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 describe the characteristics and change trends of incidence, mortality and disease burden of acute myocardial infarction (AMI) in Qingdao from 2014 to 2020.Methods:We analyzed the incidence data of AMI retrieved from Qingdao Chronic Diseases Surveillance System. The average annual percent change (AAPC) of morbidity and mortality of AMI were evaluated by using Joinpoint log-linear regression model. Disability adjusted life year (DALY) was used to estimate disease burden of AMI in Qingdao.Results:A total of 70 491 AMI cases and 50 832 deaths of AMI occurred in Qingdao from 2014 to 2020. The age-standardized morbidity and mortality were 54.71/100 000 and 36.55/100 000, respectively. During 2014-2020, the AAPC of age-standardized morbidity was 2.86% (95% CI: 0.42%-5.35%), and 4.30% (95% CI: 1.24%-7.45%) in men and 0.78% (95% CI: -0.89%-2.47%) in women, respectively. The log-linear regression model showed that age-standardized morbidity in age groups 30-39, 40-49 years increased rapidly, with the AAPCs of 8.92% (95% CI: 2.23%-16.06%) and 6.32% (95% CI: 3.30%-9.44%), respectively. The trend was also observed in age groups 30-39, 40-49 and 50-59 years in men, with the AAPCs of 11.25% (95% CI: 3.54%-19.54%), 6.73% (95% CI: 2.63%-10.99%) and 6.72% (95% CI: 2.98%-10.60%), respectively. There was no significant change in age-standardized mortality. The DALY rate increased from 7.49/1 000 in 2014 to 8.61/1 000 in 2020, with the AAPC of 1.97% (95% CI: 0.36%-3.60%). Conclusions:The age-standardized morbidity of AMI in men increased in Qingdao, especially in those aged 30-49 years, while age-standardized mortality rate of AMI was relatively stable from 2014 to 2020. The burden of disease of AMI increased in both men and women.

OBJECTIVE: To detect variants of IVD gene among 4 neonates with suspected isovalerate acidemia in order to provide a guidance for clinical treatment. METHODS: 111 986 newborns and 7461 hospitalized children with suspected metabolic disorders were screened for acyl carnitine by tandem mass spectrometry. Those showing a significant increase in serum isovaleryl carnitine (C5) were analyzed for urinary organic acid and variants of the IVD gene. RESULTS: Four cases of isovalerate acidemia were detected, which included 2 asymptomatic newborns (0.018‰, 2/111 986) and 2 children suspected for metabolic genetic diseases (0.268‰, 2/7461). The formers had no obvious clinical symptoms. Analysis of acyl carnitine has suggested a significant increase in C5, and urinary organic acid analysis has shown an increase in isovaleryl glycine and 3-hydroxyisovalerate. Laboratory tests of the two hospitalized children revealed high blood ammonia, hyperglycemia, decreased red blood cells, white blood cells, platelets and metabolic acidosis. The main clinical manifestations have included sweaty foot-like odor, feeding difficulty, confusion, drowsiness, and coma. Eight variants (5 types) were detected, which included c.158G>A (p.Arg53His), c.214G>A (p.Asp72Asn), c.548C>T (p.Ala183Val), c.757A>G (p.Thr253Ala) and 1208A>G (p.Tyr403Cys). Among these, c.548C>T and c.757A>G were unreported previously. None of the variants was detected by next generation sequencing of 2095 healthy newborns, and all variants were predicted to be likely pathogenic based on the guidelines from the American College of Medical Genetics and Genomics. CONCLUSION The incidence of isovalerate acidemia in Liuzhou area is quite high. Screening of metabolic genetic diseases is therefore recommended for newborns with abnormal metabolism. The discovery of novel variants has enriched the mutational spectrum of the IVD gene.
Infant, Newborn ; Child ; Humans ; Acidosis ; Carnitine ; Erythrocytes ; High-Throughput Nucleotide Sequencing

【Objective】 To evaluate the curative effect of posterior atlantoaxial joint release and internal fixation in treating unstable craniocervical junction malformation （UCVJM）. 【Methods】 This study retrospectively enrolled 31 patients with UCVJM， who received posterior atlantoaxial joint release and internal fixation between January 2015 and December 2018. The pre- and postoperative changes of the Japanese Orthopaedic Association （JOA） scores， the cervicomedullary angle （CMA）， the atlantodental interval （ADI） and the height above the Chamberlain line of the odontoid （H） were traced to evaluate whether clinical symptoms， compression of spinal cord， horizontal and vertical dislocation of atlantoaxial were improved postoperatively. 【Results】 The average operation duration， bleeding during operation and the average days of hospitalization were （168.38±38.21）min， （147.09±59.84）mL， and （9.54±2.81） days， respectively. None of the patients had vertebral artery or spinal cord injury during operation. JOA score， ADI， H， and CMA were （11.94±1.37） points， （2.72±1.08）mm， （3.03±0.78）mm， and （145.35±8.00）° respectively on the 6th days after operation compared with the preoperative （9.94±1.26） points， （4.96±1.60）mm， （6.89±1.36） mm and （122.16±9.58）°， with statistical differences， which indicated all indexes were improved （all P<0.001）. During 6-25 months’ follow-up， there was no internal fixation looseness or displacement and JOA score was increased to （13.16±1.19） for all the patients in the last follow-up （all P<0.001）. 【Conclusion】 The posterior atlantoaxial joint release combined with internal fixation is safe and effective for patients with UCVJM.

【Objective】 To discuss and summarize the choice of the operation plan and evaluation of curative effect of spasmodic cerebral palsy. 【Methods】 Clinical data of 80 patients with spastic cerebral palsy treated by neurosurgery in The First Affiliated Hospital of Xi’an Jiaotong University were collected retrospectively and analyzed statistically. Eighty patients were followed up for 12 to 52 months, with an average follow-up of 21.3 months. The muscle tension grading, spasm index, range of motion, Holden walking ability and postoperative complications were compared one year after surgery. 【Results】 Totally 64 cases received selective posterior rhizotomy (SPR) combined muscle strength muscle tension adjustment method (MMA) and 16 cases selective peripheral neurotomy combined muscle strength muscle tension adjustment method. The grade and spasm index of muscle tension decreased significantly one year after operation (P<0.001). The range of joint motion and Holden walking ability were significantly improved (P<0.001). Transient urination disorder occurred in two cases (2.5%), and limb sensation disorder in two cases (2.5%), all of which were improved within three months. Weakness of dorsiflexion of foot in one case (1.25%). 【Conclusion】 Selective partial neurotomy and muscle tension adjustment is a safe and effective surgical method to treat spasmodic cerebral palsy. Real-time evaluation of muscle tension and ankle clonus changes during the operation is an important factor to ensure the postoperative efficacy.

【Objective】 To compare the application of modified selective posterior rhiotomy of spinal nerve with traditional rhiotomy in the treatment of spastic cerebral palsy and to evaluate the efficacy and complications of the two surgical methods. 【Methods】 The clinical data of 52 patients with spastic cerebral palsy were analyzed retrospectively. Among them 23 cases were treated with traditional selective posterior rhiotomy and the remaining 29 cases with modified selective posterior rhiotomy. Operation time, amount of blood loss, proportion of root after spinal nerve amputation, postoperative complications, spasm index, ankle clonus, and Holden walking ability at 1 year after operation were compared between the two groups. 【Results】 The operation time of modified selective posterior rhiotomy was longer than that of conventional surgery (P<0.05). There was no difference in intraoperative blood loss, postoperative complications, spasm index one year after surgery, or Holden walking ability between the two groups (P>0.05). The proportion of root was smaller in the modified group than in the traditional group (P<0.05). The improved group was superior to the traditional group in the disappearance of ankle clonus (P<0.05). 【Conclusion】 Modified selective posterior rhiotomy has more advantages in eliminating ankle clonus. It is a safe and effective surgical improvement method to evaluate the changes of muscle tension and ankle clonus to quantitatively cut the posterior root of spinal nerve during the operation. This can reduce the proportion of the posterior root of spinal nerve during the operation, and keep the anatomical and functional basis for reducing the occurrence of surgical complications.

Objective: To investigate the correlation between serum asymmetric dimethylarginine (ADMA) and cystatin C (CysC) in degenerative calcific aortic valvular disease and its clinical application value. Methods: One hundred and eighty patients with degenerative calcific aortic valvular disease who were treated in Beijing Luhe Hospital Affiliated to Capital Medical University from June 2016 to June 2018 were selected as the study subjects, and another 82 healthy subjects from the same hospital in the same period were selected as the control group. Serum ADMA and CysC levels were detected by enzyme-linked immunosorbent assay and latex-enhanced immunoturbidimetric assay. Risk factors of degenerative calcific aortic valvular disease were analyzed by Logistic regression analysis. Evaluation of the diagnostic efficacy of serum ADMA and CysC for degenerative calcific aortic valvular disease was used by receiver operating characteristic curve. Results: There were no significant differences in the general data between the two groups in terms of age, gender, body mass index, drinking history, smoking history, and history of hypertension (P>0.05). The systolic blood pressure(SBP), diastolic blood pressure (DBP), heart rate (HR), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterin(LDL-C), CysC and ADMA levels of the study group were significantly higher than those of the control group [(131.51 ± 19.09) mmHg (1 mmHg=0.133 kPa) vs. (126.48 ± 16.68) mmHg, (91.11 ± 16.35) mmHg vs. (86.89 ± 10.71) mmHg, (74.39 ± 15.22) beats/min vs. (70.09 ± 13.01) beats/min, (4.51 ± 1.12) mmol/L vs. (4.15 ± 0.92) mmol/L, (1.91 ± 0.63) mmol/L vs. (1.60 ± 0.65) mmol/L, (2.59 ± 1.13) mmol/L vs. (2.27 ± 0.85) mmol/L, (1.01 ± 0.22) mg/L vs. (0.79 ± 0.16) mg/L, (20.17 ± 6.38) ng/L vs. (11.88 ± 4.22) ng/L], and left ventricular ejection fraction (LVEF), high density lipoprotein cholesterin (HDL-C) levels were significantly lower than those of the control group [(56.45 ± 9.21)%vs. (60.87 ± 10.02)%, (1.56 ± 0.63) mmol/L vs. (1.76 ± 0.62) mmol/L], there were significant differences (P<0.05). Logistic multivariate regression analysis showed that serum CysC and ADMA were independent risk factors for degenerative calcific aortic valvular disease (P<0.05). Receiver operator characteristic (ROC) curve analysis showed that area under curve (AUC) of serum CysC for degenerative valvular heart disease was 0.785, with a sensitivity of 71.67%, and a specificity of 73.17%. The AUC of serum ADMA for degenerative valvular heart disease was 0.862, with a sensitivity of 71.67%, and a specificity of 87.80%. The AUC of serum CysC combined with ADMA in the diagnosis of degenerative valvular heart disease was 0.910, with a sensitivity of 85.56%, and a specificity of 84.15%, which was significantly higher than the two alone (Z=4.897 and 3.335, P<0.05). Conclusions Serum ADMA is positively correlated with CysC in patients with degenerative valvular heart disease, and can be used as diagnostic serum markers for degenerative calcific aortic valvular disease. It has clinical reference value for improving the diagnosis of degenerative calcific aortic valvular disease.

Objective:To evaluate lung protection of remote limb ischemic preconditioning after pulmonary resection.Methods:Methods sixty adult patients scheduled for elective pulmonary resection, were randomly divided into control group(group C, 30 cases) and remote limb ischemic preconditioning(group RLIP, 30 cases) using a random number table. Before one-lung-ventilation(T0), at 30 minites, 1 hour and 2 hours of OLV(T1, 2, 3), 15minites after re-expansion of the collapsed lung(T4), blood samples were drawn from the radial artery and vein for blood gas analysis, alveolar-arterial oxygen gradient(A-aDO 2)、pulmonary shunt ratio(Qs/Qt)were calculated. Extraction time of closed thoracic drainage tube, length of hospital stay, the incidence of in-hospital complications after operation were recorded. Results:Compared to T0 , each group at T1-T4, A-aDO 2 were obviously increased. We found that at T3, A-aDO 2 of group C increased much more higher and statistically significant( P<0.05). Compared to group RLIP, Qs /Qt of group C were significantly increased at T2( P<0.05). Compared with C group, the expression of microtubule-associated protein 1 light chain 3B in lung tissues was significantly"up-regulated in RLIP group( P<0.05). Followed the extraction time of closed thoracic drainage tube, length of hospital stay, the incidence of in-hospital complications after operation there were no statistically different( P>0.05). Conclusion:Remote limb ischemic preconditioning had some protective effect after pulmonary resection, which mechanism may be related to enhancing autophagy in the operated 1ung tissues of the patients.

Objective: To explore the regulatory mechanism of E2F1 transcription factor on M2 macrophages in full-thickness skin defect wounds of mice. Methods: E2F1 gene knockout heterozygotes C57BL/6 mice and wild-type C57BL/6 mice were introduced and self-reproduced. Two weeks after birth, E2F1 gene knockout homozygotes mice and wild-type mice were identified by polymerase chain reaction (PCR). Twelve identified 6-8 weeks old male E2F1 gene knockout homozygotes C57BL/6 mice and wild-type C57BL/6 mice were selected respectively according to the random number table and set as E2F1 gene knockout group and wild-type group. A full-thickness skin defect wound was made on the back of each mouse. On post injury day (PID) 2 and 7, 6 mice in each group were selected according to the random number table and sacrificed, and the wound tissue was excised. The expression of CD68 and CD206 double positive M2 macrophages was observed by immunofluorescence method, and the percentage of CD206 positive cells was calculated. The protein expression of CD206 was detected by Western blotting. The mRNA expression of arginase 1 was detected by real-time fluorescent quantitative reverse transcription PCR (RT-PCR). Wound tissue specimens of the two groups on PID 7 were obtained, and the protein and mRNA expressions of peroxisome proliferator-activated receptor gamma (PPAR-γ) were detected by Western blotting and real-time fluorescent quantitative RT-PCR respectively. The above-mentioned experiments were repeated four times. Three specimens of wound tissue of mice in wild-type group on PID 7 were obtained to detect the relationship between E2F1 and PPAR-γ by co-immunoprecipitation and Western blotting, and this experiment was repeated two times. Data were processed with unpaired t test. Results: The size of PCR products of E2F1 gene knockout homozygotes C57BL/6 mice and wild-type C57BL/6 mice were 227 and 172 bp respectively, which were the same as those of the designed DNA fragments. On PID 2 and 7, the number of CD68 and CD206 double positive M2 macrophages in the wound tissue of mice in E2F1 gene knockout group was more than that of wild-type group, and the percentages of CD206 positive cells in the wound tissue of mice in E2F1 gene knockout group were (0.234±0.032)% and (0.584±0.023)% respectively, which were significantly higher than (0.129±0.017)% and (0.282±0.071)% of wild-type group (t=3.29, 3.54, P<0.05). On PID 2 and 7, the protein expression of CD206 in the wound tissue of mice in E2F1 gene knockout group were 1.00±0.23 and 1.63±0.26 respectively, which were significantly higher than 0.43±0.06 and 0.97±0.08 of wild-type group (t=2.41, 2.45, P<0.05). On PID 2 and 7, the mRNA expressions of arginase 1 in the wound tissue of mice in E2F1 gene knockout group were 0.482±0.105 and 0.195±0.031 respectively, which were significantly higher than 0.163±0.026 and 0.108±0.017 of wild-type group (t=3.04, 2.86, P<0.05). On PID 7, the protein and mRNA expressions of PPAR-γ in the wound tissue of mice in E2F1 gene knockout group were 0.61±0.12 and 0.51±0.13 respectively, which were significantly higher than 0.20±0.04 and 0.20±0.04 of wild-type group (t=3.36, 2.86, P<0.05). On PID 7, detection of the wound tissue of mice in wild-type group showed that PPAR-γ had unidirectional effect on E2F1. Conclusions E2F1 transcription factor affects the polarization of M2 macrophages by inhibiting the expression of PPAR-γ, thereby inhibiting the healing process of full-thickness skin defect wounds in mice.

Objective: To investigate an effective method for solving the venous stasis in reverse peri-auricular flap pedicled on the frontal branch of superficial temporal artery(STA). Methods: From October 2013 to May 2016, 5 patients with peri-orbital defects were reconstructed with a retrograde flap pedicled on the frontal branch of STA that incorporated additional venous anastomosis. The additional venous anastomosis was created between the parietal branch of STV (superficial temporal vein) and the middle temporal vein. The defects at donor sites were directly sutured. Results: The size of flaps ranged from 2 cm×2 cm to 2 cm×8 cm. All flaps survived without venous stasis. Color and texture match of the flap were excellent .In three cases, flaps were thinned in secondary operation. During the follow-up period(6 months to 2 years, average of 12.4 months), flaps survived well on early period. Excellent color and tissue match with peri-orbital tissue were achieved on later stage. The scar at the donor site was inconspicuous. Conclusions Retrograde island flaps pedicled on the frontal branch of superficial temporal artery with vein anastomosis has the advantages of robust blood supply, good texture, and color match, and acceptable donor mobidity, while avoiding the venous stasis and flap necrosis.