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 diagnosis and treatment strategy of the portal vein complications in children undergoing split liver transplantation. Methods The clinical data of 88 pediatric recipients who underwent split liver transplantation were retrospectively analyzed. Intraoperative anastomosis at the bifurcating site of the portal vein or donor iliac vein bypass anastomosis was performed depending on the internal diameter and development of the recipient's portal vein. A normalized portal venous blood stream monitoring was performed during the perioperative stage. After operation, heparin sodium was used to bridge warfarin for anticoagulation therapy. After portal vein stenosis or thrombosis was identified with enhanced CT or portography, managements including embolectomy, systemic anticoagulation, interventional thrombus removal, balloon dilatation and/or stenting were performed. Results Among the 88 recipients, a total of 10 children were diagnosed with portal vein complications, of which 4 cases were diagnosed with portal vein stenosis at 1 d, 2 months, 8 months, and 11 months after surgery, and 6 cases were diagnosed with portal vein thrombosis at intraoperative, 2 d, 3 d (n=2), 6 d, and 11 months after surgery, respectively. One patient with portal vein stenosis and one patient with portal vein thrombosis died perioperatively. The fatality related to portal vein complications was 2% (2/88). Of the remaining 8 patients, 1 underwent systemic anticoagulation, 2 underwent portal venous embolectomy, 1 underwent interventional balloon dilatation, and 4 underwent interventional balloon dilatation plus stenting. No portal venous related symptoms were detected during postoperative long term follow up, and the retested portal venous blood stream parameters were normal. Conclusions The normalized intra- and post-operative portal venous blood stream monitoring is a useful tool for the early detection of portal vein complications, the early utilization of useful managements such as intraoperative portal venous embolectomy, interventional balloon dilatation and stenting may effectively treat the portal vein complications, thus minimizing the portal vein complication related graft loss and recipient death.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective To explore the clinical value of micro ribonucleic acid(miR)-27a and miR-1299 in predicting the long-term prognosis of patients with esophageal cancer.Methods A total of 89 patients with esophageal cancer in the hospital were enrolled between June 2020 and June 2022,and all underwent Minimally invasive thoracic and laparoscopic resection of esophageal cancer.The expression levels of miR-27a and miR-1299 were detected by real-time fluorescence quantitative polymerase chain reaction(PCR)before surgery,and level of serum ferritin(SF)was detected by enzyme linked immunosorbent assay.The relationship between miR-27a,miR-1299,SF and clinicopathology in patients with esophageal cancer was analyzed.All were followed up till February 2023 after surgery,and survival of patients was record.The relationship between miR-27a,miR-1299,SF and prognosis was analyzed.The risk factors of long-term prognosis in patients with esophageal cancer were analyzed by multivariate Cox regression model.The relationship between miR-27a,miR-1299 and serum SF was analyzed by Pearson.Results There were significant differences in miR-27a,miR-1299 and serum SF among patients with different tumor staging,lymph node metastasis and differentiation degree(P＜0.05).The results of survival analysis showed that overall survival rates in high-expression miR-27a and SF groups were lower than those in low-expression miR-27a and SF groups(P＜0.05),while which was higher in high-expression miR-1299 group than low-expression miR-1299 group(P＜0.05).Cox regression analysis showed that miR-27a ≥2.54,miR-1299＜4.18 and serum SF ≥223.78 μg/L(P＜0.05)were independent risk factors of postoperative long-term prognosis of patients with esophageal cancer.Pearson correlation analysis showed that level of serum SF was positively correlated with relative expression level of miR-27a(P＜0.05,r=0.612),while negatively correlated with relative expression level of miR-1299(P＜0.05,r=-0.517).Conclusion The miR-27a,miR-1299 and serum SF are related to tumor staging,lymph node metastasis and differentiation degree in patients with esophageal cancer,which can be applied to evaluate postoperative long-term prognosis.

Objective: To explore the association of health literacy with smoking attempt behavior among middle school students in China，and to provide ideas for health education for middle school students. Methods: Using stratified cluster sampling method, 1 066 students were selected from Zhejiang, Guangdong, Jiangxi, Sichuan and Guizhou provinces in China during June to November 2017, a questionnaire survey was conducted to collect health literacy and smoking attempt behavior. Results: The score of health literacy among middle school students was (13.49±1.87). Students who lived in eastern and rural areas, girls, guardians who were jointly supervised by their parents and grandparents, the only child, non smokers, and small amount of weekly pocket money had higher scores in health literacy（ t/F =9.81,3.10,11.12,2.65,3.50,4.47,2.64， P ＜0.05）. The prevalence of smoking attempt behavior was 5.5%. Multiple Logistic regression analyses showed that central and western China, drinking and low healthy literacy were positively correlated with smoking attempt behavior ( OR =2.75, 3.54, 21.62, 2.50, P <0.05). Conclusion Low healthy literacy can be used as a predictor of smoking attempt among middle school students, the health education should be conducted to control the smoking attempt behavior.

Objective: To explore the association between incidence of injuries and health related behavior among middle school students in China, to provide evidence for injury prevention. Methods: A questionnaire survey was conducted among 1 067 students who were selected from Zhejiang, Guangdong, Jiangxi, Sichuan and Guizhou provinces by using stratified random cluster sampling method. Chi square test and multiple Logistic regression analyses were used to analyze incidence of injuries and health related behavior. Results: The prevalence of self injury among middle school students in five provinces was 11.0%, the prevalence of intentional injury was 13.2%. Multiple Logistic regression analyses showed that attempting smoking, not eating breakfast every day, having a low mood more than 2 weeks in the past 6 months were positively correlated with self injury ( OR=3.02, 2.04, 4.30, P ＜0.01) after adjusting for region, and the smoking attempt behavior was positively correlated with intentional injury ( OR=2.03, P ＜0.05) after adjusting for region, urban and rural, residence condition, weekly allowance condition. Conclusion Smoking attempt behavior could be viewed as a shared predictor for both self injury and intentional injury behavior among middle school students, smoking control intervention should be carried out actively among students.

Objective: To explore the association of screen time with self-injury behavior in primary school students in China, to provide evidence for prevention on self-injury behavior. Methods: From June to November in 2017, 1 090 primary school students were selected by stratified cluster sampling method from Zhejiang, Guangdong, Jiangxi, Sichuan and Guizhou province in China, to analyze the association between screen time and incidence of self-injury. Results: Totally 5.6% students reported screen time over 2 hours per day, boy, rural students, students with low health literacy, ever drinking had a higher rate of screen overuse(χ 2=12.35, 6.94, 6.86, 16.86, P<0.05). The prevalence of screen overuse varied significantly by amount of pocket money(P<0.01). The prevalence of self-injury was 11.3%, students from western areas, boy, grade three, from rural area, adult relatives as guardians, low health literacy, smoking, drinking and screen time over 2 hours per day had a higher rate of self-injury behavior(χ 2=27.31, 11.49, 23.91, 22.12, 15.11, 55.16，19.03, 25.16, 19.35, P<0.05). Compared with the students with screen time less than 2 hours per day, multiple Logistic regression analyses showed that, the OR(95%CI) values of self-injury was 2.62(1.31-5.23) among students with screen time less than 2 hours per day. Conclusion The risk of self-injury behavior is related to screen time in primary school students, specific health education should be conducted to reduce screen time.

Objective To investigate the application value of transjugular liver biopsy (TJLB) in the diagnosis and treatment of complicated and severe liver diseases. Methods A retrospective analysis was performed for the clinical data of 31 patients who underwent TJLB in The Fifth Medical Center of Chinese PLA General Hospital, including indication for puncture, success rate, and final diagnosis. Results Among the 31 patients, there were 15 male patients and 16 female patients. Percutaneous liver biopsy was unsuitable for 8 patients with liver failure and disturbances of blood coagulation, 13 with liver cirrhosis and ascites, and 10 with liver cirrhosis and thrombocytopenia (< 50×10 9 /L), which were the indications for TJLB. The success rate of TJLB puncture was 100%, with 2-4 passes for puncture. No serious adverse event was observed. Of all 31 patients, 26 (83.87%) had a definite diagnosis at discharge, among whom there were 5 patients with idiopathic portal hypertension, 9 patients with drug-induced liver failure or liver cirrhosis, 5 patients with autoimmune liver disease, and 7 patients with liver cirrhosis or liver failure due to other causes, and 5 patients had unknown etiology. In addition, 3 patients underwent biopsy to confirm the diagnosis and decision of whether liver transplantation should be performed. Conclusion TJLB plays an important role in the diagnosis and treatment of complicated and severe liver diseases and still has certain limitations, and therefore, suitable patients should be selected in clinical practice.

Objective: To investigate the association of health literacy and incidence of self-injury, intentional injury in primary and middle school students in China, to provide guidance for prevention on self-injury and intentional injury in adolescence. Methods: From June to November in 2017, a total of 2 173 primary and middle school students were selected by stratified cluster sampling method from Zhejiang, Guangdong, Jiangxi, Sichuan and Guizhou province in China, The association between health literacy with incidence of self-injury, intentional injury was analyzed. Results: The score of health literacy among 2 173 students was(13.13±2.27), with primary school students (12.79±2.55) lower than middle school students (13.49±1.88) (t=-7.29，P<0.05), the prevalence of self-injuries was 11.1%, primary school students was 11.3% which was similar with that of middle school students was 11.0% (χ2=0.06，P>0.05), the prevalence of intentional injury was 17.8%, the primary school students was 22.4% which was significantly higher than that of middle school students (13.2%) (χ2=31.31，P<0.05). Compared with the students with high health literacy, multiple Logistic regression analyses showed that, the OR(95%CI) values of self-injury, intentional injury were 2.38(1.78-3.20) and 1.45(1.11-1.88). Conclusion The risk of self-injuries and intentional injury of primary and middle school students was related to health literacy, the health education should be conducted to improve their health literacy.