Objective:To analyze the emergency sample testing time of VITROS XT 3400 biochemical testing system and evaluate its testing method.Method:Retrospective analysis was conducted on all specimens from the emergency laboratory department of our hospital from August 2020 to July 2022, including albumin(Alb), total protein(TP), aspartate amino transferase(AST), alanine aminotransferase(ALT), creatinine (Cr), blood Urea Nitrogen(BUN), calcium (Ca) and glucose (Glu) to calculate the utilization rate of composite dry slide projects. A total of 635 serum samples were collected from emergency patients in our hospital from June 20 to 26, 2022, and the difference in sample testing time was compared between VITROS XT 3400 (composite dry tablets) group and VITROS 4600 (ordinary dry tablets) group during low and peak periods. The difference in replacement reagent and daily maintenance time was also compared between the two groups.Result:The pairing rates of three projects (Alb-TP, AST-ALT, Cr-BUN) are all over 99%. The detection time of the VITROS XT 3400 group samples was significantly shorter than that of the VITROS 4600 group [(945±477) s compared to (1 101±567) s, t=20.378, P<0.001]. The detection time of the VITROS XT 3400 group samples during high and low peak periods was significantly shorter than that of the VITROS 4600 group [low peak period ( n=322): (857±567) s compared to (905±528) s, t=13.102, P<0.001; peak period ( n=313): (1 035±400) s compared to (1 303±492) s, t=21.876, P<0.001], The reagent replacement time of the VITROS XT 3400 group was significantly shorter than that of the VITROS 4600 group [(690±127) s vs (869±152) s, t=11.470, P<0.001]. There was no statistically significant difference in daily maintenance time between the VITROS XT 3400 group and the VITROS 4600 group [(1 771±123) s vs (1 765±95) s, t=0.238, P=0.834]. Conclusion:XT 3400 has faster detection speed when using the composite dry slides, which can better alleviate the detection pressure during peak hours.

To summarize the nursing experience of a patient with lower limb lymphedema treated with latissimus dorsi lymph node flap transplantation combined with lymphatic vessel venous anastomosis. The main contents of nursing included refining the observation steps and accurately evaluating the blood supply of the skin flap; real time dynamic communication between medical WeChat images and text, and targeted treatment; implementing personalized disease management to prevent complications; adopting an integrated medical and nursing remote follow-up model to improve follow-up efficiency. After 20 days of careful nursing, the patient′s skin flap had good blood circulation and no vascular crisis or skin flap necrosis after surgery One week after surgery and 1 to 3 months of follow-up, the degree of swelling in the affected limb significantly decreased and the skin softened significantly.

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 Verify the improvement effect of rhomboid intercostal and sub-serratus plane block on the quality of early postoperative recovery in patients undergoing thoracoscopic radical resection of lung cancer;Comparison of the differences in the effect of regional block at different timing on improving the quality of early postoperative recovery.Methods A total of 75 patients,aged 18 to 75 years,with ASA gradeⅠ-Ⅱ,who were scheduled to undergo thoracoscopic radical resection of lung cancer from January 2022 to January 2023 were selected.Randomly divided into three groups:blank control group(Group C),preoperative block group(PR group),and postoperative block group(PO group).The PR group and the PO group received ultrasound guided rhomboid intercostal and sub-serratus plane block in the preoperative anesthesia preparation room and postoperative anesthesia recovery room,respectively,with a dosage of 0.375％ropivacaine 30ml.Evaluate the postoperative recovery quality of patients at 24 and 48 hours using the postoperative recovery quality rating scale(QoR-40)scoring scale.Record numeric rating scale(NRS)pain scores in resting and active states at 0.5h,1h,2h,4h,8h,12h,24h,and 48h after surgery.Record the consumption of opioid drugs during and after surgery,the effective number of postoperative patient-controlled intravenous analgesia(PCIA)compressions,and the incidence of nausea and vomiting.Results Compared with Group C,the consumption of opioids during surgery in the PR group was significantly reduced.The QoR-40 score at 24 hours after surgery was significantly higher in the PR and PO groups.Significant reduction in NRS scores between 1-8 hours of rest and 1-12 hours of activity after surgery,and the effective times of PCIA compressions and opioid consumption were significantly reduced(P<0.05).Compared with the PR group,the PO group consumed more opioids during surgery and had a higher NRS score at 0.5 hours after surgery(P<0.05).There was no significant difference in postoperative QoR-40 scores,PCIA effective compressions,and opioid consumption;There was no statistically significant difference in the incidence of postoperative nausea and vomiting among the three groups.Conclusion Rhomboid intercostal and sub-serratus plane block can improve the early recovery quality of patients undergoing thoracoscopic radical resection of lung cancer,reduce the postoperative pain level of patients,and reduce the amount of opioids used in perioperative period,and its effectiveness has nothing to do with the blocking time.

This paper reviews the research progress concerning the prevention and treatment of tension blisters after fracture. There are 8 preventive measures to reduce the incidence of fracture tension blisters, such as correct identification of the high risk factors for fracture blister, immobilization and fixation, and elevation of the affected limb. There are 4 treatments: blister aspiration, deroofment, leaving the blister intact, and negative pressure wound therapy. This review is to provide useful reference for those who need construction of clinical protocls for prevention and treatment of fracture tension blisters.

Abstract: Objective　To analyze the effect of adjuvant to levofloxacin in the treatment of retreatment smear positive pulmonary tuberculosis, as well as its effect on respiratory function, immune function and inflammatory factors. Methods　One hundred cases of retreatment smear positive pulmonary tuberculosis patients admitted to Rudong County People's Hospital in Nantong city in Jiangsu province from 2017 to 2021 were randomly divided into a control group (n=50) and an observation group (n=50) according to random number table method. Both groups received conventional treatment (3 months of isoniazid, rifampicin, ethambutol, pyrazinamide / 6 months of isoniazid, rifampicin, ethambutol), with levofloxacin added to the control group, and thymopentin added to the observation group for the first three months in addition to routine treatment. The treatment effect of the two groups were compared. Results　The sputum smear conversion rate of the observation group was significantly higher than that of the control group after 3 months and 5 months of treatment (χ2=7.142, P<0.05; χ2=6.250, P<0.05). The cavity absorption time and lesion absorption time in the observation group were significantly lower than those in the control group (t=4.006, P<0.05; t=5.165, P<0.05). The turning time of bacteriological culture in the observation group was significantly lower than that in the control group (t=4.220,P<0.05). After 3 months of treatment, CD4+, CD3+, CD4+/CD8+ of the observation group were higher than those of the control group, the differences were statistically significant (t=8.885, P<0.05; t=6.274, P<0.05; t=4.357, P<0.05). After 3 months of treatment, the IFN-γ (interferon-γ) of the observation group was higher than that of the control group (t=8.892, P<0.05), whereas the , IL-10 (interleukin-10) was significantly lower than that in the control group (t=5.986, P<0.05). After 3 months of treatment, forced vital capacity (FVC), forced expiratory volume in one second (forced expiratory volume in one second, FEV 1) and the one-second rate (forced expiratory volume in one second / forced vital capacity, FEV1/FVC) in the observation group were significantly higher than those in the control group (t=11.223, P<0.05; t=10.128, P<0.05; t=4.464, P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (χ2=0.378, P>0.05). Conclusions　Thymopentin combined with levofloxacin had a significant application effect in the treatment of retreatment smear positive pulmonary tuberculosis, s, which led to improved inflammatory reaction, respiratory function and immune function. Additionally, it can increase sputum smear conversion rate and accelerate patient recovery, improving overall treatment efficacy, with a relatively high clinical application value.

ObjectiveThrough the targeted lipidomics， we explored the intervention mechanism of Kaixuan Bushen method on psoriasis vulgaris （PV） from the perspective of lipid metabolism， providing reference for the diagnosis and treatment of PV. MethodTwenty-six patients with PV admitting the outpatient clinic of the Department of Dermatology， Guang'anmen Hospital， China Academy of Chinese Medical Sciences from September 2019 to November 2020 were selected as the research object （observation group）， and 26 sex- and age-matched healthy volunteers in the same period were recruited as control group. Venous blood was collected for lipid index and targeted lipidomics detection in the control and observation groups at inclusion. After 12 weeks of continuous treatment of Kaixuan Bushen method， the psoriasis area and severity index （PASI） was measured and compared before and after treatment to assess the clinical efficacy， while venous blood was collected again in the observation group to compare the blood lipid level and lipid metabolism of patients before and after treatment. Targeted lipidomics analysis was performed by ultra performance liquid chromatography tandem mass spectrometry （UPLC-MS/MS） on an ACQUITY UPLC BEH C₈ column （2.1 mm×100 mm， 1.7 μm） with mobile phase of 5 mmol∙L^-1 ammonium formate in acetonitrile-water （6∶4， A）-5 mmol∙L^-1 ammonium formate in acetonitrile-isopropanol （1∶9， B） for gradient elution and flow rate of 0.26 mL∙min^-1. Conditions of MS were electrospray ionization （ESI）， positive and negative ion modes， and scanning range of m/z 50-1 200. Then principal component analysis （PCA） and partial least squares-discriminant analysis （PLS-DA） models were developed to screen differential metabolites， and the differential metabolites were identified and the pathways were enriched. ResultAfter 12 weeks of treatment with Kaixuan Bushen method， PASI score decreased by more than 50% in a total of 22 out of 26 patients with PV， suggesting the total effective rate was 84.62%. The serum triglyceride level of patients with PV was significantly higher than that of healthy individuals （P<0.05）， and the triglyceride level was significantly reduced after treatment （P<0.05）. Targeted lipidomics analysis screened a total of 43 potential biomarkers for PV， of which 42 were up-regulated and 1 was down-regulated， involving 7 signaling pathways such as linoleic acid metabolism， glycerophospholipid metabolism and unsaturated fatty acid biosynthesis. Moreover， there were 14 response makers for clinical efficacy of Kaixuan Bushen method on PV， of which 6 were up-regulated and 8 were down-regulated， involving five signaling pathways such as linoleic acid metabolism， glycerophospholipid metabolism and sphingolipids metabolism. In a comparison between healthy individuals and patients with PV and PV before and after treatment， the common differential metabolites were screened as phosphatidylcholine （PC） 38∶0 and ceramide （Cer） 42∶1， and the common pathways were linoleic acid and glycerophospholipid metabolic pathways. ConclusionThe disorder of lipid metabolism in PV are largely due to abnormal sphingolipid， glycerophospholipid and linoleic acid metabolic pathways， of which Kaixuan Bushen method can regulate the glycerophospholipid and linoleic acid metabolism， thereby improving psoriatic lesions.

Objective:To investigate the factors affecting the accuracy of electronic portal imaging device (EPID)-based in vivo dose verification in radiotherapy for patients with lung and esophageal cancers, and to recommend the workflow and specifications for the application of the in vivo dose verification. Methods:This study randomly selected 32 patients who received radiotherapy for esophageal and lung cancers at the Department of Radiation Oncology, Jinhua Municipal Central Hospital from May to August 2022, including 14 lung cancer cases and 18 esophageal cancer cases. Using a uRT-linac 506c linear accelerator, these patients were treated according to the dynamic intensity-modulated radiotherapy (dIMRT) and EPID-based In vivo dose verification ( In vivo EPID) plans developed with the uRT-TPOIS planning system. The In vivo dose verification performed during the treatment included 238 fractions of In vivo EPID and 80 fractions of image-guided radiotherapy (IGRT) for the lung cancer cases, as well as 414 fractions of In vivo EPID and 105 fractions of IGRT for the esophageal cancer cases. The 2D γ passing rate for each irradiation field was obtained according to the set threshold value. Furthermore, fractioned irradiation fields with γ-passing rates below the threshold value were analyzed, and primary factors decreasing the γ-passing rate were further analyzed by combining the online CT images and 3D reconstruction-derived dose. Results:For lung and esophageal cancers, the mean γ-passing rates were 95.1% ± 5.7% and 96.5% ± 4.5%, respectively at 3 mm/5%; 91.5% ± 8.4% and 92.2% ± 4.9%, respectively at 3 mm/3%, and 79.1% ± 14.7% and 83.7% ± 8.2%, respectively at 2 mm/2%, indicating no statistically significant differences between two cancers ( P > 0.05). The average γ passing rate for beam orientations near 0°/180° (Group A) was higher than those near 90°/270° (Group B) 3 mm/5%: Z = -25.4, P < 0.05; 3 mm/3%: Z = -26.8, P < 0.05). The IGRT correction of setup errors significantly improved the γ passing rates (96.3% ± 5.1% and 96.4% ± 4.9%, respectively at 3 mm/5%, Z = -5.50, P < 0.05; 92.3% ± 8.0% and 91.3% ± 7.7%, respectively at 3 mm/3%, Z = -9.54, P < 0.05). The results of In vivo dose verification were affected by changes in the volumes and motion of tumors and normal tissues, radiotherapy positioning, and adequacy of pre-treatment preparation. Conclusions:EPID-based In vivo dose verification during radiotherapy can avoid incorrect irradiation. However, it is necessary to standardize the workflow of the EPID-based In vivo dose verification to avoid the decrease in the γ passing rate caused by artificial factors.

Abstract The study elaborates on the historical development of the home-school-community partnership in the United States, as well as physical activity strategies to prevent overweight and obesity in school age children. Feasible suggestions are proposed for implementing the home-school-community collaboration in China. The finding suggests that in addition to cooperation with schools, families and communities need to take initiatives to actively support children s participation in various physical activities and provide facilities and guarantees. Schools should also do a top level design that links with families and communities, and incorporate their participation into long term physical education planning, making them an integral part of a closely interconnected collaborative network to further prevent overweight and obesity in school age children.

Objective:To explore the effect of individualized strength training based on adjustable sandbags in early rehabilitation after total knee arthroplasty.Methods:From November 2019 to November 2020, convenience sampling was used to select 60 patients admitted to the Joint Surgery Department of the Affiliated Huaian First People's Hospital of Nanjing Medical University as the research object. According to the random number table, the patients were divided into the experimental group and the control group, 30 cases in each group. The patients in the control group were given routine rehabilitation after operation, and the patients in the experimental group received individualized strength training using adjustable sandbags in the early postoperative period. The Hospital for Special Surgery (HSS) and the range of motion of the knee joint were compared between the two groups on the third day, the seventh day after operation and at the time of discharge.Results:On the third and seventh days after operation and at the time of discharge, the HSS score and the range of motion of the knee joint in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Early implementation of individualized strength training based on adjustable sandbags can promote postoperative rehabilitation of patients undergoing total knee arthroplasty, and improve their ability to adapt to early ambulation.