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 identify the dosimetric and radiobiological differences of three radiotherapy techniques of whole breast irradiation with simultaneous integrated boost (WBI-SIB) following breast-conserving surgery for early breast cancer (EBC).Methods:The data of 20 patients with early left-sided breast cancer who received radiotherapy following breast-conserving surgery were retrospectively analyzed. Three radiotherapy techniques, namely hybrid intensity-modulated radiotherapy (HIMRT), intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT), were redesigned with the same prescription dose and target conditions. Then, doses to target volume (TV) and organs at risk (OAR), along with the normal tissue complication probability (NTCP) and secondary cancer risk (SCR) for specific organs, were compared.Results:Compared to HIMRT and IMRT, VMAT led to significant decreases in various dosimetric indices of the affected lung and heart and increases in the Dmean doses to the healthy lung and healthy breast and V5 Gy doses to the healthy breast, with the differences being significantly different ( P < 0.05). The average NTCP values of cardiac death, radiation pneumonitis, and pulmonary fibrosis induced by VMAT were 0.41%, 1.62%, and 23.59%, respectively, significantly lower than those caused by other two techniques ( P < 0.05). No statistical differences were found in 10 dosimetric indices of OAR between IMRT and HIMRT, while the NTCP analysis suggested that the risks of cardiac death ( t = 2.70, P < 0.05) and pulmonary fibrosis ( t =4.11, P < 0.05) induced by IMRT were slightly lower than those caused by HIMRT. In addition, the excess absolute risk (EAR) to the healthy lung posed by VMAT was 1.65 and 1.83 times those induced by HIMRT and IMRT, respectively ( z = -3.92, t = -6.43, P < 0.05). In contrast, the EAR to the healthy breast induced by VMAT was 2.79 and 2.65 times those posed by HIMRT and IMRT, respectively ( z = -3.21, -3.70, P < 0.05). Conclusions:Among three intensive-modulated radiotherapy techniques of WBI-SIB for EBC, VMAT provides the optimal protection for the heart and affected lung but leads to the highest SCR to the healthy lung and breast. When VMAT is employed for young EBC patients or those with normal cardiopulmonary function, special attention should be paid to reducing low-dose irradiations to the healthy breast and thereby minimizing SCR. In contrast, VMAT might be more favorable for patients with pronounced cardiopulmonary risks or aged patients.

Objective:To evaluate the effect of esmketamine for labor analgesia on the occurrence of postpartum depression (PPD).Methods:Two hundred and forty-two cases of nulliparous parturients who selected natural labor and agreed to receive labor analgesia were selected and divided into conventional labor analgesia group (C-LA group, n=119) and esmketamine-based labor analgesia group (E-LA group, n=123). The epidural labor analgesia solution contained ropivacaine 100 mg and sufentanil 30 μg in 100 ml of normal saline in C-LA group. The epidural labor analgesia solution contained ropivacaine 100 mg, sufentanil 30 μg and esketamine 50 mg in 100 ml of normal saline in E-LA group. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen parturients for depression on admission to the predelivery room and at 2 h and 1, 7 and 42 days after delivery, and EPDS scores were recorded. The patients were diagnosed as having PPD when EPDS score ≥ 9 at 7-42 days after delivery. Peripheral venous blood samples were collected on admission to the predelivery room and at 1 day after delivery to determine the concentrations of serum estrogen, progesterone, 5-hydroxytryptamine and cortisol by enzyme linked inmunosorbent assay. Results:Compared with group C-LA, the EPDS scores were significantly decreased on the 1 and 42 days after delivery( P<0.01), no significant change was found in the incidence of PPD (1.7%/0.8%, P>0.05), no significant change was found in the concentrations of serum estrogen, progesterone, 5-hydroxytryptamine and cortisol on admission to the delivery room ( P>0.05), and the concentrations of serum progesterone and cortisol were significantly increased on 1 day after delivery in group E-LA ( P<0.05). Conclusions:Combination of esketamine is helpful in reducing the risk of postpartum depression when used for epidural labor analgesia, and the mechanism is related to slowing the declines in blood levels of sex hormones and stress hormones after delivery.

Objective:To observe the effect of combination of esketamine and sufentanil on postoperative analgesia and postpartum depression after cesarean section.Methods:A total of 150 primiparous women who underwent lower segment cesarean section under spinal anesthesia and postoperative analgesia at Changsha Maternal and Child Health Hospital from February to October 2021 were selected and randomly divided into three groups: A, B, and C, with 50 cases in each group. All three groups underwent combined spinal epidural anesthesia and received patient-controlled intravenous analgesia (PCIA) after surgery. The group A received low-dose esketamine via intravenous pump after fetal delivery, with PCIA formula esketamine combined with sufentanil; After the delivery of fetuses in the group B and the group C, an equal dose of physiological saline was pumped into the vein. The PCIA formula of esketamine combined with sufentanil for the group B and Sufentanil for the group C. We compared the pain Visual Analogue Scale (VAS) and Edinburgh Postpartum Depression Scale (EPDS) scores of three groups of patients at different time points after surgery, as well as the postoperative pain relief rate and incidence of adverse reactions.Resultsl:There was a statistically significant difference in VAS between the group A and the group B within 48 hours after surgery compared to the group C (all P<0.05), while there was a statistically significant difference in VAS between the group A and the group B within 24 hours after surgery (all P<0.05). The postoperative pain relief rate in the group A and group B was significantly lower than that in the group C, and the incidence of postpartum depression within 7 days after surgery was significantly lower than that in the group C. Moreover, the incidence of postpartum depression in the group A was lower than that in the group B within 3 days after surgery, and the differences were statistically significant (all P<0.05). There was no statistically significant difference in the incidence of postpartum depression among the three groups 42 days after surgery (all P>0.05), and there was no statistically significant difference in the incidence of adverse reactions among the three groups ( P>0.05). Conclusions:Esketamine combined with sufentanil can synergistically enhance the analgesic effect after cesarean section and reduce the incidence of early postpartum depression after surgery.

Objective:To explore the clinical phenotype and genotype of a family with hereditary hypofibrinogenemia.Methods:Activated partial thrombin time (APTT), prothrombin time (PT),thrombin time (TT) and thrombelastogram (TEG) were tested in all family members. Fibrinogen activity and antigen were detected by Clauss method and immunoturbidimetric method respectively. All exons and flanking sequences of fibrinogen FGA,FGB,FGG genes were analyzed by PCR, and the products were subjected to Sanger sequencing.Results:The proband represented prolonged PT and TT, low Fg activity and antigen, elevated K value and decreased Angle value in TEG. Other family members reported similar changes including proband′s father,daughter and son, and his elder brother and his niece. Exon 5 c.510_512 of FGG gene in the proband revealed a minor deletion mutation.Conclusion:The novel heterozygous missense mutation of exon 5 c.510_512del (Gln170_Ile171 del ins His) of FGG gene is the molecular mechanism that leads to hereditary hypofibrinogenemia in this family.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Objective: To investigate the situation of social sports activities and the relationship with depression among junior middle school students, to provide evidence for depression intervention. Methods: A total of 3 623 students from eight middle schools in Chengdu were recruited and surveyed by self-made questionnaire during Sept. to Dec. 2019 Z test, Chi-Square test and Logistic regression analysis were applied to explore influence factors. Results: The prevalence of depression symptoms was 45.60%. 57.34% of the students liked social sports activities, 65.87% of them participated in social sports activities during the past week, 42.25% took less than 30 minutes on exercise while 22.24% took over 45 minutes. Among the students, 20.16% of them had no special feeling after social sports activities, while 31.88% felt sweat. Uni-variate analysis indicated that compared with boys, girls participated more frequently and got stronger feeling than boys (χ2/Z=6.28，-2.67，P<0.05). Regression results indicated that for boys, high grade,low education degree of mother, low household socioeconomic status, not the only-child ,exercise alone would significantly increase the risk of depression, while liking social sports activities was protective factor (OR=1.26，1.91，1.52，2.56，1.58，1.71，0.77，P<0.05). For girls, high grade,low education degree of father, without one-child would significantly increase the risk of depression, while like social sports activities was protective factor(OR=1.29，1.74，1.37，1.47，0.66，P<0.05). Conclusion Social sports activities could reduce depression symptoms, which can be considered as first choice as after-class activity among junior middle school students.

Objective To explore the impact of butylphthalide soft capsules on the related factors and quality of life of Parkinson patients with dementia.Methods 90 Parkinson patients with dementia were selected,and they were divided into the study group and the control group by the random number table method,45 cases in each group.The control group was treated with donepezil hydrochloride combined with routine nursing method,and the study group was treated with butylphthalide soft capsules based on the treatment of the control group.Before and after treatment,the serum C-reactive protein(CRP),recombinant human Parkinson disease protein 7 (PARK7),neurotrophic factor -3 (NT-3) levels of all patients were detected.And the quality of life of patients at admission and discharge were evaluated by the scale of disease self management efficiency and quality of life scale WHO (WHO QOL-BREF),quality of life of the two groups was compared before and after treatment.The Parkinson's Disease Rating Scale (UPDRS) scores was compared between the two groups before and after treatment.Results Before treatment,the dementia related factors and quality of life score,UPDRS score of the two groups had no statistically significant differences (all P ＞ 0.05).After treatment,the dementia related factors of the two groups were all improved,which of the study group improved significantly [CRP:(3.24 ± 0.78) mg/L vs.(6.02 ± 0.95) mg/L,PARK7:(13.15 ± 1.51) μg/L vs.(24.93 ±2.02)μg/L,NT-3:(34.16 ± 3.47) μg/L vs.(26.23 ± 2.97) μg/L,all P ＜0.05].After treatment,the quality of life(QOL) and UPDRS score of the study group were significantly higher than those of the control group [(80.5 ± 12.5) points vs.(66.0 ± 10.3) points,(33.28 ± 2.18) points vs.(41.26 ± 2.54) points,all P ＜ 0.05].Conclusion Butylphthalide soft capsules can effectively improve the dementia related factor of Parkinson patients with dementia,and enhance the quality of life with good effect.

Objective To establish the decision tree model of Yang deficiency syndrome and clinical conventional indexes in type 2 diabetes mellitus patients.Methods Syndrome decision and clinical indexes collection from 249 type 2 diabetes mellitus patient were observed and analyzed.Tree structure model were built to summarize the correspondence between Yang deficiency syndrome and clinical conventional indexes based on T test,nonparametric analysis,and Spearman correlation analysis.Results The Yang deficiency syndrome accounted for 31.33％ of 249 type 2 diabetes mellitus patients.The accuracy identification rate of tree structure model of Yang deficiency syndrome with four core index,such as LPa、FT3、TSH、FINS was 84.74％,the sensitivity and specificity were 74.36％ and 89.47％.Conclusion Decision tree model can identify Yang deficiency syndrome of type 2 diabetes mellitus patients clearly and more intuitive.Decision tree model can provide the chance of syndrome objective.

Objective To compare the safety and efficacy of the 2μm laser and the bipolar electrotome used in transurethral re-section of bladder tumor(TURBT)for treating non-muscle invasive bladder cancer(NMIBC).Methods The clinical data in the pa-tients with NMIBC treated by TURBT in our hospital from March 2009 to May 2013 were retrospectively analyzed.All patients were divided into the 2μum laser group(n=89)and the bipolar electrotome group(n=82).The operation time,complications,post-operative hospital stay and recurrence rate were compared between the two groups.Results There were no statistically significant differences in the operation time,postoperative hospital stay and recurrence rate between the two groups(P>0.05).Compared with the 2 μm laser group,the bipolar electrotome group showed significantly higher occurrence rate of the obturator nerve reflex (20.7%vs.0,P<0.05)and the bladder perforation(7.3% vs.0,P<0.05)and longer postoperative bladder irrigation time [(3.1±0.9)d vs.(2.2±1.0)d,P<0.05],the differences between the two groups had statistical significance.Conclusion Com-pared with bipolar electrotome,the 2μm laser used in TURBT is safe and effective with few complications for treating NMIBC.