Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is an uncommon but potentially catastrophic pathology. Multiple classification schemes have been proposed for this occurrence. Although no consensus has emerged regarding which classification should be used, Li's classification scheme is more precise and complete compared to other classification systems and can be used to guide the treatment of SISMAD. Initial conservative treatment is promising, with favorable early and long-term outcomes for most patients; endovascular treatment is recommended for patients with persistent/recurrent symptoms after conservative treatment; surgical treatment should be performed without delay for patients with arterial rupture, intestinal necrosis, or failed endovascular treatment.
Classification* ; Consensus ; Humans ; Mesenteric Artery, Superior* ; Necrosis ; Pathology ; Rupture

Objective To evaluate risk factors of hepatitis B virus (HBV) reactivation after transarterial chemoembolization (TACE) in patients with HBV-related hepatocellular carcinoma (HCC) with undetectable HBV DNA levels.Methods From August 2012 to Sepemter 2015,all patients who underwent TACE for HBV-related HCC with HBV DNA level less than 103 copies/ml in the First Affiliated Hospital of Soochow University were enrolled into the study.These patients were followed-up for at least 6 months after TACE to assess HBV reactivation.Univariate and multivariate logistic regression analyses were done to evaluate the risk factors related to HBV reactivation in these patients.Results With predetermined inclusion and exclusion criteria,99 patients were enrolled into the study.Twenty-four patients (24.2％) developed HBV reactivation after TACE in the followed-up period.The level of transaminase was significantly higher in the HBV reactivation group than the non HBV reactivation group (P ＜ 0.05).HBeAg positivity and tumors more than 3 in number were independent risk factors of HBV reactivation.Conclusion HCC patients with undetectable levels of HBV DNA had a significant risk of HBV reactivation after TACE.

Objective To investigate the efficacy of gelatin sponge particles(GSP)or polyvinyl alcohol particles (PVA) for hemoptysis secondary to bronchiectasis or pulmonary tuberculosis. Methods The clinical data on 271 patients with bronchiectasis- or tuberculosis-induced hemoptysis were retrospectively analyzed. The efficacy and rates of recurrence and complications were analyzed. Results A total 271 patients were included in this study, 176 of whom suffered from bronchiectasis and the rest 95 had tuberculosis. One-week cure rate was signifi-cantly higher in bronchiectasis group than in tuberculosis group(73.3%vs. 46.3%,P<0.05),and one-year recur-rence rate was significantly lower in bronchiectasis group(17.6%vs. 26.3%,P<0.05). One-year recurrence rate was slightly higher in patients receiving GSP than in those undergoing PVA(bronchiectasis group:22.2%vs. 10.3%, P<0.05;tuberculosis group:28.8%vs. 22.2%,P>0.05). No severe complications occurred. Conclusions In-terventional artery embolization therapy for hemoptysis secondary to bronchiectasis is better than tuberculosis-induced hemoptysis,and PVA is more effective than GSP. Recurrence of massive hemoptysis mostly occurrs within one month ,and most of the patients are complicated with blood supply and have a history of hemoptysis.

Portal vein tumor thrombus (PVTT) is a common finding in patients with advanced hepatocellular carcinoma (HCC),and the presence of PVTT usually indicates a poor prognosis.At present,two PVTT classifications are adopted in clinical practice;they are VP classification of Japan and eastern hepatobiliary classification (Cheng's classification).There are some differences in PVTT classification between the above two typing criterion.Certain correlation exists between patient's prognosis and PVTT typing;for example,PVTT of type Ⅰ0 carries the best prognosis,while PVTT of type Ⅳ indicates the worst prognosis.The choice of treatment plan is limited by the type of PVTT for a given patient.Therefore,the optimal therapeutic regimen should be formulated based on the type of PVTT in order to control HCC and to benefit the patient.

Objective This study was aimed to characterize the swine leukocyte antigen( SLA) class I genes of GGTA1 -/ - Wuzhishan minipigs and compare their similarity to human leukocyte antigen( HLA) . It has important implica?tions for understanding the cellular rejection in xenotransplantation. Methods Specimens of ear tissue from six founding GGTA1 -/ - Wuzhishan minipigs were collected, and the SLA class I genes (SLA?1, SLA?3, SLA?2) were amplified by RT?PCR. Purified products were cloned into pEASY?T1 vectors and sequenced, followed by BLAST alignment and using bioin? formatc analysis to characterize the SLA class I genes and compare with the similarity to HLA. Results A total of six al?leles were detected, among them alleles were previously reported (SLA?1?0703,SLA?2?1102, SLA?3?0401, SLA?3?0403), and the other were novel (SLA?1?0401wz01, SLA?2?11wz01). The homology between alleles of SLA class I genes in Wuzhishan minipigs and HLA was from 70?5% to 72?1%. The homology analysis of critical amino acid residues on HLA binding with human CD8 + molecules showed that SLA?1?0401wz01, SLA?1?0703, SLA?2?11wz01, SLA?2?1102 and SLA?3?0401 occurred mutant at amino acid positions 225 and 228 ( T→S,T→M) , whereas the other loci were highly conserved. There was a high homology at amino acid level between SLA?2?11wz01, SLA?2?1102 and HLA class I genes which are NK cell KIRs binding sites. Conclusions The amino acid sequences of SLA class I genes of GGTA1 -/ -Wuzhishan minipigs have a high homology to HLA. From the point of view of cell?mediated xenograft rejection, the amino acid sequences of SLA class I genes of GGTA1 -/ - Wuzhishan minipigs have a high homology to HLA, therefore, Wzhishan minipigs may become a good potential donor for pig?human xenotransplantation.

Objective To investigate the clinical features,diagnosis,treatment,and prognosis of patients with liver injury caused by Periploca forrestii Schltr.Methods A retrospective analysis was performed for the general data,clinical manifestations,and laboratory examinations of 22 patients who were diagnosed with liver injury caused by Periploca forrestii Schltr.from November 2014 to December 2015,and their clinical type was determined according to the classification criteria of drug-induced liver injury recommended by the Council for Intemational Organizations of Medical Sciences.Results There were 12 female and 10 male patients.The mean medication time ranged from 1 week to 2 months,and as for biochemical markers,there were mainly abnormalities in alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil),alkaline phosphatase (ALP),and gamma-glutamyl transpeptidase (GGT).ALT and AST increased in all the patients,with mean levels of 676.68±481.11 U/L and 527.36±361.14 U/L,respectively;TBil increased to a mean level of 170.26±147.30 μmol/L in 19 patients;ALP increased to a mean level of 135.61±59.26 U/L in 13 patients;GGT increased to a mean level of 195.65±138.48 U/L in 20 patients.As for clinical typing,18 patients had liver cell injury,none had cholestasis,3 had a mixed type,and 1 had an unclassified type.One patient died and all the other patients fully recovered.Conclusion Periploca forrestii Schltr.had complex constituents,and liver injury caused by this drug is mainly liver cell injury.The pathogenesis of liver injury caused by Periploca forrestii Schltr.is presumed to be related to patients' idiosyncratic reaction to its constituents.