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 compare the effects of different doses of ticagrelor on microcirculation, inflammatory factors and cardiac function in older adult patients with coronary heart disease after percutaneous coronary intervention (PCI).Methods:A total of 250 older adult patients with coronary heart disease who received PCI in The First People's Hospital of Wenling, China between March 2019 and March 2020 were included in this study. They were randomly assigned into group A and group B, with 125 patients per group. The group A was subjected to staged exercise and oral ticagrelor (45 mg once, twice a day). The group B was given staged exercise and oral ticagrelor (90 mg once, twice a day). Platelet function (maximum platelet aggregation rate, P2Y12 reaction unit), microcirculation (the index of microcirculatory resistance, circulatory flow reserve), inflammatory factor levels (high-sensitivity C-reactive protein, tumor necrosis factor alpha, interleukin-6), cardiac function recovery (left ventricular ejection fraction, 6-minute walk test, maximal oxygen consumption), cardiovascular adverse events, and bleeding events were compared between the two groups.Results:After treatment, maximum platelet aggregation rate and P2Y12 reaction unit in group B were (28.79 ± 3.52)% and (132.36 ± 12.16) U, respectively, which were significantly lower than those in group A [(33.45 ± 4.60)%, (146.79 ± 13.52) U, t = 8.99, 8.87, both P < 0.001]. After treatment, the index of microcirculatory resistance in group B was significantly lower than that in group A [(26.43 ± 4.51) vs. (29.68 ± 5.14), t = 5.31, P < 0.001]. Circulatory flow reserve in group B was significantly higher than that in group A [(2.16 ± 0.62) vs. (1.61 ± 0.50), t = 7.72, P < 0.001]. After treatment, tumor necrosis factor alpha, interleukin-6 and high-sensitivity C-reactive protein in group B were (39.54 ± 6.74) ng/L, (19.68 ± 4.06) ng/L, (5.98 ± 1.35) mg/L, respectively, which were significantly higher than those in group A [(28.26 ± 6.15) ng/L, (15.33 ± 3.87) ng/L, (4.83 ± 1.28) mg/L, t = 13.82, 8.67, 6.91, all P < 0.001]. After treatment, left ventricular ejection fraction, 6-minute walk test, maximal oxygen consumption in group B were (37.39 ± 5.10)%, (443.28 ± 29.64) m, (19.69 ± 3.57) L/min, respectively, which were significantly higher than those in group A [(34.64 ± 4.86)%, (410.45 ± 25.76) m, (17.33 ± 3.27) L/min, t = 4.36, 9.34, 5.45, all P < 0.001]. There was no significant difference in total incidence of cardiovascular events between the two groups (χ 2 = 0.05, P > 0.05). The incidence of bleeding events in group A was significantly lower than that in group B (4.80% vs. 13.60%, χ 2 = 5.79, P < 0.05). Conclusion:Compared with ticagrelor 90 mg/d, ticagrelor 180 mg/d can more greatly improve platelet function and microcirculation, reduce inflammatory reaction, promote the recovery of cardiac function, and reduce bleeding events in older adult patients with coronary heart disease after percutaneous coronary intervention.

With continuous discovery of tumor immune targets and continuous changes in antibody research and development technology, antibody drugs are becoming more and more widely used in clinical practice. However, some targets are not only expressed on tumor cells, but also on red blood cells. Therefore, the clinical application of antibodies against the corresponding targets may interfere with the detection of blood transfusion compatibility, resulting in difficulty in blood matching or delay of blood transfusion. This consensus summarizes the current solutions for the interference of CD38 monoclonal antibody (CD38 mAb) in transfusion compatibility testing. After analyzing the advantages and disadvantages of different methods, polybrene and sulfhydryl reducing agents [dithiothreitol (DTT) or 2-mercaptoethanol (2-Me)], as a solution for CD38 mAb interference in blood compatibility testing, are recommended for Chinese patients, so as to eliminate blood transfusion interference produce by CD38 mAb and further provide a pre-transfusion workflow for clinicians and technicians in Department of Blood Transfusion.

OBJECTIVETo explore the feasibility and safety of transanal minimal invasive or combined laparoscopy total mesorectal excision.

METHODSClinical data of 11 cases with rectal cancer undergoing transanal total mesorectal excision(taTME) in our hospital between September 2014 and May 2015 were analyzed retrospectively.

RESULTSAmong 11 patients, 3 underwent pure-taTME successfully without abdominal incision and ileostomy, whose operation time was 210, 230, 215 min respectively, while other 8 patients underwent laparoscopy-assisted taTME(hybrid-taTME) with operation time ranging from 150 to 290 (median 205) min. No patient was transferred to open operation, while larger tumors of two patients were removed from hypogastric 5 cm incision. Postoperative first day VAS score was 1 to 3(2.0±0.6), the first flatus was 6 to 70(30.2±17.3) h, hospital stay was 4 to 12(7.5±2.5) d, the blood loss was (104±127) ml and the liquid food intake was (28.3±6.3) h. Postoperative complications included 1 case of subcutaneous emphysema, 1 case of anastomotic stoma bleeding, 2 cases of dysuria, which were cured by conservative therapy. One patient developed rectovaginal fistula 20 days after operation and then underwent ileostomy. No relapse of tumor or death during follow-up.

CONCLUSIONSFor suitable rectal cancer patients, taTME or hybrid-taTME is feasible.

Anal Canal ; Humans ; Ileostomy ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Operative Time ; Postoperative Complications ; Rectal Neoplasms ; Retrospective Studies

OBJECTIVETo investigate the quality of life of rectal cancer patients after anterior resection and the role of 5-hydroxytryptamine(5-HT) in the pathogenesis of anterior resection syndrome (ARS).

METHODSBetween November 2012 and October 2014, 90 rectal cancer patients who underwent Dixon procedure in the Institute of Surgery Research, Daping Hospital, Third Military Medical University, and developed ARS postoperatively were enrolled in the study. By clinic interview and telephone follow-up, they were investigated according to the 4 questionnaires, including gastrointestinal quality of life index(GIQLI), Wexner constipation and incontinence score(WCS, WIS), and 36-item short form health survey(SF-36). Associated clinical data and above parameters were compared between postoperative 0-6 months and 7-24 months. Expression of 5-HT in rectal mucosa was determined by immunohistochemistry preoperatively and postoperatively.

RESULTSThe GIQLI, WCS and WIS were significantly improved in 7-24 months group compared with those in 0-6 months group(all P<0.05). Furthermore, the SF-36 test result also showed significant improvement in the terms of physical function, physical role, vitality, social function, emotional role and health changes spheres in 7-24 months group(P<0.05). 5-HT expression in rectal mucosa(upper anastomosis 3402.95±1876.24, lower anastomosis 3045.35±1373.59 of ARS patients was significantly down-regulated compared with the preoperative expression(rectal margin mucosa 7176.60±3927.61)(P<0.05).

CONCLUSIONSPatients with ARS experience a significant trend toward recovery in their whole long-term quality of life. The down-regulation of 5-HT expression in rectal mucosa after surgery may be related with the pathogenesis of ARS.

Constipation ; Humans ; Intestinal Mucosa ; Prospective Studies ; Quality of Life ; Rectal Neoplasms ; Serotonin ; Treatment Outcome

Objective To observe late effect of 60Co radiation accident on eye lens in the victims.Methods Medical observations of eye lens were performed on ten victims accidentally exposed to 60Co sources in four radiation accidents that have occurred from 1986 to 2000 in Henan Province.Pathological changes of the eye lenses were examined by using slit lamp microscopy after mydriasis with compound tropicamide.Results Of these ten victims, Liang in a radiation accident in Kaifeng (in 1986), Mei in Xinxiang (in 1999) and Xu in Xuchang (in 2000) all had typical radiation-induced cataract 2, 3 and 6 years after irradiation, respectively.Follow-up observation of the lens showed the punctate and/or granular opacities present in the eye posterior subcapsular of Yan in Kaifeng accident, Jie in Zhengzhou (1987), and Tian, Yong and Yi in Xinxiang accident, featuring the early changes of radiation-induced cataract, but the posterior subcapsular opacities were not observed in Wang and Min in Xinxiang accident.Conclusions Focus should be on the eye lens as the target organ of radiation exposure in long-term follow-up of victims accidentally exposed to radiation source.Severity of the lens opacity induced by ionizing radiation is closely associated with radiation doses.

OBJECTIVE To observe therapeutic efficacy and safety of transcatheter arterial chemoembolization (TACE) com-bined with high intensity focused ultrasound (HIFU) in the treatment of middle and advanced primary hepatocellular carcinoma (HCC). METHODS:76 patients with middle and advanced primary HCC were randomly divided into treatment group(36 cases) and control group(40 cases). Control group was given TACE alone,and treatment group was additionally given HIFU 2-3 weeks after TACE. Clinical efficacy,the content of alpha-fetoprotein(AFP)before and after operation,survival rate,survival period and ADR were compared between 2 groups. RESULTS:The efficiency rate and total effective rate of treatment group were 61.1% and 94.4%,which were significantly higher than those of control group(35.0%,77.5%),with statistical significance(P<0.05). The content of AFP in 2 groups decreased significantly after operation,with statistical significance(P<0.05);there also was statistical significance between 2 groups(P<0.05). Survival rate of treatment group was higher than that of control group 24 and 36 months after operation,with statistical significance (P<0.05). The median survival time was 11.3 months in treatment group and 9.2 month in control group,with no statistical difference(P>0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Com-pared with TACE alone,TACE combined with HIFU in the treatment of middle and advanced primary HCC can improve long-term survival rate and the short-term efficacy,with good safety.

Objective To investigate the quality of life of rectal cancer patients after anterior resection and the role of 5-hydroxytryptamine (5-HT) in the pathogenesis of anterior resection syndrome (ARS). Methods Between November 2012 and October 2014, 90 rectal cancer patients who underwent Dixon procedure in the Institute of Surgery Research, Daping Hospital, Third Military Medical University, and developed ARS postoperatively were enrolled in the study. By clinic interview and telephone follow-up, they were investigated according to the 4 questionnaires, including gastrointestinal quality of life index(GIQLI), Wexner constipation and incontinence score(WCS, WIS), and 36-item short form health survey (SF-36). Associated clinical data and above parameters were compared between postoperative 0-6 months and 7-24 months. Expression of 5-HT in rectal mucosa was determined by immunohistochemistry preoperatively and postoperatively. Results The GIQLI, WCS and WIS were significantly improved in 7-24 months group compared with those in 0-6 months group (all P<0.05). Furthermore, the SF-36 test result also showed significant improvement in the terms of physical function, physical role, vitality, social function, emotional role and health changes spheres in 7-24 months group (P<0.05). 5-HT expression in rectal mucosa (upper anastomosis 3402.95 ±1876.24, lower anastomosis 3045.35 ±1373.59 of ARS patients was significantly down-regulated compared with the preoperative expression (rectal margin mucosa 7176.60±3927.61)(P<0.05). Conclusions Patients with ARS experience a significant trend toward recovery in their whole long-term quality of life. The down-regulation of 5-HT expression in rectal mucosa after surgery may be related with the pathogenesis of ARS.

Objective To explore the feasibility and safety of transanal minimal invasive or combined laparoscopy total mesorectal excision. Methods Clinical data of 11 cases with rectal cancer undergoing transanal total mesorectal excision (taTME) in our hospital between September 2014 and May 2015 were analyzed retrospectively. Results Among 11 patients, 3 underwent pure-taTME successfully without abdominal incision and ileostomy, whose operation time was 210, 230, 215 min respectively, while other 8 patients underwent laparoscopy-assisted taTME (hybrid-taTME) with operation time ranging from 150 to 290 (median 205) min. No patient was transferred to open operation, while larger tumors of two patients were removed from hypogastric 5 cm incision. Postoperative first day V AS score was 1 to 3 (2.0±0.6), the first flatus was 6 to 70 (30.2±17.3) h, hospital stay was 4 to 12 (7.5±2.5) d, the blood loss was (104±127) ml and the liquid food intake was (28.3±6.3) h. Postoperative complications included 1 case of subcutaneous emphysema, 1 case of anastomotic stoma bleeding, 2 cases of dysuria, which were cured by conservative therapy. One patient developed rectovaginal fistula 20 days after operation and then underwent ileostomy. No relapse of tumor or death during follow-up. Conclusions For suitable rectal cancer patients, taTME or hybrid-taTME is feasible.

Objective To investigate the quality of life of rectal cancer patients after anterior resection and the role of 5-hydroxytryptamine (5-HT) in the pathogenesis of anterior resection syndrome (ARS). Methods Between November 2012 and October 2014, 90 rectal cancer patients who underwent Dixon procedure in the Institute of Surgery Research, Daping Hospital, Third Military Medical University, and developed ARS postoperatively were enrolled in the study. By clinic interview and telephone follow-up, they were investigated according to the 4 questionnaires, including gastrointestinal quality of life index(GIQLI), Wexner constipation and incontinence score(WCS, WIS), and 36-item short form health survey (SF-36). Associated clinical data and above parameters were compared between postoperative 0-6 months and 7-24 months. Expression of 5-HT in rectal mucosa was determined by immunohistochemistry preoperatively and postoperatively. Results The GIQLI, WCS and WIS were significantly improved in 7-24 months group compared with those in 0-6 months group (all P<0.05). Furthermore, the SF-36 test result also showed significant improvement in the terms of physical function, physical role, vitality, social function, emotional role and health changes spheres in 7-24 months group (P<0.05). 5-HT expression in rectal mucosa (upper anastomosis 3402.95 ±1876.24, lower anastomosis 3045.35 ±1373.59 of ARS patients was significantly down-regulated compared with the preoperative expression (rectal margin mucosa 7176.60±3927.61)(P<0.05). Conclusions Patients with ARS experience a significant trend toward recovery in their whole long-term quality of life. The down-regulation of 5-HT expression in rectal mucosa after surgery may be related with the pathogenesis of ARS.