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 compare the efficacy and safety of plasma exchange (PE) combined with double plasma absorption and simple PE in the treatment of acute-on-chronic liver failure. Methods: We retrospectively analyzed 251 cases of acute-on-chronic liver failure treated with artificial liver treatment since January 2015. Changes in clinical manifestations, laboratory tests, and complications of the patients before and after different modes of treatment were compared and short-term efficacy was tracked. In accordance with different data, t-test, Pearson's chi-squared test and Fisher's exact test were used for statistical analysis. Results: The effectiveness of low-volume PE combined with double plasma molecular adsorption system (DPMAS) and equal amount of PE combined with DPMAS was significantly better than simple PE (83.7%, 84.05% and 82.15 vs 55.6%, P < 0.05) in early stage of liver failure. In late-stage of liver failure, there was no significant difference in the treatment efficiency of each group (P > 0.05). Bilirubin and bile acid levels were significantly decreased in combined treatment groups than that to simple PE group (P < 0.05). PTA and albumin improvement rate of DPMAS PE groups were significantly lower than that of simple PE group (P < 0.05). There was no statistical difference in adverse reactions between each group. Conclusion PE combined with DPMAS improves the treatment efficiency of early hepatic failure and decrease dosage of plasma when compared with simple PE. A beforehand DPMAS treatment after PE treatment can improve the adverse effects of DPMAS on blood coagulation function and albumin levels.

Objective To observe and study the influence degree of strengthen training for family members for the treatment compliance and unhealthy lifestyle of patients with diabetes mellitus. Methods A total of 64 patients with diabetes mellitus from January 2015 to March 2016 were selected and divided into two groups by the method of random number table,32 patients in control group were taken care with routine nursing of diabetes mellitus,32 patients in observation group were taken care with strengthen training for family members,then the treatment compliance,related knowledge cognition of unhealthy lifestyle and unhealthy lifestyle situation of two groups before the intervention and at 4th, 8th and 12th week after the intervention were compared. Results The treatment compliance, related knowledge cognition of unhealthy lifestyle and unhealthy lifestyle situation of two groups before the intervention all had no obvious differences (all P>0.05). The treatment compliance at 4th, 8th and 12th week after intervention were (6.26 ± 0.32), (6.95 ± 0.36), (7.28 ± 0.40) scores in observation group, and (5.23 ± 0.29), (6.01 ± 0.30), (6.30 ± 0.33) scores in control group, and the differences were significant (t=8.253, 9.201, 10.257, all P<0.05). The related knowledge cognition of unhealthy lifestyle at 4th, 8th and 12th week after intervention were (80.78±5.90), (89.44±6.02), (93.43±6.20) scores in observation group, and (73.38± 5.73), (77.93±5.84), (82.20±6.01) scores in control group, and the differences were significant (t=11.258,12.563, 13.324, all P<0.05 ). The unhealthy lifestyle situation at 4th, 8th and 12th week after intervention were 75.00%(24/32), 90.63%(29/32), 96.88%(31/32) in observation group, and 59.38%(19/32), 68.75%(22/32),78.13%(25/32) in control group, and the differences were significant (χ2=7.251, 7.468, 9.169, all P<0.05). Conclusions The influence of strengthen training for family members for the treatment compliance and unhealthy lifestyle of patients with diabetes mellitus are more active, so the value of strengthen training for family members of patients with diabetes mellitus is higher.

Objective: To investigate the association between aflatoxin exposure and primary hepatocellular carcinoma (PHC) development. Methods: From December 2013 to May 2016, we selected 214 patients newly diagnosed with PHC as cases, and 214 patients as controls from three hospitals in Chongqing. Cases were confirmed with PHC diagnosis standard. And cases caused by clear reasons such as drug-induced liver injury, alcoholic liver damage, fatty liver and gallstones etiology, were excluded. Controls were included with no cancer and no digestive system disease, and recruited simultaneously with cases. Cases and controls were frequency-matched (1∶1) by same gender and age (±3 years). Peripheral blood and random urine samples were collected and analyzed for serum HBsAg status by biochemistry analyzer, and serum AFB₁-ALB adduct and urinary AFB₁-N⁷-GUA adduct by ELISA. Basic information, living habits and history of disease for patients were obtained by questionnaires. We used wilcoxon rank sum test to compare the median of serum AFB₁-ALB adduct and urinary AFB₁-N⁷-GUA adduct in cases and controls. Logistic regression analyses were performed to assess risk factors for PHC, and synergism index (S) of aflatoxin with other factors was estimated by the method of Andersson. Results: There was no significant difference in age between PHC cases (50.74±9.67) years and controls (51.15±9.90) years. Logistic regression showed that the odds ratio of HBV infection for PHC development was 46.3 (95% CI: 23.3-88.0). There was a significant difference in median concentrations of serum AFB₁-ALB adduct (cases vs controls: 146.23 vs 74.42 ng/g albumin, P<0.001), but no difference in median concentrations of urinary AFB₁-N⁷-GUA adduct was observed (cases vs controls: 0.17 vs 0.14 ng/mg creatinine, P<0.210). The odd ratios for PHC risk after adjustment were 1.9 (95%CI: 1.1-3.4) for AFB₁-ALB adduct, and 2.1 (95%CI: 1.0-4.2) for AFB₁-N⁷-GUA adduct. Moreover, we observed a positive interaction of aflatoxin exposure with HBV, alcohol drinking, and diabetes. The S was 4.7 (95%CI: 2.8-7.9), 3.5 (95%CI: 1.0-12.0), and 12.4 (95%CI: 1.8-84.2), respectively for serum AFB₁-ALB adduct with each of the three factors mentioned, and was 1.9 (95%CI:1.1-3.1), 2.0 (95%CI: 1.1-3.6), and 2.0 (95%CI: 1.1-3.6), respectively for urinary AFB₁-N⁷-GUA adduct with each of the three factors mentioned. Conclusion HBV was still the main risk factor, and AFB₁ exposure was also an independent risk factor for PHC in Chongqing. There was a positive interaction of aflatoxin with HBV, alcohol drinking, and diabetes.

Objective To study the clinical features and follow-up of newborns with severe hypoxic-ischemic encephalopathy ( HIE) , and to provide the basis for rational diagnosis, treatment and follow-up.Methods Clinical data of cases of HIE from the Neonatal Department of our Hospital from January 2011 to October 2014 were studied retrospectively. The data of general information, laboratory examination, treatment, outcome, follow-up and prognosis of the patients were collected. Multivariate logistic regression analysis was used to study the influential factors of the prognosis of HIE.Results A total of 123 infants with sever HIE were enrolled in our study. In addition to general therapy, 6 cases were treated with mild hypothermia, and 21 cases were treated with high pressure oxygen. 60 cases improved our treatment, 55 cases had withdrawal treatment with parental consent, and 8 cases died. Single factor analysis showed that 5 minutes Apgar score, convulsions, coma, pH, BE, organ injury, and mild hypothermia treatment were the risk factors that affect the prognosis of severe HIE. Multiple factors analysis showed that 5 min Apgar score <3 points ( OR=4. 071 ,95℅CI 1. 309-15. 613 ) and BE≤-10 mmol/L ( OR=36. 810, 95℅CI 5. 913-41. 119) were independent risk factors of prognosis of severe HIE ( P<0. 05). Hospitalization within the first 72 hours of life ( OR=0. 096, 95℅CI 0. 096-0. 353) was a protective factor of severe HIE. Multiorgan injury ( mainly the injury of brain, lung and heart) and electrolyte imbalance ( mainly hypocalcemia and hyponatremia ) were common complications of serve HIE. In the follow-up of these patients, 33 cases were loss in follow up, and 49 cases died (8 cases died during hospitalization, 41 cases died after withdrawal of treatment). The top five causes of death were abandonment of treatment due to financial reasons and the fear of adverse outcome (n=20), multiple organ dysfunction ( n =16 ) , and pneumothorax ( n =4 ) , diffuse intravascular coagulation (n=6), and shock (n=3). 41 cases survived were followed up for 9~54 months. The critical clinical conditions observed among these infants included cerebral palsy ( n = 5 ) , epilepsy ( n = 3 ) and developmental retardation(n=26).Conclusions There are many complications of severe HIE.The mortality of severe HIE is high, and the incidence of poor outcome of survivors is also high. Timely detection of risk factors is the key to the prevention of severe HIE. Long-term prognosis of severe HIE requires proper organization of neonatal follow up.

Antiviral Agents ; therapeutic use ; Guanine ; analogs & derivatives ; therapeutic use ; Hepatitis B ; immunology ; Hepatitis B Antibodies ; immunology ; Hepatitis B Surface Antigens ; immunology ; Humans ; Reproducibility of Results ; Stem Cell Transplantation ; Stem Cells ; Tissue Donors

Humans ; Infant, Newborn ; Intestinal Perforation ; complications ; diagnosis ; Mycoses ; complications ; diagnosis

Objective To study the expression of the tumor suppressor gene TSHR and pl6 in papillary thyroid carcinoma (PTC) and explore the relationship of the tumorigenesis and the promoter aberrant methylation of the two above genes. Methods RT-PCR was used to detect the mRNA expression of two tumor suppressor genes in 50 cases of PTC, 20 cases of nodular goiter and 12 cases of thyroid adenoma tissue. The promoter methylation status of the two genes were detected by methylation-specific PCR technique (MSP) (which of p16 by nested PCR). The promoter hypermethylation of the two genes was tested by randomly gene sequencing. Results Hypermethylation of promoter region were detected from 68.0 % (34/50) TSHR gene and 54.0 % (27/50) pl6 gene in PTC, while 21.9 % (7/32) and 15.60 % (5/32) in controls. The rate of promoter methylation in PTC was significantly higher than that in controls (χ2 = 16.61, P <0.05 vs χ2 =12.08 P <0.05). The relative mRNA expression of TSHR gene and pl6 gene were (0.41±0.11) and (0.51±0.17) in PTC, respectively, while those were (0.63 ±0.08) and (0.72 ±0.22) in controls, respectively. The mRNA expression of the TSHR gene and pl6 gene was obviously lower in PTC than that in controls (t = 3.86, P < 0.05 vs t =3.66, P <0.05). By the sequencing, it was confirmed that the CG in methylated promoter of the two genes was not changed, while the CG in unmethylated promoter was changed into TG. Conclusion Methylation of the TSHR gene and p16 gene in promoter region is a common molecule event and may be invovled in the genesis and development of human PTC.

Objective To study the expressions of the tumor suppressor gene TSH receptor( TSHR),P16, and RAS in papillary thyroid carcinoma ( PTC ) , and the correlation between the occurrence of tumor and the aberrant promoter hypermethylation of three tumor suppressor genes. Methods RT-PCR was used to detect the mRNA expression of three tumor suppressor genes in tissues of 50 cases of PTC ,20 cases of nodular goiter,and 12 cases of thyroid adenoma. The promoter methylation status of three tumor suppressor genes was examined by methylation-specific PCR technique( MSP). Gene sequencing was used to test if the hypermethylation existed in the promoter of three tumor suppressor genes. Results In 68.0% (34/50) TSHR gene, 54.0% (27/50) P16 gene, and 60.0% ( 30/50 ) RAS gene in PTCs, hypermethylation in promoter region was detected, the respective results 21.9% (7/32) , 15. 6% (5/32) ,and 31. 3% (10/32) were found in control tissues. The rates of the three genes with promoter hypermethylation in PTC were significantly higher than those in control tissues ( all P<0. 05). The mRNA expressions of TSHR,P16,and RAS were significantly lower in PTC than those in control tissues (0. 41 ± 0.11 vs 0.63±0. 08,0. 51±0. 17 vs 0. 72±0. 22,0. 56±0. 10 vs 0. 67±0. 16, all P<0. 05). The sequencing confirmed that there was CC to TC transmission in the promoters of three tumor suppressor genes. Conclusions The methylation of three tumor suppressor genes in promoter region is a common molecule event and may be involved in the genesis and development of human PTC.

Objective To study the organizational commitment and influencing factors of clinical nurses at tertiary hospital in Shenzhen. Methods 347 clinical nurses from a tertiary hospital were select-ed by stratified random sampling and investigated and analyzed for organizational commitment with ques-tionnaires. Results Total score for organizational commitment of clinical nurses was (60.45±9.99),in which, from the highest to the lowest, the scores for five aspects were normative commitment (14.49±2.97), affective commitment (13.50±3.57), ideal commitment (11.69±3.20), economic commitment (11.27±3.23), opportunity commitment (9.50±3.30),respectively, their influencing factors included age, nursing age, mari-tal status, professional tide. Conclusions The organizational commitment of clinical nurses is at higher-middle level, their influencing factors are multi-dimensional, demographic characteristics have different im-pact on five aspects of organizational commitment.