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 analyze the prevalence status,influencing factors,and differences among different school age groups of myopia in children and adolescents in Ningxia Hui Autonomous Region.Methods From September to De-cember 2019,inYinchuan,Wuzhong,Shizuishan,Guyuan and Zhongwei of Ningxia,8 primary schools,6 junior high schools,6 senior high schools and 4 universities were randomly selected by stratified cluster random sampling.Five classes were se-lected from each grade of primary school,and four classes were selected from each grade of junior high school to university.All students in the selected classes were included in the study.A total of 14 211 students were selected for questionnaire sur-vey,physical examination and visual acuity measurement.The influencing factors of myopia in children of different grades were analyzed using the least absolute shrinkage and selection operator(LASSO)and logistic regression,and the model with the smallest Bayesian information criterion(BIC)was selected as the optimal model.Results The detection rate of myopia in children and adolescents in Ningxia Hui Autonomous Region was 70.3％.The detection rate of myopia in girls was higher than that in boys,and that in cities was higher than that in towns,with statistically significant differences(both P＜0.001).Compared with primary school students,the detection rate of myopia in junior high school students,senior high school students and college students gradually increased,and that in the college students was the highest,with statistically signifi-cant differences among different grades(all P＜0.001).The LASSO-logistic regression analysis of the influencing factors of myopia showed that urban and rural areas,gender,age,whether or not to wear glasses at present,the number of daily break exercises,whether or not to actively participate in physical activities,and whether or not to maintain regular exercises in the past 6 months were the influencing factors of myopia in primary school students(all P＜0.05).Gender and whether or not to wear glasses at present were the influencing factors of myopia in junior high school students and senior high school students(all P＜0.05).Whether or not to wear glasses at present was the influencing factor of myopia in college students(P＜0.05).Conclusion The detection rate of myopia in children and adolescents in Ningxia Hui Autonomous Region is high,and there are significant differences in the influencing factors of myopia among different age groups of children and adolescents.Wear-ing glasses is a protective factor to control myopia.Targeted health education on vision should be provided based on the aca-demic stage of children and adolescents to enhance their awareness of health care and improve their visual health.

Objective:To study the safety and efficacy of hiatal hernia-endoscopic submucosal dissection (HH-ESD) for the treatment of giant hiatal hernia (>3 cm in length) complicated with refractory gastroesophageal reflux disease (GERD).Methods:Patients with giant hiatal hernia complicated with refractory GERD who voluntarily received HH-ESD at the Digestive Endoscopy Center of the Affiliated People's Hospital of Inner Mongolia Medical University from April 2018 to March 2020 were included in the clinical study. The completion of HH-ESD and the occurrence of complications were observed, and the changes of indicators before and after the treatment were observed, including gastroesophageal reflux disease-health related quality of life (GERD-HRQL) score, gastroesophageal reflux disease questionnaire (GERD-Q) score, endoscopy results, 24 h esophageal pH monitoring results, esophageal high-resolution manometry results and proton pump inhibitor (PPI) usage.Results:Data of 10 patients were collected during the study, with a medical history of 2-10 years. All patients successfully underwent HH-ESD treatment. No adverse events such as perforation and massive bleeding occurred during the operation, and the hospital stay was 6-12 days. Dysphagia occurred in 3 cases after the operation, which was relieved spontaneously within 3 or 6 months. The preoperative GERD-HRQL scores ranged from 19 to 29, which were reduced to 0-14 and 0-8 at 3 and 12 months after the operation, respectively. The preoperative GERD-Q score was 9-17, and the scores at 3 and 12 months after the operation were all 6-9, which were significantly lower than those before. Gastroscopy showed that esophagitis was improved in all patients, hernia sac was reduced, and Hill grade was reduced compared with that before. The preoperative DeMeester score was 30.3-247.1, and the postoperative 12-month score was 0.2-29.9, which was significantly lower than that before. The long diameter of hiatal hernia was 3.0-6.0 cm before the operation and 0-5.0 cm at 12 months after, which was smaller than that before. At 12 months of the follow-up, 7 patients had stopped PPI, and the remaining 3 had changed to intermittent oral PPI.Conclusion:Preliminary results show that HH-ESD is safe and effective for the treatment of giant hiatal hernia complicated with refractory GERD.

Objective: To understand secular trend of blood pressure among Han ethnic students aged 7-18 years in Ningxia from 2000 to 2014，and to provide preliminary evidence for hypertension prevention and control. Methods: Data of blood pressure, height, weight of Han students aged 7-18 years in Ningxia were collected in the National Students Physical Fitness and Health Survey during 2000-2014 years were analyzed by using SPSS 21.0. Results: From 2000 to 2014, the systolic pressure of the Han students in Ningxia showed a decreasing-increasing trend(F=357.44, P<0.05), with an average decrease of 3.37 mm Hg; diastolic pressure showed a decreasing-increasing trend(F=172.95, P<0.05), with an average decrease of 4.18 mm Hg; pulse pressure showed a decreasing-increasing trend(F=311.86, P<0.05), with an average decrease of 1.98 mm Hg. The body mass index of the Han nationality students in Ningxia was on the rise(F=128.15, P<0.05). The detection rates of high blood pressure, high systolic blood pressure and high diastolic blood pressure increased by 1.0, 0.4 and 0.9 percentage. Conclusion Blood pressure in Ningxia Han students aged 7-18 years increases gradually in recent years, which warrants further attention. Health education and health promotion is needed to prevent the occurrence of hypertension.

Objective: To analyze the trend of overweight and obesity among Han students aged 7-18 years in Ningxia from 2000 to 2014, and to provide scientific basis for child and adolescent obesity prevention and control in Ningxia. Methods: Based on data of the height and weight of Han students aged 7-18 in the four waves of national student physical surveys in Ningxia from 2000 to 2014, SPSS 21.0 was used for trend analysis. Results: From 2000 to 2014, the overweight and obesity rate of Han students in Ningxia from 7 to 18 years old showed an upward trend. Compared with the year of 2000, the total overweight rate increased by 2.06 times in 2014 and the obesity rate increased by 4.40 times. The overweight and obesity rate of boys was higher than that of girls in 2005 and 2014, and the difference was statistically significant(χ2=4.91, 6.20, P<0.05). The overweight and obesity rates of urban students were higher than those of rural students in 2005 and 2010(χ2=9.63, 5.97, P<0.05). The correlation analysis between the overweight and obesity rate of Ningxia students and socioeconomic indicators showed that the overweight and obesity of Ningxia students from 2000 to 2014 was closely related to the level of Ningxia socioeconomic development, especially the obesity detection rate of rural students was related to Ningxia’s GDP and The correlation between GDP, per capita disposable income, per capita consumption expenditure, and urbanization rate is stronger(r=0.98, 0.98, 0.99, 1.00, 0.93, P<0.05). Conclusion Socioeconomic of Ningxia is rapidly increasing, and the overweight and obesity rate of Han students aged 7 to 18 is also increasing. It is suggested that society, schools and parents should pay great attention to this phenomenon, build community-wide efforts to prevent childhood obesity, and prevent chronic diseases caused by overweight and obesity occurrence risk.

Objective: To understand the vitamin D nutritional status and associated factors of children and adolescents aged 6-18 in Yinchuan, so as to provide theoretical basis for improving the vitamin D malnutrition status of children and adolescents. Methods: Using stratified cluster sampling method, 1 615 children and adolescents from 36 classes in 2 primary schools, junior high schools and high schools were randomly selected from Yinchuan, Ningxia. Venous blood sampling,physical examinations and questionnaires were conducted. Results: The vitamin D deficiency rate and appropriate rate for students were 66.9% and 33.1%, respectively. There was a statistically significant difference in vitamin D deficiency among different age groups(χ2=25.65, P<0.05). The 6-year-old group had the highest(79.2%), followed by the 13-year-old group (76.6%), and the 12-year-old group (75.3%). The results of binary Logistic regression showed that the factors influencing the vitamin D nutritional status of children and adolescents included age(OR=0.95), daily outdoor exercise time(OR=0.49), exclusive breastfeeding (OR=0.63) and mother’s education(OR=0.73, 0.43). The decision tree QUEST and Logistic regression combination model results show that the key factors affecting vitamin D nutrition status include daily outdoor exercise time, age, mother’s education, BMI, and interaction between outdoor exercise time and age, interaction between outdoor exercise time and mother’s education, interaction between age and mother’s education, interaction between exclusive breastfeeding and BMI. Conclusion The detection rate of vitamin D deficiency in children and adolescents aged 6-18 in Yinchuan is high, factors associated with vitamin D nutritional status includes daily outdoor exercise time, age, mother’s education, BMI, and interaction between outdoor exercise time and age, interaction between outdoor exercise time and mother’s education, interaction between age and mother’s education, interaction between exclusive breastfeeding and BMI.

Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease, and its prevalence rate is increasing year by year. Insulin resistance and oxidative stress are the main pathogeneses of NAFLD, and there are still no effective drugs for the treatment of this disease. Insulin resistance is also a main pathogenesis of type 2 diabetes, and people with type 2 diabetes have a higher prevalence rate of NAFLD than those without diabetes. Liraglutide is a human glucagon-like peptide-1 analogue and can improve insulin resistance, and more and more studies have found that liraglutide has a certain therapeutic effect in patients with type 2 diabetes and NAFLD, while related mechanisms have not been fully clarified. This article reviews the therapeutic effect and related mechanisms of liraglutide in the treatment of type 2 diabetes and NAFLD.

Objective:To explore the clinical effects of single pedicle transfer of expanded axial flap across the midline of the frontal-parietal region in reconstruction of large scar deformities in the face and neck.Methods:From January 2016 to August 2019, 10 male patients, aged from 20 to 52 years with post-burn facial and cervical scar deformities, were admitted to the First People′s Hospital of Zhengzhou, with the size of scar ranging from 15 cm×7 cm to 23 cm×11 cm. In the first stage, a cylindrical skin and soft tissue expander with rated capacity ranging from 400 to 600 mL was placed in the frontal-parietal region. Another cylindrical expander with rated capacity ranging from 50 to 100 mL was placed in the temporal region of the patient with scars in front of the ear and in cheek. The injection time was 3 to 5 months with the total injection volume being 1.5 to 2.5 times of the rated capacity of expander. In the second stage, the superficial temporal artery frontal branch and its branches were explored, the expander was removed, the scars in the face and neck were conducted resection and contracture relaxation, and the single pedicle transfer of expanded axial flap across the midline of the frontal-parietal region for reconstruction was performed. When the branches of the superficial temporal vessels were difficult to be detected by Doppler ultrasonic blood stream detector, the patient underwent computed tomography (CT) angiography and three-dimensional reconstruction. The donor site in frontal-parietal region was directly sutured, and the wound of the exposed donor site at the pedicle and temporal region was temporarily covered with scar skin. After the suture wound was healed and the hair in expanded flap grew out, hair removal and laser hair removal were performed. Three to four weeks after transplantation of expanded flap, the flap pedicle was cut off, restored, and trimmed in the third stage. The status about the completion of operation, the implantation of expander in the temporal region, CT angiography and three-dimensional reconstruction were recorded. The effective resection area of expanded flap, the length across the midline and the length of the pedicle, and the survival status of the expanded flap and complications after operation were observed. The appearance of donor and recipient sites, the scar recurrence, the appearance and function improvement of patients, and the satisfaction degree of patients were followed up.Results:All the 10 patients successfully completed three stages of operation, of which 6 patients had an auxiliary expander placement in the temporal region, and 5 patients underwent CT angiography and three-dimensional reconstruction. The effective resection area of expanded flap ranged from 18 cm×8 cm to 25 cm×13 cm. The distal end of the flap across the midline extended 4-6 cm to the opposite side, and the length of pedicle was 2-6 cm. All the expanded flaps of patients survived well after formation and transfer. The venous reflux disorder and obvious swelling occurred in 6 patients at the distal end of the flap after operation, and the blood supply recovered after acupuncture bloodletting, etc. Follow-up of 6 to 24 months showed that the color, texture, and thickness of the expanded flaps were similar to those of the facial skin, and no recurrence of scar was observed; the incision in the donor site of the frontal-parietal region was concealed, the hair growth of the temples and head was normal, and the reconstructed hairline was natural; compared with those before operation, the appearance, head-up, mouth-opening, and other functions of patients were significantly improved; the patients were satisfied with the effect of reconstruction.Conclusions:Clinical application of single pedicle transfer of expanded axial flap across the midline of the frontal-parietal region in reconstruction of large scar deformities in the face and neck can achieve a good appearance and function, and the donor site shows good shape, which enriches the application range of the trans-regional blood supply flap. It is a reliable method for reconstruction of large scar deformities in the face and neck.

Objective: To investigate the visual acuity of primary and middle school students in Ningxia by using decision tree model and logistic regression, and to provide evidence for the prevention and control of visual acuity. Methods: Using stratified cluster sampling method, 3 257 children aged 7-18 years were randomly selected from Yinchuan and Wuzhong in Ningxia. Visual acuity test and questionnaire survey were conducted. The C 5.0 algorithm in Clementine12.0 and Logistic regression were used to analyze the factors associated with visual acuity. Results: The overall rate of low vision of the middle school of Ningxia was 62.6%, with girls (68.1%) higher than that of boys(56.8%)(P<0.01). There was a significant difference in the prevalence of low vision among different educational stages(P<0.01), with high school students had the highest detection rate(82.2%). Results of decision tree C 5.0 algorithm showed that educational stage, gender, time to do homework after school and frequency of moderate intensity exercise per week associated with poor eyesight of primary and secondary school students. Logistic regression results showed that girls, the distance between the eyes and the computer display screen <66 cm(OR=1.24, 95%CI=1.00-1.52), and the distance between the eyes and the textbook when reading was less than one foot (OR=2.05, 95%CI=1.23-3.40) were positively associated with poor vision. Low grade students and homework time <2 hours after school (OR=0.76, 95%CI=0.62-0.92) were negatively associated with lower risk of poor vision. Conclusion Educational stage, gender and time of homework after school are associated with the visual acuity of primary and secondary school students in Ningxia. It is suggested that prevention of myopia should start from the low-grade students, reducing after-school work for primary and secondary school students, and increasing outdoor activities. All the girls should be encouraged to engage in more outdoor activities, to prevent the occurrence and development of myopia.

Objective: To investigate the clinical effect of percutaneous transhepatic bile duct drainage guided by ultrasound. Methods: From June 2016 to June 2018, 100 patients with obstructive jaundice in Lishui Central Hospital were treated with ultrasound-guided percutaneous transhepatic bile duct drainage.The success rate and postoperative complications of the patients were analyzed. Results: Among 100 cases, 98 cases were successful, 2 cases failed, and the failure rate was 2%.The success rate of one-time catheterization in 0.5-2.0 cm patients with intrahepatic bile duct diameter(98.91%) was significantly higher than that in intrahepatic bile duct diameter 0.3-0.4 cm patients(87.50%), compared with two different diameter puncture catheterization, the difference was statistically significant(χ²=12.369, P<0.05). All 98 cases with successful puncture were followed up after operation (P<0.05), and there was no statistically significant difference between the two groups(P<0.05). The drainage tube was removed in 2 cases, bile duct infection was found in 2 cases, the remaining patients were unobstructed, and there were no obvious complications. Conclusion Ultrasound-guided percutaneous transhepatic catheterization and drainage for the treatment of obstructive jaundice caused by malignant tumor is simple, reliable, safe and effective, and has a certain clinical value.It is worthy of popularizing and application.