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 summarize the clinicopathologic characteristics of undifferentiated embryonal sarcoma of the liver.Methods:The clinical data of 16 patients with undifferentiated embryonal sarcoma of the liver admitted to Shandong Provincial Hospital and Yantai Yuhuangding Hospital from Jan 2000 to Jan 2023 was retrospectively analyzed.Results:The diagnosis of undifferentiated embryonal sarcoma in all the 16 patients was established by postoperative pathology. The clinical manifestations of the patients were mainly asymptomatic abdominal mass, abdominal pain and discomfort. The laboratory examination was mostly nonspecific, the image exam showed mostly solid cystic mass. 14 cases underwent radical surgical resection.The minimum survival time was 7 months, maximum survival time was 121 months with median survival time of 35.9 months.Conclusions:Undifferentiated embryonal sarcoma of the liver is an extremely rare malignant tumor of the liver. The disease lacks specific clinical manifestations. CT examination can assist in the diagnosis of the disease. Diagnosis of undifferentiated embryonal sarcoma of the liver depends on pathological examination. The prognosis of patients is poor, surgical resection of the tumor is an effective treatment.

Objective To analyze the recurrence factors of the patients with intermediate risk papillary thyroid carcinoma(PTC)after radioactive iodine treatment(RAIT).Methods A total of 254 intermediate risk PTC patients after RAIT from January 2018 to May 2020 in our hospital were enrolled into this study.Chi square test and multivariate analysis were applied to analyze the main recurrence factors after RAIT.Results Thirty four(13.4%)patients with intermediate risk PTC relapsed after RAIT.The primary tumor size,lymph node metastasis staging,and pre-ablation stimulated thyroglobulin(psTg)were associated with tumor recurrence.According to the receiver operating characteristic(ROC)curve,psTg 25.6 μg/L was the best cutoff value for predicting recurrence.Further multivariate analysis revealed that lymph node metastasis staging and psTg levels were independent factors of predicting PTC recurrence.When the patients with N1b and psTg≥25.6 μg/L,the incidence of tumor recurrence after RAIT was 58.3%.While the patients with N1a and psTg<25.6 μg/L,the incidengce of tumor recurrence was only 2.3%.Conclusions Lymph node metastasis staging and psTg level are the important indicators of PTC recurrence,and combining these two indicators can help predict tumor recurrence after RAIT.

Objective: To compare the irradiated dose to unprotected lymph node stations (LNS) between volume-modulated arc therapy (VMAT) and 5-field intensity-modulated radiotherapy (5F-IMRT) in the treatment of patients with upper thoracic esophageal cancer. Methods: A total of 20 patients were selected for re-planning. LNS were not included in the GTV and CTV, instead, LNS were contoured as normal tissues. However, LNS were not constrained in the VMAT and 5F-IMRT inverse optimization for protection. Dosimetric parameters of conformal index (CI), homogeneity index (HI) of targets, V₉₅, V₁₁₀ of planning target volume (PTV), D_mean, V₅, V₂₀, V₃₀ of lung, D_mean, V₂₅ of heart, D_max of spinal cord, MU, as well as the equivalent uniform dose (EUD) and V₄₀ of LNS were compared between the two plans. Results: 5F-IMRT was superior in PTV_V_95% (t=-9.4, P<0.05), but worse in terms of CI (t=-5.3, P<0.05) compared with VMAT. 5F-IMRT reduced the V₅ of lung by 10.9% (t=-7.8, P<0.05) and the D_max of spinal cord by 9% (t=-10.2, P<0.05), but increased the MU (t=-6.2, P<0.05) compared with VMAT. The average EUD and V₄₀ of LNS in upper thoracic were significantly increased by 4.7% and 2.4% in 5F-IMRT compared with VMAT, respectively. The irradiated doses to LNS were significantly associated with the volume of PTV (R=0.716-0.933, P<0.05) expect for 106tbL. Conclusions The irradiated doses to unprotected LNS were less for IMRT plans and were highly associated with PTV volume in patients with upper thoracic esophageal cancer.

OBJECTIVETo evaluate the effect of techniques of precise liver surgery for donor hepatectomy in living donor liver transplantation.

METHODSEighty-nine donors aged from 19 to 57 years were performed by the same surgical team from June 2006 to December 2013 in Chinese People's Liberation Army General Hospital.Individualized surgical program were developed according to preoperative imaging examination and hepatic functional reserve examination. The evaluation included liver function, liver volume, vascular anatomy and bile duct anatomy. According to the results after the operation, preoperative evaluation accuracy, postoperative donor liver function and postoperative complications were analyzed. ANOVA analysis was used to compare the difference of graft volume by two-dimensional, three-dimensional calculation method and actual postoperative graft weight. Pearson correlation test and linear regression analysis were used to verify the correlation between the estimated graft volume each method and actual graft postoperative weight.

RESULTSAll the 89 cases operation protocol as following, there were 5 cases with left lateral lobe graft, 10 cases with left lobe liver graft, 74 cases with right lobe graft. There were 59 cases with middle hepatic vein (MHV) harvested, and 30 cases without MHV. The mean graft volume by two-dimensional, three-dimensional calculation method and actual postoperative graft weight were (656.2±134.1) ml, (631.7±143.2) ml and (614.5±137.7) ml respectively. ANOVA analysis results showed that there were no statistically significant difference in the three methods (P>0.05). Compared to the actual postoperative graft weight, the average error rate of the two methods were 7.9% and 5.3% respectively. Pearson correlation test showed the graft volume calculated by two-dimensional and three-dimensional methods had a significantly positive correlation with actual graft weight (r=0.821, 0.890, P<0.01) and linear regression analyze showed the R2 were 0.674 and 0.792, respectively. The accuracy rate of preoperative evaluation about portal vein, hepatic vein, hepatic artery and bile duct were 100%, 100%, 97.8% and 95.5%, respectively. The preoperative plan and postoperative practical scheme coincidence rate was 95.5%. Overall donor complication rate was 7.4%. All donors were alive. Sixteen donors received right lobe hepatectomy with gallbladder preserved had a good liver function and gallbladder function.

CONCLUSIONThrough the precise preoperative evaluation, surgical planning, fine operation and excellent postoperative management, precise liver surgery technique can ensure the safety of donor in living donor liver transplantation.

Adult ; Bile Ducts ; Body Weight ; Hepatectomy ; methods ; Hepatic Artery ; Hepatic Veins ; Humans ; Linear Models ; Liver Transplantation ; methods ; Living Donors ; Middle Aged ; Portal Vein ; Postoperative Complications ; Postoperative Period ; Young Adult

Objective To discuss the application of strengthening propaganda and education for ischemic stroke patient′s spouse.Methods Ischemic stroke patients′spouse ( n =100 ) were divided into experimental group ( strengthening propaganda and education ) and control group ( normal propaganda and education) on average by randomly controlled trail.SS-QQL, SF-36, SDS and SAS had been used for assessment of ischemic stroke patients and their spouse′s quality of life, anxiety and depression.Results The scores of SDS for patients and spouses were (51.24 ±6.65) and (49.01 ±7.32) in the experimental group comparing with (58.21 ±6.31) and (56.51 ±7.12) in the control group at reexamination after 12 months discharged (t=5.474, 5.288;P<0.05);similarly, the scores of SAS were (50.24 ±7.24) and (47.01 ± 7.51) lower than (56.21 ±7.35) and (55.51 ±7.42) in the control group (t=4.166, 5.796; P<0.05). the scores of dimensions SS-QQL and spouses′quality of life were higher than those in the control group ( P<0.05) except dimensions of physical pain (P>0.05).Conclusions Strengthening propaganda and education during hospitalization can minimize patient′s anxiety, depression and enhance them and their spouses′quality of life.

Carotid Body Tumor ; surgery ; Humans ; Hypertension ; Pressoreceptors

Objective To analyze the biophysical dosimetric characteristics and clinical application ability of VMAT technology for breast cancer post-mastectomy.Methods 28 patients with breast cancer (10 at left side and the other at right side) were planned in different ways respectively.One was two 90 degree arc VMAT plan and the other were 5 beam IMRT plan.The dosimetric parameters of two different plans including tumor control probability (TCP),conformity index(CI),homogeneity index (HI),V95and V110 in target,normal tissue complication probability (NTCP),V5,V20,V30 for ipsilateral lung,NCTP,D V25 for heart,D for the contralateral breast in OARs,MU and times were compared.Results The average tumor control probability (TCP) in VMAT and IMRT group was(96 ±2)％ and (90 ±2)％ (t =-6.28,P ＜ 0.01),respectively.The PTV dose average homogeneity index (HI) of VMAT plans was better than that of IMRT plan (0.15 ±0.04 vs 0.22 ±0.02,t =13.29,P ＜0.01).For cancer position in left side,the mean dose of heart was decreased by 433.24 cGy in the VMAT plan.The NTCP of the hearts in VMAT plans had statistically significant difference compared with IMRT plans [(1.00±0.12)％ vs (1.70±0.13)％,t =2.14,P ＜0.05].For plans of right breast cancer,the average mean dose of hearts in two control group was (3.27 ± 0.26) Gy and (6.00 ± 0.47) Gy (t =9.21,P＜0.01).The total monitor unit (MU) was 530.7 in the VMAT arm and 693.9 in the IMRT arm (t =9.58,P ＜0.01).The treatment time was shorter in VMAT arm (t =8.40,P ＜0.05).Conclusions VMAT plans have better clinical value and more superior biophysical dosimetric characteristics for breast cancer post-mastectomy.

A recently identified protein, FAN1 (FANCD2-associated nuclease 1, previously known as KIAA1018), is a novel nuclease associated with monoubiquitinated FANCD2 that is required for cellular resistance against DNA interstrand crosslinking (ICL) agents. The mechanisms of FAN1 regulation have not yet been explored. Here, we provide evidence that FAN1 is degraded during mitotic exit, suggesting that FAN1 may be a mitotic substrate of the anaphase-promoting cyclosome complex (APC/C). Indeed, Cdh1, but not Cdc20, was capable of regulating the protein level of FAN1 through the KEN box and the D-box. Moreover, the up- and down-regulation of FAN1 affected the progression to mitotic exit. Collectively, these data suggest that FAN1 may be a new mitotic substrate of APC/CCdh1 that plays a key role during mitotic exit.
Anaphase-Promoting Complex-Cyclosome ; Bone Neoplasms ; metabolism ; pathology ; Cadherins ; genetics ; metabolism ; Cdc20 Proteins ; Cell Cycle Proteins ; genetics ; metabolism ; Cell Line, Tumor ; Exodeoxyribonucleases ; genetics ; metabolism ; HEK293 Cells ; Humans ; Mitosis ; Osteosarcoma ; metabolism ; pathology ; Ubiquitin-Protein Ligase Complexes ; genetics ; metabolism

Objective To comprehensively evaluate the curative effect and adverse effects of rituximab plus cyclophosphamide, vincristine, doxoruhicin and prednisone(R-CHOP) chemotherapy and CHOP chemotherapy alone on the treatment for low and moderate malignant B cell non-Hodgkin lymphoma (NHL). Methods By the application of the systematic review method of Cochrance International Collaboration, the world-wide randomized controlled trials (RCT) on the comparison between different curative effects of R-CHOP and CHOP chemotherapy alone on the treatment low and moderate malignant B cell NHL was collected and the study results was evaluated systematically. Results Seven RCT studies involving 1569 patients and had no heterogeneity between themselves (χ=5.31,P=0.50). The baseline of patients characteristics was comparable in all the studies. By comparing complete response (CR) rate and adverse effects through fixed effect analysis model, the results showed that R-CHOP was better than CHOP chemotherapy on the treatment for low and moderate malignant B cell NHL(OR =2.22, 95 %CI 1.72-2.85, P ＜0.000 01), and adverse events of R-CHOP had no significant difference compared with CHOP chemotherapy alone (P＞0.05). Conclusion With good curative effect on the treatment low and moderate malignant B cell NHL and without obvious differences from the CHOP chemotherapy alone in adverse effects, R-CHOP chemotherapy should be recommended as the best treatment method for low and moderate malignant B cell NHL And much more well-designed clinical RCT should be made to further prove its clinical effect.