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 evaluate the value of radiomics based on contrast-enhanced spectral mammography (CESM) of internal and peripheral regions combined with clinical factors in predicting benign and malignant breast lesions of breast imaging reporting and data system category 4 (BI-RADS 4).Methods:A retrospective analysis was performed on the clinical and imaging data of patients with breast lesions who were treated in Yantai Yuhuangding Hospital (Center 1) Affiliated to Qingdao University from July 2017 to July 2020 and in Fudan University Cancer Hospital (Center 2) from June 2019 to July 2020. Center 1 included 835 patients, all female, aged 17-80 (49±12) years, divided into training set (667 cases) and test set (168 cases) according to the "train-test-split" function in Python software at a ratio of 8∶2; and 49 patients were included from Center 2 as external validation set, all female, aged 34-70 (51±8) years. The radiomics features were extracted from the intralesional region (ITR), the perilesional regions of 5, 10 mm (PTR 5 mm, PTR10 mm) and the intra-and perilesional regions of 5, 10 mm (IPTR 5 mm, IPTR 10 mm) and were selected by variance filtering, SelectKBest algorithm, and least absolute shrinkage and selection operator. Then five radiomics signatures were constructed including ITR signature, PTR 5 mm signature, PTR 10 mm signature, IPTR 5 mm signature, IPTR 10 mm signature. In the training set, univariable and multivariable logistic regressions were used to construct nomograms by selecting radiomics signatures and clinical factors with significant difference between benign and malignant BI-RADS type 4 breast lesions. The efficacy of nomogram in predicting benign and malignant BI-RADS 4 breast lesions was evaluated by the receiver operating characteristic curve and area under the curve (AUC). Decision curve and calibration curve were used to evaluate the net benefit and calibration capability of the nomogram.Results:The nomogram included ITR signature, PTR 5 mm signature, PTR 10 mm signature, IPTR 5 mm signature, age, and BI-RADS category 4 subclassification for differentiating malignant and benign BI-RADS category 4 breast lesions and obtained AUCs of 0.94, 0.92, and 0.95 in the training set, test set, and external validation set, respectively. The calibration curve showed good agreement between the predicted probabilities and actual results and the decision curve indicated a good net benefit of the nomogram for predicting malignant BI-RADS 4 lesions in the training set, test set, and external validation set.Conclusion:The nomogram constructed from the radiomics features of the internal and surrounding regions of CESM breast lesions combined with clinical factors is attributed to differentiate benign from malignant BI-RADS category 4 breast lesions.

Objective:To investigate breast ultrasound imaging and pathological characteristics of patients with hereditary breast cancer-ovarian cancer syndrome (HBOC).Methods:A total of 12 patients with HBOC admitted to Shanxi Province Cancer Hospital from January 2012 to 2021 April were retrospectively analyzed. All patients were pathologically diagnosed as invasive breast cancer based on the preoperative puncture or surgical specimens, including 3 patients with double primary cancers of breast and ovary. The clinical, breast ultrasound imaging and pathological data of patients were analyzed.Results:The ultrasound imaging of HBOC usually showed regular morphology in 8 cases, clear border in 9 cases, no burr sign in 10 cases, no calcification in 10 cases, rear echo in 10 cases; the maximum blood flow velocity was (0.21±0.09) m/s, the vascular resistance index was 0.72±0.17, and aspect ratio ≤ 1 in 8 cases. Among 12 cases of HBOS, 9 cases were invasive ductal carcinoma, 3 cases were breast cancer with medullary features; histological grade: 7 cases of grade Ⅱ, 5 cases of grade Ⅲ; molecular classification: Luminal B type in 2 cases, human epithelial receptor 2 (HER2) type in 4 cases, and triple-negative type in 6 cases. The histological types of 3 patients with double primary cancers of breast and ovary were all high-grade serous carcinoma.Conclusions:HBOC is a type of neoplastic disease with a special genetic background. Ultrasound and pathological manifestations have certain characteristics. Sonographers should improve the understanding of the disease and pay attention to the medical history and family history in order to reduce the rate of misdiagnosis and increase the rate of diagnosis.

Objective:To investigate the effects of different chemotherapy dose intensity on the short-term efficacy and adverse reactions of patients with advanced colon cancer.Methods:A real-world database of patients with advanced colon cancer in Wangjing Hospital of China Academy of Chinese Medical Sciences and China-Japan Friendship Hospital from January 2017 to December 2020 was established, including 105 patients treated with the same chemotherapy regimen for two consecutive cycles. The patients were grouped according to the average relative dose intensity (ARDI) of chemotherapy, and the population differences, treatment regimens, short-term efficacy and adverse reactions of different chemotherapy dose intensities were evaluated. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of ARDI for short-term efficacy.Results:There were 31 patients in the high dose intensity group (ARDI≥80%) , 34 patients in the medium dose intensity group (80%0.05) . ROC curve analysis found that the area under the curve predicting objective response was 0.70, the sensitivity was 92.30%, and the specificity was 52.10% when the chemotherapy ARDI threshold was 64%. Conclusion:In the real world, colon cancer patients receiving high dose intensive chemotherapy have better objective response rate, and tumor markers decreased significantly. The baseline status of colon cancer patients receiving low dose intensive chemotherapy is poor, but there is no statistically significant difference in disease control rate between patients receiving low dose intensive chemotherapy and patients receiving high dose intensive chemotherapy, and the adverse reactions are controllable.

Objective:To investigate the application of three-dimensional digital technique in customized ear framework fabrication for auricular reconstruction.Methods:From July 2018 to October 2019, the patients with microtia who underwent ear reconstruction in the Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University were enrolled. Each patient with unilateral microtia underwent auricular CT scan and preoperative analysis and ear framework design were carried out with Mimics software 18.0. The two-dimension(2D) ear films and three-dimension(3D) silicon models were produced by 1∶1 2D printing and 3D printing, respectively. Microtia reconstruction was performed according to the guide of the models, patients were followed up over a six-month period to evaluate the size, outline, height and auriculocephalic angle of the reconstructed ear. The satisfactory outcomes of the patients were scored according to a 5-point Likert scale.Results:A total of 15 patients were included in this study, including 11 males and 4 females, aged 8-27 years, with an average of 15.5 years old. All the 15 patients completed the surgical planning and ear reconstruction successfully, without major complications, such as hematomas, inflammation, skin necrosis and framework exposure. The costal cartilage frameworks were very similar to the printed 3D models in size and contour. Comparison between the two sides was made at six months postoperatively. The reconstructed ear was much the same as that of contralateral side, and all patients were satisfied with their reconstructed ear outcomes with average score of 4.4.Conclusions:With the application of digital technique for pre-surgical planning in microtia reconstruction patients, ear templates were produced from 2D to 3D, and the correction of microtia was changed from standard auricular reconstruction to personalized auricular reconstruction, with a great improvement of the precision in ear framework fabrication.

Objective:To investigate the application of three-dimensional digital technique in customized ear framework fabrication for auricular reconstruction.Methods:From July 2018 to October 2019, the patients with microtia who underwent ear reconstruction in the Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University were enrolled. Each patient with unilateral microtia underwent auricular CT scan and preoperative analysis and ear framework design were carried out with Mimics software 18.0. The two-dimension(2D) ear films and three-dimension(3D) silicon models were produced by 1∶1 2D printing and 3D printing, respectively. Microtia reconstruction was performed according to the guide of the models, patients were followed up over a six-month period to evaluate the size, outline, height and auriculocephalic angle of the reconstructed ear. The satisfactory outcomes of the patients were scored according to a 5-point Likert scale.Results:A total of 15 patients were included in this study, including 11 males and 4 females, aged 8-27 years, with an average of 15.5 years old. All the 15 patients completed the surgical planning and ear reconstruction successfully, without major complications, such as hematomas, inflammation, skin necrosis and framework exposure. The costal cartilage frameworks were very similar to the printed 3D models in size and contour. Comparison between the two sides was made at six months postoperatively. The reconstructed ear was much the same as that of contralateral side, and all patients were satisfied with their reconstructed ear outcomes with average score of 4.4.Conclusions:With the application of digital technique for pre-surgical planning in microtia reconstruction patients, ear templates were produced from 2D to 3D, and the correction of microtia was changed from standard auricular reconstruction to personalized auricular reconstruction, with a great improvement of the precision in ear framework fabrication.

Objective:To investigate the ultrasound image and pathological features of invasive fibromatosis, and to provide a basis for the diagnosis of invasive fibromatosis.Methods:The clinicopathological data of 22 patients pathologically diagnosed with invasive fibromatosis from January 2016 to March 2019 in Shanxi Provincial Cancer Hospital were retrospectively analyzed. The clinical, ultrasound and pathological data were also summarized.Results:Ultrasound images of invasive fibromatosis showed irregular morphology, unclear boundaries, uneven echo, spot-like or strip-shaped blood flow signals. The coincidence rate of ultrasound diagnosis was 59.1% (13/22), 3 cases were misdiagnosed as fibrous, fat and other sarcomas, 4 cases were misdiagnosed as nerve-derived tumors, 1 case was misdiagnosed as nodular fasciitis, and 1 case was misdiagnosed as gastrointestinal stromal tumor. The pathological characteristics of invasive fibromatosis were more typical, and the positive expression rate of vimentin and β-catenin in immunohistochemistry was 100.0% (22/22); the coincidence rate of preoperative pathological diagnosis of puncture was 78.6% (11/14), 1 case was misdiagnosed as nerve fiber tumor, 1 case was misdiagnosed as low-grade fibromyxoid sarcoma, and 1 case was misdiagnosed as nodular fasciitis.Conclusion:Invasive fibromatosis has a certain specificity in ultrasound and pathological diagnosis, which can be diagnosed and differentially diagnosed according to the ultrasound image and pathological characteristics.

[Abstract] Objective: To explore the key genes and molecular mechanisms of liver metastasis in colorectal cancer (CRC), and to provide potential targets and biomarkers for the treatment of CRC with liver metastasis. Methods: Based on the bioinformatics method, the gene data sets of CRC liver metastasis were downloaded from the GEO database to screen the differentially expressed genes (DEGs); the GO and KEGG enrichment analyses of DEGs were performed by using DAVID online tool, and the protein-protein interaction (PPI) network was constructed to screen out the key genes, and subsequently the prognosis was analyzed. Results: A total of 321 DEGs were selected from 183 CRC specimens and 39 liver metastasis specimens, including 153 up-regulated genes and 168 downregulated genes. The results of enrichment analysis of GO and KEGG showed that the functions of DEGs were mainly related to protein activation cascade, inflammatory response, extracellular matrix, platelet degranulation, complement and coagulation cascade reaction etc. 8 key CRC genes (ALB, APOB, FGA, F2, APOA1, SERPINC1, FGG and AHSG) were screened by PPI network. Survival analysis showed that patients with high expressions of SERPINC1 and FGG had poor prognosis(all P<0.05). Conclusion: The biological functions and signaling pathways of DEGs are related to the occurrence and development of liver metastasis. The 8 key genes may be the potential therapeutic targets of CRC liver metastasis, and SERPINC1 and FGG may be new prognostic markers.

Objective To investigate the clinical features, treatment strategies and outcomes of patients with Moyamoya disease and lenticulostriate artery (LSA) aneurysm rupture. Methods Patients with moyamoya disease and LSA aneurysm rupture admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medicine School from October 2012 to March 2015 were analyzed retrospectively. They were followed up for 1 year. The modified Rankin Scale (mRS) was used to evaluate the outcomes, and 0-2 was defined as good outcome. The demographic characteristics, image anatomical features, treatment schemes, and outcomes of the patients were summarized. The Pubmed database was used to retrieve other similar studies, which combined with this group of cases for analysis. Results A total of 10 patients were enrolled, 2 males and 8 females, aged 29-72 years, with an average of 43. 6 years. All cases were intracranial hemorrhage, including 3 cases of cerebral hemorrhage, 6 cases of ventricular hemorrhage, and 1 case of subarachnoid hemorrhage. At the time of admission, 7 patients had disturbance of consciousness, and 3 patients underwent emergency extraventricular drainage. Among them, 5 patients received endovascular embolization, 4 had good outcome, 1 had mild neurological deficit (mRS score 3); 2 received surgical treatment, all had good outcome; 3 received conservative treatment, all had re-bleeding, 2 died, and 1 had severe disability (mRS score 4). Fourteen eligible articles were included, and a total of 18 patients were included in the analysis: surgical treatment in 7 cases, endovascular treatment in 6 cases, and conservative treatment in 5 cases (self-healing in 1 case). According to the data of this group of patients and literature reports, the good outcome rate of the patients with early interventional embolization or craniotomy clipping treatment was significantly higher than that of conservative treatment (70. 6％vs. 22. 2％; P = 0. 038). Conclusion There is a certain risk of conservative treatment of Moyamoya disease complicated with LSA aneurysm rupture and requires active treatment. Interventional embolization of the parent artery or surgically clipping of aneurysm can effectively improve the clinical outcome of such patients. Interventional embolization of the parent artery and aneurysm can be selected simultaneously if the condition of the parent artery is allowed. Surgery can be selected when the condition of parent artery is poor and the aneurysm is located in the superficial part.

Objective To investigate the effect of the Shaofu zhuyu decoction on the changes of the body writhing behavior,inflammatory reaction and COX-2 expression of the rats with the primary dysmenorrhea. Methods Fifty SD female rats were randomly divided into blank control group,model control group,high,middle and low dose of Shaofu zhuyu decoction groups,10 in each group.Dysmenorrhea rat model was established by treating with estradiol benzoate and oxytocin.Effect of Shaofu zhuyu decoction of different doses on writhing behavior,changes of endometritis cells and COX-2 expression in uterine smooth muscle of dysmenorrhea rats were observed. Results In the model control group,latency of the body writhing behavior was shortened and the total score was high,many inflammatory cells (especially for neutrophils) infiltrated in endometrium and uterine smooth muscle,immunohistochemistry showed that brown granules were found in the cytoplasm of smooth muscle cells of uterus,and COX-2 expression was positive in uterine smooth muscle cells.As compared with the model control group,writhing latency increased,total score decreased in both the high and middle dose of Shaofu zhuyu decoction groups,and infiltration of a small number of inflammatory cells was seen in the endometrium and smooth muscle(P<0.01);COX-2 expression was decreased (P<0.01) especially for the high dose of Shaofu zhuyu decoction group.As compared with the model control group,the latency of the low dose of Shaofu zhuyu decoction group was significantly increased,and the total score was decreased(P<0.01),but there was no significant difference in inflammatory cell infiltration and COX-2 expression (P>0.05). Conclusion A potential mechanism by which Shaofu zhuyu decotion treats primary dysmenorrhea may be related with alleviating pain,inhibiting inflammatory responses,and down-regulating expression of COX-2.