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 observe the expression and trends of tight junction proteins Occludin and zonula occlu-den-1(ZO-1)in blood-brain barrier(BBB)of rats with traumatic brain injury(TBI),and to explore the interven-tion effect of cannabidiol(CBD)on the BBB.Methods The TBI model of rat was prepared by modified"Feeney free fall method"and randomly divided into three groups:the sham-operated group(Sham group),the model group(TBI+vehicle group)and the CBD intervention group(TBI+CBD group),with 24 rats in each group.Each group was subdivided into six time points:8 h,1,2,3,5 and 7 d after injury.The expression of Occludin and ZO-1,which are closely related to the permeability of BBB,was detected by immunohistochemistry,immuno-fluorescence staining and Western blot at different points.The permeability of BBB was detected by sodium fluores-cein assay.Results The results of immunohistochemistry showed that compared with Sham group,the positive ex-pression of Occludin and ZO-1 decreased with time after brain trauma(P<0.05),and both reached the lowest level at 2 d.The expression levels of Occludin and ZO-1 were up-regulated after 1 d of CBD intervention(P<0.05).Immunofluorescence staining showed a similar trend to Western blot results,with Occludin and ZO-1 fluo-rescence expression intensity and protein expression reduced after TBI compared with Sham group(P<0.05).And the expression levels of Occludin and ZO-1 were up-regulated after 2 d of CBD intervention(P<0.05).The results of fluorescein sodium experiment showed that the BBB integrity of brain tissue was destroyed after TBI,and the permeability increased after TBI(P<0.01).The permeability of BBB decreased after CBD intervention(P<0.05).Conclusion The expression of tight junction proteins Occludin and ZO-1 decreases after TBI,and the permeability of BBB is disrupted,and CBD intervention reverses the disruption of the BBB by TBI.

Objective To investigate testicular damage in traumatic brain injury(TBI)rats and to analyze the in-terventional effects of cannabidiol(CBD)on TBI-induced testicular damage.Methods 18 Sprague Dawley(SD)rats were randomly divided into three groups:the sham operation group(Sham group),model group(TBI group)and treatment group(TBI+CBD group).HE staining was used to observe the testicular histopathological changes in the rat testis.ELISA was used to detect testosterone level in rat serum.TUNEL staining was utilized to observe apoptosis,while immunofluorescence staining,Western blot and RT-qPCR were employed to evaluate Bax,Bcl-2,Cleaved Caspase-3 and TNF-α protein and mRNA expression.Results HE staining showed pathological changes in the testes of TBI rats compared with those in the Sham group.ELISA assay showed a decrease in testosterone levels in the TBI group compared to the Sham group,but there was no significant difference(P＞0.05).Immunofluores-cence results showed that the intensity of Bax fluorescence expression increased in the TBI group compared with the Sham group(P＜0.01),whereas the intensity of Bax fluorescence decreased and the intensity of Bcl-2 fluorescence increased in the rats after the CBD intervention(P＜0.01).Western Blot results showed that CBD treatment in rats decreased the protein levels of testicular apoptosis-related proteins(Bax and Cleaved Caspase-3,all P＜0.05)and inflammation-related proteins(TNF-α,P＜0.01),and increased the protein level of the anti-apoptotic protein,Bcl-2(P＜0.05).The trend of RT-qPCR results was similar,with mRNA expression of Bax(P＜0.05)and TNF-α(P＜0.01)decreased and mRNA expression of Bcl-2 increased after CBD intervention compared with the TBI group(P＜0.05).Conclusion TBI induces testis injury,and CBD treatment effectively repairs apoptosis and in-flammatory in testicular tissue of TBI rats.

Background::Copper and zinc are involved in the development of multiple malignancies; yet, epidemiological evidence on hepatocellular carcinoma (HCC) is limited. This study aimed to investigate the association between dietary intake and serum levels of copper and zinc with the risk of HCC.Methods::A total of 434 case-control pairs matched for sex and age (±1 year) were included in this study. Cases with newly diagnosed HCC were from the Guangdong Liver Cancer Cohort (GLCC) study, and healthy controls were from the Guangzhou Nutrition and Health Study (GNHS). A semi-quantitative 79-item food frequency questionnaire (FFQ) was used to assess habitual dietary intakes of copper and zinc. Serum levels of copper and zinc were measured by using inductively coupled plasma mass spectrometry. The copper (Cu)/ zinc (Zn) ratio was computed by dividing copper levels by zinc levels. Conditional logistic regression models were performed to calculate the odds ratio (OR) and 95% confidence intervals (CI) for per 1 standard deviation increase (per-SD increase) in copper and zinc levels.Results::Higher dietary intake (OR per-SD increase = 0.65, 95% CI: 0.44, 0.96, Ptrend = 0.029) and serum levels of zinc (OR per-SD increase = 0.11, 95% CI: 0.04, 0.30, Ptrend <0.001) were both associated with a lower risk of HCC. Subgroup analyses showed that the inverse association was only pronounced in men but not in women ( Pinteraction = 0.041 for dietary zinc intake and 0.010 for serum zinc levels). Serum copper levels (OR per-SD increase = 2.05, 95% CI: 1.39, 3.03, Ptrend = 0.020) and serum Cu/Zn ratio (OR per-SD increase = 6.53, 95% CI: 2.52, 16.92, Ptrend <0.001) were positively associated with HCC risk, while dietary copper intake and dietary Cu/Zn ratio were not associated with HCC risk. Conclusion::Zinc may be a protective factor for HCC, especially among men, but the effects of copper on HCC risk are not clear.

Objective To explore the therapeutic effect of transumbilical single-port laparoscopic high uterosacral ligament suspension(HUS)and iliacpubic ligament fixation(ILF)in the treatment of pelvic organ prolapse(POP)mainly caused by middle pelvic defects.Methods Clinical data of 15 cases of POP with middle pelvic defects from June 2017 to June 2023 were analyzed retrospectively.The HUS and ILF were performed by transumbilical single-port laparoscopy.At one year after operation,gynecological examination(POP-Q system)and maximum straining pelvic MRI examination were performed for objective evaluation.The Pelvic Floor Distress Inventory Short Form(PFDI-20)and Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire(PISQ-12)were used for subjectiveevaluation.Results Theoperationtimewas 65-135 min(mean,102.9±16.3 min),thebleedingvolumewas 20-50 ml,and the postoperative hospital stay was 6-9 d.Follow-up time ranged from 6 to 72 months(mean,42.8±22.3 months),among which 14 cases were≥12 months.No pelvic pain,lumbosacral pain,urinary retention and thread exposure occurred.Stress urinary incontinence(SUI)occurred in 1 case at 1 year after operation.Surgical failure was noted in 1 case(degree Ⅱ),the objective success rate being 93.3%(14/15).At 1 year after operation,the distance from the anatomical landmarks of pelvic MRI to the pubococcygeal line(PCL)was significantly higher than that before operation(P<0.01),and the PFDI-20 and PISQ-12 scores were significantly better than those before operation(P<0.01).Conclusions Transumbilical single-port laparoscopic HUS and ILF is a safe and effective mutual aid procedure for the treatment of POP mainly caused by middle pelvic defects with surgical indications,which can improve pelvic floor function and quality of life.It is simple and easy to perform with low cost of consumables,which is suitable for primary hospitals.

ObjectiveTo explore the pretreatment methods to promote the enzymatic digestion and extraction of active ingredients from Magnoliae Officinalis Cortex dregs（MOCD）， and to provide a reference basis for the utilization of resource components in MOCD. MethodLiquid chromatography-mass spectrometry（LC-MS） was used for qualitative analysis of resource components in MOCD with an Agilent C₁₈ reversed-phase column（3.0 mm×100 mm， 2.7 µm） at the flow rate of 0.4 mL·min^-1， the mobile phase was water（A）-acetonitrile（B） for gradient elution（0-3 min， 25%-48%B； 3-6 min， 48%-59%B； 6-10 min， 59%-80%B； 10-20 min， 80%-90%B； 20-25 min， 90%B）， electrospray ionization（ESI） was employed with negative ion mode scanning and scanning range of m/z 50-1 200. A high performance liquid chromatography（HPLC）， which refered to the determination in the 2020 edition of Chinese Pharmacopoeia， was used for quantitative analysis of resource components in MOCD. Four kinds of pretreatment agents were used to separate the resource components from MOCD， and the mechanism of different pretreatment agents was investigated by field emission scanning electron microscopy（FESEM）， X-ray powder diffraction（XRD） and Fourier transform infrared spectroscopy（FT-IR）. ResultMagnolol， honokiol and lignocellulose were identified as the main resource components of MOCD by qualitative and quantitative analysis. Under the conditions of 1% NaOH， reaction temperature at 80 ℃ and reaction time of 60 min， the concentration of reducing sugar produced by the enzymatic hydrolysis was 32.18 g·L^-1， which was 79.8% higher than that of the untreated MOCD. After adding tween-80， the enzymatic hydrolysis time was reduced to 1/3 of the original time， the concentration of reducing sugar was increased by 102.0%. And the total recovery of magnolol and honokiol in the pretreatment solution was 69.23%. ConclusionMagnolol， honokiol and lignocellulosic components in MOCD are valuable for development and utilization， the combination of alkaline pretreatment and tween-80 can realize the recovery and utilization of these three resource components， which can provide a new idea for comprehensive utilization of resource components in MOCD.

Objective:To investigate the application effect of a sequential clinical skill curriculum system in standardized residency training.Methods:A total of 300 residents who participated in the residency training of a clinical medical school from 2020 to 2022 were selected as the research subjects, among whom 46 residents in the experimental group had received the clinical skill training course of the clinical medical school in the undergraduate stage, and 254 in the control group had not received such training in the undergraduate stage. The teaching effect of the two groups was observed from the first year to the third year after they entered the residency training base and were trained together based on the curriculum system. SPSS 24.0 statistical software was used for data analysis, and the main statistical methods included descriptive analysis, the Kolmogorov-Smirnov test, the Mann-Whitney U test, and the chi-square test. Results:Before the residents entered the residency base, class 2020 [60.0(52.0,60.0) vs. 51.0(48.0,53.0)], class 2021 [54.0(52.0,56.0) vs. 51.0(48.0,53.0)] and class 2022 [53.0(51.0,55.0) vs. 50.0(47.0,51.0)] The difference between the entry base grades of the residents in the experimental group compared to the control group was statistically significant ( P<0.05). After 36 months of residency training, the difference between the residents in the trial group and the control group in the 2020 class was not statistically significant when it came to the passing rate of the final exam ( χ2=1.20, P=0.273). At the end of 12 months of residency training, there was a statistically significant difference ( P<0.05) between the scores of residents in the experimental group compared with the control group in the theoretical examination [124.0 (123.8,125.0) vs. 115.0 (101.0,125.0)] and medical history taking [92.0 (91.0,95.0) vs. 85.1 (79.3,94.5)]. The differences were not statistically significant ( P>0.05) at the end of 6, 18, and 24 months of residency training. At the end of 6 months [93.0(90.0,97.0) vs. 89.0(86.3,95.0)], 12 months [94.0(92.0,95.0) vs. 89.0(87.0,92.0)] and 18 months [90.0(86.5,93.5) vs. 81.0(69.0,91.0)] of residency training, residents in the experimental group Physical examination scores were statistically significant compared to the control group ( P<0.05). At the end of 24 months of residency training, there was no statistically significant difference ( P>0.05) between the physical examination scores of residents in the experimental group compared with the control group in the classes of 2020 [92.0(87.5,95.3) vs. 85.0(79.0,92.0)] and 2021 [94.0(87.0,96.0) vs. 90.0(84.0,95.0)]. Conclusions:The clinical skill curriculum system can help to improve the comprehensive clinical ability of residents, and the teaching contents and methods of physical examination should be further optimized, with a focus on the training of doctor-patient communication skills and humanistic literacy among residents in the future.

Objective:To investigate the application of debate-based immersive experiential teaching in the nursing practice teaching of stomatology.Methods:A total of 82 nursing interns of stomatology in Beijing Tongren Hospital, Capital Medical University, were selected as research subjects and were then divided into control group and observation group using the lottery method, with 41 interns in each group. The interns in the control group received traditional teaching, while those in the observation group received debate-based immersive experiential teaching. The two groups were compared in terms of the scores of comprehensive evaluation indices, nursing thinking ability, empathy ability, and recognition of teaching. SPSS 22.0 was used to perform the chi-square test and the t-test. Results:Compared with the control group, the observation group had significant increases in the scores of theoretical examination, operation examination, nursing medical record writing, reading report writing, basic nursing, communication ability, and comprehensive performance and the total score of these dimensions ( P<0.05). Compared with the control group, the observation group also had significant increases in the scores of nursing thinking ability and empathy ability ( P<0.05). The observation group had a significantly higher degree of recognition of teaching than the control group ( P<0.05). Conclusion:In the nursing practice teaching of stomatology, debate-based immersive experiential teaching can improve the comprehensive ability, nursing thinking ability, and empathy ability of interns, with a relatively high degree of recognition of teaching.

Objective:To provide a basis for selecting the optimization method for intracavitary/interstitial brachytherapy (IC/ISBT) of cervical cancer by comparing graphical optimization (GO), inverse planning simulated annealing (IPSA), and hybrid inverse planning optimization (HIPO) using dosimetric and radiobiological models.Methods:This study selected 65 patients with cervical cancer who were treated with image-guided IC/ISBT. The afterloading therapy plans for these patients were optimized using GO, IPSA, and HIPO individually, with a prescription dose high-risk clinical target volume (HRCTV) D90 of 6 Gy. The non-parametric Friedman test and the non-parametric Wilcoxon rank test were employed to analyze the differences in duration, dose-volume parameters, and radiobiology between the three types of optimized plans. Results:Inverse planning optimization (IPSA: 46.53 s; HIPO: 98.36 s) took less time than GO (135.03 s). In terms of gross target volume (GTV) dose, the high-dose irradiation V150% (53.66%) was slightly higher in the HIPO-optimized plans, while the V200% (30.29%) was higher in the GO-optimized plans. The GO-optimized plans had a higher conformity index (CI; 0.91) than other plans, showing statistically significant differences. Compared with other plans, the HIPO-optimized plans showed the lowest doses of D1 cm 3 and D2 cm 3 at bladders and rectums and non-statistically significant doses at small intestines ( P > 0.05). In terms of the equivalent uniform biologically effective dose (EUBED) for HRCTV, the HIPO-optimized plans showed a higher value (12.35 Gy) than the GO-optimized plans (12.23 Gy) and the IPSA-optimized plans (12.13 Gy). Moreover, the EUBED at bladders was the lowest (2.38 Gy) in the GO-optimized plans, the EUBED at rectums was the lowest (3.74 Gy) in the HIPO-optimized plans, and the EUBED at small intestines was non-significantly different among the three types of optimized plans ( P = 0.055). There was no significant difference in the tumor control probability (TCP) predicted using the three types of optimized plans ( P > 0.05). The normal tissue complication probabilities (NTCPs) of bladders and rectums predicted using the HIPO-optimized plans were lower than those predicted using the GO- and IPSA-optimized plans( χ2 = 12.95-38.43, P < 0.01), and the NTCP of small intestines did not show significant differences ( P > 0.05). Conclusions:Among the three types of optimization algorithms, inverse optimization takes less time than GO. GO-optimized plans are more conformal than IPSA- and HIPO-optimized plans. HIPO-optimized plans can increase the biological coverage dose of the target volume and reduce the maximum physical/biological exposure and NTCP at bladders and rectums. Therefore, HIPO is recommended preferentially as an optimization algorithm for IC/ISBT for cervical cancer.

Objective:To observe the role of Huaiqihuang Granules (HQ) in the long-term management of bronchial asthma in young children, and the effective effect on concomitant rhinitis.Methods:A prospective real-world multicenter study was conducted in children aged 2-5 years with asthma diagnosed in the outpatient department (from April 2016 to March 2019)who received either inhaled corticosteroid (ICS)/leukotriene receptor antagonist (LTRA)(control group); inhaled ICS/LTRA plus HQ(combination group), or HQ alone(HQ group). All patients were followed up at week 4, 8, 12 after treatment. The number of days with asthma symptoms, the frequency of severe asthma attacks, the level of asthma control, and the days with rhinitis symptoms in the last 4 weeks were recorded. Differences before and after treatment, and those among groups after treatment were compared using Kruskal- Wallis H test or Wilcoxon rank-sum test. Results:A total of 2 234 eligible patients were recruited, and 2 147 cases completed followed-up visits, including 477, 1 374 and 296 cases in the control group, combination group, and HQ group, respectively. After the treatment, all 3 groups showed significant declines in the days with asthma symptoms, frequency of severe asthma attack and the days with rhinitis symptoms (all P<0.01), and the rate of well-controlled asthma increased significantly ( P<0.01). It lasted until the end of follow-up. Among groups, patients in the combination group showed significantly less days of asthma symptoms than those of the other 2 group at week 8 and 12[0(0, 0.9) d vs.0(0, 0.3) d, P<0.05; 0(0, 0.1) d vs. 0(0, 1.0) d, P<0.01]. Patients in the combination group and HQ group showed a significantly lower rate of severe asthma attacks than that of the control group at week 12 [0(0, 1), 0(0, 1), 0(0, 2), all P<0.05]. The well-controlled rate of asthma in the combination group was significantly higher than that of the control group and HQ group at week 8 and 12 (89.6% vs. 85.9% vs.82.1%, H=15.28; 90.9% vs. 84.1% vs. 81.8%, χ2=29.32, all P<0.01). Conclusions:HQ can significantly alleviate symptoms of asthma and rhinitis, severe attack of asthma, and increase the control rate of asthma when used as an additional treatment or used alone.