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.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Humans ; Atrial Fibrillation/surgery* ; Left Atrial Appendage Closure ; Heart Atria/surgery* ; Catheter Ablation/methods* ; Atrial Appendage/surgery* ; Treatment Outcome

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

In the past ten years, the research and application of microbiome has continued to increase. The microbiome has gradually become the research focus in the fields of life science, environmental science, and medicine. Meanwhile, many countries and organizations around the world are launching their own microbiome projects and conducting a multi-faceted layout, striving to gain a strategic position in this promising field. In addition, whether it is scientific research or industrial applications, there has been a climax of research and a wave of investment and financing, accordingly, products and services related to the microbiome are constantly emerging. However, due to the rapid development of microbiome sequencing and analysis related technologies and methods, the research and application from various countries have not yet unified on the standards of technology, programs, and data. Domestic industry participants also have insufficient understanding of the microbiome. New methods, technologies, and theories have not yet been fully accepted and used. In addition, some of the existing standards and guidelines are too general with poor practicality. This not only causes obstacles in the integration of scientific research data and waste of resources, but also gives related companies unfair competition opportunity. More importantly, China still lacks national standards related to the microbiome, and the national microbiome project is still in the process of preparation. In this context, the experts and practitioners of the microbiome worked together and developed the consensus of experts. It can not only guide domestic scientific research and industrial institutions to regulate the production, learning and research of the microbiome, the application can also provide reference technical basis for the relevant national functional departments, protect the scale and standardized corporate company's interests, strengthen industry self-discipline, avoid unregulated enterprises from disrupting the market, and ultimately promote the benign development of microbiome-related industries.
China ; Consensus ; Humans ; Industry ; Microbiota

Objective:To investigate the application value of 3D printing technology in preoperative evaluation of laparoscopic radical resection of right colon cancer.Methods:The prospective study was conducted. The clinical data of 60 patients with right colon cancer who were admitted to the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University from January to November of 2019 were collected. Patients were randomly divided into two groups by random number method. All the 60 patients were examined by plain scan and enhanced X-ray computed tomography (CT) preoperatively. Patients with vascular images printed into a 1∶1 full simulation entity using the 3D printing technology were divided into 3D printing group, and patients who only completed the plain scan and enhanced CT examination were divided into control group. All the 60 patients underwent laparoscopic complete mesocolic excision for right colon cancer. Observation indicators: (1) anatomic courses of Henle trunk of the 3D printing group in the preoperative 3D printing models and their consistency with intraoperative anatomic courses; (2) intraoperative and postoperative situations of two groups. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent-sample t test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Results:A total of 60 patients were selected for eligibility, including 42 males and 18 females, aged (64±7)years, with a range from 44 to 78 years. Of the 60 patients, 30 were in the 3D printing group and 30 were in the control group. (1) Anatomic courses of Henle trunk of the 3D printing group in the preoperative 3D printing models and their consistency with intraoperative anatomic courses: Henle trunk was observed in 28 of the 30 patients in the 3D printing group. Of the 28 patients, 7 had the gastropancreatic trunk of 2 branches formed with the right gastroepiploic vein and the superior anterior pancreaticoduodenal vein, 13 had the gastrocolonic trunk of 2 or 3 branches formed with the right gastroepiploic vein, the middle colonic vein and (or) the right colonic vein (including 4 cases with gastrocolonic trunk of 2 branches formed with the right gastroepiploic vein and the middle colonic vein, 6 cases with gastrocolonic trunk of 2 branches formed with the right gastroepiploic vein and the right colonic vein, 3 cases with gastrocolonic trunk of 3 branches formed with the right gastroepiploic vein, the middle colonic vein and the right colonic vein), 8 had the gastropancreaticocolonic trunk of 3 or 4 branches formed with the right gastroepiploic vein, the superior anterior pancreaticoduodenal vein, the right colonic vein and (or) the middle colonic vein (including 4 cases with gastropancreaticocolonic trunk of 3 branches formed with the right gastroepiploic vein, the superior anterior pancreaticoduodenal vein and the middle colonic vein, 2 cases with gastropancreaticocolonic trunk of 3 branches formed with the right gastroepiploic vein, the superior anterior pancreaticoduodenal vein and the right colonic vein, 2 cases with gastropancreaticocolonic trunk of 4 branches formed with the right gastroepiploic vein, the superior anterior pancreaticoduodenal vein, the right colonic vein and the middle colonic vein). The consistency of anatomic courses of Henle trunk of the 28 patients in the preoperative 3D printing models with intraoperative anatomic courses of bared Henle trunk was 100%(28/28). (2) Intraoperative and postoperative situations of two groups: the operation time, volume of intraoperative blood loss, the numbers of lymph node dissected, cases with postoperative complications (cases with incision infection, cases with intestinal obstruction, cases with anastomotic leakage, cases with pulmonary infection), postoperative duration of hospital of the 3D printing group were (147±18)minutes, (79±29)mL, 19.1±2.8, 3 (1, 1, 0, 1), (9.0±2.5)days, respectively. The above indicators of the control group were (172±16)minutes, (118±17)mL, 15.6±2.6, 4(1, 1, 1, 1), (9.1±2.6)days, respectively. There were significant differences in the operation time, volume of intraoperative blood loss, the numbers of lymph node dissected between the two groups ( t=-5.630, -18.400, 3.318, P<0.05), and there was no significant difference in the cases with postoperative complications and postoperative duration of hospital between the two groups ( χ2=0.875, t=0.103, P>0.05). Conclusion:For laparoscopic right colon cancer radical resection, 3D printing technology can effectively evaluate the preoperative vascular anatomic courses, which can shorten operation time, reduce volume of intraoperative blood loss and improve the number of lymph node dissected. Trial Registration: This study was registrated at Chinese Clinical Trail Registry with the registration number of ChiCTR1800017161.

Objective: To explore the value of computed tomography angiography (CTA) and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer. Methods: The retrospective and descriptive study was conducted. The clinicopathological data of 60 patients who underwent laparoscopic radical resection of rectal cancer in the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University from February 2018 to March 2019 were collected. There were 39 males and 21 females, aged from 45 to 81 years, with an average age of 67 years. All patients underwent abdominal multi-slice spiral computed tomography (CT) plain scan and dual-phase enhanced scan before operation. The original CT images were observed by multiplanar reconstruction and performed three-dimensional (3D) reconstruction of blood vessels by volume rendering. The CT images of arterial vessels with large density difference were abstracted by threshold segmentation and direct abstraction, and the CT images of venous vessels with small density difference were abstracted by region growing method. Then the 3D images of blood vessels were obtained after image fusion with red and blue pseudocolor added. All the 60 patients were performed laparoscopic radical resection of rectal cancer by the same surgical team, and were identified inferior mesenteric artery (IMA) and branches after being bared vessels, including anatomic course of left colonic artery (LCA), sigmoid artery (SA), and superior rectal artery (SRA). Observation indicators: (1) anatomic courses of IMA, LCA, SA, and SRA on the 3D images and their consistency with intraoperative anatomic courses; (2) the first branch of IMA and the distances from the root of IMA to the first branch and from the root of IMA to bifurcation point of the abdominal aorta on 3D images of blood vessels; (3) the spatial relationship between the horizontal level of LCA and the inferior mesenteric vein (IMV) on the 2D CT images and 3D images of blood vessels. Measurement data were represented as Mean±SD, and count data were represented as absolute numbers and percentages. Results: (1) Anatomic courses of IMA, LCA, SA and SRA on the 3D images and their consistency with intraoperative anatomic courses: of the 60 patients, 31 (51.7%) had type Ⅰ anatomic course of IMA on the 3D images, with LCA and SA from the common trunk; 9 (15.0%) had type Ⅱ, with LCA and SA from the common trunk; 18 (30.0%) had type Ⅲ, with LCA, SA, and SRA from the common trunk; 2 (3.3%) had type Ⅳ, with no LCA. The consistency of anatomic courses of IMA, LCA, SA, and SRA on the 3D images with intraoperative anatomic courses of bared IMA, LCA, SA, and SRA was 100.0%(60/60). (2) The first branch of IMA and the distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels: of the 60 patients, 49 (81.7%) had LCA as the first branch of IMA, 11 (18.3%) had SRA or SA as the first branch of IMA. The distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels were (41±6)cm and (42±7)cm. (3) The spatial relationship between the horizontal level of LCA and the IMV on the 2D CT images and 3D images of blood vessels: two patients of type Ⅳ were excluded from the 60 patients. On the 2D CT images of the rest 58 patients, 39 (67.2%) had LCA adjacent to IMV and 19 (32.8%) had LCA distal to IMV at the horizontal level of IMA root. On the 3D images of blood vessels in the rest 58 patients, 37 (63.8%) had the LCA located at the ventral side of IMV, and 21 (36.2%) had the LCA located at the dorsal side of the IMV. Conclusion Muiti-slice CTA and image fusion technology can visually display the anatomic course and variation of IMA and its branches, which has high clinical application value.

Objective: To investigate the application value of ω-3 fish oil fat emulsion in the parenteral nutritional support treatment following radical gastrectomy for gastric cancer. Methods: The retrospective cohort study was conducted. The clinical data of 60 patients who underwent radical gastrectomy for gastric cancer in Nanjing Medical University Affiliated Wuxi Second Hospital between January 2018 and December 2018 were collected. There were 37 males and 23 females, aged from 28 to 78 years, with an average age of 64 years. Thirty patients who received parenteral nutrition containing 100 mL of ω-3 fish oil fat emulsion after radical gastrectomy and 30 patients who received parenteral nutrition containing routine fat emulsion after radical gastrectomy were allocated into experimental group and control group, respectively. Observation indicators: (1) nutritional indicators in the perioperative period; (2) inflammatory indicators in the perioperative period; (3) immune indicators in the perioperative period; (4) postoperative complications. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was evaluated using the independent-sample t test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Repeated measurement data were analyzed by the repeated measures ANOVA. Results: (1) Nutritional indicators in the perioperative period: the levels of total protein, albumin, prealbumin, and transferrin from preoperative day 1 to preoperative day 6 were respectively changed from (60.2±3.0)g/L to (57.2±3.1)g/L, from (35.3±3.1)g/L to (37.0±1.8)g/L, from (186±24)mg/L to (172±17)mg/L, from (3.0±0.7)g/L to (2.4±0.4)g/L in the experimental group and from (60.6±2.4)g/L to (55.7±4.2)g/L, from (35.0±3.8)g/L to (36.0±3.8)g/L, from (184±18)mg/L to (173±25)mg/L, from (3.1±0.6)g/L to (2.2±0.8)g/L in the control group, with no significant difference in the changing trends between the two groups (F=0.79, 2.14, 0.03, 0.36, P>0.05). (2) Inflammatory indicators in the perioperative period: the levels of white blood cells, C-reactive protein, interleukin 6, and tumor necrosis factor-α from preoperative day 1 to preoperative day 6 were respectively from (7.2±1.1)×10⁹/L to (10.2±0.9)×10⁹/L, from (7.2±2.3)mg/L to (25.5±6.3)mg/L, from (16±3)ng/L to (24±4)ng/L, from (17±4)ng/L to (22±5)ng/L in the experimental group and from (7.4±0.8)×10⁹/L to (13.0±1.3)×10⁹/L, from (6.9±2.4)mg/L to (41.6±18.9)mg/L, from (17±4)ng/L to (45±8)ng/L, from (16±4)ng/L to (43±7)ng/L in the control group, respectively, with significant differences in the changing trends between the two groups (F=63.05, 51.65, 127.82, 104.91, P<0.05). (3) Immune indicators in the perioperative period: the levels of immunoglobulin A, immunoglobulin G, immunoglobulin M, CD4⁺, CD8⁺, and ratio of CD4⁺ /CD8⁺ from preoperative day 1 to preoperative day 6 were respectively from (1.5±0.4)g/L to (2.8±0.5)g/L, from (11.1±1.7)g/L to (14.0±1.2)g/L, from (0.77±0.28)g/L to (1.61±0.31)g/L, from 42%±6% to 46%±5%, from 23%±4% to 24%±3%, from 1.82±0.42 to 2.11±0.24 in the experimental group and from (1.4±0.4)g/L to (2.3±0.6)g/L, from (10.7±1.8)g/L to (11.9±1.4)g/L, from (0.69±0.23)g/L to (1.19±0.33)g/L, from 40%±5% to 39%±4%, from 24%±3% to 23%±3%, from 1.75±0.34 to 1.81±0.35 in the control group, respectively, showing significant differences in the changing trends of the levels of immunoglobulin A, immunoglobulin G, immunoglobulin M, CD4⁺, and ratio of CD4⁺ /CD8⁺ between the two groups (F=18.39, 15.20, 38.42, 9.55, 5.50, P<0.05), showing no significant difference in the changing trend of the levels of CD8⁺ between the two groups (F=0.89, P>0.05). (4) Postoperative complications: 5 patients had postoperative complications, with a incidence rate of 16.7%(5/30), including 1 of abdominal infection, 1 of incisional infection, and 3 of pulmonary infection, and all the 5 patients were cured after symptomatic treatment. Nine patients had postoperative complications, with a incidence rate of 30.0%(9/30), including 2 of abdominal infection, 2 of incisional infection, and 5 of pulmonary infection, and all the 9 patients were cured after symptomatic treatment. There was no significant difference in the incidence of postoperative complications between the two groups (χ²=1.491, P>0.05). Conclusion For patients who receive gastric cancer surgery, ω-3 fish oil fat emulsion can reduce the inflammatory response, improve their immune function and not increase postoperative complications.

Objective To investigate the expression of DDX46 protein in colorectal cancer and its correlation with expressions of C-erbB-2, Ki-67, p53 and nm23 proteins. Methods A total of 149 cases of colorectal cancer tissues and 45 adjacent mucosa tissues after operation in the Wuxi No.2 Hospital Affiliated to Nanjing Medical University from January 2010 to December 2012 were collected. The expressions of DDX46 protein and C-erbB-2, Ki-67, p53 and nm23 proteins in tissues of colorectal cancer were detected by using immunohistochemistry. The relations between the expression level of DDX46 protein and the clinicopathological features including the age, gender, tumor differentiation, tumor infiltration, lymph node metastasis, TNM stage were analyzed, and the relations between DDX46 protein expression and expressions of C-erbB-2, Ki-67, p53 and nm23 proteins were also analyzed. Results Of 149 colorectal cancer tissues, 50 (33.6％) showed low expressions of DDX46 protein and 99 (66.4％) showed high expressions. Of 45 adjacent mucosa tissues, 37 (82.2％) showed low expressions of DDX46 protein, and 8 (17.8％) showed high expressions. There were significant differences between the high expression rate of DDX46 protein in cancer tissues and adjacent mucosa tissues (χ2=33.09, P<0.01). There were statistical differences in the expression level of DDX46 protein and tumor differentiation, tumor infiltration, lymph node metastasis, TNM staging (all P<0.05). The ratio of high-expressed DDX46 protein was increased with the low differentiation, high invasion degree, lymph node metastasis and late TNM staging. DDX46 protein expression was correlated with expressions of Ki-67, p53 and nm23 proteins (all P< 0.05), and the expression of DDX46 protein had a positive correlation with expressions of Ki-67 and p53 proteins (r values were 0.161 and 0.347), and a negative correlation with expression of nm23 protein (r= -0.561). Conclusions The high expression of DDX46 protein in colorectal cancer tissues is related with malignant biological behavior of the tumors and the key oncogenes. DDX46 protein could be regarded as the potential marker for the diagnosis and molecular targeting therapy of colorectal cancer.

Objective To observe the distribution and variation of right colonic vessels,and investigate the clinical value of computed tomography angiography (CTA),computed tomography colonography (CTC) and image fusion technology in preoperative evaluation of laparoscopic right colonic cancer (RCC).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 38 patients who underwent laparoscopic extended radical resection of RCC + D3 lymphadenectomy in the Affiliated Wuxi Second People's Hospital of Nanjing Medical University between January 2015 and July 2017 were collected.Patients received preoperative plain and enhanced scans of abdominal and pelvic CT.The original images were reconstructed and fused by CTA and CTC,and then coming out with three-dimensional images of blood vessels and gut.Observation indicators:(1) branches of superior mesenteric artery (SMA);(2) positional relationship between SMA and superior mesenteric vein (SMV);(3) composition of gastrocolic venous trunk.Results Scan images of 38 patients had fused with scan images of vessels and primary tumors and reached the diagnostic standard,with a good imaging performance.Distribution of blood vessels of virtual reality (VR) images and were compared with that of naked blood vessels under intraoperative laparoscopy,showing a coincidence rate of 100.0％ (38/38).(1) Branches of SMA:results of CTA and intraoperative anatomy showed that the occurrence rate of the right colonic artery,middle colonic artery and ileocolic artery were respectively 94.7％ (36/38),92.1％ (35/38) and 100.0％ (38/38).A right colonic artery was found in 28 patients.Ten patients had structure variation of right colonic artery,including 3 with 2 right colonic arteries and 2 without right colonic artery.The right colonic artery and middle colonic artery merged into the same trunk and then flowed into SMA were detected in 2 patients;the right colonic artery and ileocolic artery merged into the same trunk and then flowed into SMA were detected in 3 patients.(2) Positional relationship between SMA and SMV:results of CTA and intraoperative anatomy showed that the occurrence rate of both SMA and SMV was 100.0％ (38/38).The SMA in 20 patients was located in the ventral side of SMV;SMA in 18 patients was located in the dorsal side of SMV.(3) Composition of gastrocolic venous trunk:results of CTA and intraoperative anatomy showed that 29 of 38 patients had gastrocolic venous trunks,which belonged to four sources,including right colonic vein,middle colonic vein,fight gastric epiploic vein and anterior superior pancreaticoduodenal vein.Among 29 patients,18 had 2-or 3-branch type of gastrocolic trunk that consisted of the right gastric epiploic vein,middle colonic vein and right colonic vein;3 had 2-branch type of gastric pancreatic trunk that consisted of the right gastric epiploic vein and anterior superior pancreaticoduodenal vein;8 had 3-or 4-branch type of stomach-pancreas-colon trunk that consisted of right gastric epiploic vein,anterior superior pancreaticoduodenal vein,right colonic vein and middle colonic vein.Conclusion CTA,CTC and image fusion technology can intuitively show the anatomy and variation of right colonic vessels,with a high clinical value.