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.

BACKGROUND: Reports on the prevalence of psoriatic arthritis (PsA) among Chinese patients with psoriasis are very limited. This study, conducted by rheumatologists, estimated the prevalence of PsA in a large number of Chinese patients with psoriasis. METHODS: Consecutive patients with a confirmed diagnosis of psoriasis attending nine dermatology clinics in five hospitals were recruited. All psoriasis patients were asked to complete a questionnaire comprising 16 questions to identify possible cases of PsA. All patients with one or more positive answers to the questionnaire were evaluated by two experienced rheumatologists. RESULTS: A total of 2434 psoriasis patients, including 1561 males and 873 females, were enrolled. Both the questionnaire and rheumatologists' examinations were completed in the dermatology clinics. The results identified 252 patients with PsA, comprising 168 males and 84 females. The overall prevalence of PsA among psoriasis patients was 10.4% (95% confidence interval [95% CI], 9.1%-11.7%). By sex, the prevalence was 10.8% (95% CI, 9.2%-12.5%) for males and 9.6% (95% CI, 7.7%-11.9%) for females and there was no significant sex difference in the prevalence of PsA (P = 0.38). Of the 252 PsA patients, 125 (49.6%, 95% CI, 41.3%-59.1%) were newly diagnosed by rheumatologists. Consequently, the prevalence of undiagnosed PsA among psoriasis patients was 5.2% (95% CI, 4.4%-6.2%). CONCLUSION The prevalence of PsA in the Chinese population with psoriasis is about 10.4%, which is almost double that of previous reports in the Chinese population, but lower than that in Caucasians.
Humans ; Female ; Male ; Arthritis, Psoriatic/epidemiology* ; Rheumatologists ; Prevalence ; East Asian People ; Psoriasis/epidemiology*

OBJECTIVES: To summarize our experience with the sural neurofasciocutaneous flap for reconstructing the soft tissue defects over the forefoot distal to the connecting line of midpoints in the metatarsal bones, and to compare the outcomes between the flap for resurfacing the defects distal and proximal to the connecting line. METHODS: The clinical data of 425 sural neurofasciocutaneous flaps for repairing the soft tissue defects in the middle and lower leg, ankle, and foot between Apr. 2002 and Apr. 2020 were reviewed. Based on the connecting line of midpoints of the metatarsals, the sural neurofasciocutaneous flaps were divided into a forefoot group (flaps with furthest edges distal to the connecting line) and a peri-ankle group (flaps with the furthest edges proximal to the connecting line). RESULTS: The partial necrosis rate in the forefoot group (14.5%, 10/69) was significantly higher than that in the peri-ankle group (7.0%, 25/356), with significant difference (P<0.05). Using the flap alone or in combination with a simple salvage treatment, the ratio of successful coverages of the defects was 98.6% (68/69) in the forefoot group, and 97.8% (348/356) in the peri-ankle group, respectively, with no statistical difference (P>0.05). CONCLUSIONS The sural neurofasciocutaneous flap is a better choice for covering the soft tissue defects over the forefoot distal to the connecting line of midpoints of the metatarsal bones. The survival reliability of the sural neurofasciocutaneous flap reconstructing the soft tissue defect proximal to the connecting line is superior to that of the flap reconstructing the defect distal to the connecting line.
Ankle/surgery* ; Humans ; Reconstructive Surgical Procedures ; Reproducibility of Results ; Soft Tissue Injuries/surgery* ; Surgical Flaps

The study is designed to explore new methods of evaluation for teachers′ comprehensive ability in general medicine. In the whole education process of resident aiming at general practitioner (GP) residency post competency, the authors made comprehensive evaluation of GP faculty, and created a comprehensive GP faculty evaluation model of result orientation. The efforts aim at exploring and introducing faculty evaluation methods and promoting education quality, in order to develop outstanding GP residents of strong post competency.

Objective:To investigate the current status of medical record coders and their resignation tendency, and put forward suggestions for the training and team building of medical record coders.Methods:From April to May 2020, a questionnaire survey was conducted among the medical record coders in 27 DRG payment pilot hospitals in Anyang, Henan. Statistical analysis was conducted on the profile of the medical case department, basic personal information, professional quality, job satisfaction and resignation intention. Kendall coefficient was used to analyze the factors related to the resignation intention.Results:There were 98 coders in the surveyed hospitals, including 43 full-time coders and 55 part-time coders. Eighty-three valid questionnaires were recovered, and the effective recovery rate was 84.7%. Among them, 29(34.9%) had education level of junior college or below, 51(61.4%) had junior title or below, 15(18.1%) had medical information or case management as their major, 29(34.9%) coders had not obtained a coding certificate, 31(37.3%) were dissatisfied with the salary system, and 14(16.9%) had a tendency to leave. The medical record coders with lower professional titles, coding certificates and lower salary satisfaction were more likely to have the intention of resignation.Conclusions:Medical record coders in Anyang were challenged with such problems as shortage of manpower, low percentage of coding certificate holders and low salary satisfaction. Title, code certificate issuance and salary satisfaction were correlated with their resignation intention. Hospital managers should strengthen the importance of medical record coding and coders, and establish a reasonable salary, title evaluation and performance incentive system, so as to improve the attractiveness of coder position.

Objective To investigate effect of the application of misoprostol and oxytocin in full-term pregnancy induced labor with premature rupture of membranes.Methods From March 2016 to June 2017,95 pregnant women in term pregnancy induced labor with premature rupture of membranes in General Hospital of Taiyuan Iron&Steel (Group) CO.LTD were selected as the research objects,and they were randomly divided into study group and control group,the control group was given oxytocin,the study group was given misoprostol for induction of labor,then the effect,the total production process,delivery time,labor time,maternal and infant outcomes,the occurrence of adverse reactions of the two groups were observed.Results The total effective rate of pregnant women of the study group and the control group were 95.83％,78.72％,respectively,the difference was statistically significant (x2=7.136,P ＜ 0.05);The total production process,delivery time and labor time in the study group were (5.76 ±1.38)h,(9.39 ±3.44)h,(5.53 ± 1.51) h,respectively,which in the control group were (7.89 ± 1.67)h,(12.83 ±3.76)h,(7.56 ± 1.9 2)h,respectively,the research group's total stage of labor,delivery time,delivery time were shortened significantly compared with those of the control group (t =5.829,7.331,4.276,all P ＜ 0.05);The cesarean delivery,fetal distress and amniotic fluid contamination rates of the study group were 6.25％,8.33％,8.33％,respectively,which of the control group were 21.28％,31.91％,27.65％,respectively,the study group's cesarean section rate,fetal distress and amniotic fluid were significantly lower compared with those of the control group (x2 =6.936,10.185,7.429,all P ＜ 0.05).The incidence of abnormal uterine contraction,gastrointestinal reaction and tachycardia had not statistically significantly difference between the two groups (P ＞ 0.05).Conclusion Compared with oxytocin,misoprostol for full-term pregnancy with fetal membranes induction effect is more significant,which can shorten the birth process,improve maternal and child outcomes.So it is worthy of clinical promotion.

Objective To investigate the changes and clinical significance of Treg and Th17 cells in patients with ovarian endometrioma (OEM) pre-and post-laparoscopy.Methods 36 patients with OEM undergoing laparoscopic surgery and confirmed by the pathology were enrolled as the experiment group,and 25 patients with fallopian tube obstruction who received laparoscopic examination were enrolled as the control group.The peripheral blood samples were collected from the control group and the experiment group before operation as well as from the experiment group 3 months after operation.Intraoperative peritoneal fluid were also collected from both groups.The levels of IL-17,IL-22,IL-23,IL-10 and TGF-β in serum and peritoneal fluid were detected by ELISA.The proportion of Treg and Th17 cells in peripheral blood was detected by flow cytometry.Results Compared with the control group,the levels of IL-17,IL-22 and IL-23 in the peritoneal fluid and serum of the experiment group increased significantly,while the levels of IL-10 and TGF-β were significantly decreased (P＜0.05).The proportion of Th17 cells in the peripheral blood of the experiment group increased significantly,and the proportion of Treg cells decreased significantly (P＜0.05).Compared with pre-laparoscopic treatment,the serum IL-17,IL-22 and IL-23,and the proportion of Th17 cells in peripheral blood were significantly decreased in the experiment group,and the levels of IL-10 and TGF-β in serum increased significantly (P＜0.05).Conclusions In patients with OEM,Treg and Th17 cell imbalance and the expression of related cytokines in disorder may be an important factor in the occurrence and development of disease.Detection of Treg/Th17 cells and their cytokines plays an important role in evaluating the severity of the disease and judging the efficacy of laparoscopic treatment and prognosis of OEM.

Objective To investigate the effect of L-carnitine combined with psychological intervention on nutritional status and inflammatory status in maintenance hemodialysis patients. Methods 75 cases of maintenance hemodialysis patients treated in our hospital from September 2016 to December 2016 were randomly divided into control group(n=37) and study group(n=38)by single and double number method (hospital visit order). The control group in the hemodialysis treatment combined with Levocarnitine; the study group in the use of L-carnitine combined with psychological intervention. Results There were no significant differences in ALB, Hb, BMI, IL-6 and CRP between the two groups before treatment. After the corresponding treatment, the improvement of ALB, Hb, BMI, IL-6, CRP and other inflammatory indexes and nutritional indexes in the study group were better than those in the control group(P<0.05). Conclusion The application of L-carnitine in maintenance hemodialysis patients combined with psychological intervention can significantly improve the body's Micro inflammatory status and nutrition indicators, has positive significance to protect the patients' quality of life and physical and mental health.

Objective: To investigate the association between miR-146a single nucleotide polymorphism and genetic susceptibility to hepatocellular carcinoma (HCC). Methods: PubMed, Web of Science, Cochrane Library, Wanfang Data, and Google Scholar were searched for case-control studies on the association between miR-146a single nucleotide polymorphism and genetic susceptibility to HCC published up to October, 2016 in Chinese or English. The Q-statistics test was used to evaluate the heterogeneity of these articles. Results: A total of 18 articles with 5 610 cases and 7 531 controls were included for the meta-analysis. There was no significant association between miR-146a single nucleotide polymorphism and genetic susceptibility to HCC. The odds ratio (OR), 95% confidence interval (95% CI), and P values for the five genetic models were as follows: the allele model C/G (OR = 0.99, 95% CI 0.88-1.06, P = 0.440); the heterozygous model CG/GG (OR = 0.99, 95% CI 0.90-1.10, P = 0.898); the homozygous model CC/GG (OR = 0.91, 95% CI 0.75-1.10, P = 0.314); the dominant model CC+CG/GG (OR = 0.97, 95% CI 0.79-1.19, P = 0.759); the recessive model CG+GG/CC (OR = 1.05, 95% CI 0.94-1.18, P = 0.405). A subgroup analysis of race, source of control population, and Hardy-Weinberg equilibrium were performed in these five genetic models, and miR-146a single nucleotide polymorphism increased the susceptibility to HCC only in the control population-based subgroups of the recessive model CG+GG/CC (OR = 1.20, 95% CI 1.02-1.40, P = 0.024). There was no association between miR-146a rs2910164 polymorphism and susceptibility to HCC in all the other subgroups. A stratified analysis of HBV infection revealed that miR-146a rs2910164 polymorphism increased the risk of HBV-positive HCC (OR = 1.26, 95% CI 1.10-1.49, P = 0.001). Conclusion There is no significant association between miR-146a rs2910164 polymorphism and the risk of HCC, but miR-146a rs2910164 polymorphism may increase the risk of HBV-positive HCC.

Objective To understand the Oncomelania hupensis snail distribution in the working areas of Yangtze River hy?drologic agencies located in the middle and lower reaches of the Yangtze River in 2016,so as to provide the evidence for assess?ing the risk of schistosome infection of hydrological workers and establishing the control strategies. Methods The suspicious en?vironments with O. hupensis snails in the above working areas were selected as study areas,and the snail situation was surveyed by the system sampling method combined with the environmental sampling method. The survey data were collected and analyzed statistically. Results Totally 19 working areas from 17 hydrological agencies were selected as the investigation sites,among which,10 working areas from 9 agencies were found with O. hupensis snail distribution. The constituent ratio of the areas with snails reached to 38.81%of the investigation areas,the occurrence rate of frames with snails was 3.08%,and the average densi?ty of living snails was 0.07/0.1 m2. By comparison,the average density of living snails and occurrence rate of frames with snails in hydrological agencies under the jurisdiction of the Middle Reaches Administrative Bureau were the most serious among three administrative bureaus of the Yangtze River Water Resources Commission. Conclusions There are various degrees of O. hupen?sis breeding in the working areas of hydrological agencies located in the middle and lower reaches of the Yangtze River ,and the hydrological workers are facing with the risk of schistosome infection.