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.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Background: The mechanism of peripheral axon transport in neuropathic pain is still unclear. Chemokine ligand 13 (CXCL13) and its receptor (C-X-C chemokine receptor type 5, CXCR5) as well as GABA transporter 1 (GAT-1) play an important role in the development of pain. The aim of this study was to explore the axonal transport of CXCL13/CXCR5 and GAT-1 with the aid of the analgesic effect of botulinum toxin type A (BTX-A) in rats. Methods: Chronic constriction injury (CCI) rat models were established. BTX-A was administered to rats through subcutaneous injection in the hind paw. The pain behaviors in CCI rats were measured by paw withdrawal threshold and paw withdrawal latencies. The levels of CXCL13/CXCR5 and GAT-1 were measured by western blots. Results: The subcutaneous injection of BTX-A relieved the mechanical allodynia and heat hyperalgesia induced by CCI surgery and reversed the overexpression of CXCL13/CXCR5 and GAT-1 in the spinal cord, dorsal root ganglia (DRG), sciatic nerve, and plantar skin in CCI rats. After 10 mmol/L colchicine blocked the axon transport of sciatic nerve, the inhibitory effect of BTX-A disappeared, and the levels of CXCL13/CXCR5 and GAT-1 in the spinal cord and DRG were reduced in CCI rats. Conclusions BTX-A regulated the levels of CXCL13/CXCR5 and GAT-1 in the spine and DRG through axonal transport. Chemokines (such as CXCL13) may be transported from the injury site to the spine or DRG through axonal transport. Axon molecular transport may be a target to enhance pain management in neuropathic pain.

Objective:To observe the effect of electroacupuncture at Baihui and Dazhui on cognitive function of vascular dementia rats and explore its possible mechanism. Methods:Male Sprague-Dawley rats were randomly divided into the sham operation group, model group and electroacupuncture group, with 10 rats in each group. Rats in the model group and the electroacupuncture group were made as vascular dementia models by carotid artery ligation of the two sides. After 2 weeks of modeling, the electroacupuncture group received electroacupuncture at Baihui and Dazhui for 4 weeks. Before and after the intervention, take the novel object recognition behavior test to detect the 1, 24 h new object preference coefficient; and use magnetic resonance spectroscopy to scan the levels of NAA/Cr and Cho/Cr neurometabolites in the hippocampus. q-PCR was used to detect the expression of caspase-3 and Bax in apoptotic cells. Immunohistochemistry was used to detect synapsin SYN expression. Results:Compared with the model group, the preference coefficient of new object of the electroacupuncture group at 1 h [(69.85 ± 11.26)% vs. (50.26 ± 8.85)%] and 24 h [(60.85 ± 11.86)% vs. (43.26 ± 10.25)%] significantly decreased ( P<0.01). The content of NAA/Cr (1.344 ± 0.149 vs. 0.892 ± 0.178) significantly increased ( P<0.01), and the content of Cho/Cr (0.661 ± 0.142 vs. 0.902 ± 0.178) in the hippocampus significantly decreased ( P<0.01). The expression of hippocampus caspase-3 (1.342 ± 0.041 vs. 2.437 ± 0.089), Bax (2.135 ± 0.083 vs. 4.358 ± 0.137) significantly decreased ( P<0.01), and the expression of SYN (0.577 ± 0.035 vs. 0.315 ± 0.025) significantly increased ( P<0.01). Conclusion:Electroacupuncture at Baihui and Dazhui can effectively improve the cognitive dysfunction of rats with vascular dementia, which may be related to the improvement of neuronal metabolites NAA, Cho content and inhibition of neuronal apoptosis and improvement of neuronal touch function.

Objective To investigate the correlation between mechanical properties and hemostatic ability of the sealing hydrogels. Methods The gelation time, elastic modulus, viscous modulus, bursting strength and hemostatic ability of the hyaluronic acid/gelatin hydrogels were measured. Compared with fibrin sealant, gelation time and mechanical parameters were proposed to judge the feasibility of sealing hydrogels to be used for hemostasis in clinic. Results Hydrogels with a long gelation time, low elastic modulus, low viscous modulus and small bursting strength were merely suitable for hemostasis in minor bleeding. The hydrogels with short gelation time, high elastic and viscous modulus and large bursting strength could effectively reduce the blood loss in the cases of massive bleeding. Conclusions The hemostatic ability of a hydrogel was correlated to its gelation time, elastic modulus, viscous modulus and bursting strength. To achieve hemostasis as effective as fibrin sealant, the gelation time of a sealing hydrogel should be less than 120 s, its elastic and viscous modulus should exceed 600 Pa and 120 Pa, respectively. For the damage with diameter of 2 mm in the tissue model, the burst strength should exceed 10.7 kPa and preferably be larger than 16.0 kPa.

Objective To OxplorO thO opOrating mOthods and clinical OffOcts of arthroscopic anatomical antO-rior cruciatO ligamOnt(ACL) rOconstruction with dirOct insOrtion tOchniquO vOrsus traditional mOthod.Methods From January 2017 to DOcOmbOr 2017,totally 52 patiOnts who accOptOd ACL rOconstruction and mOt thO inclusion and Oxclu-sion critOria in BOijing FriOndship Hospital of Capital MOdical UnivOrsity wOrO OnrollOd in this rOtrospOctivO study. ThOy wOrO dividOd into two groups by random sOquOncO softwarO and patiOnts′sOlOction rOsults. ThO obsOrvation group (27 casOs) rOcOivOd dirOct insOrtion tOchniquO,and thO control group(25 casOs) rOcOivOd traditional mOthod. At post-opOrativO 1 month, 3 months, 6 months, 1 yOar, thO clinical OffOct was OvaluatOd by imaging indOx, subjOctivO and objOctivO indicators.Results All 52 patiOnts wOrO availablO for follow up with an avOragO of 11.5 months. No postop-OrativO complications such as infOction, joint instability and soft lOgs, with a satisfiOd rOcovOry of rangO of motion, pain rOliOvOd significantly. ThO Lysholm scorO of thO obsOrvation group was (94.80 ± 4.18)points, which was signifi-cantly highOr than (91.02 ± 1.96)points of thO control group (t=2.674,P<0.05).Lachman tOst and KT-1000 wOrO improvOd significantly comparOd with thosO bOforO opOration ( all P <0.01), whilO thOrO was no statistically significant diffOrOncO bOtwOOn thO two groups(all P>0.05),but thO pivot-tOst of thO obsOrvation group was bOttOr than that of thO control group, thO diffOrOncO was statistically significant ( P < 0. 05 ). ThO ACL anglO of thO obsOrvation group was (51.52 ± 5.18)°, which was significantly lowOr than (55.86 ± 2.45)° of thO control group ( P<0.05). According to modifiOd Lysholm scorOs classification, in thO obsOrvation group, 24 casOs wOrO OxcOllOnt, 2 casOs wOrO good,1 casO was fair, and thO OxcOllOnt and good ratO was 96.3%. In control group,18 casOs wOrO OxcOllOnt,5 casOs wOrO good,2 casOs wOrO fair, and thO OxcOllOnt and good ratO was 92.0%. ThO diffOrOncO in thO OxcOllOnt and good ratO bOtwOOn thO two groups was statistically significant(P<0.05).Conclusion DirOct insOrtion anatomical rOconstruction is a safO and OffOctivO tOchniquO for rOconstruction of ACL. It can rOstorO thO stability of ACL and rotation of knOO joint.

Objective: To investigate the methylation status and expression of FOXP3 in CD4+ T cells of patients with chronic hepatitis B (CHB). Methods: Peripheral blood mononuclear cells (PBMCs) from 59 CHB patients and 22 healthy controls (HC) were collected. The percentage of CD4+ CD25+ Foxp3+ Tregs in CD4+ T cells was estimated by flow cytometry. FOXP3 expression was measured by quantitative real time-polymerase chain reaction (RT-qPCR) and Western blotting. The methylation status of FOXP3 was determined by methylation-specific polymerase chain reaction. Results: The percentage of CD4+ CD25+ pFoxp3+ Tregs in CD4+ T cells, FOXP3 mRNA and protein expression levels were significantly higher in patients with CHB than HCs (P<0.05). Meanwhile, the methylation frequency of FOXP3 was significantly lower in CHB patients than HCs (P<0.05). FOXP3 mRNA levels and the percentage of CD4+ CD25+ Foxp3+ Tregs were significantly lower (P<0.05) in patients with gene methylation than those without. Conclusions Aberrant demethylation of FOXP3 gene existed in CD4+ T cells of CHB, which contributed to an elevation in FOXP3 expression and percentage of CD4+ CD25+ Foxp3+ Tregs. It might provide a new target for prevention and treatment of CHB.

Objective To study the effects of mechanical load on in vivo degradation performance of high-purity magnesium (HP Mg, 99.99 wt.%) quantitatively. Methods Cylindrical Mg specimens, with a 2 mm diameter and a 14 mm length, were mounted in polyetheretherketone (PEEK) rings to bear compressive stresses ［（6.2±0.6） MPa］, tensile stresses ［（4.6±0.1） MPa］ or no stress (as control). The specimens under different stress states were implanted subcutaneously in dorsal abdominal regions of SD rats for 4 weeks. The mass loss, residual volume and surface morphology of the specimens and staining of surrounding soft tissues were used to analyze the degradation rate of HP Mg. Results Specimens and rings were completely encapsulated by membranous tissues after implantation for 4 weeks. No significant differences in the degradation rates were noted between specimens bearing stress and the control. The corrosion layers of specimens under each stress state were uniform. Conclusions The compressive and tensile stresses (4-6 MPa) could not affect significantly HP Mg degradation performance in vivo. The research findings provide theoretical references for the design and clinical application of Mg-based degradable implants.

Objective To evaluate the cleanliness and tolerance of different administration speed on polyethylene glycol electrolyte solution (PEG-ES) for colonoscopy preparation. Methods 97 consecutive asymptomatic individuals underwent colonoscopy and therapy were enrolled and randomly assigned into 2 groups. Subjects in group A drank 2000 ml PEG-ES (1000 ml every 10 ~ 20 min rapidly) within 1 h before colonoscopy;Subjects in group B drank 2000 ml PEG-ES (250 ml every 10 min) within 2 h before colonoscopy. The total time of drinking PEG-ES, the first defecation time and total numbers of defecation after drinking PEG-ES, score and degree of Boston bowel preparation scale (BBPS) and PEG-ES related adverse effects of the two groups were assessed and compared. Results There were no significant differences in gender, age and cecal insertion rate between group A and group B (P > 0.05). The total time of drinking PEG-ES, the first defecation time in group A were significant faster than those in group B, while total numbers of defecation was significantly more than that in group B (P < 0.05). No patients in the two groups complained PEG-ES related bellyache and vomiting, a little subjects in group B complained PEG-ES related nausea and bloating (P < 0.05), but the incidence were both less than 10.00 %. Accepting rate of colonoscopy preparation in group A was lower than that in group B, but both more than 90.00%, while accepting rate of re-colonoscopy than that in group B. BBPS score of the right half colon, transverse colon, total colon were significantly higher in group A than that in group B respectively (P < 0.05), while that of the left colon no significant differences between the two groups (P > 0.05). Conclusions Both regimens met the requirement of conventional colonoscopy and therapy, while rapid drinking PEG-ES within 1 h provides more better colonic cleansing quality for colonoscopy preparation.

Nowadays,with the rapid development of science and technology of medicine,the detection rate of obstructivc azoospermia increased gradually,clinically not uncommon.Surgical treatment of obstructive azoospermia is also improved from traditional vasovasostomy and epididymovasostomy to microsurgical vasovasos-tomy and microsurgical va-soepididymostomy,and from 3-suture intussusception vasoepididymostomy to 2-suture intussusception vasoepididymostomy,then our modified reverse single needle anastomosis,and finally to the robot assisted anastomosis.Therefore,the anastomosis is more precise,the recanalization rate and the pregnancy rate have a revolutionary improvement.The robot era is coming.The article focuses on surgical treatment of obstructive azoospermia,comparison of the advantages and disadvantages of each operation,and prediction of the future direction of development.