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.

Diabetes mellitus is a disease characterized by absolute or relative lack of insulin, which leads to hyperglycemia, and its high mobidity and complications have a great impact on the lives of patients. Animal models are widely used to study the pathogenesis and treatment of diabetes and its complications. Different types of diabetes, with different pathogenesis and pathognomonic features, have different treatment options. In animal experimental, in addition to considering the genetic factors and physiological characteristics of the animal (such as sex and age), it is also necessary to consider the experimental protocol and various response options, which have a great impact on the experimental data, the reproducibility and stability of the experimental results. Therefore, it is necessary to select suitable animal models for experiments in the study of diabetes. Type 1 diabetes is characterized by absolute insulin deficiency, and existing mouse models of type 1 diabetes include chemically (STZ-induced) induced and spontaneous diabetes model (NOD mice), etc. Type 2 diabetes, characterized by insulin resistance and impaired glucose tolerance, is established in both obese and non-obese animal models, including diet-induced (high-fat diet induced), spontaneous diabetes (including monogenic and polygenic obese mice) models, and genetically modified mouse models. In this review, we discussed the common types of diabetic mouse models and analyzed the elements of their construction, the key factors that should be considered in the selection of diabetic mouse models, and explore the impact of these factors on the research of diabetes.

【Objective】 To evaluate the protective effect of siNLRP3-loaded nanosystem on diabetic cardiomyopathy (DCM) via silencing NLRP3 under ultrasound-targeted microbubble blasting (UTMD). 【Methods】 After synthesis of polyethylene glycol polylysine block copolymer (mPEG-b-PLLys), siNLRP3-loaded hetero-assembled nanosystem system (siNLRP3-NBs) was constructed and characterized. Subsequently, a DCM rat model was established to investigate the protective effect of siNLRP3-NBS on the heart. Cardiac function of the rats was observed by small animal ultrasonography. HE and Masson staining were used to observe the degree of myocardial fibrosis change; the protein expression of NLRP3 and cell pyroptosis indexes were detected by Western blotting. 【Results】 ¹H NMR indicated that the structure of mPEG-b-PLLys was correct. The results of agarose electrophoresis showed that NBs could protect naked siNLRP3 from RNAase degradation, and the particle size and zeta potential of siNLRP3-NBs were (379.7±14.8) nm and (8.73±1.93) mV, respectively. The shape of NBs was almost spherical. siNLRP3-NBs combined with UTMD could enhance the protective effect on cardiac function and improve myocardial fibrosis in DCM rats. Protein expression indicated that UTMD could enhance the inhibitory effect of siNLRP3-NBS on cardiomyocyte pyroptosis. 【Conclusion】 UTMD-mediated ultrasonic response combined nanosystem can enhance the therapeutic effect of siNLRP3 on DCM, suggesting that ultrasonic response siNLRP3-loaded nanosystem is a potentially effective strategy for the treatment of heart disease.

Objective To investigate and compare the predictive value of 2 prediction scoring systems for diagnosis of coronary heart disease (CHD) in patients with suspected symptom, and provide information for diagnosis and therapy. Methods By prospectively studying a database of 272 patients with suspected CHD,the total score was calculated by prediction scoring system including PROCAM (The Prospective Cardiovascular Munster Study) and SCP(Suspected CHD Prediction Scoring System) with the data of clinic parameters and risk factors. All patients received coronary angiography and they were categorized into the CHD group (n =94) and non CHD group ( =178) according to the angiography result. The relationship between total scores and the SYNTAX score was evaluated by Spearman analysis and the value of the prediction scoring system was evaluated by the ROC (receiver operating characteristic) system. Results The score of PROCAM was from 6. 00 -77. 00(41. 76 ± 19. 91), and the score was significantly correlated with the extent and severity of coronary artery atherosclerosis (rs = 0. 420,P = 0. 023). The score of SCP was from 1. 00 - 13. 00(8. 64 ± 3. 42), and it was significantly correlated with the SYNTAX score (rs = 0. 482,P = 0. 016). The areas under ROC was 0. 770 (P = 0. 007) in PROCAM and that was 0. 733 (P = 0. 012) in SCP. Conclusions The nature and extent of coronary artery atherosclerosis could be evaluated by the scoring system effectively,which had a good correlation with CAG result.

Objective To investigate the effect of extremely high temperature and high humidity exposure on the survival and blood biochemical indexes of SD rats and the to the major organs .Methods Twenty-six SD rats were divided into the normal tem-perature and humidity group and the extremely high-temperature and high-humidity group .The mortality of SD rats in extremely high-temperature and high humidity environment was observed ,and at the median lethal time ,the living rats were undergoing the tests of serum biochemical indicators and the pathological examination of the heart ,lung ,kidney ,brain ,muscles and intestinal tis-sues .Results The exposure to the extremely high-temperature and high-humidity environment could lead to the death of SD rats , the median lethal time was 48 h .The serum creatinine(Scr) increased significantly(P<0 .05) ,and the serum alkaline phosphatase (ALP) and ischemia modified albumin (IMA) decreased significantly (P<0 .05) when compared with the normal temperature and humidity group ,and there was no significant difference in other biochemical indicators .The inflammatory cell infiltration was ob-served in heart ,lung ,kidney and intestines ,and there were no obvious pathological changes in brain and muscle .Conclusion The exposure to the extremely high-temperature and high-humidity environment has obvious lesion on SD rats ,it can lead to the abnor-mality of some biochemical indicators ,the inflammatory changes in heart ,lung ,kidney and intestines ,and even death .

Objective Excimer laser coronary atherecomy ( ELCA) has been recently used for the treatment of complex coronary lesions including calcified stenosis , chronic total occlusions and in-stent restenosis. Such complex lesions are difficult to adequately treat with balloon angioplasty and /or intracoronary stenting.The aim of this study was to introduce our early experiences in using ELCA in China . Methods Fifteen patients were enrolled through our center from March 2015 to April 2016 , and excimer laser coronary angioplasty was performed on 15 lesions.Eleven patients were previously failed cases either from uncrossable balloon ( 9 lesions ) or expandable balloon ( 6 lesions ) . The procedure and clinical endpoints were recorded .Results Laser catheter with 0.9 mm diameters were used in all 15 coronary lesions.All the lesions were successfully crossed with laser catheter and finally dilated with balloon .The procedural success rate was 100%.Drug eluting stents ( DES ) were implanted in 86.7% lesions and 2 cases were treated with drug eluting balloon .Clinical success was obtained in all patients (100%).There was no dissection , major side branch occlusion , spasm, no-reflow phenomenon nor acute vessel closure . Conclusions This study shows that laser-facilitated coronary angioplasty is a simple , safe and effective device for the management of complex coronary lesions .

Objective To investigate serum level of thymidine kinase 1 (TK1) in middle-aged and elderly people in high humidity area,and explore the high risk age of cell abnormal proliferation and the cause.Methods Serum level of TK1 was measured with enhanced chemiluminescence in 128 cases aged 49-89 years living in the region with an average humidity of 83％.People were divided into control group (n =52,aged 49-59 years) and experimental group (n=76,aged 60 years and over).Results Serum TK1 level was lower in control group than in the experimental group [(1.3894±0.504) pmol/L vs.(1.6518±0.8685) pmol/L,t=2.159,P＜0.05].There was no significant difference in positive rate of TK1 between control and experimental groups (9.62 ％ vs.18.42％,x2 =1.894,P＞0.05).Experimental group was subgrouped into three age groups:aged 60-69 years,70 79 years and 80 89 years group.In the three age groups,serum TK1 levels were (1.7854 ±0.9736) pmol/L,(1.5345 ± 0.7039) pmol/L and (1.4420 ± 0.7354) pmol/L respectively.Compared with control group,serum TK1 level was increased in aged 60-69 years group (t=2.369,P ＜0.05),with no significant difference in serum TK1 level between control group and the other two age groups (all P＞0.05).Meanwhile,there was no significant difference in serum TK1 level among the three age groups (all P＞0.05).Conclusions Serum TK1 concentration is higher in elderly people than in middle-aged people,which shows that the abnormal cell proliferation is higher in elderly people than in middle-aged people.We should pay more attention to physical examination in the elderly people aged 60-69 years.

PURPOSE5.12 Wenchuan earthquake and 4.25 Nepal earthquake are of the similar magnitude, but the climate and geographic environment are totally different. Our team carried out medical rescue in both disasters, so we would like to compare the different traumatic conditions of the wounded in two earthquakes.

METHODSThe clinical data of the wounded respectively in 5.12 Wenchuan earthquake and 4.25 Nepal earthquake rescued by Chengdu Military General Hospital were retrospectively analyzed. Then a contrast study between the wounded was conducted in terms of age, sex, injury mechanisms, traumatic conditions, complications and prognosis.

RESULTSThree days after 5.12 Wenchuan earthquake, 465 cases of the wounded were hospitalized in Chengdu Military General Hospital, including 245 males (52.7%) and 220 females (47.3%) with the average age of (47.6±22.7) years. Our team carried out humanitarian relief in Katmandu after 4.25 Nepal earthquake. Three days after this disaster, 71 cases were treated in our field hospital, including 37 males (52.1%) and 34 females (47.9%) with the mean age of (44.8±22.9) years. There was no obvious difference in sex and mean age between two groups, but the age distribution was a little different: there were more wounded people at the age over 60 years in 4.25 Nepal earthquake (p<0.01) while more wounded people at the age between 21 and 60 years in 5.12 Wenchuan earthquake (p<0.05). The main cause of injury in both disasters was bruise by heavy drops but 5.12 Wenchuan earthquake had a higher rate of bruise injury and crush injury (p<0.05) while 4.25 Nepal earthquake had a higher rate of falling injury (p<0.01). Limb fracture was the most common injury type in both disasters. However, compared with 5.12 Wenchuan earthquake, 4.25 Nepal earthquake has a much higher incidence of limb fractures (p<0.01), lung infection (p<0.01) and malnutrition (p<0.05), but a lower incidence of thoracic injury (p<0.05) and multiple injury (p<0.05). The other complications and death rate showed no significant differences.

CONCLUSIONMajor earthquakes of the similar magnitude can cause different injury mechanisms, traumatic conditions and complications in the wounded under different climate and geographic environment.When an earthquake occurs in a poor traffic area of high altitude and large temperature difference, early medical rescue, injury control and wounded evacuation as well as sufficient warmth retention and food supply are of vital significance.

Adult ; Aged ; Earthquakes ; Female ; Humans ; Male ; Middle Aged ; Nepal ; Prognosis ; Wounds and Injuries ; epidemiology

Objective To investigate the carriage of nuc-mecA gene among different altitudes in high humidity district,provid-ed guiding data for prevention of staphylococcus aureus and drug-resistant bacteria,standardizing the usage for antibiotics. Methods The nose swabs were collected in different altitudes:1 000 m,1 200 m and 1 400 m,nuc-mecAgene was confirmed by multi-channel real-time PCR.Results The carrier of nuc gene in the noses were 4.878%,2.899% and 7.143%,in 1 000 m,1 200 m and 1 400 m respectively,and there were no statistical significant among the altitudes (P>0.05).The carrier of mecA gene were 14.634%,31.884% and 41.837% in the 1 000 m,1 200 m and 1 400 m respectively,the difference showed statistical significe (P<0.05).The carrying rate of mecA gene showed statistically significant differences between 1 000 m and 1 200 m (P<0.05),and showed statistically significant differences between 1 000 m and 1 400 m (P<0.01)also.The carrier of nuc-mecA gene were 0%,1.449% and 3.061% in 1 000 m,1 200 m and 1 400 m respectively,there were no statis-tical significant (P>0.05).Conclusion The carrier of mecA gene in noses was increased with the increasing of the altitude. The residents who living at higher altitude should keep the colonization sites of pathogens clean,and needed timely medical when got sick,shouldn’t abuse the antibiotics without authorization.Medical staff should rational use of antibiotic drugs,a-voided overusing of antibiotics and overtreatment.

Objective To compare the serum pepsinogen (PG)in different altitude population.Methods By testing serum PG of people from different altitudes,detected the concentration of serum PG.Results The serum PGI,serum PGII and PGR were respectively 136.89±22.64 μg/L,10.05 ± 5.14 μg/L and 13.07 ± 7.41 in 1 000 m group,and they were 30.87 ± 48.66 μg/L,11.55±2.78 μg/L and 12.89±4.76 in 1 300 m group.There were significant difference in PGI and PGII(P <0.05)except PGR (P >0.05)between the two groups.The corresponding indices in 1500m group (126.64±29.84 μg/L, 12.18±5.99 μg/L and 12.2±14.84,respectively),the serum PGI was decreased obviously compared with those groups (P<0.05),the serum PGII was increased obviously compared with those groups (P < 0.05),No significant difference was found when compared with those groups (P >0.05).The serum PGI was negative correlated with higher altitudes,the ser-um PGII was positively correlated with higher altitudes.Conclusion The study found that the serum PGI content would re-duce with the increase of altitude,and on the contrary the serum PGII would rise with the increase of altitude.The main rea-son that the serum PG change may be influenced by oxygen partial pressure.