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 value of high-frequency linear array probe in prenatal ultrasound diagnosis of fetal kidney fusion anomalies.Methods:A senior sonographer for prenatal diagnosis used a convex array probe and a high-frequency linear array probe to obtain and store renal images of the transverse section, sagittal and coronal plane and ectopic kidney of 27 fetuses with suspected or diagnosed fetal renal fossa emptiness, abnormal renal position and abnormal renal contour in Guangdong Women and Children Hospital from December 2018 to October 2019. The images were analyzed to judge the possibility of kidney fusions by another senior sonographer (subject 1) and a junior sonographer (subject 2) separately. Then, ROC curves were plotted and statistically analyzed based on postnatal follow-up results. The Kappa coefficient between the two subjects was calculated.Results:Areas under the two ROC curves were 0.969 and 0.756 when using a convex array probe, but 1.000 and 1.000 with a high-frequency linear array probe by two subjects separately. Subject 1 had no significant difference using two kinds of probes ( P>0.05), however, subject 2 had higher diagnostic accuracy when using high frequency linear array probes ( P<0.05). The diagnostic consistence of high-frequency linear array probe between subjects was higher than convex array probe, the Kappa coefficients were 1.000 and 0.516, respectively. Conclusions:The application of high-frequency linear array probe in prenatal diagnosis of fetal kidney fusion anomalies is feasible, and can improve the confidence and diagnostic accuracy for fetal kidney fusion anomalies.

Objective: To compare the clinical efficacy of stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) in the treatment of brain metastases from January 2006 to December 2016, lung adenocarcinoma and analyze the related factors. Methods: In this multi-center retrospective analysis, clinical data of 208 patients with brain metastases from lung adenocarcinoma were retrospectively analyzed and assigned into the SRT (n=86) and SRS groups (n=122). The clinical characteristics of patients in two groups were analyzed. The local tumor control rate, median survival time and radiation brain injury were statistically compared between two groups. Results: At the end of follow-up, the objective response rates (ORR) were 70.9% and 71.3% in the SRT and SRS groups (P=0.772). The local tumor control rates at 12 months were 89% and 86% in the SRT and SRS groups (P=0.383). The median overall survival time of all patients was 14.3 months, 15.6 months in the SRT group and 13.7 months in the SRS group (P=0.349). Multivariate analysis showed that large target volume (P<0.001), low GPA score (P=0.012) and no insensitive gene mutation (P<0.001) were the main factors of poor prognosis. The incidence of late radiation brain injury was 5.8% and 14.8% in two groups (P=0.043). Conclusions SRT and SRS yield similar clinical efficacy in the treatment of brain metastases from lung adenocarcinoma. SRT may have a lower incidence of late radiation brain injury than SRS.

Objective To evaluate the clinical efficacy and safety of stereotactic radiotherapy (SRT) combined with bevacizumab for brain metastases in patients with lung adenocarcinoma.MethodsThe clinical data of 95 patients with brain metastases of lung adenocarcinoma were retrospectively analyzed, including 36 patients treated with SRT and bevacizumab (bevacizumab group) and 59 patients treated with SRT, corticosteroids, and mannitol (traditional drug group).The tumor response rate, peritumoral edema control rate, improvement in Karnofsky Performance Scale (KPS) score, and adverse reactions were analyzed.Results Compared with the traditional drug group, the bevacizumab group had significantly higher tumor response rate (P=0.033) and peritumoral edema control rate (P=0.000) at 1-4 weeks after treatment, as well as an obvious improvement in KPS score and reduced doses of corticosteroids and mannitol.In addition, the adverse reactions in the bevacizumab group were mild and controllable.Conclusions SRT combined with bevacizumab for brain metastases in patients with lung adenocarcinoma can achieve higher short-term tumor response rate and peritumoral edema control rate and improve patients' quality of life.

Objective To quantitatively study the distance between the left atrial posterior wall and the descending aorta(DLD)in the normal fetal four-chamber view using fetal echocardiography.Methods The distances between the left atrial posterior wall and the descending aorta in end-systole (DLDs) and in end-diastole(DLDd) were measured in a standard apical four-chamber view using fetal echocardiography in 300 normal fetuses.The gestation ages ranged from 20 to 40 weeks.Fetal non-cardiac biometric parameters included femoral length(FL),biparietal diameter(BPD) and gestation age (GA) based on menstrual age. The correlation between DLDs,DLDd and non-cardiac biometric parameters were analyzed.Results In normal fetuses,the DLDs was (0.32±0.08)cm with a range of 0.19 -0.48 cm,the DLDd was (0.43 ± 0.10)cm with a range of 0.25-0.62 cm.The DLDs and DLDd increased with the growth of GA,and were correlated with GA and BPD and FL significantly (r = 0.545,0.556,0.574,0.530,0.563 and 0.576, respectively,all P <0.001).The linear regression equations between DLDs,DLDd and GA,BPD,FL were:Y =0.009GA+0.041 ,Y =0.038BPD+0.028,Y =0.044 FL+0.073,Y =0.01 1 GA+0.083,Y =0.048 BPD+0.063,Y = 0.054 FL + 0.124,respectively.Conclusions In normal fetuses,the DLDs and DLDd increase with the growth of GA,and have good correlation with GA,BPD,and FL respectively.Normal reference ranges of DLDs and DLDd have been provided.These normative data may be a new tool for assessment of fetal heart,especially has potential applications in screening of total anomalous pulmonary venous connection(TPVAC),absent pulmonary valve syndrome(APVS)or other complex congenital heart defects.

Objective To evaluate the preliminary clinical efficacy of bevacizumab for cerebral radiation necrosis (CRN). Methods Nineteen patients with CRN for whom the treatment with steroids and mannitol failed were retrospectively analyzed with a total of 22 lesions. Except for 5 lesions confirmed by pathological evidence, all lesions were confirmed by the following imaging evidence:1. computed tomography (CT)?or magnetic resonance imaging (MRI)?enhanced lesions showed loss of tension and were accompanied by substantial edema;2. CT?or MRI?enhanced lesions had a low perfusion pressure;3. magnetic resonance spectroscopy indicated that the enhanced areas had a decreased choline peak; 4. positron emission tomography showed that the fluorodeoxyglucose uptake was substantially reduced in the enhanced areas. All patients were given 5 mg/ kg bevacizumab at an interval of 14 days for 2?6 cycles. MRI examination was performed in each cycle before treatment, and the enhanced lesions on T1?weighted images ( T1 WI) and edema on T2?weighted images (T2 WI) were compared before and after treatment. The clinical symptoms, Karnofsky Performance Status ( KPS), and adverse reactions in all patients were evaluated. Comparison before and after treatment was performed by paired t test. Results All 19 patients completed the treatment successfully and there were no severe adverse reactions. The clinical symptoms of patients were substantially improved after the second cycle of treatment, and the KPS score increased by 26?? 8 on average. The visible volume of enhanced lesions on MRI T1 WI was significantly reduced by 54?? 8% after treatment (P= 0?? 000), while the visible volume of edema on MRI T2 WI was reduced by 80?? 7% after treatment (P= 0?? 000). The follow?up time ranged from 3 to 12 months with a mean value of 5?? 6 months. Eleven patients kept clinical improvement in CRN, four patients had recurrence, and four patients died from tumor progression. Conclusions Bevacizumab is preliminarily confirmed to substantially improve the clinical symptoms and quality of life in patients with CRN.

BACKGROUNDCollaterals to occluded infarct-related coronary arteries (IRA) have been observed after the onset of acute ST-elevation myocardial infarction (STEMI). We sought to investigate the impact of early coronary collateralization, as evidenced by angiography, on myocardial reperfusion and outcomes after primary percutaneous coronary intervention (PCI).

METHODSAcute procedural results, ST-segment resolution (STR), enzymatic infarct size, echocardiographic left ventricular function, and major adverse cardiac events (MACE) at 6-month follow-up were assessed in 389 patients with STEMI undergoing primary PCI for occluded IRA (TIMI flow grade 0 or 1) within 12 hours of symptom-onset. Angiographic coronary collateralization to the occluded IRA at first contrast injection was graded according to the Rentrop scoring system.

RESULTSLow (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralization was detected in 329 and 60 patients, respectively. Patients with high collateralization more commonly had prior stable angina and right coronary artery occlusion, but less often had left anterior descending artery occlusion. At baseline, these patients presented with less extent of ST-segment elevation and lower serum levels of creatine kinase myocardial band (CK-MB) and cardiac troponin I (cTnI). Procedural success rate, STR, corrected TIMI flame count, and area under the curve of CK-MB and cTnI measurements after the procedure were similar between patients with high collateralization and those with low collateralization (for all comparisons P > 0.05). There were no differences in left ventricular ejection fraction and rates of MACE at 6 months according to baseline angiographic collaterals to occluded IRA.

CONCLUSIONSIn patients with acute STEMI undergoing primary PCI within 12 hours of symptom-onset, coronary collateralization to the occluded IRA was influenced by clinical and angiographic features. Early recruitment of collaterals limits infarct size at baseline, but has no significant impact on myocardial reperfusion after the procedure and subsequent left ventricular function and clinical outcomes.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnostic imaging ; therapy ; Treatment Outcome ; Young Adult

Objective To determine the frequency of depression in patients with Parkinson' s disease(PD) and healthy controls over 50 years of age and to analyze the characteristics and influencing factors of PD with depression(PDD) in Nanjing.Methods One hundred and twenty-six PD patients were diagnosed and assessed using Self-rating Depression Scale (SDS) and Hamilton Depression Scale (HAMD).The frequency,characteristics and influencing factors of depression were statistically analyzed,and the factor analysis of HAMD was carried out.Also,one hundred and twenty-four healthy subjects over the age of 50 were selected as the control group.Ressults The incidence of depression in PD group was 48.4％ ( 61/126):15.1％ (19/126) for mild depression,27.8％ (35/126) for moderate depression,5.6％ (7/126) for severe depression.The incidence of depression in the control group was 9.7％ (12/124):5.7％ (7/124) for mild depression,2.4％ (3/124) for moderate depression,1.6％ (2/124) for severe depression.There was a significant difference between these two groups( x2 =45.36,P ＜ 0.01 ).Univariate and Logistic regression analysis revealed that a high frequency of depression occurred in patients with long PD duration,high H-Y stage and UPDRS Ⅲ.According to each factor analysis of HAMD,the scores of cognitive impairment,tardiness,anxiety and sleep disturbances of the PD patients with depressive syndromes were higher than that of the control group.Conclusion Depression is a relatively common complication of PD in Nanjing which is associated with long PD duration,severity of motor disturbances and increasing H-Y stage.

Background and purpose:It was reported that erythropoietin may directly or indirectly induce the tumor cells to proliferate and result in diseases progression when recombinant human erythropoictin is used clinically in cancer-related anemia.Recently,the expression of erythropoietin-receptor(Epo-R)was detected in breast cancer.This study was done to detect the expression of Epo-R,estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor 2(Her-2)in breast cancer,and to investigate the relationships between these indexes and the clinical significance.Methods:Sixty breast cancer patients were analyzed,the expression of Epo-R and microvascular density(MVD)were detected by immunohistochernistry,in order to clarify the relationships between the expression level of Epo-R,MVD and ER,PR,Her-2.Results:The rate of Epo-R expression was 78.3%,the mean number of positive tumor cells was 39±24,while the tissue MVD was 25±9.The expression level of Epo-R was positively correlated with the MVD.Also,the level of MVD was higher in the group of Epo-R positive than the negative,which has significant difference(t=3.4252,P＜0.001).The expression level of ER,PR has no definite relationships with Epo-R,MVD.The expression level of Her-2 was both closely associated with Epo-R,MVD.The expression level of Epo-R has an obvious relationship with clinical stage,lymph node status and the size(P＜0.001).The value of MVD was positively correlated with lymph node status,while not with clinical stage and the size.Conclusion:The expression level of Epo-R was markedly higher in breast cancer,and has a positive correlation with the tissue MVD.The expression level of Epo-R and MVD were significantly associated with Her-2,but not with ER and PR.It may contribute to clarifying the clinicopathological characteristics and prognosis of breast cancer by detecting both the expression level of Epo-R and MVD.

To find a new source of seed cells for constructing tissue-engineered intervertebral disc, nucleus pulposus (NP) cells and mesenchymal stem cells (MSCs) were isolated from New Zealand white rabbits. The nuclcus pulposus cells population was fluorescence-laelled and co-cultured with MSCs with or without direct contact. Morphological changes were observed every 12 h. Semi-quantitaive reverse transcriptase-polymerase chain reaction was performed to assess the expression levels of Sox-9, aggreacan and type Ⅱ collagen every 24 h after the co-culture. MSCs treated with direct contact rounded up and presented a ring-like appearance. The expression of marker genes was significantly increased when cells were co-cultured with direct contact for 24 h. No significant change was found after coculture without direct contact. Co-culture of NP cells and MSCs with direct contact is a reliable method for generating large amount of NP cells used for cell-based tissue engineering therapy.