Objective To clarify the clinical application effect of electronic medical record linkage time node reminder system(hereinafter referred to as reminder system)in trauma center.Methods A total of 90 patients with severe trauma admitted to the Trauma Center of Huzhou First People's Hospital from June 2022 to March 2023 were selected,and 45 patients admitted from June to October 2022 were included in control group for routine pre-hospital in-hospital treatment.Forty-five patients with severe trauma admitted from November 2022 to March 2023 were included in experimental group,and reminder system was implemented to guide the treatment process.The indexes of medical quality control,emergency black hole procedure time and patient outcome were compared between two groups.Results Bedside FAST ultrasound examination time,CT scan completion time,emergency room stay time,nursing waiting time,make diagnosis and treatment plan and surgical talk time,and travel transport time of patients in experimental group were significantly shorter than those in control group(P<0.05).There were no significant differences in the first tranexamic acid administration time,completion time of damage control treatment,length of stay in intensive care unit,duration of invasive mechanical ventilation and success rate of treatment between two groups(P>0.05).Conclusion The application of reminder system is helpful to strengthen the cooperation of medical care,shorten the unnecessary waiting time for treatment,and accelerate the time node transformation in the process of severe trauma treatment.

【Objective】 To investigate whether the blood donors' coagulation status may lead to apheresis platelet aggregation in vitro. 【Methods】 Thirty blood donors with aggregation in apheresis platelets collected by AMICUS blood cell separator no less than 3 times previously and occurred when the last time of apheresis donation were observed in aggregated group (referred to as the experimental group); Thirty donors without aggregation in apheresis platelets collected by AMICUS blood cell separator no less than 3 times were observed in the control group simultaneously. The basic platelet parameters in the two groups, including Plt, MPV, PDW, Pet, P-LCR were detected by automatic blood cell analyzer (BC-3000Plus), and thromboelastogram indexes including reaction time(R), kinetics time(K), kinetics of clot development(α), maximum amplitude (MA) and coagulation index(CI) were tested by Thrombosis elastography (TEG) before collection. With SPSS24.0 software, t test was used to compare the differences between the two groups. 【Results】 The CI value in experimental group was significantly different from that of the control group (0.48± 1.00 vs -0.99 ±1.96, P< 0.05), and there was no significant difference in all above basic platelet parameters and other TEG parameters (P>0.05 ) . 【Conclusion】 The coagulation status of blood donors may be an independent risk factor for the in vitro aggregation of apheresis platelets.

【Objective】 To search compatible and suitable platelets for platelet transfusion refractoriness (PTR) patient caused by compound antibodies against HLA and CD36. 【Methods】 ELISA method was used to detect the antibody against platelet antigens and the specificity of HLA-I antibody in PTR patients. The specificity of HLA-I antibody and corresponding epitopes of patients were analyzed using MATCH IT! and HLA Matchmaker software. The HLA genotype of both donor and patient was obtained by HLA-SSO method. Compatible or suitable donor platelets for PTR patients were searched through cross-reactive group (CREG) of HLA-I and HLA epitope-matched approach (Eplet). The matching degree was identified using monoclonal antibody-specific immobilization of platelet antigens (MAIPA) and the platelet suspension immunofluores-cence test (PIFT). Finally, the transfusion effect was evaluated according to the corrected count increment (CCI). 【Results】 Compound antibodies against both CD36 and HLA-I antigens were detected in two PTR patients, and their phenotype of CD36 was conformed to be type I deficient. Through LSA testing, high-frequency of HLA -I antibodies was found in these two patients, and the panel reactive antibody in patients 1 and 2 was 56% (54/96) and 53% (51/96), respectively. According to HLA-CREG and Eplet matching strategies, one donor of grade C-matching with patient 1 and one donor of grade D-matching with patient 2 were screened from the CD36 deficiency donor bank, respectively. And the selected donors avoided the antigen of HLA-I antibody epitope. These results of MAIPA and PIFT also confirmed that no immune response was detected between the patient and the donor. And a CCI of >4.5 within 24 hour of transfusion of compatible platelets was obtained in patient 2. 【Conclusion】 For PTR patients caused by HLA and CD36 compound antibodies, a combination strategy including serological cross-matching, HLA-CREG and Eplet approach should be used to select the CD36 deficient donor platelets which evaded the antigen corresponding to HLA-I antibodies and had the compatible HLA epitopes.

Objective: To investigate the refractive status of children and adolescents aged 4-18 years in Chengdu, and to analyze the epidemiological characteristics of refractive parameters. Methods: A cross sectional survey was conducted among 82 024 children and adolescents aged 4-18 years in Gaoxin District of Chengdu from August to September 2021. The prevalence of screening myopia, low vision rate, high myopia rate, refractive status and axial development were analyzed. Results: The prevalence of screening myopia in students aged 4-18 years was 40.42%(33 158/82 024). Low myopia was 24.51%(20 108/82 024), moderate myopia was 13.05%(10 703/82 024) and high myopia was 2.86%(2 347/82 024). The prevalence of screening myopia was 1.81% (233/12 848) in kindergarten, 34.44%(17 095/49 644) in primary school, 79.73%(9 738/12 214) in junior high school and 83.25% (6 092/7 318) in senior high school. The rate of visual impairment increased by year from the age of 4, and the rate of myopia increased most rapidly from 6 to 15 years old, the prevalenct of high myopia was compared between adjacent age groups: there were statistical differences between 9-15 years old were more likely to be nearsighted than boys( P <0.035 7). Significant differences in screening myopia between 5- and 7-17 year old groups,and in boys and girls.The median total diopter was 0.40 D at the age of 4 and developed to -2.90 D at the age of 18 . The diopter of girls aged 8-15 years was higher than that of boys, and there was statistical significance( Z=-2.53, -4.09, -5.67, -8.64, -5.56, -4.97, -2.52, -2.14, P <0.05). The axial length gradually increased with age, with the mean value of (22.31±0.59) mm at 4 years old and (24.91±1.00) mm at 18 years old. The mean corneal curvature did not change with age (43.19±1.47)D. Conclusion 6-15 years old is a especially critical period for myopia development. More efforts need to be taken to decrease the prevalence of myopia before 6 years old. Prevention of the development of high myopia should start before the age of 10. The prevalence of myopia in girls is higher than that in boys, more prevention and control of myopia should focus on girls.

Objective:To observe the clinical effect of treatment with follicular unit extraction (FUE) and transplantation in treating cicatricial alopecia.Methods:The retrospective cohort study was conducted. From January 2012 to January 2018, 56 patients (36 males and 20 females, aged (25±9) years, 1% to 30% alopecia area of the whole scalp area) who met the inclusion criteria visited the outpatient department of the First Affiliated Hospital of Xi'an Medical University. They were treated with FUE transplantation. The procedure of treatment was performed through the preoperative planning, follicular extraction, follicular preparation, punching recipient site and hair transplantation. The survival rate of hair and density of survived hair were calculated, hair growth and complication were observed. The evaluation was conducted through questionnaire survey by 4 levels: very satisfied, satisfied, not satisfied, and not at all satisfied with effects.Results:After a follow-up of 9 to 24 months, the survival rate of hair in 56 patients was (70±9)%, and the density of survived hair was (35±8) roots/cm 2. In the evaluation of the curative effect after the first stage surgery, 34 cases (60.7%) were very satisfied, 16 cases (28.6%) were satisfied, and 6 cases (10.7%)thought the treatment was effective but not satisfied. Six unsatisfactory patients and 16 satisfactory patients underwent the second-stage transplantation, with 19 (86.4%) of them being very satisfied and 3 cases (13.6%) satisfied after the second-stage operation. None of the patients underwent the third-stage surgery. The transplanted hairs grew naturally, and there were no serious complications in all cases. Conclusions:FUE transplantation can effectively treat and improve cicatricial alopecia with less trauma, fewer complication, no scar in the donor site and rapid post-operative recovery, so it is worthy of clinical promotion.

Kallmann syndrome ( KS) is a rare disease and characteristic of an absence of puberty, infertility, and a defective sensation of smell (anosmia or hyposmia). Here, we analyze the features of a case of KS diagnosed clinically. In addition, the etiology, genetic features, clinical manifestations, diagnosis, and treatment of KS were reviewed.

Klinefelter syndrome(KS) is the most common sex chromosome disorder in males,which is caused by the presence of the extra X chromosome that maybe inherited from mother or father. Approximately 80% karyotype of the cases is 47,XXY. KS is characterized by small firm testes, hypergonadotropic hypogonadism, infertility,gynaecomastia, increased height. However, cognitive disabilities and psychiatric disorders are rarely diagnosed in KS because they lack screening in related aspects. At the present, the pathogenesis of cognitive disabilities and increased risk of psychiatric diseases in KS have not been delineated. In this article,we report two cases of KS,and review their clinical manifestations,diagnosis,and treatments.

Objective To systematically evaluate the therapeutic effect of pulse high volume hemofiltration (PHVHF) for treatment of patients with sepsis. Methods Databases such as PubMed in American National Medical Library, Holland medical abstract Embase, the Cochrane Library, China National Knowledge Internet (CNKI), China Biological Medical Literature Database (CBM), VIP, WanFang databases, etc. were searched by computer to retrieve randomized controlled trials (RCTs) on PHVHF for treatment of patients with sepsis, and the retrieval time ranged from the creation of database to March 25, 2017. Both groups of patients received conventional treatments, including antibiotics, fluid resuscitation, vasoactive agents as well as other organ function support treatments to maintain the basic vital signs stable. Patients in PHVHF group received PHVHF besides conventional treatment, while the patients in control group received conventional treatment or any other continuous renal replacement therapy (CRRT) mode with PHVHF excluded. The literatures accepted should at least include one of the following changes of outcome indicators, such as overall mortality, the levels of inflammatory mediators eliminated, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, service life of filter, amount of replacement fluids used. Two researchers independently screened literatures, extracted data, and assessed the methodological quality of included studies. Meta-analysis was conducted by using RevMan 5.3 software and the publication bias was evaluated by visually inspecting funnel plots. Results A total of 11 RCTs involving 410 patients met eligibility criteria, of which 204 patients in the PHVHF group and 206 patients in the control group. In the control group 5 RCTs used other CRRT modes, and 6 RCTs applied the conventional therapy. Meta-analyses showed that interleukin-6 [IL-6, standard mean difference (SMD) = -0.80, 95% confidence interval (95%CI) = -1.56 to -0.06, P = 0.04], tumor necrosis factor-α (TNF-α, SMD = -0.78, 95%CI = -1.33 to -0.23, P = 0.006), APACHE Ⅱ scores [mean difference (MD) = -3.80, 95%CI = -5.08 to -2.52, P < 0.000 01] were obviously lower than those in control group, but no significant statistical significance in mortality was seen between the two groups [relative risk (RR) = 0.72, 95%CI = 0.49 - 1.07, P = 0.10]. Further subgroup analyses suggested that compared with conventional treatment group, in PHVHF group mortality (RR = 0.40, 95%CI = 0.16 - 0.95, P = 0.04), IL-6 (SMD =-1.87, 95%CI = -3.58 to -0.16, P = 0.03), TNF-α (SMD = -1.32, 95%CI = -2.24 to -0.40, P = 0.005), and APACHE Ⅱscore (MD = -4.29, 95%CI = -6.02 to -2.56, P < 0.000 01) were significantly decreased; however, only a significantly decreased APACHE Ⅱ score (MD = -2.95, 95%CI = -4.56 to -1.35, P = 0.000 3) was observed in PHVHF group compared to that in subgroup of other CRRT modes. Conclusions Compared with using conventional therapy alone, using PHVHF combined with conventional therapy for treatment of patients with sepsis can more effectively improve their prognosis, and PHVHF can be the efficacious alternatives of other CRRT modes especially the HVHF. However, due to the limited quantity and quality of the included studies, further high-quality, multicenter, large-scale RCTs are needed to verify the above conclusion.

Objective To investigate the clinical efficacy of Changqin No. 1 combined with Western therapy for severe traumatic brain injury and its effects on prognosis. Methods Totally 65 cases of severe traumatic brain injury were randomly divided into the treatment group (n=32) and the control group (n=33). The control group was treated with basic Western therapy (dehydration reduction of intracranial pressure, nutrition nerve, scavenging oxygen free radicals, improve cerebral circulation, nutritional support and maintain the internal environment stability, anti-infection, prevention and treatment of complications, hyperbaric oxygen). The treatment group was treated with Changqin No. 1 plus the basis of routine treatment, 1 dosage per day, 2 times stomach tube nasal feeding or blunt, for 14 d. One month after treatment, awake rate, awake time, the incidence of complications and MMSE in both groups were compared. Three months after treatment, the prognosis of two groups were compared by GOS. Results One month after treatment, the awake rate in treatment group was 77.4% (24/31) and 53.1% (17/32) in the control group, with statistical significance (χ2=4.089, P=0.043), and the death rate was 0. The awake time in the treatment group was significantly shorter than that of the control group (t=2.458, P=0.017). The incidence of pulmonary infection in the treatment group was lower than the control group (P=0.001). There was no statistical significance in urinary tract infection, epilepsy, liver and kidney dysfunction rate of the two groups (P>0.05). The number of awake case was 24 in the treatment group and 17 in the control group. The number of normal MMSE cognitive function was 3 in the treatment group and 2 in the control group, and the treatment group was better than the control group (Z=-2.205, P=0.027). Three months after treatment, the good prognosis was 58.08% (18/31) in the treatment group and 28.12%(9/32) in the control group, with statistical significance (χ2=5.763, P=0.016). Conclusion Changqin No. 1 combined with Western basic treatment can help patients with severe traumatic head injury awake early, reduce pulmonary infection complications, and improve the cognitive function of sober patients and improve the prognosis.

Objective To explore the molecular mechanisms of hepatic stimulator substance (HSS) gene knockout in promoting the development and progression of nonalcoholic steatohepatitis (NASH).Methods NASH model mice (n=20) with HSS wild-type (HSS+/+) or HSS gene knockout (HSS-/-) were constructed using modified choline-deficient diet (CD-diet),untreated C57BL6-HSS-/-and C57BL6-HSS+/+ mice (n=20) were considered as control.Ten mice of each group were killed at month 1 and 2,respectively.The levels of triglyceride (TG) and total cholesterol (TC) in liver were measured using ELISA method.Histopathology and collagen deposition in liver tissue were observed using HE staining and Masson staining,respectively.Lipid content in liver tissue was observed and calculated using oil red O staining.The levels of mRNA and proteins of peroxisome proliferators activated receptor gama coactivator 1 alpha (PGC-1α),mitochondrial transcription factor A (TFAM),transcription factor-E2 related factor α (Nrf2),[-loop,dynamin-related protein 1 (Drp1),mitochondrial fission 1 protein (Fis1),mitofusins 1 (Mfn1),autophagy related gene 3 (Atg3) in liver tissue were detected using Real-time PCR and Western blot,respectively.Content of malonaldehyde (MDA),cyclooxygenase Ⅳ (COX Ⅳ) and adenosine tirphosphate (ATP) were measured using kits,and the activity of respiratory chain complex Ⅴ and cytochrome C oxidase in liver tissue were measured using spectrophotometry.the comparison between groups was done by t test.Results The levels of HSS mRNA and protein in mice-HSS-/-were 0.154± 0.04 and 0.08± 0.01,respectively,which were both significantly lower than those in mice-HSS+/+ (0.952 ± 0.08 and 1.362±-0.130,respectively),and t he differences had statistical significance (t =10.244 and 10.375,respectively,both P＜0.05).One month and 2 months after NASH modeled,TC contents in mice-HSS-/ were (248.6±21.5) μmol/g and (217.4±18.0) μmol/g,respectively,which were both remarkably higher than those in mice-HSS+/+ [(153.5 ± 11.2) μmol/g and (140.8 ±7.5) μmol/g,respectively],and the differences had statistical significance (t=15.270 and 10.524,respectively,both P＜0.05).The results form HE staining,oil red O staining and Masson staining indicated that fat deposition,collage deposition and inflammation in liver tissues of mice-HSS-/-were severer than those in mice-HSS+/+.One month after NASH modeled,protein levels of Drp1,Fis1,Mfn1 and Atg3 in liver tissues of mice-HSS-/ were all significantly decreased compared with those in mice-HSS+/+,and the differences had statistical significance (t=10.705,24.072,9.892 and 17.540,respectively,all P＜ 0.05).Two months after NASH modeled,protein levels of Drp1,Fis1,Mfn1and Atg3 in liver tissues of mice-HSS-/ were all significantly decreased compared with those in mice-HSS+/+,and the differences had statistical significance (t=125.378,15.926,34.330 and 13.437,respectively,all P＜0.05).One month after NASH modeled,mRNA levels of Drp1,Fis1,Mfn1 and Atg3 in liver tissues of mice-HSS-/-were all significantly decreased compared with those in mice-HSS+/+,the differences had statistical significance (t=36.337,40.825,33.508 and 28.104,respectively,all P＜0.05).Two months after NASH modeled,mRNA levels of Drp1,Fis1,Mfn1 and Atg3 in liver tissues of mice-HSS-/-were all significantly decreased compared with those in mice-HSS+/+,and the differences had statistical significance (t=35.210,42.375,27.753 and 20.560,respectively,all P＜0.05).The protein levels of PGC-1α,TFAM,Nrf2 and D-loop in liver of C57BL6-HSS-/-group were lower than those in liver of C57BL6-HSS+/+ group,and the differences had statistical significance (one month:t=20.548,31.036,19.445 and 10.974,respectively;two months:t=9.887,13.330,22.375 and 18.903,respectively,all P＜0.05).The mRNA levels of PGC-1α,TFAM,Nrf2 and D-loop in liver of C57BL6-HSS-/-group were all lower than those in C57BL6-HSS+/+ group,and the differences had statistical significance (one month:t=9.087,12.582,21.451 and 7.774,respectively;two months:t=23.758,17.924,9.924 and 15.209,respectively,all P＜0.05).One month and 2 months after NASH modeled,the levels of ATP mRNA in liver of C57BL6-HSS / group were both significantly lower than those in C57BL6-HSS+/+,and the differences had statistical significance 0=43.775 and 28.375,respectively,both P＜0.05);the levels of COXⅣ mRNA in liver of C57BL6-HSS / group were 0.142 ± 0.06 and 0.068± 0.001,respectively,which were both significantly lower than those in C57BL6-HSS+/+ group (0.255± 0.08 and 0.172 ±0.06,respectively),and the differences had statistical significance (t=28.337 and 19.782,respectively,both P＜0.05);the levels of MDA mRNA in liver of C57BL6-HSS-/-group were 0.973 ±0.112 and 1.253±0.054,respectively,which were both significantly lower than those in C57BL6-HSS+/+ group (0.366±0.02 and 0.872±0.05,respectively),and the differences had statistical significance (t=8.357 and 6.582,respectively,both P＜0.05).Conclusion Deletion of HSS accelerates NASH progression via inhibiting mitochondrial fusion,which leads to dysfunction of mitochondrial respiratory chain and inhibition of fatty acid oxidation.