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:Applying bibliometrics to analyze the research history, hotspots and trends of Traditional Chinese Medicine (TCM) interventions in edema-related diseases, and to provide reference for the revision of diagnostic and therapeutic criteria for edema in TCM.Methods:The literature about edema treated with TCM was retrieved from CNKI, Wanfang, VIP, CBM from 1 st. Jan 1995 to 25 th. May 2022. CiteSpace and VOSviewer softwares were used to draw the knowledge map, and analyze the co-occurrence relationship and clustering characteristics of the institution, author, keywords and mechanism hotspots. Results:Totally 3 198 articles were included. The annual number of documents issued generally shows a spiral rise trend. Liaoning University of Chinese Medicine published the most articles. Core authors published the most articles were Sun Wei (13 articles); the team with the highest cooperation intensity was Yang Hongtao's team; keywords formed 7 clusters. Hotspot mechanisms included metabolic disorders, immune balance, anti-inflammation, calcium and phosphorus metabolism. Keywords in the past 7 years were membranous nephropathy, chronic heart failure, diabetes, lymphedema etc.Conclusions:The attention paid to the intervention of TCM in the field of edema is generally on the rise, and has decreased in the past two years. The research categories focus on the experience of famous doctors, clinical trials, and mechanistic studies, and nephropathy-related edema has been the focus of research; diabetic nephropathy, chronic heart failure, metabolomics, and immunotherapy are expected to be the focus of attention in the next stage.

Objective:To analyze the efficacy evaluation criteria of the existing TCM treatment for edema RCT research, and to provide reference for the construction of unified standards.Methods:The batabases CNKI, WanFang Data, VIP, CBM, Pubmed and Web of Science were retrieved. The randomized controlled trials for the treatment of edema of TCM research, from September 1, 1993 to July 31, 2022, were screened and included. The content of efficacy evaluation, performed statistics on evaluation standard, the curative effect evaluation indexes, as well as standard composition, usage were extracted. We analyzed the characteristics, application and problems of the existing efficacy evaluation criterion.Results:A total of 123 Chinese articles were included. The included literature involved nephrogenic edema, cardiogenic edema, idiopathic edema, apoplexy limb edema and other edema. In recent years, randomized controlled trials on the treatment of edema by TCM have mainly used four efficacy evaluation criteria. Of which the Guidelines for Clinical Research on New Chinese Medicines (Trial) in 2002 had the highest utilization rate of 29.27%. Secondly, the utilization rate of Standard for Diagnosis and Curative Effect of TCM Diseases and Syndromes was 21.14%. The rest of the criteria were used by less than 6%. While 39.02% of the literature did not use the standards or used self-designed standards. Among the composition of efficacy evaluation indices, the application rate of TCM syndrome or symptom efficacy index was the highest (91.87%), the utilization rate of the Minnesota Living with Heart Failure Questionnaire Indicators was only 4.88%; biochemical tests accounted for a large proportion of Western medical indicators, while the measurement of edema severity was rarely applied. Conclusions:At present, the evaluation criteria of edema curative effect are diversified and insufficiently popularized, which need to be further screened and improved. It is suggested to construct a TCM edema efficacy evaluation model based on the characteristics of edema syndrome, comprehensively evaluate the efficacy from multiple dimensions such as TCM syndromes, western medicine indicators, and quality of life, and improve the scientific indicators.

Objective:To evaluate the effect of intravenous infusion of dexmedetomidine before induction of anesthesia on concentrations of blood potassium and blood glucose in the patients with gastrointestinal tumors.Methods:One hundred and twenty patients, irrespective of gender, aged 18-75 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, scheduled for elective radical gastrointestinal tumor surgery, were divided into 3 groups ( n=40 each) using a random number table method: control group (group C), dexmedetomidine 0.5 μg/kg group (group D 1), and dexmedetomidine 1.0 μg/kg group (group D 2). Dexmedetomidine 0.5 and 1.0 μg/kg were intravenously infused prior to anesthesia induction over 10 min in D 1 and D 2 groups, while the equal volume of normal saline 20 ml was intravenously infused instead in group C. Before intravenous infusion (T 0), at 15 min after intravenous infusion (T 1), and at 30 min after intravenous infusion (T 2), blood samples from the radial artery were collected for blood gas analysis, and concentrations of blood potassium and blood glucose were recorded. The occurrence of complications such as hyperglycemia, hypoglycemia, hyperkalemia, hypokalemia, hypotension, hypertension, tachycardia and bradycardia was also recorded. Results:Compared with C group, the blood glucose concentrations were significantly increased at T 1 in D 1 and D 2 groups and at T 2 in D 2 group ( P<0.05). The blood glucose concentrations were significantly higher at T 1, 2 in D 2 group than in D 1 group ( P<0.05). There was no significant difference in blood potassium concentrations at T 0-T 2 among the three groups ( P>0.05). No patients presented with complications such as hyperglycemia, hypoglycemia, hyperkalemia, hypokalemia, hypotension, hypertension, tachycardia and bradycardia. Conclusions:Intravenous infusion of dexmedetomidine before induction of anesthesia exerts no marked effect on blood potassium concentrations and can increase glucose concentrations to a certain extent, but the elevation has no clinical significance in the patients with gastrointestinal tumors.

【Objective】 To apply the spatial distribution analysis based on ArcGIS software, which has been applied widely in other fields, so as to analyze the intended locations for whole blood donation. 【Methods】 After a random stratified sampling was conducted among blood donors in the 17 donation sites during August 1st, 2021- July 30th, 2022, their intended blood donation locations were collected by an e-questionnaire. Addresses of donors′ intended donation locations were derived for GCJ-02 coordinates form and transformed by pandas module of Python to WGS84 coordinates, which further loaded to ArcGIS Arcmap module using Grouping Analysis for 17 median centers. The addresses of 17 blood donation sites in Guangzhou Blood Center were transformed to WGS84 coordinates and loaded to ArcGIS Arcmap module using the same methods for 3 ring buffer analysis. The criterion for judging whether the two were " matched" was whether the intended blood donation sites were covered by or adjacent to the 3 ring buffer zone of the existing blood donation sites. 【Results】 Of the 17 potential sites obtained from the spatial distribution analysis of 40 523 valid addresses of donors, 8 sites were covered or adjacent to the buffer of the existing donation sites, while the other 9 sites were far away from the existing donation sites. 【Conclusion】 By analyzing the spatial distribution of donors′ intended donation addresses, we can find out the service needs of donors for donating blood conveniently, which can provide basis for further blood donation service optimization.

Objective:To evaluate the impact of the reform of the county medical community on the expenditure of medical insurance funds, and to provide references for maintaining the stability of the medical insurance fund and deepening the reform of the medical community.Methods:Medical insurance data of urban and rural residents in M County, Yunnan province from 2016 to 2019 were collected, and a discontinuous time series model was used to analyze the impact of county medical community reform on medical insurance fund expenditures.Results:Since the reform, the number of patients discharged from county-level hospitals has shown a downward trend, averaging a decrease of 25.996 people per month; yet increases have emerged with the average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure, averaging a monthly increase of 90.931 yuan, 50.014 yuan and 1.528 yuan respectively. The average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure of the township hospitals all showed an upward trend, averaging a monthly increase of 31.191 yuan, 38.678 yuan and 0.085 yuan respectively. The flow of external medical insurance funds of the medical community has shown a continuous upward trend, averaging a monthly increase of hospitalization fund expenditures of 33.005 yuan, and a monthly increase of outpatient overall fund expenditures of 4.896 yuan overall.Conclusions:The M County medical community should further strengthen the top-level design, explore the reform of medical insurance payment methods, improve the regional information platform, standardize the referral system, and strengthen supervision to deepen the construction of the medical community to ensure the sustainable operation of medical insurance funds.

Objective:To evaluate the effects of different doses of dexmedetomidine infused at nighttime on early postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of malignant gastrointestinal tumors.Methods:Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of either sex, aged 65-75 yr, with body mass index of 18-24 kg/m 2, scheduled for elective radical resection of malignant gastrointestinal tumors, were divided into 4 groups ( n=20 each) using a random number table method: control group (group C) and different doses of dexmedetomidine groups (D 1-3 groups). Dexmedetomidine 0.1, 0.2 and 0.3 μg·kg -1·h -1 (infusion rate 4 ml/h) were intravenously infused from 21: 00 on the day of surgery and the first day after surgery until 6: 00 in the next morning.Normal saline was given instead of dexmedetomidine in group C. The period of sleep and the number of awakening at night were recorded before surgery and at 2 and 7 days after surgery.Cognitive function was assessed at 1 day before surgery and 7 days after surgery.The concentrations of plasma cortisol were measured at 16: 00 before surgery and 2 and 7 days after surgery and at 8: 00 in the corresponding morning of the next day.The difference in the plasma cortisol concentration measured at 8: 00 every day and at 16: 00 of the previous day were calculated. Results:The incidence of POCD was significantly lower in D 2, 3 groups than in group C ( P<0.05). The number of awakening at night was significantly decreased at 2 days after surgery in group D 3 as compared with the other three groups ( P<0.05). The difference in the plasma cortisol concentration was significantly decreased at 2 and 7 days after surgery in D 2, 3 groups when compared with group C and group D 1 ( P<0.05). Compared with group D 2, no significant change was found in the difference in the plasma cortisol concentration at each time point in group D 3 ( P>0.05). There were no significant differences in the incidence of hypotension, hypertension, bradycardia, and tachycardia among the four groups ( P>0.05). Conclusion:Infusing dexmedetomidine 0.2 or 0.3 μg·kg -1·h -1 at the nighttime can reduce the development of POCD in the elderly patients undergoing radical resection of malignant gastrointestinal tumors.

Objective: To undersand the monitor of occupational hazards in the enterprises in the past 5 years, as well as the distribution of occupational disease hazards and their dynamic changes in their respective jurisdictions, for providing scientific basis for prevention and control of occupational diseases in relevant departments. Methods: Taking the method of cluster sampling, select the monitoring results of the occupational disease hazard factors commissioned by the Municipal Center for Disease Control and Prevention from 2014 to 2018 and the annual monitoring data of the network of the occupational hazard declaration system of the Safety Supervision Bureau, using chi-square test, trend Statistical analysis was performed by chi-square test or Fisher exact probability method. Results: There were 461 testing companies in the past 5 years, with a total of 15, 186 monitoring points and 43428 samples. The pass rate was 94.32% (14324/15186) . The pass rate was increasing year by year from 2014 to 2017 (P<0.05) ; The pass rate of various occupational disease hazards surveillance were greater than 90% except the rate of physical factors. In 2014, the qualified rate of physical factors was the lowest, which was 86.99% (1558/1791) ; the production rate of different production scale enterprises in 2018 was higher than that of 2014. From 2014 to 2018, the number of inspection enterprises and the number of inspection points of the joint-stock economy and state-owned economic enterprises are both high, 58 (10091 points) and 71 (1830 points) respectively; The qualified rate of state-owned economy and collective economy monitoring is high, 98.36% (1800/1830) and 100% (74/74) respectively. It had reached more than 95%; The enterprises tested mainly from the economic development zone and Guangling, respectively accounting for 34.27% (158/461) and 33.84% (156/461) of the total number of enterprises. Which followed by the Hanjiang, accounting for 23.21% of the total number of enterprises (107/461) ; The monitoring enterprises were mainly distributed in the manufacturing and power industries, which accounted for 85.25% (393/461) and 6.07% (28/461) of the total number of enterprises, respectively. Conclusion The monitoring rate of enterprises had been increasing year by year from 2014 to 2018. Noise was the main disease prevention and controlling factor in the area.In addition, micro-enterprises, individual economy and foreign-invested economy were the key targets for occupational health.

Objective To compare the changes of antrum and fundus cross‐sectional area ( CSA ) measured by bedside ultrasonography on gastric insufflation during anesthesia induction in non‐obese female patients and analyze the relationships between these changes as well as postoperative nausea and vomiting ( PONV ) . Methods Fourty‐six patients scheduled for elective gynecological laparoscopic operations were enrolled in the study . T he patients w ho appeared the comet‐tail artifacts were defined as gastric insufflation positive group( GI+ group) ,w hile the ones without comet‐tail artifacts were defined as gastric insufflation negative group( GI‐ group) . Blood oxygen saturation ( SPO 2 ) ,end‐expiratory partial pressure of CO 2 ( PET CO2 ) ,tidal volume( T V ) were recorded after 180 seconds ventilation in both groups . T he longitudinal and anteroposterior diameters of gastric antrum and fundus were measured before and after facemask ventilation respectively and the corresponding CSA were calculated . T he cutoff values of prediction of gastric insufflation were determined according to the ROC curve and the corresponding sensitivity and specificity were calculated . PONV of the two groups were also recorded . Results T he analysis was based on the remaining 41 data sets actually . T here were 13 patients in GI‐group and 28 ones in GI+ group . Compared with GI‐group ,the changes of T V and fundus CSA in GI+ group had significantly differences( P ＜0 .05) ; w hile compared with before mask ventilation ,the changes of antrum and fundus CSA in both groups had significantly differences ( P ＜0 .05).T he areas of antrum and fundus CSA under the ROC curve (95% CI) were 0 .67 and 0 .80 ,with cut‐off value 3 .19 cm2 and 24 .90 cm2 ,sensitivity 0 .93 and 0 .93 and specificity 0 .39 and 0 .69 ,respectively .T he incidence of PONV in GI+ group was higher than that in GI‐group( P ＜0 .05). Conclusions Changes of fundus CSA by ultrasonography might be superior to antrum CSA in gastric insufflation caused by 20 cm H2 O peak airway pressure of facemask ventilation during anesthesia induction . Gastric insufflation caused by positive pressure ventilation is related with PONV for young female patients undergoing gynecological laparoscopic operation .

Objective To evaluate the effect of facemask ventilation with different pressures on perioperative complications in the patients undergoing gynecological laparoscopic surgery. Methods Seven-ty-five American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-60 yr, with body mass index of 18-24 kg∕m2 , scheduled for elective gynecological laparoscopic surgery under general anesthesia, were divided into 3 groups ( n=25 each) using a random number table method: 10 cmH2 O group ( group P10) , 15 cmH2 O group ( group P15) and 20 cmH2 O group ( group P20) . The pres-sure for facemask ventilation was 10, 15 and 20 cmH2 O during induction of anesthesia in group P10, group P15 and group P20, respectively. Before facemask ventilation ( T0 ) and at 180 s of facemask ventilation ( T1 ) , longitudinal and anteroposterior diameters of the antral area in the supine position were measured u-sing ultrasonography, the antral cross-sectional area was calculated, and the development of serious flatu-lence was recorded. The development of hypoxemia, tidal volume and end-tidal pressure of carbon dioxide in each group were recorded at T1 . The operation time and occurrence of postoperative flatulence and nausea and vomiting were recorded. Results Compared with group P10, the incidence of serious flatulence and postoperative flatulence and nausea and vomiting was significantly increased, and the incidence of hypox-emia was decreased in group P15 and group P20, and tidal volume was increased at T1 in group P20 ( P<0. 05) . Compared with group P15, the incidence of serious flatulence was significantly increased ( P<0. 05) , and no significant change was found in the incidence of hypoxemia and postoperative flatulence and nausea and vomiting in group P20 ( P>0. 05) . There was no significant difference in the end-tidal pressure of carbon dioxide at T1 or antral cross-sectional area at T0 and T1 among the three groups ( P>0. 05) . Con-clusion Pressure of 10-15 cmH2 O for facemask ventilation is optimal during induction of general anesthe-sia and can ensure adequate oxygen supply and reduce perioperative complications in the patients undergoing gynecological laparoscopic surgery.