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 relationship between spicy diet and uremic pruritus(UP)in the patients with maintenance haemodialysis(MHD).Methods A total of 403 patients receiving the treat-ment in the blood purification center of this hospital from December 2023 to February 2024 were selected as the study subjects and grouped by the sum of the scores of frequency and degree of pepper intake.The visual analogue rating scale(VAS)was used to conduct the preliminary pruritus score in all patients,and the pa-tients with the score＞0 point conducted the multidimensional evaluation by the 14-item uremic skin pruritus scale.The blood routine and itch-related blood biochemical indexes levels of all patients were measured.Results There were 65 cases in the bland diet group,119 cases in the mild spicy diet group and 219 cases in the spicy diet group,and there was no significant difference in the number of genders between the groups(P＞0.05).There were statistically significant differences in age,dialysis age and lymphocyte count among the groups(P＜0.05).There was no statistically significant difference in the degree of pruritus among the groups(Z=9.301,P=0.157),but it was seen that the proportion of moderate and severe pruritus in the mild spicy diet group and the spicy diet group was decreased,and the proportions of no pruritus and mild pruritus showed the increasing trend.The itching score of the bland diet group was higher than that of the mildly spicy diet group and spicy diet group,and the difference was statistically significant(P＜0.05),but there was no statistically significant difference between the mild spicy diet group and spicy diet group(P＞0.05).There was a statistically significant difference in the itch score of the patients aged 40-60 years in each group(P＜0.05),and there was no statistically significant difference in the itch score between the patients aged＞60 years old and＜40 years old in each group(P＞0.05).There was no statistically significant difference in the itch-related blood biochemical indexes among the groups(P＞0.05).Conclusion The spicy diet may reduce the degree of pruritus in patients with MHD,moreover which is not affected by the age and other factors,and may be associated with lymphocyte level decrease in the patients.

Background Preterm birth-related complications are the leading cause of death in newborns and children under the age of 5 years. Maternal heat exposure has been associated with both sleep status during pregnancy and the increased risk of preterm birth. However, whether sleep status could mediate the association between heat exposure and preterm birth remains unclear. Objective To evaluate the association between maternal heat exposure in early pregnancy and preterm birth, and to further explore potential mediation effect of sleep status on the association between heat exposure and preterm birth. Methods A birth cohort was established in Guangzhou Panyu Maternal Child Health Hospital (Guangzhou Panyu District He Xian Memorial Hospital) from 2017 until now. Pregnant women (with gestational age between 8 and 13 weeks) were included in this study when they presented to the hospital for their first prenatal care visit and signed an informed consent. Then they were followed up until delivery. A total of 3 268 pregnant women were included for the final analysis. Questionnaires were distributed to collect the demographic characteristics, lifestyles, and sleep status of pregnant women. Daily meteorological data during the study period were collected from meteorological monitoring stations in Guangzhou and the average ambient mean temperature of four weeks before the survey was calculated and assigned for each pregnancy. The 75th, 80th, 85th, 90th, and 95th percentiles (P₇₅, P₈₀, P₈₅, P₉₀, and P₉₅) of the average ambient temperature of all pregnant women were used as the thresholds to define heat exposure. Logistic regression was used to evaluate the effects of heat exposure in different definitions on preterm birth and sleep status (sleep duration, night sleep timing, and wake up timing). The mediation effects of sleep status on the relationship between heat exposure and preterm birth were also analyzed. Results Among all the included participants, 165 newborns were preterm births with an incidence rate of 5.0%. Heat exposures with thresholds of P₉₀ and P₉₅ increased the risk of preterm birth, with ORs (95%CIs) of 1.66 (1.04-2.57) and 1.90 (1.03-3.33), respectively (P<0.05). Heat exposures with thresholds of P₇₅, P₈₀, P₈₅, P₉₀, and P₉₅ decreased the sleep duration (<9 h vs. ≥9 h, control group: ≥9 h), and the ORs (95%CIs) were 1.51 (1.25-1.83), 1.44 (1.17-1.77), 1.35 (1.08-1.70), 1.43 (1.09-1.87), and 1.45 (1.00-2.13), respectively. Heat exposures with P₇₅ and P₈₀ thresholds resulted in earlier wake up timing (<8: 00 vs. ≥8: 00, control group: <8: 00), with ORs (95%CIs) of 0.77 (0.63-0.93) and 0.76(0.61-0.93), respectively. No significant association was observed between heat exposure and night sleep timing. The mediation analyses showed that under heat exposure with P₉₀ threshold, a statistically significant mediation effect was observed for sleep duration, and the proportion mediated was 6.07% (95%CI: 0.17%-25.00%) (P<0.05). No significant mediation effect was observed for night sleep timing and wake up timing. Conclusion An elevated risk of preterm birth after heat exposure in early pregnancy may be partly mediated through reducing sleep duration.

Objective: To analyze the medical care seeking of local and non-local pulmonary tuberculosis (TB) patients in Beijing from 2016 to 2021 and provide evidence for TB prevention and control in Beijing. Methods: The reported pulmonary TB data from 2016 to 2021 were collected from tuberculosis management information system and standard code management system of Chinese information system for disease control and prevention. The map data were obtained from the Institute of Geographic Sciences and Natural Resources Research. Excel 2016, SPSS 19.0, Python 3.9 and ArcGIS 10.6 softwares were used for data analysis and visualization for the inter-provincial mobility and inter-district mobility of pulmonary TB patient's medical care seeking in Beijing. Results: Among the reported pulmonary TB patients in Beijing from 2016 to 2021, 35.27%(24 307/68 926) were from 30 provinces (autonomous regions, municipalities) and Xinjiang Production and Construction Corps. The top 5 provinces with pulmonary TB patients medical care seeking in Beijing were Hebei (39.58%,9 620/24 307), Shanxi (8.82%,2 145/24 307), Inner Mongolia Autonomous Region (8.66%,2 105/24 307), Heilongjiang (6.95%,1 690/24 307) and Henan (6.88%,1 672/24 307). Patients from these 5 provinces accounted for 70.89% (17 232/24 307) of total pulmonary TB patients from other provinces. The pulmonary TB patients from other provinces mainly flowed to Tongzhou district of Beijing, accounting for 46.72% (11 356/24 307). These pulmonary TB patients mainly visited grade Ⅲ (A) hospitals, such as Beijing Chest Hospital of Capital Medical University with the highest proportion of 44.76% (10 880/24 307). Among pulmonary TB patients with current residence in Beijing, those sought medical care in other districts accounted for 55.06% (24 566/44 619). The outflow and inflow of TB cases' medical care seeking occurred in 16 districts of Beijing. The median proportion of cross district medical care seeking in 16 districts was 59.30% (56.05%, 65.13%). The inflow of the medical care seeking in Tongzhou, Haidian and Xicheng district was greater than the outflow, and the outflow was greater than the inflow in the other 13 districts. The pulmonary TB patients in Beijing mainly went to Beijing Chest Hospital in Tongzhou for medical care seeking, accounting for 42.18%(18 822/44 619). Conclusions: The proportions of non-local pulmonary TB patients seeking medical care in Beijing from 2016 to 2021 and local pulmonary TB patients seeking medical care in other districts in Beijing were high, and the hospitals where non-local pulmonary TB patients and local pulmonary TB patients sought medical care respectively belonged to grade Ⅲ (A) and municipal designated medical institutions of TB.
Humans ; Tuberculosis, Pulmonary/therapy* ; Hospitals ; Asian People ; China/epidemiology* ; Chlorhexidine

Objective:To understand the spatiotemporal distribution of pulmonary tuberculosis (TB) and influencing factors in Beijing from 2008 to 2018.Methods:The incidence data of pulmonary TB in Beijing from 2008 to 2018 were from Tuberculosis Information Management System of Chinese Disease Prevention and Control Information System. Software ArcGIS 10.2 was used to visualize the spatiotemporal distribution of pulmonary TB incidence. Getis's G i* statistic was applied to analyze the spatial clustering of pulmonary TB incidence at street/township scale. Bayesian spatiotemporal model was applied to analyze factors affecting its spatiotemporal distribution, including urbanization rate, GDP per capita, number of hospital beds per thousand population, permanent migrant population and population density. Results:The reported pulmonary TB incidence showed a downward trend in the past 11 years in Beijing, from 58.64/100 000 to 30.43/100 000. The incidences were higher in Tongzhou, Changping and other newly developed urban districts, with the hot spots concentrated in local areas of these districts. The incidences of pulmonary TB were lower in Dongcheng, Xicheng and other old urban districts-with the cold spots also concentrated in these area. The risk for the incidence of pulmonary TB was associated with the urbanization rate and the permanent migrant population. For every 1% increase in the urbanization rate, the relative risk of pulmonary TB would increase by 1%. For every 10 000 person increase of permanent migrant population, the relative risk of pulmonary TB would increase by 0.6%.Conclusions:In Beijing, the current pulmonary TB prevention and control needs to be focused on the newly developed urban areas. Due to the accelerated process of urbanization, it is necessary to strengthen TB prevention and control in permanent migrant population to reduce the incidence of TB in Beijing.

Objective:To investigate the expression level of serum ficolin-3 (FCN3) in breast cancer patients and its relationship with prognosis.Methods:A total of 145 patients with breast cancer (the breast cancer group) who were treated in Boao Evergrande International Hospital from February 2014 to February 2016 and 148 healthy women during the same period (the healthy control group) were selected. The level of FCN3 was detected by using enzyme-linked immunosorbent assay (ELISA); the serum carbohydrate antigen 153 (CA153) level of the two groups was detected by using automatic electrochemiluminescence immunoassay; the diagnostic value of serum FCN3 for breast cancer was evaluated by using receiver operating characteristic curve (ROC). The relationship between the level of serum FCN3 and the clinicopathological characteristics of breast cancer patients was analyzed. Kaplan-Meier method was used to analyze and compare the 3-year overall survival rate of breast cancer patients with different serum FCN3 levels.Results:Serum FCN3 level in breast cancer group was (14.1±3.4) μg/ml, which was higher than that in the healthy control group [(9.1±3.0) μg/ml], and the difference was statistically significant ( t = 13.644, P < 0.01). The serum CA153 level in breast cancer group was (36.3±15.2) U/ml, which was higher than that in the healthy control group [(16.8±6.9) U/ml], and the difference was statistically significant ( t = 14.397, P < 0.01). The area under the curve (AUC) of serum FCN3 and CA153 for the diagnosis of breast cancer was 0.894 and 0.720, respectively. The AUC of combined detection of serum FCN3 and CA153 for the diagnosis of breast cancer was 0.909, which was higher than that of CA153 alone ( Z = 2.050, P = 0.040), but compared with FCN3 alone, the difference was not statistically significant ( Z = 0.157, P = 0.875). Serum FCN3 level in stage Ⅲ breast cancer patients was higher than that in stage Ⅰ and Ⅱ patients, and serum FCN3 level in stage Ⅱ patients was higher than that in stage Ⅰ patients (all P < 0.05). The breast cancer patients with lymph node metastasis had higher serum FCN3 level compared with those patients without lymph node metastasis ( P < 0.05). The 3-year overall survival rate of breast cancer patients in the low-level FCN3 group (≤12.07 μg/ml) was higher than that in the high-level group (>12.07 μg/ml) ( P = 0.033). Conclusion:Serum FCN3 is up-regulated in breast cancer patients, which is expected to be a potential index for diagnosis and prognosis evaluation of breast cancer.

Objective: There is no effective therapy for patients with advanced medullary thyroid carcinoma (MTC). Vandetanib,a novel multitargeted receptor tyrosine kinase inhibitor, has previously shown antitumor activity in phase Ⅱ studies of patients with advanced MTC. This study was to evaluate the efficacy and the safety of vandetanib on advanced MTC. Methods: This study was an open, international multi-center phase Ⅲ clinical trial and the study number was NCT01298323. The single-center study was a sub-group analysis of the international study, which was conducted on 9 pathologically confirmed advanced MTC patients by Cancer Hospital Chinese Academy of Medical Sciences between March 2012 and October 2017. Vandetanib (300 mg) was orally administered daily till death or withdrawal. The efficacy was evaluated according to RECIST criteria and the adverse events were evaluated according to NCI criteria. Results: The objective response rate was 3/9,and the disease control rate was 4/9. The median progression-free survival was 44 months. All patients who had the elevated levels of calcitonin (CTN) and carcino-embryonic antigen (CEA) before treatment began to show the decreases in the level of CTN and CEA after 3 months and later showed again the increases in the levels of both tumor markers with tumor progression. By ROC curve analysis, CTN was of statistically significance(P<0.05, 95%CI 0.558-0.834), but CEA was not(P>0.05). Adverse events were generally mild (grade 1 or 2),including hypertension (9 cases),skin rash (9 cases), and diarrhea (6 cases). Two patients developed grade 3 elevation of serum glutamate pyruvate transaminase and one patient developed grade 3 elevation of drug-related bowel disease. No grade 4 drug-related adverse event occurred. Conclusions Vandetanib is effective and well tolerated for patients with locally advanced or metastatic MTC who have no chance for surgery. This indicates the increase of CTN is clinically relevant to disease progression, but the number of patients are extremely low, and, therefore further research is needed. Long-term use of vandetanib may cause resistance.

Objective To retrospectively investigate the characteristics of background parenchymal enhancement(BPE)in the contralateral breast following neoadjuvant chemotherapy(NAC)and whether BPE could help predict tumor response in early stage of advanced breast cancer. Methods Data from 161 patients who were diagnosed with unilateral breast cancer and then underwent NAC before surgery were analyzed retrospectively from August 2014 to December 2016.All the patients underwent both bilateral breast MRI scan with contrast enhancement. Two experienced radiologists independently categorized the patients' levels of BPE into four categories (1=minimal, 2=mild, 3=moderate, 4=marked) at baseline and after the 2nd cycle of NAC. All the patients were divided in to pathologic complete response (pCR) group and non-pCR group according to the histopathologic tumour response.The status of estrogen receptor(ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) were recorded before underwent NAC.The t test and Pearson chi-squared test were used to compare the baseline characteristics of the pCR and Non-pCR groups.The kappa test was used to test the inter-observer agreement.The Wilcoxon test was used to test for changes of BPE categories after NAC.The Mann-Whitney U test was used to test the difference of BPE between pre-and post-menopausal status. Associations were evaluated using Binary logistic regression models. Results Fifty nine patients achieved pCR, and 102 patients had residual disease (non-pCR). Age, tumor size, distribution of size, menopausal status and lymph node showed no significance between pCR and non-pCR groups(all P>0.05),while only ER/PR status and HER2 status had a significant difference (P>0.05 in both). Inter-observer agreement regarding BPE categorization was moderate and substantial before and after NAC(Kappa value 0.644 and 0.708).The level of BPE was higher in premenopausal than post-menopausal women both at baseline and after the 2nd cycle of NAC(P<0.01). Decreased BPE was observed in 106 cases(premenopausal 60 cases and postmenopausal 46 cases),and no change in BPE were observed in 55 cases (premenopausal 27 cases and postmenopausal 28 cases). A significant reduction in BPE was observed after the 2nd NAC cycle in the overall cases, pre-and post-menopausal cases (all P<0.01). Logistic model showed that hormonal receptor (HR) negative and HER-2 receptor at baseline and the change of BPE after NAC were the independent factors for predicting pCR. Conclusions Regardless of the menopausal status, BPE showed a reduction after NAC, and it can serve as an additional imaging biomarker of tumour response at an early stage of NAC.

Objective To identify the significance of serum phospholipase A2 receptor antibody (PLA2R-Ab) in idiopathic membranous nephropathy (IMN) patients.Methods A total of 108 patients diagnosed as IMN by medical history,physical examination,laboratory examination and renal biopsy in Tongji Hospital affiliated to Tongji Medical College,Huazhong University of Science and Technology between Dec 1,2014 and Aug 31,2017 were enrolled,and all related data were recorded.According to the results of serum PLA2R-Ab test,patients were divided to positive group and negative group,and the data were compared with the independent sample t test and the chi-square test.Kaplan-Meier survival analysis was performed to compare remission rates between groups,and the Logrank method was used to evaluate the significance of differences.Univariate and multivariate Cox regression analysis were used to verify predicting factors for achieving remission.Results Overall,67.6％(73/108) patients had detectable serum PLA2R-Ab.Compared with patients in negative group,patients in positive group exhibited higher proportion of male patients (P=0.002),lower level of serum albumin (P ＜ 0.001),higher level of cholesterol (P ＜ 0.001),lower level of immunoglobulin G (P ＜0.001),higher level of proteinuria (P=0.003),a lower of chance of remission (P=0.049),longer time needed to achieve partial remission (P=0.001) and complete remission (P=0.002).The 1-and 2-year cumulative renal partial remission rates were 72.4％,86.1％,and the cumulative renal complete remission rates were 43.8％,54.0％,respectively.Patients in negative group had higher partial remission (x2=9.84,P=0.002) and complete remission (x2=15.50,P＜0.001) than those in positive group.Multivariate Cox regression model indicated that serum positive PLA2R-Ab was a significant independent risk factor.Conclusions IMN patients with serum PLA2R-Ab show more severe condition and lower remission rates than those without serum PLA2R-Ab.Serum positive PLA2R-Ab is an independent remission-related predictor for IMN patients.

Objective: To explore the application effect of tarso-conjunctival flap for one-stage repairing eyelid posterior defect after resection of eyelid tumors. Methods: From June 2014 to December 2016, 33 patients with 33 cases of eyelid posterior tumors were treated, including 21 cases of Pigmented nevus of eyelid, 7 cases of eyelid basal cell carcinoma, 3 cases of eyelid adenocarcinoma and 2 cases of eyelid squamous cell carcinoma. Direct resection was performed for eyelid nevus, Mohs method (intraoperative delivery of frozen sections to control the cut edge) resection was performed for malignant tumors. According to the scope and location of the defect, the tarso-conjunctival flap was used to repair the posterior defect of the eyelid, and the eyelid anterior defect was treated with local flap transfer. Results: All 33 patients were followed up for 3 to 24 months. In addition to the absence of eyelashes in the defect area, one case had mild blepharoptomy (1 mm) and recovered after self-recovery. The remaining cases had recovered in appearance and function of eyelid with no serious complications. Conclusions The flexible application of tarso-conjunctival flap can basically solve the problem of repairing eyelid posterior defect after resection of eyelid tumors. The operation method has clinical practical value.