Objective:To construct a new thrombus risk assessment model and evaluate its predictive ability for venous thromboembolism(VTE)in the patients with malignant tumors,and to provide the basis for the early predition of the malignant tumor patients with high risk for VTE.Methods:A total of 128 untreated malignant tumor patients were included,of which 40 were diagnosed with VTE within 2 months of malignant tumor diagnosis and categorized as VTE group.A total of 88 patients who did not develop VTE were categorized as non-VTE group.The clinical risk factors and laboratory indicators of the patients in two groups were compared and analyzed;the types of thrombotic events of the patients were analyzed;the diagnostic values of thrombin-antithrombin-complex(TAT),α2-plasmin inhibitor-plasmin complex(PIC),D-dimer(D-dimer),and fibrin degradation products(FDP)in malignant tumors complicated by VTE were assessed using receiver operating characteristic(ROC)curve analysis;Multivariate Logistic regression analysis was used to analyze the correlations of the clinical risk factors and biomarkers with the malignant tumors complicated with VTE.A new thrombus risk assessment model was constructed,consisting of TAT≥0.70 μg·L-1,poor differentiation,and cardiovascular risk factors.The predictive probability of the model for malignant tumors complicated by VTE was evaluated based on the significance,goodness of fit,calibration curve,and C value of the model.The clinical application value of the new thrombus risk assessment model,COMPASS-CAT risk score(CRS),and Khorana risk score(KRS)in assessing malignant tumor patients complicated by VTE was compared using the C value and decision curve analysis(DCA).Results:The plasma levels of TAT(P＜0.001),PIC(P＜0.001),D-dimer(P＜0.05),and FDP(P＜0.01)of the patients in VTE group were higher than those in non-VTE group.Compared with the patients without cardiovascular risk factors,poor differentiation,and lymphatic metastasis,the malignant tumor patients with cardiovascular risk factors(P＜0.001),poor differentiation(P＜0.001),and lymphatic metastasis(P＜0.05)were more likely to develop VTE.Most VTE events(65％)were isolated deep vein thromboembolism(DVT).The ROC curve analysis showed that the area under the curve(AUC),sensitivity,and specificity of TAT and PIC were higher than those of D-dimer and FDP.TAT≥0.70 μg·L-1(P＜0.05),poor differentiation(P＜0.01),and cardiovascular risk factors(P＜0.01)were the independent risk factors for VTE in the malignant tumor patients.A new thrombus risk assessment model consisting of TAT≥0.70 μg·L-1,poor differentiation,and cardiovascular risk factors was constructed.The new risk assessment model had a high goodness of fit(P=0.805)and good predictive ability during internal validation(x2=75.266,P＜0.001).The ROC curve analysis results showed that the C values for the new thrombus risk prediction model,CRS,and KRS were 0.908,0.676,and 0.541,respectively.The DCA curve analysis results showed that the new thrombus risk assessment model had a higher net benefit rate compared with CRS and KRS.Conclusion:TAT and PIC have greater diagnostic efficiency than D-dimer in the early prediction of the malignant tumor patients with high-risk VTE.For the patients included in this study,the new thrombus risk assessment model,constructed from TAT≥0.70 μg·L-1,poor differentiation,and cardiovascular risk factors,has superior diagnostic efficiency and clinical predictive value compared with CRS and KRS.

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.

A patient with 20-segments multi-planar amputation of the 2nd-5th fingers of the right hand was treated in December 2020 in the Department of Hand and Microsurgery, Affiliated Taihe Hospital of Hubei Universtiy of Medicine. The groupings was performed with microscopic anastomosis and splicing, and the replantation was finally completed. Followed-up at 1 year after surgery, the 17 segments of 20 severed finger segments finally survived. According to the Chinese Medical Association's Hand Surgery Branch's Functional Evaluation Criteria for Replantation of Amputated Fingers, the patient's finger function rating was 57 points and the function was poor at 1-year follow-up. The range of motion of the metacarpophalangeal joint was significantly improved compared with half a year after the operation. The simple grasping, pinching and fingering can be completed. The finger sensation was improved compared with half a year after the operation, but the finger body of right hand atrophied progressively, the interphalangeal joint was stiff, wirheut flexion nor extension range of motion. The function of the replanted finger was limited.

Objective To study the effects of prosthetic alignment on internal contact mechanical characteristics of intact knee joint for transfemoral amputees. Methods The gait experiment of transfemoral amputees was performed under different alignment conditions, and the differences of lower limb motion and ground reaction force (GRF) were analyzed and compared with those of the non-amputees. The three-dimensional （30） finite element model of knee joint was build and used to analyze the effect of alignments of socket adduction and abduction on internal contact mechanical characteristics between femur cartilage, tibia cartilage and meniscus. Results For knee joint of the non-amputees, contact force was mainly concentrated on the medial sides at the moment of the first GRF peak, while contact force was mainly concentrated on the lateral sides at the moment of the second GRF peak. However, for intact knee joint of the transfemoral amputees, contact force was mainly concentrated on the medial side at the moment of two GRF peaks. The stress of the medial meniscus, contact force and contact area between the medial meniscus and cartilage all obviously increased under the alignment of 6° socket adduction. Conclusions Compared with non-amputees, the incidence of knee osteoarthritis (OA) in amputees was higher, which was related to the long-term overload of the medial knee joint. The alignment of socket adduction may increase the risk of knee OA in the intact side of transfemoral amputees. In clinic, excessive adduction of the socket should be avoided during prosthetic alignment.

Objective To compare the degree of liver injury during resuscitation with different crystalloid solutions in a rat model of hemorrhagic shock.Methods Forty-eight SPF healthy male SpragueDawley rats,aged 7-9 weeks,weighing 280-320 g,were assigned into 4 groups (n=12 each) using a random number table:sham operation group (group S),normal saline group (group NS),Ringer's lactate solution group (group RL) and Ringer's malate solution group (group RM).Hemorrhagic shock was induced by withdrawing blood from the right internal jugular vein until mean arterial pressure was reduced to 35-45 mmHg which was maintained for 1 h.The internal jugular vein and artery were cannulated after anesthetization,but no animals were subjected to hemorrhage in group S.The crystalloid solution (2 times the volume of blood loss) was infused intravenously over 30 min starting from 1 h of shock.The animals were resuscitated with 0.9％ sodium chloride solution in group NS,with Ringer's lactate solution in group RL,and with Ringer's malate solution in group RM.Mean arterial pressure was continuously monitored and recorded during the experiment.Before shock (T1),at 1 h of shock (T2) and at 4 h after resuscitation (T3),blood samples were collected from the right internal jugular vein for determination of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentrations by enzyme-linked immunosorbent assay.Rats were sacrificed at T3,and livers were removed for measurement of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in liver tissues (using colorimetric method) and for examination of pathological changes of liver tissues (with light microscope).Results Compared with group S,the serum ALT and AST concentrations at T2.3 and SOD activity and MDA content at T3 were significantly increased in NS,RL and RM groups (P＜0.05).Compared with group NS or group RL,the serum ALT and AST concentrations were significantly decreased,the SOD activity was increased,and the MDA content was decreased at T3 (P＜0.05),and the pathological changes of liver tissues were significantly attenuated in group RM.Conclusion Ringer's malate solution produces better efficacy than normal saline and Ringer's lactate solution when used for resuscitation and mitigating liver injury in a rat model of hemorrhagic shock.

Objective To test the protective effect of a new Ringer's malate solution on intestine's apoptosis caused by hemorrhagic shock in rats.Methods Forty-eight Sprague-Dawley male rats, weighing 280-320 g, were randomly assigned into four groups: sham shock group (group SS), normal saline group (group NS), Ringer's lactate group (group RL) and Ringer's malate (group RM), n=12 each.The group SS was served as control group, the other groups were subjected to 60 min of hemorrhagic shock followed by crystalloid resuscitation.Those rats were sacrificed 3 h after resuscitation.Intestinal tissue was harvested to detect Bcl-2/Bax protein level, the bioactivity of superoxide dismutase (SOD) and malondialdehyde (MDA) level.The level of intestinal cell apotosis was measured using TUNEL method and apoptosis index was calculated.The intestinal histopathology was examined.Results Compared with group SS, the expression of Bcl-2 and the bioactivity of SOD were lower, the level of Bax protein, MDA and apoptotic index were higher in groups NS, RL and RM (P<0.05).Compared with groups NS and RL, the expression of Bcl-2 and the bioactivity of SOD was higher, the level of Bax protein, MDA and apoptotic index were lower in group RM (P<0.05).Histopathological examination showed that group RM was better than group NS and group RL.Conclusion Ringer's malate alleviated intestinal apoptosis caused by hemorrhagic shock in rats.The study suggests that Ringer's malate solution could be a potential new therapeutic agent for fluid resuscitation.

Objective To explore the application effects of segmental design principles in the small incision approach rigid internal fixation for the treatment of maxillofacial fractures.Methods With a retrospective study,from September 2012 to April 2016,172 patients with maxillofacial fractures were selected as the research object in our hospital.All the patients were divided into the observation group of 100 patients and control group of patients according to the different treatment methods.Two groups were treated with mall incision approach rigid internal fixation.The observation group were given the preoperative design based on the segmental design principles.The other operation process were similar with the control group.Results All patients were completed the operation,the fracture were healed by Ⅰ stage.The postoperative 3months of total effective rates of the observation group and the control group were 98.0％ and 83.3％.The total effective rate of the observation group was significantly higher than that of the control group (P ＜ 0.05).The postoperative 3months of infection,nerve injury,salivary fistula,screw loosening and complication rate in the observation group was 3.0％,so that was 20.8％ in the control group,the observation group was significantly lower than the control group (P ＜ 0.05).The postoperative 3months of occlusal relationship and normal rates of the observation group were 99.0％ and 98.0％,respectively.The control group was 93.1％and 90.3％,respectively.There were between the two groups statistically significance difference(P ＜ 0.05).Conclusion The segmental design principles in the small incision approach rigid internal fixation for the treatment of maxillofacial fractures can improve the therapeutic effect,reduce the incidence of postoperative complications,improve the occlusal relationship with normal mouth opening rate.It is an ideal method for the treatment of maxillofacial fracture.

Objective To compare the safety and effectiveness between ozone (O3) and hyaluronic acid (HA) in treating knee osteoarthritis(KOA) by using the meta analysis method.Methods The relevant randomized controlled trials(RCTs) in PubMed,Cochrane Library (issue 1,2016),Embase,CNKI,CBM,VIP,and Wan-Fang databases were retrieved from their establishment to January 23,2016.Two reviewers independently screened the literatures,extracted the data and evaluated the quality of the included RCTs.The results were performed the statistical analysis by using the RevMan5.3 and Stata13.0 software.Results Twenty RCTs involving 2 136 KOA patients were included.Compared with the HA treatment of KOA,the O3 treatment had higher treatment effective rate[odds ratio(OR) =2.78,P＜0.01],and better pain relief effect[at 1,3,6 month after treatment:mean difference(MD) =-0.25,-0.71,-1.70,P＜0.01].There were no statistically significant differences in complications between the two treatment methods[OR=0.84,P=0.56].Conclusion Current evidences indicate that the short-term therapeutic effect of O3 for KOA is superior to HA,and the safety is similar.

Objective To study the effects of two types of crystalloids on postoperative inflam-matory reaction during the process of cesarean section.Methods Sixty patients undergoing cesarean section were randomly divided into Ringer lactate solution group (RL)and Ringer acetate solution group (RA)with 30 cases in each group.Before anesthesia,10 ml/kg crystal solution was infused, the infusion rate was 1 5-20 ml·kg-1 ·h-1 .The patients were performed epidural anesthesia in left lateral position.Crystal solution was infused to maintain the blood pressure during the operation.Ve-nous blood was drawn at the beginning of the operation (T1 ),the end of the operation (T2 ),four hours after operation (T3 ),twenty-four hours after operation (T4 )in order to measure the blood plasma value of IL-6,TNF-α,CRP.Results The blood plasma value of IL-6,TNF-α,CRP had no significant differences at T1 ,T4 ;but the value of group RA was significantly higher than that of group RL (P <0.05)at T2 ,T3 .Conclusion Ringer acetate solution causes more significant postop-erative inflammatory cytokine release than Ringer lactate solution does during the process of cesarean section.

Objective To investigate the clinical values of sodium hyaluronate combined arthroscopic joint clean-up surgery for the patellofemoral arthritis knee pain patients.Methods From June 2012 to September 2015 in Taihe Hospital Affiliated to Hubei Medical College,136 patellofemoral arthritis knee pain patients were selected and randomly divided into treatment group (68 cases) and control group (68 cases).All patients were given arthroscopic joint clean-up surgery,the control group were given the postoperative glucosamine sulfate capsules treatment,and the treatment group were given the postoperative intra-articular injection of sodium hyaluronate choose treatment,the treatment period was 5 weeks.Results Five weeks after treatment,the response rates in the treatment group and control group were 98.5％ (67/68) and 89.7％ (61/68),and the effect of the treatment group was better(x2 =4.202,P＜0.05).The pain scores in the treatment and control group were (1.34±0.45) points and (2.89±0.62) points,significandy lower than that of before operation ((7.30 ± 0.76) points and (7.31 ± 0.56) points;t =34.855,25.142;P ＜ 0.05).The Lysholm score in the treatment and control group were (88.87 ± 6.33) points and (76.13 ± 5.98) point,significantly higher than before operation ((44.23 ± 4.29) points and (44.67 ± 5.13) point;t =14.875,8.113;P＜0.05).The incidence of adverse events during the treatment in the treatment group and the control group were 8.8％(6/68) and 13.2％(9/68) respectively,there was no significant differemce between the two groups (x2 =0.391,P＞0.05).All adverse reactions after symptomatic treatment were improved.Conclusion Sodium hyaluronate combined arthroscopic joint clean-up surgery for the patellofemoral arthritis knee pain patients can effectively play the role of promoting the knee pain and function,and has good efficacy and safety,and is worth popularizing and applying.