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 explore the epidemiological factors of patients with OHCA who did not attempt CPR, and analyze the reasons and clinical features of non resuscitation.Methods:Data from OHCA patients who did not undergo CPR were collected from January 2020 to December 2020 at Beijing Emergency Medical Center. The registration form was designed according to the Utstein model, and the data were analyzed retrospectively by the chi-square test.Results:A total of 5 977 patients were enrolled and divided into two groups according to age: 2 349 patients aged ≤ 80 years old and 3 628 patients aged ≥ 81 years old. Compared with the younger group, the proportion of patients in the older group who did not undergo CPR due to disease (97.0%) and family desertion (99.4%) were higher, and the difference was statistically significant (both P<0.01). Conclusions:Elderly people over 80 years old with underlying diseases have a high probability of developing OHCA at home. Most of the witnesses at the scene were family members and could not implement CPR in time. After the emergency personnel arrived at the scene, they found that the patient had been in cardiac arrest for too long and had apparently died. Family members would choose to give up treatment.

Objective To observe the effect of abdominal electrical stimulation combined with high-frequency chest wall oscillation on airway clearance ability in critical ill patients with tracheostomy. Methods From January to June, 2021, a total of 84 critical ill patients with tracheostomy in the department of Critical Care Medicine, Zhongda Hospital, Southeast University, were randomly divided into control group (n = 28),experimental group A (n = 28) and experimental group B (n = 28). All the groups received routine therapy and early activities; while high-frequency chest wall oscillation was added to experimental group A, and abdominal electrical stimulation combined with high-frequency chest wall oscillation were added to experimental group B, for two weeks. Their involuntary cough peak flow (ICPF), Clinical Pulmonary Infection Score (CPIS), diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and thickness of abdominal muscle (Tab) were measured before and after treatment. Results The improvement of CPIS, ICPF and Tab were better in the experimental group B than in the other two groups (P < 0.05). The improvement of DE and DTF were slightly better in experimental group B, however, there was no significant difference among groups (FDE = 0.514, FDTF = 1.582, P > 0.05). The thickness d-values of rectus abdominis, musculi obliquus internus abdominis and musculus transversus abdominis were positively correlated with the d-value of ICPF in the exprimental group B (r > 0.415, P < 0.05). ICPF was highly negatively correlated with CPIS before treatment for all the patients (r = -0.702, P < 0.001). No adverse events occurred during the intervention period. Conclusion Abdominal electrical stimulation combined with high-frequency chest wall oscillation could improve airway clearance ability in critical ill patients with tracheostomy.

Objective:To explore the value of cardiovascular MR (CMR) T 1 mapping in evaluating myocardial injury in patients recovered from COVID-19. Methods:The clinical and image data of 15 patients with COVID-19 (9 with moderate clinical manifestation, 6 with severe clinical manifestation) who underwent CMR screening at 3 months after being discharged from the Second People′s Hospital of Fuyang City during May 2020 to June 2020 were prospective collected. Fifteen COVID-19 patients were selected as case group, and another 11 healthy volunteers were selected as control group. A standardized CMR protocol included cine, native and enhanced T 1 mapping, late gadolinium enhancement (LGE). Cardiac functional parameters, native T 1 value of left ventricular and extracellular volume fraction (ECV) were measured. One way ANOVA was used to assess the difference between CMR parameters among moderate and severe manifestation groups and control group, and LSD- t was used to assess the difference between the three groups. Results:LGE value was negative in all subjects. ECV values were higher in recovered COVID-19 patients with either moderate (27.9%±2.7%) or severe manifestation (30.0%±3.7%) than control group (23.2±1.9%) ( P<0.05); there was no significant difference of ECV values between recovered COVID-19 patients with moderate and severe manifestation ( P=0.100). There was no difference of native T 1 values and other functional and morphologic parameters of left ventricular and right ventricular among recovered COVID-19 patients with moderate and severe manifestation and control group ( P>0.05). Conclusion:CMR myocardial tissue ECV increase in patients who recovered from COVID-19, suggesting subclinical myocardial injury.

The antigen of cluster of differentiation CD200 is widely expressed in hematological malignancies, and is of great significance for the diagnosis, monitoring of minimal residual disease and prognosis evaluation of B cell lymphoproliferative disorders, multiple myeloma and acute leukemia. In addition, CD200 plays an important regulatory role in tumor immune tolerance, suggesting that CD200 is a potential molecular target for the immunotherapy of hematological malignancies.

Objective To summarize the relationship between WT1 gene mutation and prognosis of acute myeloid leukemia (AML). Methods The related literatures were searched in PubMed, Google Scholar and Cochrane Library databases, and the deadline was April 2, 2018. The Meta_analysis was performed by using Review Manager 5.2 software. Results A total of 9 literatures were included. Meta analysis showed that for the pediatric AML patients, the overall survival (OS) time in the WT1 gene mutated group was shorter than that in the wild_type group ( HR＝1.41, 95% CI 1.07-1.87, P＝0.01). For the total AML patients, the relapse_free survival (RFS) time in the WT1 gene mutated group was shorter than that in the wild_type group ( HR＝2.21, 95% CI 1.15-3.93, P＝0.02), but there was no significant difference in OS and disease_free survival (DFS) time between the two groups ( HR＝1.65, 95% CI 0.97-2.80, P＝0.06; HR＝0.46, 95% CI 0.08-2.57, P＝0.38). For the AML patients with normal karyotype and adult AML patients, there was no difference in OS time between the WT1 gene mutated group and wild_type group ( HR＝ 2.66, 95% CI 0.57-12.31, P＝ 0.21;HR＝ 2.10, 95% CI 0.70-6.30, P＝ 0.18). Conclusion WT1 gene mutation is a risk factor affecting OS of pediatric AML patients and RFS of general AML patients.

Objective: To investigate the effect of biology and mTOR pathway activity of down-regulated TSC2 gene expression on U937 leukemia cells. Methods: Gene expression was down-regulated by lentivirus induced RNA interference on TSC2 high expressed U937 cell line; the proliferation, apoptosis and differentiation were detected by CCK-8 assay, colony formation assay and flow cytometry; the gene expression level and protein kinase activity were detected by qRT-PCR and Western blot. Results: Down-regulated expression of TSC2 gene promoted U937 cell proliferation and colony formation ability (P<0.05) . The proportion in G₀/G₁ phase of TSC2 down-regulated U937 cell was much lower than that of the control cells [ (52.53±3.75) % vs (75.10±4.33) %, t=6.829, P=0.002], the S phase [ (22.43±1.00) % vs (15.47±1.20) %, t=-5.581, P=0.019] and G₂/M phase [ (25.03±4.34) % vs (14.33±0.91) %, t=-5.413, P=0.013] was remarkably higher than that of the control cells (P<0.05) . There were no statistically significant differences in cell apoptosis and differentiation (P>0.05) . Down-regulation of TSC2 led to the increased activity of mTOR, 4EBP1 and S6K1, but did not influence the activity of AKT. The expressions of proliferation related cyclinD1, c-myc and PTEN were also up-regulated after TSC2 silenced, but the expressions of P27KIP and BCL-XL were not changed. Conclusion Downregulation of TSC2 could promote the proliferation of U937 cells through up-regulation of mTOR activity.

Objective The primary culture of synovial fibroblasts is a convenient tool to study the pathology and physiology of synovial tissues .An improved method was constructed in this study by C57BL /6 mice to study the mechanism of rheumatoid ar-thritis(RA) .Methods The synovium around the hip joints were collected .Attention should be paid to eliminate the egg-yolk like yellow oval substance in the middle of the synovium .The synovium was transferred into a 1 .5 mL Eppendorf tube containing 0 .5%type Ⅳ collagenase and cut into 1 mm3 blocks or so .The Eppendorf tube was placed in 37 ℃ Constant temperature orbital shaker incubator for 60 min .After digestion ,the tube was placed on the Vortex for a high-speed oscillation for 1 .5 minutes to guarantee the separation of cells .Results Within about 1 week ,the first passage was performed by the trypsin digestion method .On day 10 , the number of synovial macrophages reached the maximum and then decreased gradually .After the third generation (day 15 to 20) , the synovial macrophages generally disappeared .Vimentin was suitable for the immunofluorescence cytochemical staining for the synovial fibroblasts .The cell purity was indicated as > 95% .The cytometric analysis indicated that purity of Vimentin and CD90 .2-labelled cells was over 95% ;the purity of CD54-labelled cells was 80% approximately .Conclusion It is a simple and effective method for primary culture of synovial fibroblasts in mice .

Objective To analyze the 2015 IAAF World Athletics Championships victim of disease type and composition,investigate medical emergency services for major international sporting events.Methods The 2015 IAAF World Athletics Championships in Medical Encounter Forms records in 737 cases during the game (2015-8-21 to 2015-8-30) were retrospectively reviewed and analyzed.Results Total of 737 patients during the match,trauma 259 cases (35.1％),respiratory diseases 196 cases (26.6％),digestive diseases 77 cases (10.4％),heat-related illnesses 41 cases (5.6％).Athletes 170 cases (23.1％),174 cases of staff (23.6％),139 cases of the IAAF family members (18.9％),136 cases of spectators (18.4％),members of the media 56 cases (7.6％).Conclusions 2015 IAAF World Athletics Championships type of disease the treatment of patients with the most common sports injury,followed by respiratory diseases and common diseases in summer heat-related illnesses.Clinic staff personnel structure the most common,followed by extended family members as well as the IAAF athletes and spectators.Major sports events should develop reasonable security programs for priority diseases and key customer base,and to ensure a smooth operation.

BACKGROUND:Fisher-Lewis rat kidney transplant models are the international common chronic renal alograft rejection models, but their application is greatly limited because of difficulty in model preparation and high costs. OBJECTIVE:To explore a new method of establishing SD-Wistar rat models of chronic renal alograft rejection. METHODS: Fifty-six pairs of SD-Wistar rats were subjected to left kidney orthotopic transplantation. The right kidneys of the recipients were intact and used as internal controls. 23 rat recipients were randomly divided into model group (n=15) and control group (n=8). The rats in the model group were injected with cyclosporine microemulsion for 10 days (2 mg/kg/day,i.p.) after kidney transplantation. The rats in the control group were not treated with immunosuppressive therapy. RESULTS AND CONCLUSION:The irreversible acute rejection occurred in al the transplanted kidneys of rats in the control group within 4 weeks, leading to the necrosis of transplanted kidney. Moderate inflammatory cel infiltration appeared in the transplanted kidneys of rats in the model group at 4, 8 and 12 weeks after transplantation. Typical histopathological changes of chronic rejection were observed within 12 weeks after transplantation. The Banff total scores were increased with time after transplantation. Al these histopathological changes were not observed in the intact right kidneys of rat recipients in both groups. The valey value of