Objective:To explore the early coagulation function changes of penetrating intestinal firearm injury of pig in high-altitude environments.Methods:Twenty healthy long white piglets were selected and divided into the plain group and the high-altitude group using the random number table method, with 10 pigs in each group. Pigs in the plain group were placed in a plain environment at an altitude of 800 meters, while pigs in the high-altitude group were placed in an experimental chamber simulating an altitude of 6 000 meters for 48 hours. Both groups received pistol gunshot to have firearm penetrating wounds to the abdominal intestinal tract and then returned to the plain observation room. At 0, 2, 4, 8, 12 and 24 hours after injury, coagulation in the peripheral blood and fibrinolytic indexes [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fbg), D-dimer (D-D), and fibrinogen degradation product (FDP)], thromboelastogram (TEG) [reaction time (R), clotting time (K), clot formation rate (α), maximum amplitude (MA) and coagulation composite index (CI) ], platelet parameters [platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR)] in the two groups were detected separately.Results:The PT values at 0 and 2 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours than those in the plain group ( P<0.01); there was no significant difference at 4 hours between the two groups ( P>0.05). The APTT values at 0, 2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The TT values at 0, 2 and 4 hours after the injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 12 and 24 hours after injury than those in the plain group ( P<0.01); there was no significant difference at 8 hours after injury between the two groups ( P>0.05). The Fbg, D-D and FDP values at 0, 2, 4, 8, 12 and 24 hours after injury were higher in the high-altitude group than those in the plain group ( P<0.01). The R values at 0, 2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The K values at 0, 2, 4 and 8 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 12 and 24 hours after injury than those in the plain group ( P<0.05 or 0.01). The α angles at 0, 2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The MA values at 0, 2 and 4 hours after the injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The CI values at 0, 2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The PLT values at 0, 2, 4 and 8 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 12 and 24 hours after injury than those in the plain group ( P<0.05 or 0.01). The MPV values at 0, 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group ( P<0.01). The PDW values at 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group ( P<0.05 or 0.01), while there was no significant difference in PDW at 0 hour after injury between the two groups ( P>0.05). The P-LCR values at 0, 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were all significantly higher than those in the plain group ( P<0.01). Conclusion:Compared with the plain environments, pig intestinal firearm penetrating injury in the high-altitude environments is more prone to early hypercoagulable state accompanied by mild hyperfibrinolysis, and faster to reach a hypocoagulable state accompanied by obvious hyperfibrinolysis.

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.

Background and purpose:Lung adenocarcinoma has the characteristics of difficult early detection,rapid tumor progression and low surgical resection rate.Although studies on immunotherapy alone and immunotherapy combined with chemotherapy have shown initial success in improving prognosis and overcoming drug resistance,the majority of lung adenocarcinoma patients still receive limited benefits.Therefore,there is an urgent need to identify novel biomarkers with relatively high sensitivity and specificity to improve the prognosis of lung adenocarcinoma.Cell division cycle protein 20(CDC20)is involved in the occurrence and development of various tumors,but its biological role and mechanism in lung adenocarcinoma remain unclear.The aim of this study was to investigate the expression of CDC20 in lung adenocarcinoma and its predictive value for the prognosis of patients with lung adenocarcinoma,and to further explore the effects of CDC20 on the proliferation and invasion capabilities of lung adenocarcinoma cells.Methods:Utilizing immunohistochemistry(IHC)to detect the expression of CDC20 in lung adenocarcinoma tissues,we analyzed its correlation with poor prognosis in combination with bioinformatics and clinicopathological parameters.Kaplan-Meier survival curves were employed to illustrate the impact of CDC20 on postoperative survival rates in lung adenocarcinoma patients.COX multivariate regression analysis was conducted to identify independent prognostic factors influencing postoperative survival rates.Additionally,receiver operating characteristic(ROC)curves were applied to assess the diagnostic value of CDC20 expression in lung adenocarcinoma patients.Real-time fluorescence quantitative polymerase chain reaction(RTFQ-PCR)and Western blot were used to measure the expression levels of CDC20 in normal human lung epithelial cells(BEAS-2B)and human lung adenocarcinoma cells(A549 and H1299).In cellular experiments,CDC20 was knocked down in lung adenocarcinoma cells,which were divided into three groups:si-NC(control group),si-CDC20#1(knockdown group 1)and si-CDC20#2(knockdown group 2).Cell counting kit-8(CCK-8),colony formation,transwell and wound healing assays were conducted to assess cell proliferation,migration and invasion capabilities.Functional enrichment analysis using Geng Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathways was conducted to explore the biological roles of CDC20 in lung adenocarcinoma.Finally,gene set enrichment analysis(GSEA)was employed to investigate potential regulatory pathways of CDC20 in lung adenocarcinoma.This study was approved by the Ethics Committee of Hebei Chest Hospital(Number:2022051).Results:The results of both bioinformatics analysis and IHC demonstrated a significantly high expression of CDC20 in lung adenocarcinoma tissues(P＜0.05).Both bioinformatics analysis and clinical parameter evaluation revealed a correlation between high CDC20 expression and poor patient prognosis.Kaplan-Meier survival analysis and COX regression analysis consistently indicated a significant negative correlation between CDC20 expression and postoperative survival rates in patients(P＜0.05).Additionally,the expression levels of CDC20 were higher in human lung adenocarcinoma cell lines A549 and H1299 compared with BEAS-2B(P＜0.05).Knockdown of CDC20 effectively inhibited the proliferation,migration and invasion of lung adenocarcinoma cells(P＜0.05).The results of GO,KEGG pathways and GSEA consistently pointed to a relationship between CDC20 and cell cycle regulation.Conclusion:CDC20 is highly expressed in lung adenocarcinoma.High expression of CDC20 is an independent risk factor for poor prognosis of lung adenocarcinoma patient.CDC20 can promote the proliferation,migration and invasion of lung adenocarcinoma cells.

Objective:To investigate the predictive value of Doppler ultrasonography combined with cytokeratin fragment 19 (Cyfra21-1) and soluble interleukin-2 receptor (sIL-2R) in cervical lymph node metastasis of thyroid micropapillary carcinoma.Methods:102 patients with minimal papillary carcinoma of thyroid confirmed by surgery and pathology admitted to Ultrasound Department, Shanxi Cancer Hospital from Aug. 2020 to Aug. 2023 were selected and treated with thyroidectomy plus central region and at least one cervical lymph node dissection. Among them, There were 24 cases in the LLNM group and 78 cases in the non-LLNM group.Results:There were significant differences in age, shape, nodular and capsule contact area, tumor shape aspect ratio > 1, blood flow, microcalcification, serum Cyfra21-1 and serum sIL-2R levels between the two groups (Cyfra21-1: P<0.001, sIL-2R: P=0.001). Logistic regression analysis showed that age ≥50 years old ( OR=0.443, 95% CI: 0.217-0.904), microcalcification ( OR=2.787, 95% CI: 1.491-5.208), Cyfra21-1>3.3ng/ml ( OR=3.117, 95% CI: 1.404-6.922) and sIL-2R > 110.45pmol/L ( OR=3.408, 95% CI: 1.473-7.884) were independent risk factors for cervical lymph node metastasis in PTMC patients ( P < 0.05). The ROC curve results showed that the area under the curve of cervical lymph node metastasis predicted by Doppler ultrasound combined with Cyfra21-1 and sIL-2R was 0.82, and the sensitivity and specificity were 83.67% and 70.56%, respectively. Conclusions:The calcification features of Doppler ultrasound and the elevation of serum Cyfra21-1 and sIL-2R are closely related to cervical lymph node metastasis of thyroid micropapillary carcinoma. The combination of Doppler ultrasound with serum Cyfra21-1 and sIL-2R has important reference value in predicting cervical lymph node metastasis.

Objective:To investigate the impact of achievement goals on the academic achievement of medical students.Methods:In May to June of 2019, an online questionnaire survey was performed for data collection, and the stratified sampling method was used for sampling. Demographic factors, Achievement Goal Scale, and Academic Achievement Scale were used in this study, and descriptive statistics, the Pearson correlation analysis, and the multivariate linear hierarchical regression analysis were performed to analyze the impact of achievement goals on the academic achievement of medical students.Results:For these medical students, the mean value of achievement-near to the goal orientation was (3.45±0.77), the mean value of achievement-dodge the goal orientation was (3.43±0.80), and the mean value of mastery goal orientation was (3.85±0.66). Achievement-near to the goal orientation had a significant positive impact on academic achievement ( β=0.336, P<0.01), and mastery goal orientation also had a significant positive impact on academic achievement ( β=0.540, P<0.01). Conclusion:The achievement goals dominated by mastery goal orientation is the most beneficial dimension for the development of medical students.

Long non-coding RNAs (lncRNAs) are a group of non-coding RNAs with a length of over 200 nucleotides. Recently, studies have shown that lncRNAs can regulate gene expression at the epigenetic, transcriptional, and post-transcriptional levels, affect the proliferation, migration, and infiltration of tumor cells, and participate in the occurrence and development of benign and malignant proliferative skin diseases, such as keloids, hemangioma, squamous cell carcinoma and melanoma. This review summarizes roles of lncRNAs in the pathogenesis of benign and malignant proliferative skin diseases.

ObjectiveTo investigate the features of surface electromyography (sEMG) signals of elbow and shoulder muscle groups during maximal isometric contraction of elbow joint, and flexion and extension exercises of elbow joint after elbow fracture surgery. MethodsFrom August, 2021 to April, 2022, 15 convalescent patients after elbow fracture surgery (patient group) and 11 healthy controls (control group) were collected. sEMG signals of biceps brachii, triceps brachii, brachioradialis brachii, upper trapezius, anterior deltoid, middle deltoid and posterior deltoid were recorded during maximal isometric contraction, and flexion and extension exercises of the elbow joint. Root mean square (RMS) value, co-synergy contraction ratio (CSR), co-activation radio (CR), and target muscle activation percentage during flexion and extension were calculated. ResultsIn flexion and extension of elbow joint during maximal isometric contraction, the maximum strength of biceps brachii and triceps brachii were lower in the patient group than in the control group (|t| > 4.109, P < 0.01), and the RMS value of triceps brachii was lower in the patient group than in the control group (t = -7.695, P < 0.001). During maximal isometric extension of elbow joint, the CR of biceps brachii and brachioradialis brachii were more in the the patient group than in the control group (t > 2.326, P < 0.05); during maximal isometric flexion of elbow joint, the CSR of upper trapezius was more in the patient group than in the control group (t = 2.232, P < 0.05). During the extension exercise, the activation level of triceps brachii was more in the patient group than in the control group (t = 3.336, P < 0.05); during flexion exercise, the activation level of biceps brachii and triceps brachii was more in the patient group than in the control group (t >2.339, P < 0.05). ConclusionThere is abnormal contraction pattern of elbow and shoulder muscle groups in patients with elbow fracture after operation, which includes obvious co-contraction pattern of elbow flexor muscle group, insufficient activation of elbow extensor muscle and the compensatory contraction pattern of perishoulder muscle group. sEMG has great potential in quantitative evaluation of motor function after elbow fracture.

Objective To investigate the influencing factors for rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding. Methods A retrospective analysis was performed for the clinical data of the patients with liver cirrhosis and esophagogastric variceal bleeding who were hospitalized in Tianjin Third Central Hospital from January 1, 2017 to December 31, 2018, and according to the presence or absence of rebleeding and bleeding time, the patients were divided into non-bleeding group ( n =148) and bleeding group ( n =119). The risk factors for rebleeding after gastroscopy were analyzed. The t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Cox regression model was used for univariate and multivariate analyses. The receiver operating characteristic (ROC) curve was used to evaluate the accuracy of Child-Turcotte-Pugh (CTP), fibrosis-4 (FIB-4), and albumin-bilirubin (ALBI) scores in predicting rebleeding after gastroscopy, and MedCalc was used to compare the area under the ROC curve (AUC). Results A total of 267 patients with liver cirrhosis and esophagogastric variceal bleeding were enrolled, among whom 53 (19.9%) had liver cancer. A total of 119 patients suffered from rebleeding, with an overall rebleeding rate of 44.6% and a median time to rebleeding of 11.0 (0-39.0) months. The univariate Cox regression analysis showed that liver cancer (hazard ratio [ HR ]=0.377, P < 0.001), aspartate aminotransferase (AST) ( HR =1.002, P =0.025), serum Na ( HR =0.935, P =0.004), and FIB-4 ( HR =1.030, P =0.049) were associated with rebleeding, and the multivariate Cox regression analysis showed that liver cancer ( HR =0.357, P < 0.001), AST ( HR =1.003, P =0.030), prothrombin time (PT) ( HR =0.196, P =0.001), CTP score ( HR =1.289, P =0.014), FIB-4 ( HR =1.062, P =0.033), and ALBI score ( HR =0.433, P =0.011) were independent risk factors for rebleeding. CTP, FIB-4, and ALBI scores had an AUC of 0.711 (95% confidence interval [ CI ]: 0.647-0.776), 0.705 (95% CI : 0.640-0.770), and 0.730 (95% CI : 0.667-0.793), respectively, in predicting rebleeding. There was no significant difference in AUC between CTP, FIB-4, and ALBI scores ( P > 0.05). Conclusion Liver cancer, AST, PT, CTP score, FIB-4 score, and ALBI score are associated with rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding, among which CTP, FIB-4, and ALBI scores have a good value in predicting rebleeding outcome, while there is no significant difference in predictive ability between them.

【Objective】 To investigate the negative emotions among university students during home quarantine under the epidemic of coronavirus disease 2019 (COVID-19) so as to provide scientific basis for psychological counseling. 【Methods】 We conducted an online questionnaire survey to collect 405 undergraduates’ and postgraduates’ DASS-21 scale scores and responses to epidemic prevention knowledge, and analyzed the university students’ negative emotions during the epidemic and influencing factors. 【Results】 Of the 405 students surveyed, 178 individuals (44.0%) had depression, 171(42.2%) felt anxious, and 119(29.4%) felt stressed. Individuals in the DASS21+ group spent much time on entertainment on the cell phone daily than those in the DASS21- group (P<0.001), and the degree of impact by COVID-19 on daily life was significantly higher (P<0.001). Correlation analysis showed that entertainment time on the cell phone, the severity of COVID-19, and the impact of the epidemic were positively related to DASS-21 scores, with correlation coefficients of 0.231, 0.143 and 0.259, respectively (all P<0.01). Binary logistic regression analysis found that mobile entertainment time for over 5 hours per day (OR=3.370, 95% CI: 1.369-8.294, P=0.008) was a risk factor for negative emotions during quarantine at home. 【Conclusion】 During quarantine at home in the epidemic of COVID-19, nearly half of university students are prone to breed negative emotions, like depression, anxiety or stress, which may be related to long-term mobile phone entertainment.

Objective:To understand the willingness to accept peer-referral strategies for promoting HIV testing and related factors in men who have sex with men (MSM) in Shijiazhuang.Methods:A total of 544 MSM were recruited using convenient sampling and sharing two-dimensional code of online questionnaire througth MSM social organizations in Shijiazhuang from August to September in 2018. The anonymous online survey were taken by login through the website "jinshuju.com" ( https://im.jinshuju.com/users/sign_in). The information collected included: the demographic and behavioral characteristics, the attitude to HIV testing for partners, and the willingness to accept peer-referral strategies for promoting HIV testing. The socio-demographic characteristics were analyzed by χ 2 test. Univariate and multivariate logistic regression analyses were conducted to identify the related factors associated with willingness. The SAS 9.4 software was used for statistical analysis. Results:A total of 521 MSM completed the survey. Among them 59.50% (310/521) were willing to advise their partners to receive HIV testing, and 90.02% (469/521) were willing to accept the partners' advice of HIV testing. Higher HIV testing frequency for once a year (a OR=2.72,95% CI:1.42-5.20); for once a half year (a OR=5.72, 95% CI:2.97-11.02); for ≥1 time a quarter (a OR=8.76,95% CI:4.56-16.83), enquiring their partners' HIV status (a OR=1.94, 95% CI: 1.15-3.28) and STD history of their partners (a OR=1.83, 95% CI:1.06-3.14) before having sex were the factors positively associated with the willingness to advise partners to receive HIV testing. Discussing HIV testing with partners (a OR=4.43,95% CI:1.87-10.54) was the factor positively associated with the desire to accept the advice of HIV testing from partners, but feeling emotional hurt by the suggestion of HIV testing (a OR=0.35,95% CI:0.15-0.82) was the factor negatively associated with the willingness to accept the advice of HIV testing from partners. Conclusion:To improve the willingess of MSM to advise their partners to receive HIV testing and strengthen self-protection awareness and equal communication skills are essential for the success of peer-referral strategies for promoting HIV testing among MSM.