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.

Hepatitis B virus infection and hepatitis C virus infection often progress to end-stage liver diseases such as liver cirrhosis, liver failure, and hepatocellular carcinoma, which endanger the life of patients. Recent studies have shown that gut microbiota are closely associated with chronic viral liver diseases. This article reviews the association of gut microbiota with chronic hepatitis B (CHB), chronic hepatitis C (CHC), and their related liver diseases and the research advances in therapies targeting gut microbiota against CHB and its related liver diseases, in order to provide more ideas for the clinical treatment of CHB, CHC, and their related liver diseases.

The liver is the main place for metabolism in human body, and when severe liver injury is induced by various factors, there will be disorders in the functions of synthesis, metabolism, and biological conversion. This article summarizes the features of the metabolism of nutrients such as glucose, amino acids, and lipids in the presence of liver failure, as well as the assessment of malnutrition and clinical interventions. For patients with liver failure, it is of great importance to identify and correct malnutrition in a timely manner, so as to improve energy metabolism and inflammation and increase survival rate.

Objective: To understand the injuries among 16 459 left-behind children from 27 poor rural areas in 12 provinces of China, 2016. Methods: Data were collected from the survey of 'Health Service Needs Assessment’ (HSNA) program on left-behind children, from poor rural areas in the middle and western parts of China. Factors including causes, types, locations, related activities, ways of treatment and outcomes among left-behind children with injuries in 2016, were described and analyzed by gender and age groups. Results: In 2016, per-person and person-time incidence rates of injuries were 8.88% and 11.21%, among the 16 459 left-behind children from 27 poor rural areas in 12 provinces of China, both higher in boys, than in girls. Most injuries were unintentional with its proportion higher in older children. The main types of injuries were seen as falls, blunt and sharp injuries, with burns and animal injuries more common in younger children. Injuries among left-behind children mainly took place at home, kindergarten/school, and on the highways/streets/roads, during playing. Most common ways of treatment would include at the emergency settings, self-treated, with older children more likely to treat by themselves. Most injuries were cured. Conclusions In programs on prevention and control of injuries targeting the left-behind children in poor rural areas, special attention should be given to older boys, on falls and blunt/sharp injuries, at home or kindergarten/school. Education programs should pinpoint on self-rescue skills and guidance on kids by the parents, with behavioral norms and social support included. Related comprehensive prevention and control mechanism should be developed in families, schools and communities, with medical resources and insurance mechanism explored to serve these population and districts, including those left-behind children.

Objective To compare the clinical effect of two different kinds of wound dressing on postoperative skin reactions and phlebitis for PICC in critical patients. Methods A total of 313 PICC critical patients were divided into control group (157 cases) and treatment group (156 cases) by random digits table method. After PICC, the control group was attached to transparent dressing, the experimental group was attached to Mepilex, all of the patients were received routine nursing. The incidences of adverse effect, and the degree of local skin pruritus by Visual Analogue Scale(VAS) were compared in two weeks. Results The incidence of skin allergy, infection, and mechanical phlebitis were 24.20%(38/157), 10.83%(17/157), 18.47%(29/157) in control group and 7.69%(12/156),4.49%(7/156), 3.21%(5/156) in treatment group, and there were significant differences between two groups (χ2=13.99, 4.44, 18.83, P<0.01 or<0.05). The score of VAS in control group and treatment group were (4.84±1.29) points and (3.15± 1.82) points respectively, and the difference was statistically significant (t=8.66, P<0.01). Conclusions Application of Mepilex for PICC in critical patients can decrease the incidences of adverse effect, and increase the degree of comfort. It is worth utilizing widely in the clinic.

Objective:To explore and compare the therapeutic effect of hysteroscopic cesarean scar pregnancy and transvaginal scar pregnancy.Methods: 63 cases of uterine scar pregnancy patients were divided into treatment group (32 cases) and control group (31 cases) depend on the different surgical methods. The difference of operation time, intraoperative blood loss, HCG descent, postoperative hospital stay and postoperative recovery situation were compared. Results: 32 cases of hysteroscopic surgery patients were successful in one-time operation, no serious complications. Every indicator of hysteroscopic surgery group, such as operation time, intraoperative blood loss, postoperative hospital stay and postoperative blood HCG decline situation, was better than the vaginal surgery group (t=6.743, t=4.329,t=2.482,t=2.181;P<0.05).Conclusion: Hysteroscopy surgery is an important method for minimally invasive treatment of cesarean scar pregnancy, and different individual treatment program should be adopted to treat different cases of CSP and objective in clinical practice.

Objective:To evaluate the diagnostic value of MRI and ultrasound imagingr in the breast intraductal papilloma.Methods: 29 patients with multiple or isolated breast intraductal papilloma were selected, who were pathologically confirmed. All patients underwent preoperative breast X-ray, ultrasound, dedicated breast MRI plain and dynamic enhanced MRI. According to Breast Imaging Reporting and Data System (BI-RADS), we observed the lesion size, shape, location, margin, polymorphism and its relationship with the catheter by the ultrasound and MRI scan, and analyze enhancement pattern of dynamic contrast-enhanced MRI lesion. Results: In 29 cases of patients with 30 lesions, a total of 28 lesions were detected by MRI, including one patient with bilateral lesions which were positive, and two cases of malignant tumor which were difficult to identify. 25 lesions were detected by ultrasound, in which 4 cases were negative. There were statistical differences in BI-RADS classification of lesions detected by ultrasound and MRI(Z=-2.377,P<0.05). The detection rate of malignant intraductal papilloma lesion by MRI was higher than ultrasound.Conclusion: MRI and ultrasound imaging can be used for diagnosis of intraductal papilloma, but the MRI is superior to ultrasound scanner in lesion detection rate and accuracy, especially in the intraductal papilloma of benign and malignant.

The distribution and prevalence of low pathogenic avian influenza virus in major live poultry wholesale markets around the Dongting Lake region ,China were investigated in our study to propose prevention and control measures on low pathogenic avian flu in the area of live poultry wholesale market .The samples were injected to SPF chicken embryos by allanto-ic cavity ,and then the allantoic fluid were harvested and used for hemagglutination (HA) .If it was positive by HA ,subtypes of the virus would be determined by hemagglutination inhibition (HI) and RT-PCT .We isolated 627 low pathogenic avian in-fluenza viruses in major live poultry wholesale market around Dongting Lake region systematically in winter and spring during 2009-2011 ,and the total separation rate was 22 .2% .The duck swab separation rate of low pathogenic avian influenza was the highest ,which was 24 .6% ,and the following was chicken swab that reached 21 .5% ,and the goose swab separation rate was 11% .We isolated 6 HA subtypes including H3 ,H4 ,H6 ,H9 ,H10 ,and H11 in every live poultry wholesale market ,and the separation rate of H9 ,H6 and H4 subtypes was relatively high ,which could reach 11% ,6 .3% and 3 .4% ,respectively . Those results indicated that recessive infection of low pathogenic avian influenza virus was serious in live poultry wholesale mar-ket around the Dongting Lake area ,and it was a great threat to the occurrence of avian flu .

Objective To assess the value of thickness and arterial resistive index (RI) of wrist synovium in differentiation from activity to non-activity of rheumatoid arthritis (RA). Methods Ninety-two clinically confirmed RA patients underwent high frequency ultrasonography. Maximum thickness and arterial RI of the wrist synovium were measured in active and nonactive stage. Results Thickened synovium was found in 75 of 92 patients. Color signal in the synovium was detected and then RI was measured in 67 patients, including 31 in active stage and 36 in nonactive stage. The wrist synovium thickness of 67 patients was (2.97±1.49) mm and arterial RI was 0.74±0.17. RI decreased significantly in patients in active stage compared with that in nonactive stage (P<0.001). Conclusion Arterial RI measurement with high frequency ultrasonography may be served as an objective marker of synovial membrane disease in RA. The thickness of synovium cannot predict the activity of RA.

Objective To evaluate the therapeutic effect of recombinant adeno-associated viral vector (rAAV) expressing human tissue kallikrein gene (rAAV-HK) on insulin resistance and renal complications in tyDe2 diabetic rats. Methods Male Wistar rats were injected low dose streptozotocin and fed with high fat and sucrose diets to form type 2 diabetic model. rAAV mediated HK gene (HK group) or LacZ gene (LacZ group) were introduced to the diabetic rats, and their systolic blood pressure, fasting blood glucose and insulin, serum creatinine, urine creatinine, urine osmolarity and urine microalbumin were measured. The homeostasis model assessment of insulin resistance (HOMA-IR), urinary albumin excretion rate (UAER) and creatinine clearance rate (Ccr) were calculated. The expression of PI3-kinase p11o catalytic subunit (p110) and Akt phosphorylation on Thr-308 were detected by Western blot. The morphology of kidney wag observed. Results Delivery of rAAVHK resulted in a reduction in blood pressure at 2 weeks and the hypotensive effect lasted for the duration of the study. The HOMA-IR was significantly lower in HK group than LacZ group (4.76±0.33 vs 8.36±0.48, P<0.01) at the end of the study, fasting insulin level was reduced [(8.19±2.45 vs 13.85±3.76)mIU/L. P<0.01], but there was no significant change in fasting blood glucose [(13.09±3.01 vs 13.58±2.88)mmol/L].The phosphorylation of p11o and Akt Thr-308 were significantly decreased in skeletal muscle and liver in LacZ group and were almost corrected by HK gene therapy. The UAER and Ccr were significantly lower and urinary osmolarity were higher in HK-treated rats compared with LaeZ rats. Histological assessment indicated that the renal complication was relieved by HK gene delivery. Conclusion The rAAV-mediated HK gene delivery efficiently attenuated insulin resistance partly through PI3K/Akt pathway and diabetic nephropathy in type 2diabetic rats.