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 explore the clinicopathological characteristics of primary bladder mucosal-associated lymphoid tissue extranodal marginal zone lymphoma (MALToma).Methods:A retrospective case series study was conducted. The clinicopathological data of 9 primary bladder MALToma patients diagnosed and underwent transurethral resection of bladder tumors at the Fujian Provincial Hospital, Zhangzhou Municipal Hospital, Mindong Hospital of Ningde City, Zhangzhou Second Hospital and Fuzhou Taijiang Hospital from December 2008 to December 2021 were collected. Paraffin-embedded surgical specimens were collected for HE staining, immunohistochemical staining and genetic testing, the clinicopathological characteristics of patients were summarized, and the literature was reviewed.Results:Of the 9 cases, 8 were female and 1 was male, the age was (59± 11) years old (range: 39-74 years old). Two cases had 3 lesions, 3 cases had 2 lesions, and 4 cases had single lesion. The maximum diameter of the mass was (3.2±1.9) cm (range: 0.3-7.0 cm). The follow-up time was 6-127 months, 4 cases lost to follow-up, 4 cases were disease-free survival, and 1 case was survival with tumor. Pathomorphologically, the bladder tissue consisted of diffusely infiltrating small-to-medium sized lymphocytes, with moderate amounts of pale-staining cytoplasm, without obvious nucleoli, some of them were translucent, and the mitosis was rare. Large cell proliferation in some areas was observed in 1 case, with prominent nucleoli and mitotic figures. Tumor cells in all 9 patients expressed CD20; bcl-2, CD43 and CD38 were positive in some cells in 4 cases, and CD138 was positive in a few cells in 2 cases; κ was positive in 4 cases, and scattered positive in 5 cases; λ was positive in 4 cases, and scattered positive in 5 cases. B-cell receptor gene clonal rearrangement was positive in all 8 cases who underwent the assay. No break-apart signal was observed in all 6 cases who underwent the fluorescence in situ hybridization assay with MALT1 gene segregation probe.Conclusions:Primary bladder MALToma is a rare low-grade B-cell lymphoma that is more commonly found in elderly women. There is no abnormal change in MALT1 gene.

【Objective】 To investigate the gene frequency and polymorphism of RBC blood group systems in RhD negtive population in Hunan, so as to lay a foundation for clinical blood transfusion and construction of multiple rare blood group database. 【Methods】 Blood samples were taken from 300 RhD negative blood donors, confirmed by serological method, from June 2019 to June 2020,. RHD genotyping was performed by SSP-PCR. For blood donors with typing results as RhD negative plus RHD gene deletion, antigens genotyping of MNS, Duffy, Kell, Domrock, Diego, Kidd, Sciawnna, Colton, Lutheran and Yt RBC blood group systems were performed by SSP-PCR and analyzed by the chi square test of SPSS 20 statistical software. 【Results】 RHD gene deletions accounted for 58.67% (176 / 300) of serological D negative blood donors. The gene frequencies were as follows: MNS: GYPB^*S=0.045 5(8/176), GYPB^*s=0.954 5(168/176), GYP^*Dane=0.039 8(7/176); Duffy: FY^*A =0.965 6(170/176), FY^*B=0.034 1(6/176); Dombrock: DO^*A=0.082 4(14.5/176), DO^*B=0.917 6(161.5/176); Diego: DI^*A=0.025 6(4.5/176), DI^*B =0.974 4(171.5/176); Kidd: JK^*A=0.485 8(85.5/176), JK^*B=0.514 2(90.5/176); Kell: KP^*A=0.005 7(1/176), KP^*B=0.994 3(175/176); Lutheran: LU^*A=0.005 7(1/176), LU^*B=0.994 3(175/176); Yt: YT^*A=0.002 8(0.5/176), YT^*B=0.997 2(175.5/176). The genotypes of Kell(K+ /k+ ), Scianna and Colton blood groups were KEL^*02 /KEL^*02, SC^*01 /SC^*01 and CO^*A /CO^*B, respectively. The expected frequencies of the combination of type O, RhD negative and other blood group systems were between 1/100 000 to 1/10 000. 【Conclusion】 Among RhD negative blood donors in Hunan, the gene profiles of MNS, Duffy, Domrock, Diego, Kidd, Kell and Lutheran blood group system were polymorphic, and Kell (K+ /k+ ), Colton and Scianna were homozygous. The data of other RBC blood group systems from RhD negative blood donors is of great significance to establish local database of rare blood groups.

Objective:To explore the role and molecular mechanism of DNAJB6 in liver regeneration during partial liver transplantation(PLT).Methods:Dark agouti(DA, donor)and Lewis(recipient)rats were prepared for liver regeneration model of PLT.Rats were divided into before perfusion, after split liver perfusion, after portal vein opening, before abdominal closure and Day 3/7 after surgery groups(n=6 each)for timepoints of PLT.C57 mice were performed for residual liver regeneration model of partial hepatectomy and divided into control, Day 1/2/3/4/5 groups(n=6 each)for timepoints of hepatectomy.Gene Expression Omnibus liver regeneration data were utilized for locating DNAJB6 in liver regeneration.DNAJB6 low-expression human hepatocytes were constructed by DNAJB6-Si transfection.The relationship between DNAJB6 and liver regeneration was examined by Western blot detection of cell proliferation markers PCNA and CCK8 cell proliferation experiments.And the possible molecular mechanism of DNAJB6 regulating liver regeneration in PLT was studied by Western blot detection of nuclear protein and protein in cell proliferation signal pathway.Results:The result of residual liver regeneration of partial hepatectomy showed that DNAJ family genes were differentially expressed on regenerated liver gene chip and DNAJB6 was lowly expressed on regenerated liver gene chip.Meanwhile, DNAJB6 was lowly expressed in regenerated liver tissues of PLT and partial liver resection.After silencing DNAJB6 by transfecting DNAJB6-Si, the cellular expression level of PCNA and proliferation rate increased.However, nuclear extraction failed to detect the nuclear/plasma changes of β-catenin and the level of Wnt4 protein had no obvious change.Although the activation levels of p38 and JNK2 downstream of Ras/MAPK showed no change, there was a higher activation level of ERK.Conclusions:In regenerating liver tissue, hepatocytes may suppress the Ras/MEK/ERK signaling pathway by lowering the expression level of DNAJB6 to promote liver regeneration.

BACKGROUND/AIMS: This study aimed to verify the reliability of the alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index (ANI) for distinguishing ALD in patients with hepatic steatosis from NAFLD, and to investigate whether ANI combined with γ-glutamyl transferase (GGT) would enhance the accuracy of diagnosis in China. METHODS: A hundred thirty-nine cases of fatty liver disease (FLD) were divided into two groups of ALD and NAFLD. The ANI was calculated with an online calculator. All indicators and ANI values were analyzed using statistical methods. RESULTS: ANI was significantly higher in patients with ALD than in those with NAFLD (7.11 ± 5.77 vs. -3.09 ± 3.89, p < 0.001). With a cut-off value of -0.22, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of diagnosed ALD cases was 87.1%, 92.5%, and 0.934 (95% confidence interval [CI], 0.879 to 0.969), respectively. The corresponding values for aspartate aminotransferase (AST)/alanine transaminase (ALT), mean corpuscular volume (MCV), and GGT were 75.29%, 72.94%, and 0.826 (95% CI, 0.752 to 0.885); 94.34%, 83.02%, and 0.814 (95% CI, 0.739 to 0.875) and 80.23%, 79.25%, and 0.815 (95% CI, 0.740 to 0.876), respectively. ANI AUROC was significantly higher than the AST/ALT, MCV, or GGT AUROCs (all p < 0.001), moreover, ANI showed better diagnostic performance. The combination of ANI and GGT showed a better AUROC than ANI alone (0.976 vs. 0.934, p = 0.016). The difference in AUROCs between AST/ALT, MCV, and GGT was not statistically significant (all p > 0.05). CONCLUSIONS: ANI can help distinguish ALD from NAFLD with high accuracy; when ANI was combined with GGT, its effectiveness improved further.
Alcoholics* ; Aspartate Aminotransferases ; China ; Diagnosis ; Diagnosis, Differential ; Erythrocyte Indices ; Fatty Liver* ; gamma-Glutamyltransferase ; Humans ; Liver Diseases, Alcoholic* ; ROC Curve ; Sensitivity and Specificity ; Transferases*

Objective To evaluate the clinical effects of two different revascularization approaches,one via percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and the other via coronary artery bypass graft (CABG),on short-and long-term prognosis in elderly patients with diabetes and multi-vessel coronary artery disease.Methods A retrospective analysis was conducted on 254 elderly patients with diabetes and multi-vessel coronary artery disease.Based on the revascularization approach,patients were divided into the PCI group (n=93) and the CABG group (n =161).The incidence of major cardiovascular events (MACE) were observed during hospitalization and 1-year after follow-up.Results All-cause mortality and the incidence of non-fatal myocardial infarction were higher in the CABG group than in the PCI group during hospitalization [4.9％ (8 cases) vs.1.1％ (1 cases),5.6％ (9 cases) vs.2.2％ (2 cases),each P＜0.05],while there was no significant difference in the incidence of MACE between the two groups1-year after follow-up (P＞ 0.05).The incidence of cerebrovascular events was lower in the PCI group than in the CABG group [2.2 ％ (2 cases) vs.6.2％ (10 cases),P＜0.05],while the rate of revascularization was higher in thePCI group than in the CABG group [6.5％ (6 cases) vs.1.9％ (3 cases),P＜0.05].Cox regression analysis showed that diabetes (OR =1.65,95％ CI:1.013-1.926,P =0.024) and left ventricular ejection fraction (OR =1.30,95 ％ CI:1.018-1.652,P =0.027) were independent risk factors for revascularization and cerebrovascular events.Conclusions MACEs during hospitalization are fewer in elderly patients with diabetes and multi-vessel coronary artery heart disease who received PCI than in those who received CABG.PCI has a similar mid-and long-term effect as CABG,bur PCI has a higher revascularization rate and lower risk of MACEs than CABG.

Objective To describe the prevalence and risk factors of insomnia among adults in YiBin City. Meth?ods Using multi-stage stratified cluster sampling, 12000 subjects over 18 years old were identified in YiBin City. The subjects were screened using the insomnia survey self-edited and risk factors of insomnia were identified through logistic analysis. Results A total of 11227 subjects completed the survey in which 1671 people (14.9%, 95%CI:14.2%~15.5%) were diagnosed insomnia using ICD-10. Among them, 9.4% (157 patients) had seeked for professional help. The multi?variate logistic analysis showed that low level of life quality(OR=2.42,P<0.01), jobless(OR=1.87,P<0.01), over 60 years old(OR=1.69,P<0.01), fewer years of education(OR=1.41,P<0.01), female(OR=1.41,P<0.01)and lower annu?al per capita income(OR=1.15,P=0.01)were risk factors in insomnia people. Conclusion The incidence of insomnia is high in YiBin city. Sleep quality in high-risk group needs more attention and corresponding measures should be taken in order to increase the rate of asking for help in insomnia people.

Objective To observe the efficacy of Wuteng Ercao decoction in treating active rheumatoid arthritis (RA) and its effects on the levels of cytokine interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α).Methods Sixty-five patients with active RA were randomly divided into treatment group (33 cases) and control group (32 cases). Patients in the control group were administered with methotrexate tablets 10 mg, oral taking, once a week;hydroxychloroquine sulfate tablets 200 mg, oral taking, twice a day;diclofenac sodium sustained release tablets 75 mg, oral taking, twice a day. Patients in the treatment group were administered with Wuteng Ercao decoction additionally, oral taking, three times a day. The treatment lasted for 12 weeks. The changes and untoward effects of various clinical and laboratory indicators were observed before and after treatment.Results After treatment, the tender joint count, swollen joint count, patient’s global assessment, and physician’s global assessment were improved (P<0.05), with statistical significance between the two groups (P<0.05). The levels of ESR, CRP, IL-6 and TNF-α decreased significantly after treatment (P<0.05), but those were more significantly in treatment group (P<0.05). There were 2 cases with untoward effects in the treatment group and 1 case in the control group (P>0.05).Conclusion Wuteng Ercao decoction is effective in patients with active RA and it can reduce the levels of IL-6 and TNF-α.

Professor Luo Lingjie is a national famous old doctor of traditional Chinese medicine (TCM). He has a set of effective thoughts and methods on health maintenance. The core of the thought is Tiao-Xin, that is to say the emotion regulation is the key to health. The idea and method include three aspects, which include emotion regulation, diet regimen and exercise regimen. The emotion regulation is divided into clean ears, optimistic mood, learn to adapt, maintain psychological balance, and comply with nature. Diet regimen is fell into pay attention to the health food, regular diet, dietotherapy as primary and followed by drug, comply with the four seasons, reasonable to choose the food. There are four principles of exercise regimen, which are the choice of sports according to individual person with the aim to relax the body, move to raise the shape which should be combined with static to repose, proceed in an orderly way and persevere it step by step. The idea and method can also be used for daily personal health and clinical nursing for health maintenance. It is important that the physical and spiritual needs be consistent with long-term practice.

Objective To observe the effects and traits of applying locking anatomic plates to the proximal femur for the old-aged aroundtrochanteric fractures. Methods From January 2006 to August 2010, 56 cases with old-aged aroundtrochanteric fractures were selected as samples. Clinical and radiographic data were retrospectively reviewed at the 1st, 3rd, 6th, 12th month after operations. In the meantime, analysis of comparison between them and ones with the DHS treatment was conducted. Results All of the operations were successful. Altogether 56 patients were followed up, average 9.4 months. All of their fractures were healed in a mean time of 5.3 months without delayed union, nonunion, hip equinovarus, failure of screws and plates or death. Comparison of the excellent and goodrate of two groups, the dif-ferences was significant (P<0.05). Conclusion Applying locking anatomic plates to the proximal femur can provide sta-ble fixation with a good functional outcome, which is an effective method for the old-ageed aroundtrochanteric fractures and reducing death rate.