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 analyze the influencing factors of contrast agent extravasation in coronary CT angiography(CTA)examination,and to formulate intervention measures.Methods:A retrospective selection of data from 583 patients who underwent coronary CTA at Peking University People's Hospital from January to December 2023 was conducted.Logistic regression was used to analyze the patients'general information and injection protocols,and the risk factors of contrast agent extravasation were determined.Results:Among the 583 patients included,11 patients had contrast agent extravasation during CTA examination,with an extravasation rate of 1.887%.The contrast agent was all extravasated into the subcutaneous tissue,and the CT value did not reach the trigger criteria.Gender,education level,diabetes mellitus,history of intravenous chemotherapy,age,weight,body mass index(BMI),injection rate and injection dose were all associated with the occurrence of contrast agent extravasation,the difference was statistically significant(x2=18.911,7.563,16.567,4.279,t=3.576,3.244,1.865,4.297,6.532,P<0.05).Age,education level,history of intravenous chemotherapy,diabetes mellitus,injection rate and injection dose were risk factors for contrast agent extravasation in coronary CTA(OR=1.008,1.372,1.029,5.092,0.975,1.421,P<0.05).Conclusion:Factors such as low education level,advanced age,history of intravenous chemotherapy,high injection rate and large injection dose can increase the risk of contrast agent extravasation in coronary CTA examination.Radiology staff should closely monitor high-risk patients,strengthen monitoring of intravenous injection of contrast agents for coronary CTA examination,and reduce the occurrence of contrast agent extravasation.

Objective:To investigate the effects of orlistat on the viability of human gall-bladder cancer (GBC) cells.Methods:The experimental study was conducted. The human GBC NOZ cells with high expression of FSAN was screened out through in vitro cultivating human GBC-SD, SGC-996 and NOZ cells. The cell proliferation assay, clone formation assay and protein detection experiment were used to analysis of the effects of orlistat on the viability of human GBC cells. Cell grouping: NOZ cells cultured with medium were set as the control group, cultured with medium + 10 μmol/L orlistat were set as the low-dose orlistat group, cultured with medium + 100 μmol/L orlistat were set as the high-dose orlistat group, respectively. Observation indicators: (1) expression of FASN protein in human GBC cells; (2) effects of orlistat on the proliferation of human GBC NOZ cells; (3) effects of orlistat on apoptosis of human GBC NOZ cells. Measurement data with normal distribution were represented as Mean± SD, the ANOVA test was used for comparison between groups and the least significant difference method was used for pairwise comparison. Results:(1) Expression of FASN protein in human GBC cells. Results of western blot showed that the relative expression of FASN protein in human GBC NOZ, GBC-SD and SGC-996 cells was 0.57±0.06, 0.12±0.04 and 0.10±0.02, respectively, showing a significant difference among them ( F=115.67, P<0.05). There were significant differences between the NOZ cells and the GBC-SD or the SGC-996 cells ( P<0.05), and there was no significant difference between the GBC-SD cells and the SGC-996 cells ( P>0.05). (2) Effects of orlistat on the proliferation of human GBC NOZ cells. ① Results of cell proliferation assay showed that the absorbance value of NOZ cells was 2.34±0.12, 1.57±0.08 and 1.07±0.13 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a significant difference among them ( F=205.88, P<0.05). ② Results of clone formation assay showed that the number of NOZ cells clones was 257±23, 153±11 and 83±11 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a significant difference among them ( F=92.64, P<0.05). ③Results of western blot showed that the relative expression of Cyclin-D1 protein of NOZ cells was 2.31±0.10, 1.52±0.05 and 1.23±0.11 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a significant difference among them ( F=120.73, P<0.05). The relative expression of CDK-4 protein of NOZ cells was 1.58±0.04, 1.21±0.02 and 1.19±0.04 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a signifi-cant difference among them ( F=110.45, P<0.05). (3) Effects of orlistat on apoptosis of human GBC NOZ cells. Results of western blot showed that the relative expression of Bcl-2 protein of NOZ cells was 1.07±0.03, 0.36±0.03 and 0.15±0.02 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a significant difference among them ( F=1 242.93, P<0.05). The relative expression of Bax protein of NOZ cells was 0.51±0.03, 0.38±0.05 and 1.38±0.04 in the control group, low-dose orlistat group and high-dose orlistat group, respectively, showing a signifi-cant difference among them ( F=583.51, P<0.05). Conclusion:Orlistat can inhibit the growth of human GBC NOZ cells and promote their apoptosis.

Objective:To study the distribution and antibiotics resistance of the main pathogens of neonatal purulent meningitis in different regions of China.Methods:A retrospective descriptive clinical epidemiological study was conducted in children with neonatal purulent meningitis which admitted to 18 tertiary hospitals in different regions of China between January 2015 to December 2019. The test results of blood and cerebrospinal fluid, and drug sensitivity test results of the main pathogens were collected. The distributions of pathogenic bacteria in children with neonatal purulent meningitis in preterm and term infants, early and late onset infants, in Zhejiang Province and other regions outside Zhejiang Province, and in Wenzhou region and other regions of Zhejiang Province were analyzed. The chi-square test was used for statistical analysis.Results:A total of 210 neonatal purulent meningitis cases were collected. The common pathogens were Escherichia coli ( E. coli)(41.4%(87/210)) and Streptococcus agalactiae ( S. agalactiae)(27.1%(57/210)). The proportion of Gram-negative bacteria in preterm infants (77.6%(45/58)) with neonatal purulent meningitis was higher than that in term infants (47.4%(72/152)), and the difference was statistically significant ( χ2=15.54, P=0.001). There were no significant differences in the constituent ratios of E. coli (36.5%(31/85) vs 44.8%(56/125)) and S. agalactiae (24.7%(21/85) vs 28.8%(36/125)) between early onset and late onset cases (both P>0.05). The most common pathogen was E. coli in different regions, with 46.7%(64/137) in Zhejiang Province and 31.5%(23/73) in other regions outside Zhejiang Province. In Zhejiang Province, S. agalactiae was detected in 49 out of 137 cases (35.8%), which was significantly higher than other regions outside Zhejiang Province (11.0%(8/73)). The proportions of Klebsiella pneumoniae, and coagulase-negative Staphylococcus in other regions outside Zhejiang Province (17.8%(13/73) and 16.4%(12/73)) were both higher than those in Zhejiang Province (2.9%(4/137) and 5.1%(7/137)). The differences were all statistically significant ( χ2=14.82, 12.26 and 7.43, respectively, all P<0.05). The proportion of Gram-positive bacteria in Wenzhou City (60.8%(31/51)) was higher than that in other regions in Zhejiang Province (38.4%(33/86)), and the difference was statistically significant ( χ2=6.46, P=0.011). E. coli was sensitive to meropenem (0/45), and 74.4%(32/43) of them were resistant to ampicillin. E. coli had different degrees of resistance to other common cephalosporins, among which, cefotaxime had the highest resistance rate of 41.8%(23/55), followed by ceftriaxone (32.4%(23/71)). S. agalactiae was sensitive to penicillin, vancomycin and linezolid. Conclusions:The composition ratios of pathogenic bacteria of neonatal purulent meningitis are different in different regions of China. The most common pathogen is E. coli, which is sensitive to meropenem, while it has different degrees of resistance to other common cephalosporins, especially to cefotaxime.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Objective:To investigate the relationship between abdominal visceral adipose tissue (VAT) and cardiometabolic risk (CMR) through quantitative computed tomography (QCT).Methods:The present study included 76226 participants. Abdominal fat areas were measured using the QCT Pro Model 4 system. Cardiometabolic indices were collected, including systolic and diastolic blood pressures, fasting plasma glucose, total cholesterol, triglyceride, and low-density and high-density lipoprotein cholesterols CMR score was the sum of abnormal blood pressure, fasting glucose, triglyceride, and high-density lipoprotein cholesterol. Restricted cubic spline and ordered logistic regression models were applied.Results:The mean age was 50±13 years and the percentage of men was 58.8%. The level of VAT area was higher in men than in women (191.7±77.1 cm 2 vs 116.4±56.2 cm 2, P<0.0001 for all). After adjustment for age, the cardiometabolic indices except high-density lipoprotein cholesterol increased with increasing VAT area. When VAT area was 300 cm 2, age-adjusted odds ratios and 95% confidence intervals of a CMR score ≥ 1 were 14.61 (13.31, 16.04) for men and 5.46 (4.06, 7.36) for women, and the age-adjusted probability of a CMR score ≥ 3 was 31.7% for men and 31.3% for women. Conclusions:QCT-derived VAT is closely related to CMR. The findings suggest that measurement of visceral fat is recommended for the management of abdominal obesity in subjects who agree to undergo lung cancer screening via low-dose CT without additional radiation exposure.

Objective: To analyze the relationship between family behaviors and overweight/obesity in primary and junior school students aged 6-14 years in Xuzhou, and to provide a reference for a targeted measure to prevent and control overweight and obesity. Methods: Using multistage stratified cluster random sampling, a total of 6 220 students aged 6-14 years old from 10 primary schools and 10 junior schools were investigated by a self-designed questionnaire. Chi-square and multivariate Logistic regression models were used to explore the relationship between family behaviors and overweight/obesity in primary and junior school students. Results: The rate of overweight/obesity in primary and junior boys was higher than that in primary and junior girls. The rate of overweight/obesity in urban students was higher than that of rural students(P<0.05). The Chi-square analysis showed that overweight of parents, irregular breakfast, eating fast food, eating sweets, drinking sweetened beverage, long screen time and short sleep duration were risk family behavior factors of overweight/obesity in primary and junior boy students(P<0.05). The risk family behavior factors of overweight/obesity in primary and junior girl students were overweight of parents, irregular breakfast, eating fast food and eating sweets(P<0.05). The risk family behavior factors of overweight/obesity, such as drinking sweetened beverage and short sleep duration, were also related to primary girls(P<0.05), and long screen time was related to junior girls(P<0.05). The multivariate Logistic regression showed that such family behavior factors as irregular breakfast(OR-boy=1.58, OR-girl=1.74), eating fast food(OR-boy=1.37, OR-girl=1.11), eating sweets(OR-boy=1.85, OR-girl=1.52), drinking sweetened beverage(OR-boy=1.64, OR-girl=1.33) and short sleep duration(OR-boy=1.56, OR-girl=1.69) were positively correlated with the prevalence of overweight/obesity in primary students. Long screen time was also correlated to overweight/obesity primary boy students(OR=1.18). Family behavior factors for child overweight and obesity induded overweight of parents(OR-boy=1.29, OR-girl=1.23) and eating sweets(OR-boy=1.44, OR-girl=1.51). Irregular breakfast(OR=1.51), eating fast food(OR=1.22), drinking sweetened beverage (OR=1.75) and long visual screen time (OR=1.15) were also positively correlated with the prevalence of overweight/obesity in junior boy students. Conclusion Family behavior factors were positively correlated with the prevalence of overweight/obesity in primary and junior students. The influence of family behavior factors were different between primary and junior students. Behavioral interventions based on family should be adopted to prevent and control the overweight/obesity of children.

Objective To study the differences of endoscopic submucosal dissection ( ESD ) for colorectal tumors of different diameters. Methods Data of 210 cases which were treated with ESD for colorectal tumors at the Endoscopy Center, the Seventh Medical Center of PLA General Hospital from October 2012 to December 2015 were retrospectively analyzed. The lesions were divided into two groups according to different diameters (≥4. 0 cm group and <4. 0 cm group) for comparative analysis of related factors. Results The mean procedure time of ESD for 210 colorectal tumor cases was 50. 3±42. 7 min and the mean size of lesions was 7. 98 ± 10. 84 cm2 . En bloc resection rate was 91. 4％, R0 resection rate was 90. 5％, and the curative resection rate was 88. 6％. Perforation rate was 5. 2％ (11/210), and the late hemorrhage rate was 0. 5％ (1/210). Compared with lesions < 4. 0 cm, those ≥ 4. 0 cm required longer resection time (79. 63±53. 91 min VS 35. 28±24. 99 min, P<0. 001); and the lesions were mainly located in the rectum ( 61. 97％) . LSTs were mainly mixed granular/nongranular type ( 54. 93％);en bloc resection rate, complete resection rate and curative resection rate of the tumors≥4. 0 cm were all lower than those of tumors < 4. 0 cm. The difference in complete resection rate was statistically significant ( 85. 92％ VS 94. 24％;P=0. 041) . The perforation rate ( 7. 04％) was higher in≥4. 0 cm group, but the difference was not statistically significant. Conclusions ESD of colorectal tumors of diameters ≥ 4. 0 cm requires longer time with higher operation risk. Additionally, physicians should be more careful with non-rectal lesions.

Objective To summarize the endoscopic appearance,endoscopic ultrasound findings and histopathological characteristics of gastric inflammatory fibroid polyp (IFP) in order to improve diagnosis of IFP.Methods From September 2011 to November 2016,49 patients with pathologically comfirmed gastric IFP,who underwent endoscopy in Taizhou Hospital of Zhejiang Province,were enrolled.The medical history,endoscopic examination,treatment and follow-up were retrospectively enalyzed.Results Among 49 patients with gastric IFP (16 males and 33 females;average age 54 years) the maximum diameter of 33 cases (67.3％) was between 1.0 cm and 2.0 cm.Forty-eight cases had single lesion and one case had multiple lesions.The lesions of 17 cases (34.7％) were located at the anterior wall of gastric antrum,the lesions of seven cases (14.3％) were at the posterior wall of gastric antrum,the lesions of seven cases (14.3％) were at the lesser curvature of gastric antrum and the lesions of seven cases (14.3％) were at the great curvature of gastric antrum.Among the lesions of 41 patients who received endoscopic ultrasonography,28 lesions were located in the submucosa of stomach,13 lesions were located in mucosa and muscularis mucosa.The rate of misdiagnosis of endoscopic ultrasonography was 29.3％ (12/41).The endoscopic ultrasound findings of the lesions included 26 hypoechoic structures,11 hyperechoic structures and four slightly hypoechoic structures.The lesions of all the patients were successfully removed by endoscopic polypectomy without any complication.Thirty-seven lesions were treated by endoscopic submucosal dissection (ESD) and 12 lesions by endoscopic mucosal resection (EMR).All the patients were not clearly diagnosed before operation and were finally diagnosed by pathological examination.Postoperative pathological examination showed that in the suhmucosa and mucosa lamina propria,spindle-shaped cells proliferated and arranged in an interwoven pattern or cells around vessels or mucosal glands formed vortex-like or onion skin like pattern.Forty-seven patients were followed up and the median follow-up time was 31 months.All patients survived withont recurrence or metastasis until the submission of this paper.Conclusions The rate of misdiagnosis of gastric IFP is high before operation,and the diagnosis is depended on histopathological examination.Endoscopic resection is the first choice because the diameter of most lesions are less than 5 cm.

Objective To analyze the relationship between sleep duration, screen viewing time, and the prevalence of overweight/obesity among primary school students in Xuzhou. Methods Using a cluster sampling method, a total of 3 228 students (including 1 679 boys and 1 549 girls with an average age of 10.78±0.69 years) from grade one to six from 10 primary schools in Xuzhou underwent interview using a self?designed questionnaire containing basic characteristics, sleep duration, and screen viewing time. Data on height and weight were also collected. The relationship between sleep duration, screen viewing time, and overweight/obesity was analyzed using a logistic regression analysis. Results The prevalence rates of overweight among boys and girls were 16.56% and 11.94%, respectively (χ2=13.59, P<0.05). The prevalence rates of obesity among boys and girls were 14.47% and 10.07%, respectively (χ2=14.01, P<0.05). In total, 74.41% students reported a lack of sleep; the average sleeping time was (9.24±1.07) h. The average sleeping time among boys was (9.35 ± 1.12) h and among girls was (9.13 ± 1.03) h. The difference in sleep duration between boys and girls was significant (t=5.79, P<0.05). The differences in sleep duration and overweight/obesity were significant between both boys (χ2=18.62, P<0.05) and girls (χ2=21.14, P<0.05). Regarding screen viewing time, 17.29% of students spent more than 2 hours per day viewing a screen. The difference in screen viewing time between boys and girls was significant (Z=3.02, P=0.014). The proportion of children with screen viewing time of more than 2 h/d among overweight/obese and healthy weight male students was 29.50% (82/278) and 22.56% (316/1401), respectively, which was significantly different (χ2=6.18, P=0.01). However, there was no significant difference when examining the same groups among girls (12.98% (24/185;obese/overweight) vs . 9.97% (136/1364; healthy weight); χ2=1.59, P=0.21). After adjusting for parental obesity, eating sweets, and physical activity, logistic regression analysis showed that students who had a sleep duration less than 10 h/d had an odds ratio of 1.4 (95% CI: 1.15-1.71), the odds ratio for boys and girls was 1.56 (95% CI: 1.13-2.14) and 1.69 (95% CI: 1.15-2.46). The students who had a screen viewing time of more than 2 h/d had an odds ratio of 1.14 (95% CI: 1.05-1.80); the odds ratio for boys in this group was 1.18 (95% CI: 1.03-1.67). Conclusion Short sleep duration is a risk factor for being overweight/obese in both boys and girls. However, long screen viewing times were associated with being overweight/obese only in boys.