squamous cell carcinoma. Result Among the thirty nine patients, they were divided into three group according to pathological findings: well differentiated (12 patients),moderately differentiated(15 patients)and poorly differentiated group(12 patients);ulcerative type (19 patients), fungating type(10 patients), medullary type(10 patients);T1, 2 stage(16 patients), T3 stage(14 patients), and T4 stage(9 patients). There was no significant difference in the value of Ktrans, Kepand Ve between different T staging groups and different tumor pathological types groups(all P>0.05).The differences of Ktrans, Kepand Vebetween different pathological grading groups were statistically significant (all P<0.05). There were positive correlation between Ktrans, Kep, Veand the pathological grading, rs value were 0.874, 0.672, 0.578 respectively, all P<0.01. The ROC curve area of Ktrans, Kepand Vein the diagnosis of poorly differentiated esophageal squamous cell carcinoma was 0.941,0.809 and 0.773 respectively.The diagnostic efficiency of Ktranswas the best.Conclusions The quantitative parameters of DCE-MRI are correlated with the pathological grading of esophageal squamous cell carcinoma. Ktrans, Kepand Vecan reflect the perfusion characteristics of esophageal squamous cell carcinoma.

OBJECTIVE:To change the drug management mode in wards,promote drug use for patients timely and rationally. METHODS:Automated dispensing cabinet(ADC)was used to manage the drugs in some wards in our hospital,and introduce its use practice from aspects of drug management mode,pharmacists'management to ADC,related measures when using ADC manag-ing ward drugs,effect evaluation after using ADC(using species of base drugs,average time of dispensing temporary medical or-ders,drug returning times in 5 wards before and after using ADC as indexes),etc. RESULTS:Drug management method was es-tablished in ADC by screening drugs into the cabinet and developing process of taking drugs out. And pharmacists had achieved drug management in wards by establishing drug lists,conducting replenishment and inventory management,developing emergency plan,enhancing supervision and inspection,etc. Compared with before using ADC,average species of base drugs in the 5 wards increased from 65.8 to 157.2;average time of dispensing temporary medical orders dropped from 24.5 min to 5.8 min;and average drug returning times in 3 months decreased from about 200 times to about 20 times(P<0.05 or P<0.01). CONCLUSIONS:Us-ing ADC in wards for drug management has not only improved use convenience of drugs in wards,working efficiency of nurses as well as pharmaceutical care quality of pharmacists,but also has changed drug management mode and promoted rational drug use of patients.

To investigate the hypoglycemic effects of ethyl acetate extract of Alismatis Rhizoma (AREEA) on type 2 diabetes mellitus,the model of type 2 diabetic rats was induced by high-fat diet feeding for 4 weeks and then intraperitoneal injection of a low dose of streptozotoin (STZ).Rats without the above-mentioned treatment were selected as the normal control group.The diabetic rats were randomly divided into 5 groups:the model control group,low doses (20 mg/kg),medium doses (50 mg/kg),high doses (100 mg/kg) of AREEA groups and positive control-metformin group (100 mg/kg).After four weeks,oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed,respectively.12 hours after the last administration,the levels of serum glucose,glycated hemoglobin(HbA1 c),insulin (Ins),total cholesterol (TC),triglyceride (TG),high density lipoprotein (HDL-C),low density lipoprotein (LDL-C),superoxide dismutase (SOD),malondialdehyde (MDA),glutathione (GSH-Px),tumor necrosis factor-or (TNF-α),interleukin-6 (IL-6),insulin-mediated tyrosine of IRS-1 and Akt phosphorylation in adipose tissue were determined.In addition,the pathological changes of pancreas were examined.After administration for 4 weeks,all doses of AREEA significantly reduced the fasting blood glucose of type 2 diabetic rats (P ＜0.05).In the high doses group of AREEA,the levels of GLU,HbA1c,TC,TG,MDA,TNF-α and IL-6 in serum were decreased significantly,and the levels of SOD and GSH-Px were increased (P ＜ 0.05).These results suggest that AREEA has the therapeutic effect on type 2 diabetes-related symptoms by metabolic regulation of glucose and lipids.

OBJECTIVE:To provide a reference for rational clinical application of Reduning injection. METHODS:The rele-vant information about the patients who sought treatment in our hospital in 2014 and used reduning injection were collected to make statistical analysis to the age,dosage,course of treatment,frequencies,etc. RESULTS:Among the above-mentioned patients,the number of males was more than that of females,children under 10 years old accounted for 36.10%,47.54%of patients received re-duning injection for a treatment course of over five days,and 14.99% of patients failed to wash the infusion tube before injection. CONCLUSIONS:Irrational clinical application of reduning injection exists. The administration and dosage should be standardized and the dosage for children under three years old as specified in the label be detailed to reduce and avoid the occurrence of adverse drug reaction so as to ensure the safety of drug use by patients.

The research of triterpenoids on hypoglycemic and anti-diabetic activities have made great progress. Findings indicated that triterpenoids could reduce blood glucose via different mechanisms, including increasing insulin secretion, enhancing insulin sensitivity, promoting glucose uptake by activation of AMP-activated protein kinase(AMPK), decreasing glycogenolysis and gluconeogenesis, and inhibiting protein tyrosine phosphates 1B(PTP1B), α-glycosidase, aldose reductase(AR)and dipeptidyl peptidase-4(DPP-4). This article reviews the hypoglycemic effects and mechanisms of triterpenoids, providing the reference for further research and development of triterpenoids.

OBJECTIVE To investigate the trends of susceptibility of Enterobacter cloacae isolates to antimicrobial agents from Shandong provincial nosocomial infection surveillance system. METHODS The data from Shandong provincial nosocomial infection surveillance system from Aug 2001 to Jul 2004 were summarized and analyzed.(RESULTS) In the period of study from Aug 2002 to Jul 2004,231 strains of E.cloacae were collected.The (sputum),(urine) and wounds were major specimens,and accounted for 55.41%, 10.82% and 9.96% from total(specimens),respectively.The resistant rates of E.cloacae isolates to antimicrobials,except imipenem,increased to some extend.CONCLUSIONS Antimicrobial resistance of clinical isolates of E.cloacae threatens the success of(infectious) disease treatment.It is very important to promote the rational use of antimicrobial agents for control of resistance and to take effective measures for the prevention of infections.

OBJECTIVE To investigate the distribution and bacterial resistance of nosocomial infection.METHODS The data of 45 hospitals from Shandong Provincial Nosocomial Surveillance System from Jan 2003 to Dec 2005 were analyzed.RESULTS Of total 5 626 isolates strains from the nosocomial infection cases,G-bacilli,G+ cocci and fungi accounted for 58.27%,25.84% and 15.89%,respectively.The ampicillin-resistant rate of commonly encountered G-bacilli was above 89%.There were 72.98% of E.coli resistant to ciprofloxacin.The rates of resistance of S.aureus and coagulase negative Staphylococcus to penicillin,ampicillin and erythromycin were all above 80%;the lincomycin-resistant rate of S.aureus increased gradually to 86.64%.CONCLUSIONS Drug resistance of the nosocomial infective bacteria is a serous problem.Surveillance of bacterial resistance should be strengthened.

OBJECTIVE To investigate the relationship of nosocomial infection with use of antimicrobial agents.METHODS A retrospective study of 171 cases admitted from Nov 2004 to Apr 2005 in a general hospital.RESULTS Sixteen thrush cases all were found to have prior use of antimicrobial agents with average time about(12.5?8.10) days.Twenty six out of 57 surgical cases had wound infection,all used antimicrobial agents preoperatively.Inadequate use of antimicrobial agents manifested as prolonged use or over frequent drug change or improper combined use of drugs etc.CONCLUSIONS Protracted use of antimicrobial agents may be related with development of thrush.Rational use of antimicrobial agents is to be emphysized.

OBJECTIVE To investigate the trends of susceptibility of Staphylococcus isolates to antimicrobial agents analyzed by the Shandong provincial nosocomial infection surveillance system.METHODS The data from Jan 2002 to Dec 2005 were summarized and analyzed by the Shandong provincial nosocomial infection surveillance system.RESULTS During this period,1644 strains of first isolate from each patient were collected.Major specimens were sputum,wounds,skin soft tissue and urine,which were 39.72%,22.08%,9.43% and 7.54% in total specimens,respectively.The drug-resistant rates of Staphylococcus isolates to antimicrobials were high,except to vancomycin.CONCLUSIONS Antimicrobial resistance of clinical isolates threatens the success of infectious disease treatment.It is very important to promote the rational use of antimicrobial agents for control of resistance and to take effective measures for the prevention of infections.