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managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control.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.

Objective: To understand the current status of follow up of people living with HIV/AIDS by health service at grass root in rural area of Jiangxi province and related factors, and provide references for the promotion of the follow up by grass root health service. Methods: People living HIV/AIDS aged ≥18 years and diagnosed before 31 December 2017 in 6 townships of Xinjian, Yushan counties and Guixi city were included in the study in Jiangxi province. They had been followed up for more than one time after the first epidemiologic survey. The information about their demographic characteristics and HIV infection status were collected by using self-designed questionnaire. Univariate and multivariate logistic regression analyses were conducted to identify the factors that influencing the acceptance of follow up by grass root health service. Results: Of the 373 surveyed HIV infected subjects aged (53.06±16.15) years, 261 were males (70.0%, 261/373). Among the surveyed subjects, the illiteracy and people who received only primary school education accounted for 54.7% (204/373). The rate of follow up of the HIV infected subjects by grass root health service was 55.8% (208/373), and those through heterosexual contact were 58.5% (190/325). The multivariate regression analysis showed that the acceptance of follow up by grass root health service was higher in those who were farmers (OR=7.36, 95%CI: 2.52-21.45), had family support (OR=16.01, 95%CI: 2.25-49.73), didn’t worry about discrimination (OR=12.97, 95%CI: 4.75-35.42), trusted health care provider (OR=5.07, 95%CI: 2.19-11.76) and showed AIDS symptoms (OR=10.58, 95%CI: 2.25- 49.73). Conclusions The performance of follow up of people living with HIV/AIDS by grass root health service was well, suggesting it is a feasible management model. Being famer or not, family member supporting or not, worry about discrimination or not, trusting health care provider or not and showing AIDS symptoms or not were the main factors influencing the acceptance of follow up by grass root health service.

The HIV-infected people were investigated for their satisfactory situation towards the follow-up management of primary medical and health care institutions in Xinjian County, Yushan County and Guixi City of Jiangxi Province from January to July 2018 and related factors were also analyzed. The total score of the Infected Patients′ Follow-up Management Satisfaction Scale higher than 59 was defined as the satisfactory. 75.68% of 259 infected patients were satisfied with the follow-up management. Compared to farmers and other follow-up modes, non-farmers (OR=10.72, 95%CI: 2.07-55.63), and patients receiving follow-up service in responsible institutions (OR=6.44, 95%CI: 3.12-13.30) were more satisfied with follow-up management.

OBJECTIVE： To establish a method for the content determination of total flavonoids from Typhonium divaricatum， and to optimize its extraction technology. METHODS： The content of total flavonoids in T. divaricatum was determined by UV spectrophotometry. Using the extraction amount of total flavonoids from T. divaricatum as index， the volume fraction of ethanol， the ratio of material to liquid， the extraction time and times as factors， the extraction technology of total flavonoids from T. divaricatum was optimized by L9（34） orthogonal design， based on the single factor test. RESULTS： The linear range of rutin were 8-48 μg/mL （r＝0.999 7）； the quantification limit was 0.54 μg/mL， and the detection limit was 0.18 μg/mL； RSDs of precision， stability and repeatability tests were all lower than 2％. The recoveries were 99.61％-102.38％（RSD＝1.15％， n＝6）. The optimal extraction technology was as follows： ethanol concentration of 70％， solid-liquid ratio of 1 ∶ 20 （g/mL）， extraction time of 45 min， extracting for 2 times. Under this condition， the average content of total flavonoids from T. divaricatum was 2.74 mg/g.  CONCLUSIONS： Established method is simple and accurate； the extraction process is stable and feasible.

Objective To establish a direct reverse transcription real-time fluorescence quantitative polymerase chain reaction ( RT-qPCR-D ) method for detecting serum circulating B cell-specific moloney murine leukemia virus integration site-1 (Bmi-1) mRNA, and analyze the levels of serum circulating Bmi-1 mRNA in colorectal cancer patients by using of this method for exploring its diagnosis value in colorectal cancer.Methods Methodology establishment.RNA was extracted from colorectal cancer HT 29 cell line, and detection standard curves of Bmi-1, ubiquitin C ( UBC), glyceraldehyde-3-phosphate dehydrogenase ( GAPDH) mRNAs were established , then the amplification efficiencies were calculated.Bmi-1 mRNA level was directly detected in serum and preparation buffer mixture , then the specificity of assay was evaluated by melting curve, and detection limit was observed through diluted serum samples.The serum circulating Bmi-1 mRNA levels were detected by ELISA in 158 cases with colorectal cancer , of which there were 26 cases of tumor node metastasis ( TNM)Ⅰstage, 53 cases of TNMⅡ, 47 cases of TNMⅢ, 32 cases of TNMⅣand 53 cases of controls with normal colonoscopy collected from January 2008 to January 2009 in Qilu Hospital of Shandong University.Comparisons of groups were determined by applying Mann-Whitney U test or Kruskal-Wallis test, and receiver operating characteristic ( ROC) curves were established to illustrate the diagnostic performance.Results The log values of Bmi-1, UBC and GAPDH showed good linear correlations with quantification cycle (Cq) values(R2 =0.990, 0.990, 0.991, all P <0.001), and the amplification efficiencies were 0.875, 0.917 and 0.935, respectively.Using the established RT-qPCR-D method, the peak of melting curve of Bmi-1, UBC and GAPDH mRNAs were single, the detection limit was up to 1.25μl.The levels of serum circulating Bmi-1 mRNA detected by RT-qPCR-D were 0.138 ( 0.078-0.228 ) in colorectal cancer stage Ⅰ patients, 0.163(0.067 -0.287) instage Ⅱ patients, 0.217(0.072-0.267) instage Ⅲpatients, 0.273(0.139 -0.419) in stage Ⅳ patients and 0.021(0.008 -0.029) in health controls, a significant difference was found among groups ( H =89.5, P <0.001 ).The levels of serum circulating Bmi-1 mRNA in each stage colorectal cancer were all significantly higher than that in control group(U=58.0, 287, 246, 72.5,all P<0.001).The levels in Ⅳstage patients were significantly higher than those in other stages patients (U=247, 590, 540,P=0.008, 0.020, 0.035), while no significant differences among Ⅰstage,Ⅱstage and Ⅲstage patients(U=633, 514, 1170,all P>0.05).ROC curve analysis showed area under the ROC curve ( AUC) for serum circulating Bmi-1 mRNA was 0.921(95%CI=0.876-0.953), which was significantly superior to the AUC of CEA (0.745, 95%CI=0.680-0.802, Z=4.697, P<0.001 ).When cutoff value was 0.034, the diagnostic sensitivity and specificity was 89.2%(141/158) and 90.6%(48/53), while 41.8%(66/158) and 73.6%(39/53) using CEA.The AUC for combination of circulating Bmi-1 mRNA and CEA was 0.933(95%CI=0.890-0.963 ) , which was no statistical significance when compared with the AUC of circulating Bmi-1 mRNA(Z=4.697, P>0.05).Conclusions The study establishes a higher sensitive, specific for detecting serum circulating Bmi-1 mRNA. Based on this method , serum circulating Bmi-1 mRNA is found to be increased in colorectal cancer , and is superior to traditional tumor marker CEA in diagnosis of colorectal cancer, which may become a potential detection index for early detection of colorectal cancer.

ObjectiveTo investigate emergency diagnosis and treatment of pelvic fracture complicated with traumatic rupture of urethra and bladder,and to improve the success rate of treatment on pelvic fracture.MethodsClinical data of 52 cases of pelvic fracture complicated with traumatic rupture of urethra and bladder in department of emergency and urology from 2000 to 2010 was retrospectively analyzed.Results Among the 52 patients,there was 41 cases of pelvic fracture complicated with posterior urethral disruption,15 cases complicated with rupture of bladder and 4 cases complicated withtraumatic rupture of urethra and bladder at the same time.In 41 cases with posterior urethral rupture,6 individual's condition were relatively so severe that they onlyunderwent bladder puncture nephrostomy,and 29 cases underwent traction urethral realignment,the other 6 cases didn't undergo surgery; In 15 cases of patients with bladder rupture,2 patients were performed urethral realignment and bladder repair,11 patients underwent the bladder repair only and the other 2 patients were not performed surgery.There were 8 patients died and the mortality rate was 15.4％.Six died cases failed to conduct emergency surgery because of uncontrollable bleeding and another 2 cases died due to multiple organ failure.ConclusionPelvic fractures is a disease with more complications,it should be diagnosed as early as possible.Patients invalid for conventional anti-shock should be performed pelvic external fixation and emergency embolization to stop bleeding in the emergency department,and undergo associated processing after they are in stable condition.

Objective To evaluate percutaneous transluminal angioplasty ( PTA) for stenosed arteries of the lower extremities in patients with ischaemic diabetic foot. Methods We retrospectively analyzed the clinical and follow-up data of using PTA to treat diseased infrapopliteal arteries in diabetic patients who were hospitalized from Oct,2006 to May,2008. Results Technical success rate was 87% , procedure related complications developed in 8. 9% of patients, postoperative complications were 11. 1% , perioperative mortality was 2. 5% , limb salvage rate was 90% , pain symptom was significantly mitigated or relieved, ulcer healed well. The median hospitalstay was 10 days. Restenosis rates were 38. 1 % , 50% respectively at 1 year and 2 years. Rest pain and ulcer recurrence rates were 10% and 12% at 1 year and 2 years respectively; Amputation rates were 10% and 15. 3% at 1 year and 2 years. Restenosis ( or occlusion) , rest pain or ulcer recurrence and amputation rate in Fontain Ⅳ group is significantly poorer than that in Fontain Ⅰ - Ⅲ group (P ＜0. 05). Conclusions Percutaneous transluminal angioplasty (PTA) for critical limb ischeamia in patients with ischaemic diabetic foot are feasible, with minimal invasiveness, low complications. Fontain classification predicts PTA thrapeutic results.

BACKGROUND: Angiotensin Ⅱ (Ang-Ⅱ) can stimulate vascular endothelial cells to excrete endothelin, a kind of potent vasoconstrictor. The content of endothelin in blood or cell culture media directly reflects the function and injured status of vascular endothelial cells. Therefore, it is significant for strengthening vascular endothelial cells to resist the injured factors. Tea polyphenols is a mainly active component of tea, and it is considered as a reagent for anti-atherosclerosis, protecting injuries of vascular endothelial cells and preventing cardiovascular diseases. OBJECTIVE: To observe the effects of tea polyphenols in different concentrations on endothelin content in vascular endothelial cells induced by Ang-Ⅱ at various time points through establishing Ang-Ⅱ-induced vascular endothelial cell injury models and further to investigate the protective effect of tea polyphenols on vascular endothelial cells. DESIGN: Observational study.SETTING: Aerospace and Diving Medical Center, Navy General Hospital of Chinese PLA.MATERIALS: The experiment was carried out in Laboratory of Aerospace and Diving Medical Center, Navy General Hospital of Chinese PLA from March to September 2005. Main materials were detailed as follows: Ang-Ⅱ (Sigma Company), tea polyphenols (Department of Tea Science, Zhejiang University) and vascular endothelial cells (human large artery vascular endothelial cell system, CBI Company, USA).METHODS: Cultured vascular endothelial cells were divided into 4 groups: ① Control group: The normal culture media was added in the isopyknic vascular endothelial cells, and 100 μL supernatant was extracted before and at 0.5, 6 and 24 hours after filling moisturized liquid. ② Ang-Ⅱ group: Cell culture media containing 10-7 mol/L Ang-Ⅱ was added in the vascular endothelial cells, and other operations were as the same as those in the control group. ③ High-concentration tea polyphenols + Ang-Ⅱ group: Cell culture media containing 50 mg/L tea polyphenols was added in the vascular endothelial cells, and other operations were as the same as those in the Ang-Ⅱ group. ④ Low-concentration tea polyphenols + Ang-Ⅱ group: Cell culture media containing 25 mg/L tea polyphenols. 100 μL supernatant was extracted before and after 0.5, 6 and 24 hours treatment in each group. Thereafter, radioimmunoassay was used to measure the content of endothelin. MAIN OUTCOME MEASURES: Content of endothelin.RESULTS: ① Content of endothelin in Ang-Ⅱ group was higher than that in the control group (P ＜ 0.01). ② At 6 and 24 hours after high-concentration tea polyphenols incubation, content of endothelin in high-concentration tea polyphenols + Ang-Ⅱ group was lower than that in Ang-Ⅱ group (P ＜ 0.01). Moreover, the content of endothelin in low-concentration tea polyphenols + Ang-Ⅱ group was lower than that in both high-concentration tea polyphenols + Ang-Ⅱ group and angiotensin Ⅱ group (P ＜ 0.01). CONCLUSION: Tea polyphenols has inhibitory effects on endothelin releasing function of vascular endothelial cells induced by Ang-Ⅱ, suggesting that tea polyphenols has protective effect on vascular endothelial cells, and the effect of low-concentration tea polyphenols is superior to that of the high-concentration one.

BACKGROUND: Studies have shown that alanine (A) to threonine (T) substitution at codon 54 of intestinal fatty acid-binding protein (FABP2) in different populations is associated with dyslipidemia and other characteristics of metabolic syndrome.OBJECTIVE: To investigate the frequency of encoding 54Ala/Thr (A/T) single nucleotide polymorphism in the FABP2 in middle-aged and old people, and explore the association between 54T FABP2 and plasma lipids.DESIGN: A case-controlled analysis. SETTING: Department of Biochemistry, Hebei North University and Department of Clinical Laboratory, the 251 Hospital of Chinese PLA.PARTICIPANTS: 469 physical examinees were selected from the Medical Examination Center, the 251 Hospital of Chinese PLA between October 2003 and April 2005. The subjects included 217 males with mean age of (56±10) years, and 252 females with mean age of (55±13) years. Only people with normal liver and kidney function, and with no blood relation were recruited. The informed consent to this study was obtained from all subjects. The experiment was admitted by Hospital Ethics Committee. METHODS: ①After fasting for 12 hours, automatic analyzer (Olympus AU 6400) was adopted to measure plasma total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apoprotein A1(Apo A1) and Apo B levels. ②1 mL venous blood was extracted and immediately mixed with anti-coagulants containing citric acid, natrium citricum and glucose. White blood cells were separated and genomic DNA was isolated using standard methods with proteinase K digestion and phenol/chloroform purification. The genotype distribution frequency in each group was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). MAIN OUTCOME MEASURES: ①Plasma TC, TG, HDL-C, LDL-C, Apo A1and Apo B levels; ②Distributions of FABP2 genotypes at codon 54. RESULTS: ①The genotype frequencies of A/A, A/T, T/T were 0.48, 0.42, and 0.10 in males, and 0.44, 0.46, and 0.10 in females, respectively. The allelic frequency of point mutant 54Thr in FABP2 gene was 0.31 in males and 0.33 in females, respectively. There was no difference between males and females (χ2=0.47, P ＞ 0.05). ②The LDL-C and Apo B concentrations in fasting plasma of males with 54T allele were significantly higher than those with 54A allele (P ＜ 0.05). The TC and LDL-C concentrations in fasting plasma of females with 54T allele were significantly higher than those with 54A allele (P ＜ 0.05). CONCLUSION: In the middle-aged and old populations, the frequency of encoding 54Ala/Thr polymorphism in FABP2 gene is not correlated with gender, but with high lipoprotein profile.