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.

Inguinal hernia is a common surgical disease, and most patients need surgical treatment. In recent years, minimally invasive surgery based on laparoscopy has been popularized in hernia surgery. With the release of clinical guidelines, the progress of instruments and materials, the update of treatment concepts and anatomical knowledge, laparoscopic inguinal hernia repair, especially laparoscopic total extraperitoneal hernia repair (TEP), is developing towards a more accurate and minimally invasive direction. Based on literatures in recent years and combined with clinical practice, the authors explore the advances in clinical application of laparoscopic TEP.

Laparoscopic radical resection of transverse colon cancer is a difficult operation, which is featured by large operation area, multiple steps, and many clinical anatomical variations. It requires the concept of complete mesocolic excision. Because of its absolute high-definition picture restoration, the 4K laparoscope can effectively assist in the identification, protection and severance of blood vessels during the operation, and assist in judging the fascia space of the operation. After entering Toldt fascial space through the intermediate approach guided by the superior mesenteric vein, the left, right transverse colon and lower area of mesangium are completely dissected, the upper area of colon, hepatic and splenic flexure are sepearted. The authors summarize practical experiences, investigate the extent of lymph node dissection in 4K laparoscopic radical resection of transverse colon cancer and share surgical experience.

【Objective】 To explore the characteristics of the D antigen epitope of individuals with RhD variants and the genetic molecular mechanism of gene mutations in Guangzhou. 【Methods】 A total of 59 samples of RhD variants were collected from blood donors and hospitals in Guangzhou from January to August 2019. Serological characteristics of D epitopes were further analyzed using two kinds of monoclonal anti-D reagents and D epitope detection kits, and RHCE phenotypic typing was performed. QuickGene DNA extraction kit was used to extract the genomic DNA of the samples, and PCR-RFLP method was used to analyze the RHD gene zygote type. The RHD gene sequence was detected by multiple ligation-dependent probe amplification(MLPA) genotyping, and the RHD exon(1~10) Sanger sequencing was performed on the samples still in doubt after the above detection. DNAStar/SeqMan analysis software was used for comprehensive analysis. 【Results】 In this group of individuals with RhD variants in Guangzhou, 27.12%(16/59) were detected from blood donors [accounting for 0.007%(16/232 793) of blood donors in Guangzhou during the same period], and difficult samples of patients sent by hospitals for determination accounted for 72.88%(43/59). RHD genotype detection: 40.68%(24/59) were RHD^*weak partial 15, 25.42%(15/59) were RHD^* DⅥ.3 and 33.90%(20/59) were rare RHD variants [76.92%(10/13) were RhD variants with 2 different alleles]. Serological D-screen revealed a relatively fixed pattern of RHD^*DⅥ.3 in anti-D antibody(clone: P3^*212 23B10), while the others was negative. The phenotypic distribution of RhD variant CE was Ccee 38.98%(23/59), ccEe 35.59%(21/59), CcEe 25.42%(15/59). 【Conclusion】 Weak partial D15 and DⅥ.3 were the most common RhD variants in Guangzhou Han population, and DⅥ can be preliminarily identified by serological methods such as D-Screen anti-D reagent, while the remaining RhD variants can only be identified by molecular biological methods, and >95% of the RhD variants were C+ or E+ phenotypes.

【Objective】 To explore the prognosis of critically ill patients with coagulation dysfunction using thrombelastogram(TEG) and coagulation four items combined with APACHEⅡ score. 【Methods】 From March 2017 to March 2020, 287 critically ill patients with coagulation dysfunction in our hospital were selected as the study group, and 303 patients with normal coagulation function during the same period were set as the control. The study group was divided into low-risk group(group A), intermediate-risk group(group B) and high-risk group (group C) based on the APACHEⅡ score, and into survival group and death group according to the prognosis. The difference of TEG, coagulation four items, and APACHEⅡ scores between the two groups were analyzed. The correlation and difference between TEG, coagulation four items and APACHE II score in the study group were analyzed. The ROC curve was drawn to analyze the prognostic predictive value of research indicators. 【Results】 Blood coagulation function related indicators in the study group fluctuated significantly: in comparison to the control, the CI value, MA value, and α angle were smaller, while the K time and R time were longer; among the coagulation four items, PT, APTT and TT were higher; Fg level was lower, and the APACHE Ⅱ score was higher(P<0.05). There were significant differences in relevant test index levels among patients with different degree of illness (APACHE Ⅱ score) in the study group. With the aggravation of the disease, the CI value, MA value, α angle, and TT continued to decrease, while K time, R time, APTT and PT showed a continuous increase trend (P<0.05). However, with the intensification of coagulation dysfunction, no significant increase or decrease was noticed in Fg(P>0.05). There were significant differences between the TEG and coagulation function related index levels in patients with different prognosis. Compared with the survivals, the CI value, MA value and α angle of the dead group were smaller, while the K time and R time were longer; and among the coagulation four items, PT, APTT, and TT were higher, the Fg level was lower, and the APACHEⅡ score was higher (P<0.05). The ROC curve showed that the corresponding AUC values of PT, APTT and INR were 0.701, 0.693 and 0.702, respectively, (P<0.05). The difference was statistically significant and had predictive value for death, but the accuracy was moderate.The combined indicators showed that the AUC values corresponding to APACHE Ⅱ score, P1, P2, P3, P4, P5, and P6 were 0.899, 0.751, 0.657, 0.759, 0.921, 0.921and 0.942, respectively, and the difference was statistically significant(P<0.05). The combined indicators have predictive value for death, except for P2<0.7, the rest were between 0.7~1.0, and the accuracy was P6>P4\\P5>APACHE Ⅱ score>P1>P2. 【Conclusion】 TEG, coagulation four items, and APACHE Ⅱ score can be used to assess the severity of patients with severe coagulation dysfunction. and the combined application of the 3 indicators are of high value in predicting the prognosis of such patients, and can provide reference for clinical formulation or adjustment of intervention programs to correct coagulation dysfunction.

[Abstract] Objective: To investigate the molecular mechanism of miR-143-3p regulating the proliferation, migration and invasion of colon cancer RKO cells via targeting enhancer of zeste homolog 2 (EZH2). Methods: A total of 40 pairs of colon cancer tissues and corresponding para-cancerous tissues resected in the First Affiliated Hospital of Kunming Medical University from March 2015 to July 2017 were collected for this study. In addition, colon cancer cell lines (COLO320, RKO and CL-11) and normal intestinal mucosa NCM460 cells were also collected. qPCR was applied to detect the expression level of miR-143-3p in colon cancer tissues and cell lines. miR-143-3p mimics, miR-143-3p inhibitor, EZH2 siRNA and negative control plasmids were transfected into RKO cells, respectively. The effect of miR-143-3p/EZH2 axis on the proliferation, migration and invasion of RKO cells were detected by CCK-8 and Transwell assay, respectively. Western blotting was used to detect the expression level of EZH2 protein in RKO cells. The targeting relationship between miR-143-3p and EZH2 was verified by Dual luciferase reporter gene assay. Results: The expression level of miR-143-3p was downregulated in colon cancer tissues and cell lines (all P<0.01). Overexpression of miR-143-3p significantly inhibited the proliferation, migration and invasion of RKO cells (all P<0.01). Dual luciferase reporter gene assay confirmed that EZH2 was a target gene of miR-143-3p. Simultaneous knockdown of miR-143-3p and EZH2 attenuated the inhibition of EZH2 knockdown on the proliferation, migration and invasion of RKO cells. Conclusion: miR-143-3p suppresses the proliferation, migration and invasion of colon cancer cells via targetedly down-regulating EZH2.

PURPOSE: This study aimed to probe into the associations among circular RNA ZFR (circ-ZFR), miR-130a/miR-107, and PTEN, and to investigate the regulatory mechanism of circ-ZFR–miR-130a/miR-107–PTEN axis in gastric cancer (GC). MATERIALS AND METHODS: GSE89143 microarray data used in the study were acquired from publicly available Gene Expression Omnibus database to identify differentially expressed circular RNAs inGC tissues. The expressions of circ-ZFR, miR-130a, miR-107, and PTEN were examined by real-time reverse transcription polymerase chain reaction, while PTEN protein expression was measured by western blot. The variation of GC cell proliferation and apoptosis was confirmed by cell counting kit-8 assay and flow cytometry analysis. The targeted relationships among circZFR, miR-130a/miR-107, and PTEN were predicted via bioinformatics analysis and demonstrated by dual-luciferase reporter assay and RNA immunoprecipitation assay. The impact of ZFR on gastric tumor was further verified in xenograft mice model experiment. RESULTS: Circ-ZFR and PTEN were low-expressed whereas miR-107 and miR-130a were highexpressed in GC tissues and cells. There existed targeted relationships and interactions between miR-130a/miR-107 and ZFR/PTEN. Circ-ZFR inhibited GC cell propagation, cell cycle and promoted apoptosis by sponging miR-107/miR-130a, while miR-107/miR-130a promoted GC cell propagation and impeded apoptosis through targeting PTEN. Circ-ZFR inhibited cell proliferation and facilitated apoptosis in GC by sponging miR-130a/miR-107 and modulating PTEN. Circ-ZFR curbed GC tumor growth and affected p53 protein expression in vivo. CONCLUSION: Circ-ZFR restrained GC cell proliferation, induced cell cycle arrest and promoted apoptosis by sponging miR-130a/miR-107 and regulating PTEN.
Animals ; Apoptosis* ; Blotting, Western ; Cell Count ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Proliferation* ; Computational Biology ; Flow Cytometry ; Gene Expression ; Heterografts ; Immunoprecipitation ; Mice ; Polymerase Chain Reaction ; PTEN Phosphohydrolase ; Reverse Transcription ; RNA ; Stomach Neoplasms*

Objective To investigate the expression of TLR9 mRNA of peripheral blood mononuclear cells (PBMCs) in patients with acute pancreatitis .Methods Fifty two AP patients with the disease duration in 24 h were collected ,peripheral EDTAK2 coag‐ulation vein blood were collected on the first ,third and fifth day ,then plasma were cryop reserved to detect pancreatic elastase , proinflammatory cytokines and anti‐inflammatory cytokines .Then the peripheral EDTAK2 coagulation vein blood two to three months after treatment were collected in the same method to undertake these tests ,and act as the reference level value .Peripheral blood was collected from 36 acute pancreatitis patients .Three months later ,peripheral blood was collected again from these 36 peo‐ple as controls .PBMCs were isolated by Ficoll‐Hypaque gradient centrifugation .RT‐PCR was adopted to determine the relative con‐tent of the expression of TLR9 mRNA of the PBMCs .Results The relative content of expression of TLR9 mRNA were significant‐ly up‐regulated in the patients with acute pancreatitis ,compared with that of controls (P<0 .05) .The up‐regulated expression of TLR9 mRNA was related to expression of TNF‐a and IL‐1 .Conclusion The up‐regulated expression of TLR9 mRNA in acute pan‐creatitis patients indicates that infective factors might be mediated by TLR 9 .

Objective To evaluate the quality of pooled platelets leukocytes reduced after filtering out leukocytes using two man-ufacturers of leucocyte filters for pooled platelets and improving the preparation method.Methods Pooled platelets was prepared from 400 mL fresh whole blood by buffy coats(BC)method,after 1 6 h,(22±2)℃ holding period,pooled six bags of ABO-matched buffy coats.and then filtered with two manufacturers of leucocyte filter,divided into the control group and the experimental group. Before and after filtering,the numbers of platelet and leukocyte,pH,hypotonic shock response(HSR),platelet aggregation and CD62p expression were detected.Results Before filtering leukocytes,the platelet quality of two groups achieved the requirements of Chinese standards.The numbers of platelet and leukocyte,pH,CD62p expression(%)and platelet aggregation showed no signifi-cant difference between two groups(P >0.05).However,After filtering,the pH,platelet aggregation and the platelet recovery,the experimental group and the control group,were (6.53±0.60)vs(7.00±0.06)、(5.5±3.8)% vs (77.4±14.7)%,(86.8±4.3)%vs (90.6±2.7)%,showed significant differences (P <0.05);but the residual leukocytes,HSR and CD62p expression respectively were (3.00±4.00)×10 6/ bag vs (2.00±3.00)×10 6/ bag,(2.40±0.90)% vs (2.00±0.80)%,(7.30±5.90)% vs (5.60 ±3. 70)%,there were no significant differences(P >0.05).Conclusion The quality of pooled platelets leukocytes is reduced,after filte-ring out leukocytes with two manufacturers of leucocyte filters and improving the preparation method,achieves the requirements of Chinese standards.However,the leukocyte filters of experimental group might have influence on platelet aggregation and pH.

Objective To explore the effect of the combination of benazepril and beraprost sodium on urinary microalbumin (UMA), serum high sensitivity C-reactive protein (hs-CRP) and TNF-α in patients with diabetic nephropathy(DN) in early stage. Methods From Mar. 2010 to Mar. 2013, 120 patients with early-stage DN were randomly divided into Benazepril Group, Beraprost Sodium Group and Combination Group. Each group consisted of 40 patients with medical therapy in 20-week duration. The levels of 24 h-UMA, serum hs-CRP and TNF-α were detected and compared before and after therapy. Results After treatment, the levels of 24 h-UMA, serum hs-CRP and TNF-αall decreased significantly in three groups (P<0.05) and there were lower 24 h-UMA, serum hs-CRP and TNF-αin Combination Group than those in Benazepril Group and Berapros sodium Group (P <0.05). Conclusion There is coordinating protection of combination of benazepril and beraprost sodium on diabetic nephropathy in early stage, possibly being related with the inhibiting of micro-inflammation.