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.

Abstract Allergic diseases can occur in all systems of the body, covering the whole life cycle, from children to adults and to old age, can be lifelong onset and even fatal in severe cases. Children account for the largest proportion of the victims of allergic disease, Children s allergies start from scratch, ranging from mild to severe, from less to more, from single to multiple systems and systemic performance, so the prevention and treatment of allergic diseases in children is of great importance, which can not only prevent high risk allergic conditions from developing into allergic diseases, but also further block the process of allergy. At present, there is no consensus on the management system of allergic children in kindergartens and primary schools. The "Consensus on Allergy Management and Prevention in Kindergartens and Primary Schools", which includes the organizational structure, system construction and management of allergic children, provides evidence informed recommendations for the long term comprehensive management of allergic children in kindergartens and primary schools, and provides a basis for the establishment of the prevention system for allergic children.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Objective: To introduce a reconstruction procedure of natural sideburn, with combined expanded retroauricular flap and scalp flap. Methods: A retrospective study was produced in Plastic Surgery Hospital, PUMC, from January 2014 to December 2017. Twenty patients (21 sides) underwent sideburn reconstruction with combined expanded retroauricular flap and scalp flap (double pedicled flap, n=3; single pedicled flap, n=17) were included in this study. There were 12 male (12 sides) and 8 female (9 sides), with the mean age of (23.8±3.2) years. The sideburn defect was caused by burn in 19 patients, and it was resulted from hemangioma in 1 patient. Results: The size of flaps ranges from 8 cm×12 cm to 10 cm×16 cm. Venous congestion at the distal end of the flap occurred in 1 patient, which was cured after dressing change, and the sideburn was not affected. The reconstructed sideburns are natural, symmetric, and without obvious scar. The follow-up time was 3-40 months. Fourteen patients were very satisfied with the reconstructed sideburn, and 6 patients were satisfied. No severe complication was observed during follow-up time. Conclusions The combined retroauricular flap and scalp flap is an alternative method for sideburn reconstruction, which provide natural hair distribution, inconspicuous scars and less complications.

Objective: To investigate the clinical outcome of autologous thin split thickness skin graft with melanocytes for the treatment of large scar with depigmentation, caused by extensive burn. Methods: From August 2016 to June 2018, autologous thin split thickness skin graft with melanocytes was used on 19 patients, who had depigmented extensive burn scar. They include 15 males and 4 females, aged 19-54 years. The operation was performed under general anesthesia or local anesthesia. Local mechanical abrasion was carried out at the depigmented surface of the scar, until the superficial dermis. The thin split thickness skin graft with melanocytes was transplanted to the wound at recipient site, followed by package and fixation. The package was kept for two weeks. Results: After a follow-up period of 3-6 months, all the grafts survived well with satisfactory appearance. The defects at donor site healed well too. Conclusions Satisfactory outcome can be achieved with autologous thin split thickness skin graft with melanocytes for the treatment of depigmented scar caused by extensive burn.

Species identification with dry specimen is usually difficult by traditional taxonomy method. According to the operational regulations for DNA barcode identification of medical insects at frontier ports, DNA barcodes of 31 dry specimens of Pollenia species captured at Shanghai port were generated. After comparing with the Barcode of Life Data (BOLD) system v4, all the 31 DNA barcodes are assigned into 5 species: Pollenia rudis (Fabricius, 1794), Pollenia pediculata (Macquart, 1834), Pollenia vagabunda (Meigen, 1826), Pollenia hungarica ( Rognes, 1987) and Pollenia sp.. A neighbor-joining tree was created based on the 31 barcodes of Pollenia and an inductive COⅠ sequence as an outgroup, it is revealed that these species can be differentiated by DNA barcodes. Therefore, COⅠ barcoding can overcome the shortages of traditional taxonomy, and improve the success rate in identification of flies with dry specimen.

BACKGROUND: Intestinal and lymphoid tissues constitute an important part of intestinal immunity, which plays an important regulatory role in spleen deficiency and hydronephrosis. OBJECTIVE: To observe the effect of acupuncture on T lymphocyte subsets in lymph nodes of rats with spleen deficiency, and to investigate the correlation of spleen deficiency with intestinal immunity and the mechanism of acupuncture for spleen deficiency syndrome. METHODS: Thirty-six female Sprague-Dawley rats were randomly divided into three groups: model, acupuncture and blank control groups. The rat model of spleen deficiency was established by fatigue-induced spleen injury plus abnormal diet for 31 days. Afterwards, the rats in the acupuncture group received acupuncture at Zusanli(ST 36).Urine D-xylose excretion rate was detected during modeling and treatment.Then, the mesenteric lymph nodes were removed, and the changes in T lymphocyte subsets in the mesentericlymph nodes were observed by immunohistochemistry. RESULTS AND CONCLUSION: Urine D-xylose excretion rate under spleen deficiency in the modeling and acupuncture groups was significantly lower than that in the blank control group (P < 0.05 or P < 0.01); after acupuncture, the urine D-xylose excretion rate was significantly increased compared with the modeling group (P < 0.01), but still lower than that in the blank control group (P < 0.05). The count of CD4+T lymphocytes, count of CD8+T lymphocytes and ratio of CD4+/CD8+T lymphocytes were ranked as follows: blank control group >acupuncture group>modeling group(P<0.01 or P<0.05).These results suggest that acupuncture at Zusanli can improve the urine D-xylose excretion rate, regulate the balance of T lymphocyte subsets in mesenteric lymph node of rats with spleen deficiency, thus improving the intestinal immune function, spleen deficiency systems, disorder of intestinal digestive function, intestinal digestion and absorption, as well as anorexia, loose stool, diarrhea and other symptoms of the digestive system.

Bladder cancer remains a commonly diagnosed malignancy worldwide, bringing huge economic burden and high morbidity for patients. Assessment of prognostic significance of lymphovascular invasion (LVI) is a critical issue in the surgical management of bladder cancer after transurethral resection or radical cystectomy. A systematic search of PubMed, Embase and Cochrane Library was performed up to Oct 10, 2014 to identify eligible studies. Outcomes of interest were collected from studies comparing overall survival (OS), cancer specific survival (CSS) and recurrence free survival (RFS) in patients with the LVI. Results of studies were pooled, and combined hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) for survival were used as the effect size estimation. Funnel plots were done to show the publication bias, while the forest plots and subgroup analyses were used to limit the heterogeneity. A total of 20 studies (10 663 patients) met the eligibility criteria and were included for this meta-analysis. Our pooled results showed that there were significant differences in OS (pooled HR, 1.71; 95%CI, 1.52-1.92; P<0.00001), CSS (pooled HR, 2.25; 95% CI, 1.80-2.81; P<0.00001) and RFS (pooled HR, 1.91; 95% CI, 1.57-2.32; P<0.00001) between the patients with LVI and the patients without LVI. There were significant heterogeneities observed in the studies concerning the relationship between LVI and CSS, RFS. There was no clear evidence of publication bias. When tumor stage was beyond T3, LVI lost its predictive value for CSS and RFS. For the patients who had negative lymph nodes, LVI was still an adverse predictor. Our pooled results demonstrate that LVI indicates poor prognosis of patients with bladder cancer after surgical procedures, and it can be of particular importance in clinical practice. However, these results need to be further confirmed by more adequately designed prospective studies.
Carcinoma, Squamous Cell ; diagnosis ; mortality ; pathology ; surgery ; Cystectomy ; mortality ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Neoplasm Invasiveness ; Neoplasm Staging ; Prognosis ; Survival Analysis ; Urinary Bladder Neoplasms ; diagnosis ; mortality ; pathology ; surgery ; Urothelium ; pathology ; surgery

This study was aimed to explore the clinical efficacy and toxicity of idarubicin (IA regimen) and daunoru-bicin combined with cytarabine (DA regimen) for treating aged patients with AML as induction chemotherapy. The clinical data of 60 newly diagnosed AML aged patients treated with IA or DA regimen were analyzed retrospectively. IA regimen group included 22 patients (8 male and 14 females with median age of 66 yrs), while the DA regimen group included 38 patients (20 males and 18 females with median age of 64 yrs). The complete remission rate, total effective rate and adverse effects after one chemotherapy course were compared. The results showed that the CR rate in IA regimen group was 63.63%, which was significantly higer than that in DA regimen group (31.58%) (P < 0.05). The total effective rate was 63.63% and 36.84% respectively in IA and DA regimen groups, there was significant difference between the two groups (P < 0.05). Both the hematological and non-hematological adverse effects were observed and no difference was found in the two regimen groups, neither in myelosupression (P > 0.05), the major hematological adverse effects, nor in non-hematological adverse effects (P > 0.05). It is concluded that for aged AML patients, IA regimen can achieve a higher CR rate and higher total effective rate than that in DA regimen without increase of adverse effects after one induction chemotherapy course.
Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cytarabine ; administration & dosage ; Female ; Humans ; Idarubicin ; administration & dosage ; Induction Chemotherapy ; Leukemia, Myeloid, Acute ; drug therapy ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo investigate whether myocardial bridging (MB) is independently associated with coronary atherosclerosis proximal to MB in the left anterior descending coronary artery (LAD) identified by computed tomographic coronary angiography (CCTA).

METHODSFrom March 2011 to December 2012, patients (n=9 862) with suspected coronary disease underwent CCTA using dual-source CT scanner. The baseline clinical characteristics (age, gender, smoking history, presence of hypertension, dyslipidemia, diabetes mellitus, family history of heart attack, and body mass index) and the results of CCTA were reviewed. Two radiologists evaluated the coronary artery for MB and coronary atherosclerosis stenosis (CAS) in LAD and made a diagnosis by consensus. Significant independent risk factors for CAS were investigated by multivariate logistic regression analysis.

RESULTSA total of 3 182 (32.3%) cases of MB and 3 359 cases of CAS of LAD were identified. No patient with CAS in the tunneled segment was found. The mean length of bridges and the mean thickness of the overlying myocardium was (17.3±5.2) mm and (1.2±0.9) mm, respectively. There were 1658 MB cases in 3 359 cases of LAD stenosis and 1 524 MB cases in 6 503 cases of no LAD stenosis (χ(2)=681.12, P<0.05). Logistic regression analysis showed that MB in the LAD were significantly associated with CAS in the proximal LAD (OR=3.07, 95%CI=2.81-3.37, P<0.001), and after final adjustment for age, gender, body mass index, family history of heart attack, smoking, hypertension, dyslipidemia, diabetes mellitus, and resting heart rate (OR=2.86, 95% CI=2.60-3.16, P < 0.001).

CONCLUSIONMB in the LAD is independently associated with CAS in the proximal segment to MB.

Adult ; Aged ; Aged, 80 and over ; Coronary Stenosis ; complications ; diagnostic imaging ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Myocardial Bridging ; complications ; diagnostic imaging ; Risk Factors ; Tomography, X-Ray Computed