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 therapeutic potential of therapeutic plasma exchange (TPE) combined with continuous venovenous hemofiltration (CVVH) in the treatment of children with severe sepsis and multiple organ dysfunction syndrome (MODS).Methods:It was a prospective randomized controlled study (RCT) involving 70 children with severe sepsis and MODS admitted to Anyang Maternal and Child Health Hospital from February 2019 to February 2023.According to random number table method, they were randomly divided into combination group (35 cases) and CVVH group (35 cases). Patients in the CVVH group were treated with CVVH alone, and those in the combination group were treated with TPE combined with CVVH.The antibiotic use time of the two groups was recorded and compared by the t test.The prothrombin time (PT), thrombin time (TT), partial prothrombin time (APTT), fibrinogen (FIB), and serum levels of interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α), high mobility group protein B1 (HMGB1), Toll-like receptor 4 (TLR4) and soluble receptor (sFLT) levels before treatment and 48 h and 72 h after treatment were compared by the repeated measurement ANOVA for the overall comparison at multiple time points, and LSD- t test for pair-wise comparison.The 28-day survival of the two groups was recorded and compared by the Chi- square test. Results:The PT, TT and APTT at 48 h and 72 h after treatment were significantly lower in the combination group than those of CVVH group (all P<0.05). The FIB at 48 h[(2.15±0.42) g/L vs.(1.84±0.31) g/L]and 72 h after treatment [(2.89±0.27) g/L vs.(2.49±0.20) g/L]were significantly higher in the combination group than those of CVVH group (all P<0.05). The duration of antibiotic use in the combination group was significantly shorter than that of CVVH group [(11.33±1.16) d vs.(13.54±1.92) d, t=5.828, P<0.05]. Serum levels of IL-1β, IL-6 and TNF-α at 48 h and 72 h were significantly lower in the combination group than those of CVVH group (all P<0.05). Serum levels of HMGB1, TLR4 and sFLT at 48 h and 72 h were significantly lower in the combination group than those of CVVH group (all P<0.05). The 28-day survival of the combination group was significantly higher than that of CVVH group (94.29% vs.77.14%, χ2=4.200, P=0.040). Conclusions:TPE combined with CVVH can improve the coagulation function and inflammatory factor levels in children with severe sepsis and MODS, which may achieve therapeutic objectives by regulating the levels of HMGB1, TLR4 and sFLT, and improve the short-term prognosis.

Objective:To evaluate the changes of cortisol and sIgA in serum and saliva of rats under different stresses and pressures, so as to provide a basis for screening non-invasive stress monitoring indicators in high-pressure working environment.Methods:A total of 54 rats were divided into six groups exposed to different air pressures of 0 kPa, 175 kPa, 350 kPa, 500 kPa, 600 kPa, and 700 kPa, respectively. According to different stress conditions, another 36 rats were divided into physiological stress group (PSSG), psychological stress group (PCSG), physiological and psychological stress group (PPSG), and blank group (BG), with 9 rats in each group. At the end of the experiment, serum sample was collected and supernatant was taken from the sublingual gland tissue homogenate. Cortisol and sIgA levels in saliva and serum were determined by radioimmunoassay and enzyme-linked immunosorbent assay (ELISA).Results:The concentrations of SIgA in group 500 kPa, 600 kPa, and 700 kPa were significantly different ( F=10.961, P<0.001; F=4.693, P=0.001; F=4.353, P=0.003). The serum cortisol levels in group 175 kPa, 350 kPa, and 600 kPa were significantly higher than that in group 0 kPa, while the serum cortisol level in group 350 kPa was significantly higher than those in group 500 kPa and 700 kPa. The cortisol concentrations of sublingual gland tissues in group 350 kPa and 700 kPa were significantly higher than those in group 0 kPa, 500 kPa, and 600 kPa. Under different stress conditions, serum sIgA concentrations in PCSG, PSSG, and PPSG were significantly lower than that in BG ( F=4.852, P=0.007; F=4.918, P=0.007; F=3.967, P=0.017). The levels of serum and sublingual cortisol in PCSG and PPSG were significantly higher than those in BG, while the levels of serum and sublingual cortisol in PSSG were significantly lower than those in PCSG. Relevant research results showed that the changes of salivary gland cortisol and serum cortisol were positively correlated under different stress conditions ( r=0.609, P<0.01). Conclusion:Cortisol as a stress monitoring indicator has good effectiveness, and using saliva as an indicator to monitor stress under high pressure environment has a certain degree of feasibility.

Objective:To evaluate the changes of cortisol and sIgA in serum and saliva of rats under different stresses and pressures, so as to provide a basis for screening non-invasive stress monitoring indicators in high-pressure working environment.Methods:A total of 54 rats were divided into six groups exposed to different air pressures of 0 kPa, 175 kPa, 350 kPa, 500 kPa, 600 kPa, and 700 kPa, respectively. According to different stress conditions, another 36 rats were divided into physiological stress group (PSSG), psychological stress group (PCSG), physiological and psychological stress group (PPSG), and blank group (BG), with 9 rats in each group. At the end of the experiment, serum sample was collected and supernatant was taken from the sublingual gland tissue homogenate. Cortisol and sIgA levels in saliva and serum were determined by radioimmunoassay and enzyme-linked immunosorbent assay (ELISA).Results:The concentrations of SIgA in group 500 kPa, 600 kPa, and 700 kPa were significantly different ( F=10.961, P<0.001; F=4.693, P=0.001; F=4.353, P=0.003). The serum cortisol levels in group 175 kPa, 350 kPa, and 600 kPa were significantly higher than that in group 0 kPa, while the serum cortisol level in group 350 kPa was significantly higher than those in group 500 kPa and 700 kPa. The cortisol concentrations of sublingual gland tissues in group 350 kPa and 700 kPa were significantly higher than those in group 0 kPa, 500 kPa, and 600 kPa. Under different stress conditions, serum sIgA concentrations in PCSG, PSSG, and PPSG were significantly lower than that in BG ( F=4.852, P=0.007; F=4.918, P=0.007; F=3.967, P=0.017). The levels of serum and sublingual cortisol in PCSG and PPSG were significantly higher than those in BG, while the levels of serum and sublingual cortisol in PSSG were significantly lower than those in PCSG. Relevant research results showed that the changes of salivary gland cortisol and serum cortisol were positively correlated under different stress conditions ( r=0.609, P<0.01). Conclusion:Cortisol as a stress monitoring indicator has good effectiveness, and using saliva as an indicator to monitor stress under high pressure environment has a certain degree of feasibility.

Objective:To evaluate the effects of different high pressure on the behavior and physiological indexes of hypothalamic-pituitary-adrenal axis (HPA) in rats, so as to provide a theoretical basis for the stress protection in decompression process.Methods:The rats were divided into four groups according to the random number table method and were separately exposed to air pressure of 0 kPa, 170 kPa, 350 kPa and 700 kPa for 60 mins and given decompression for 45 mins. The behaviors of rats were analyzed by animal open field method and video analysis system of the open field immediately after they were taken from the air pressure chamber, and the contents of adrenocorticotrophic hormone (ACTH) and glucocorticoid (GC) in the serum were measured by the enzyme-linked immunosorbent assay (ELISA).Results:Under different pressure, compared with the 0 kPa group, the total distance traveled by the rats ( F=3.354), the average traveling speed ( F=3.358), the number of standing times and standing time duration ( F=3.739; F=33.332) of the rats in the other 3 groups decreased significantly. The distance traveled in the corner of the 175 kPa group and the 700 kPa group decreased significantly ( F=3.532), while their cleaning time significantly increased ( F=4.581). The standing times and the cleaning time of the 350 kPa group were significantly less than those of the 700 kPa group. All the differences above showed statistical significance ( P<0.05). After exposure to different pressure, the ACTH level of the 175 kPa group was higher than those of the 0 kPa group and the 350 kPa group ( F=5.309) with statistical significance ( P<0.05). The GC level of the 0 kPa group was significantly lower than those of the other 3 groups, and the GC level of the 700 kPa group was especially lower than that of the 175 kPa group, with statistically significant difference ( P<0.05). Conclusion:High pressure exposure at all levels can cause definite stress reaction, and the stress reactions do not correlate with the pressure gradient. Within the physiological bearable range of stress under high pressure, the individual stress level may present a certain steady state. The individual′s behavioral response, ACTH and GC levels may be used as indicators for stress monitoring.

Objective:To evaluate the effects of different high pressure on the behavior and physiological indexes of hypothalamic-pituitary-adrenal axis (HPA) in rats, so as to provide a theoretical basis for the stress protection in decompression process.Methods:The rats were divided into four groups according to the random number table method and were separately exposed to air pressure of 0 kPa, 170 kPa, 350 kPa and 700 kPa for 60 mins and given decompression for 45 mins. The behaviors of rats were analyzed by animal open field method and video analysis system of the open field immediately after they were taken from the air pressure chamber, and the contents of adrenocorticotrophic hormone (ACTH) and glucocorticoid (GC) in the serum were measured by the enzyme-linked immunosorbent assay (ELISA).Results:Under different pressure, compared with the 0 kPa group, the total distance traveled by the rats ( F=3.354), the average traveling speed ( F=3.358), the number of standing times and standing time duration ( F=3.739; F=33.332) of the rats in the other 3 groups decreased significantly. The distance traveled in the corner of the 175 kPa group and the 700 kPa group decreased significantly ( F=3.532), while their cleaning time significantly increased ( F=4.581). The standing times and the cleaning time of the 350 kPa group were significantly less than those of the 700 kPa group. All the differences above showed statistical significance ( P<0.05). After exposure to different pressure, the ACTH level of the 175 kPa group was higher than those of the 0 kPa group and the 350 kPa group ( F=5.309) with statistical significance ( P<0.05). The GC level of the 0 kPa group was significantly lower than those of the other 3 groups, and the GC level of the 700 kPa group was especially lower than that of the 175 kPa group, with statistically significant difference ( P<0.05). Conclusion:High pressure exposure at all levels can cause definite stress reaction, and the stress reactions do not correlate with the pressure gradient. Within the physiological bearable range of stress under high pressure, the individual stress level may present a certain steady state. The individual′s behavioral response, ACTH and GC levels may be used as indicators for stress monitoring.