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 investigate the clinical characteristics of patients with hemophagocytic lymphohistiocytosis(HLH)and quantify the diagnostic value of various indexes in patients with elevated soluble interleukin-2 receptor(sCD25),so as to construct a diagnostic prediction model of HLH.Methods:The clinical characteristics of 121 patients with elevated sCD25(≥ 2 400 U/ml)in the Third Affiliated Hospital of Sun Yat-Sen University were analyzed retrospectively.The patients were divided into HLH group and non-HLH group according to the diagnostic criteria of HLH.The patients with HLH were divided into infection group,tumor group,macrophage activation syndrome(MAS)group and unknown etiology group according to their etiology.The basic data and treatment of the patients were collected for univariate and multivariate logistic analysis to establish a diagnostic prediction model of HLH.Results:Among the 121 enrolled patients with elevated sCD25,68 were diagnosed as HLH.The proportion of patients using vasopressors,the incidence rate of disseminated intravascular coagulation(DIC),and the HScore in the HLH group were higher than those in the non-HLH group(P＜0.05).Hepatomegaly,splenomegaly,and hemophagocytosis were more common in HLH patients(P＜0.05).Compared with the patients in non-HLH group,patients in HLH group had lower levels of neutrophils,platelets,fibrinogen,IgG,and IgM,while the levels of triglycerides,ferritin(FER),sCD25,serum glutamic oxaloacetic transaminase(SGOT),alkaline phosphatase(ALP),total bilirubin(TBil),lactate dehydrogenase(LDH),and D-dimer were higher(P＜0.05).In subgroup analysis,the level of sCD25 in tumor group was higher than that in infection group.The level of sCD25/ferritin in tumor group was higher than that in infection group and MAS group.Compared with HLH patients in the tumor group,the procalcitonin(PCT)level,proportion of patients using vasopressors,positive rate of hemophagocytosis,and incidence rate of DIC were all higher in the infection group,and the differences were statistically significant(P＜0.05).The results of multivariate analysis showed that fever,splenomegaly,hemophagocytosis,cytopenias,IgM,M.sCD25[multiple of sCD25 detection value relative to the diagnostic threshold(2400 U/ml)],fibrinogen,and triglycerides were independent predictive factors for HLH(P＜0.05).The diagnostic prediction model H constructed based on temperature,splenomegaly,hemophagocytosis,cytopenias,IgM,M.sCD25,fibrinogen,triglycerides showed good predictive accuracy.The optimal cutoff value of H was 39.45,the sensitivity of the model was 94.12％,the specificity was 83.02％.Conclusion:sCD25,sCD25/FER,PCT,hemophagocytosis,hemodynamic instability and DIC could help to distinguish the underlying etiology of HLH.The prediction model H has high discrimination and calibration,which could be used as a relatively accurate clinical diagnostic tool for HLH.

Male infertility (MI) and male sexual dysfunction (MSD) can often coexist together due to various interplay factors such as psychosexual, sociocultural and relationship dynamics. The presence of each form of MSD can adversely impact male reproduction and treatment strategies will need to be individualized based on patients’ factors, local expertise, and geographical socioeconomic status. The Asia Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men’s Health and Aging (ASMHA) aim to provide a consensus statement and practical set of clinical recommendations based on current evidence to guide clinicians in the management of MI and MSD within the Asia-Pacific (AP) region. A comprehensive, narrative review of the literature was performed to identify the various forms of MSD and their association with MI. MEDLINE and EMBASE databases were searched for the following English language articles under the following terms: “low libido”, “erectile dysfunction”, “ejaculatory dysfunction”, “premature ejaculation”, “retrograde ejaculation”, “delayed ejaculation”, “anejaculation”, and “orgasmic dysfunction” between January 2001 to June 2022 with emphasis on published guidelines endorsed by various organizations. This APSSM consensus committee panel evaluated and provided evidence-based recommendations on MI and clinically relevant MSD areas using a modified Delphi method by the panel and specific emphasis on locoregional socioeconomic-cultural issues relevant to the AP region. While variations exist in treatment strategies for managing MI and MSD due to geographical expertise, locoregional resources, and sociocultural factors, the panel agreed that comprehensive fertility evaluation with a multidisciplinary management approach to each MSD domain is recommended. It is important to address individual MI issues with an emphasis on improving spermatogenesis and facilitating reproductive avenues while at the same time, managing various MSD conditions with evidence-based treatments. All therapeutic options should be discussed and implemented based on the patient’s individual needs, beliefs and preferences while incorporating locoregional expertise and available resources.

Humans ; Consensus ; Hypersensitivity ; Desensitization, Immunologic/adverse effects* ; Immunotherapy/adverse effects* ; Injections, Subcutaneous ; Allergens

Objective: To investigate the clinical effects of ultra-pulsed fractional carbon dioxide laser (UFCL) in the treatment of mild to moderate microstomia after burns. Methods: A retrospective observational study was conducted on 19 patients with mild to moderate microstomia after burns who were admitted to Inner Mongolia Baogang Hospital from January 2018 to January 2022, including 15 males and 4 females aged (35±14) years. Patients had an average course of 71 d of microstomia, with 8 cases of moderate microstomia and 11 cases of mild microstomia. All the patients received UFCL treatment every 2-3 months until the microstomia was corrected or the treatment bottleneck was reached. The times of UFCL treatment for patients and the time interval from the last treatment to the last follow-up were recorded. Before the first treatment and at the last follow-up, the opening degree of mouth (finger measurement method), oral gap width, and the distance between the upper and lower incisors during mouth opening were recorded. Before the first treatment and at the last treatment, the new Vancouver scar scale (VSS) was used to evaluate the scar. At the last follow-up, the degree of satisfaction was evaluated by the Likert 5 scale by the patients themselves, and the satisfaction ratio was calculated; the adverse reactions such as pigmentation, blisters, infection, and persistent erythema in the treatment area were counted. Data were statistically analyzed with Mann-Whitney rank sum test or paired sample t test. Results: Patients received UFCL treatment of 3 (2, 6) times. The interval from the last treatment to the last follow-up was 26 months at most and 4 months at least. At the last follow-up, the opening degree of mouth of patients was significantly improved than that before treatment (Z=4.68, P<0.01). At the last follow-up, the oral gap width of patients was (35±6) mm, and the distance between upper and lower incisors during mouth opening was (3.2±0.4) cm, which was significantly improved compared with those before treatment (with t values of 10.73 and 18.97, respectively, P<0.01). The VSS score after the last treatment was 4.1±1.6, which was significantly better than that before treatment (t=22.96, P<0.01). At the last follow-up, the satisfaction ratio of patients with treatment was 18/19, and no pigmentation, blisters, infection, persistent erythema, and other adverse reactions of all patients in the treatment area occurred, however, one of the patients reported that the disease recurred about half a year after treatment. Conclusions: UFCL is an effective method for treating mild to moderate microstomia after burns, with which patients are highly satisfied, and it is worth of further study and promotion.
Blister ; Burns/therapy* ; Cicatrix/therapy* ; Female ; Humans ; Lasers, Gas/therapeutic use* ; Male ; Microstomia ; Treatment Outcome

【Objective】To explore the clinical manifestation of COVID- 19 severe cases.【Methods】Clinical data of one severe case with COVID-19 including the clinical characteristic ，laboratory testing results，radiography，treatment，complication and outcome of the patient were retrospectively collected and analyzed.【Results】 The patient with COVID-19 was a 61-year old male，He suffered with underlying disease. His symptoms included fever，cough，myalgia， fatigue，and dyspnea. Laboratory testing results included normal WBC count，decreased lymphocyte cells，elevated LDH and hypoxemia. Radiography findings showed bilateral lung infiltration. His condition deteriorated after intensive treatment for one week. He was intubated and treated with mechanical ventilation because of complicating with severe acute respiratory distress syndrome（ARDS）.【Conclusion】COVID-19 is an emerging acute communicable disease，which lack specific and effective treatment. Most patients have a good prognosis but mortality in severe cases is high. More attention should be paid on the high risk of progression in COVID-19 cases.

Objective To analyze the blood gas analysis before extubation related to early withdraw venti-lator in infants with congenital heart disease.Methods Collecting the blood gas analysis datas before extubation of infants with congenital heart disease who were treated with CICU in our hospital from 2014. 01.01 to 2017.01.01, To analyze the relationship between early withdraw ventialtor and the blood gas analysis before extubation. Re-sults 1.Univariate analysis showed that infants with congenital heart disease early postoperative rate of weaning were related to blood gas analysis before extubation with PH,HCO3-,Lac-,SaO2,A-aDO2,respiratory index and oxygenation index(P<0.05).2.The results of non conditional logisitic regression analysis showed that PH,HCO3-and Lac- were independent factors,the value of OR(95%CI) were 50.1(80-311),1.51(1.12-2.02) and 0.18 (0.05-0.65). Conclusion In infants with congenital heart disease before extubation SaO2high,A-aDO2≤ 100 mmHg,respiratory index low and oxygenation index high were the important factors of postoperative early weaning;The PH,HCO3-and Lac-were independent factors,even though early withdrawal unit blood gas analysis before ex-tubation the index is inferior to late withdrawal unit's,it can also achieve early weaning in the basic normal value range.

BACKGROUNDCerebral alveolar echinococcosis (CAE) grows infiltratively like a malignant tumor, causing great harm to the human body. It is possible to display mass lesions of CAE using various imaging systems, but regarding the infiltrating proliferation active regions, it is difficult to evaluate its actual range using conventional magnetic resonance imaging (cMRI). This research focused on proton magnetic resonance spectroscopy ((1)HMRS) techniques to find the mass and infiltration zone of CAE. We explored the marginal zone (MZ) of CAE nearly close to the actual infiltrating scope, to provide reliable images for clinical purposes, to overcome shortcomings of cMRI, to formulate beneficial clinical surgical plans and assess prognosis.

METHODSBetween September 2005 and May 2011, 15 patients who were suffering from CAE (36 effective lesions altogether) were examined by (1)HMRS at the first affiliated hospital of Xinjiang Medical University. Multi-voxel (1)HMRS was acquired with a 1.5T MRI scanner. Concentrations and the ratios of the metabolites of CAE were calculated. Furthermore, changes in the concentrations of the metabolites containing N-acetyl-aspartic-acid (NAA), choline (Cho), creatine (Cr), lipids and lactate (Lip + Lac) and the ratios of Cho/Cr, NAA/Cr, (Lip + Lac) /Cr were compared in the substantial region, 0 - 10 mm MZ, and 11 - 20 mm MZ of the infiltration zone, as well as the corresponding contralateral part of the normal brain parenchyma area (control group).

RESULTSIn this study, the ratios of Cho/Cr in the substantial region, 0 - 10 mm MZ of infiltration zone and the control group were 1.78 ± 0.70, 1.90 ± 0.54, and 0.78 ± 0.15, respectively; the ratios of NAA/Cr were 1.60 ± 0.20, 1.80 ± 0.42, 2.24 ± 0.86, respectively; the ratios of (Lip + Lac)/Cr were 25.69 ± 13.84, 25.18 ± 16.03, and 0.61 ± 0.15, respectively. From the control group, 11 - 20 mm MZ to 0 - 10 mm MZ and the substantial region of CAE, the concentrations of the metabolites showed that NAA and Cho decreased gradually and markedly. But (Lip + Lac) increased gradually and markedly. The ratios of Cho/Cr and NAA/Cr, (Lip + Lac)/Cr were statistically significant (P < 0.0083) between the substantial region and the control group, as well as between the 0 - 10 mm MZ and the control group. The ratios of Cho/Cr and NAA/Cr, (Lip + Lac)/Cr displayed no statistically significant differences (P > 0.0083) between the substantial region and the 0 - 10 mm MZ.

CONCLUSIONSThere was a pathological spectrum surrounding the infiltration zone of CAE. Multi-voxel 1HMRS has great clinical value for discerning the main lesion and the infiltration zone of CAE.

Adult ; Central Nervous System Infections ; pathology ; Echinococcosis ; pathology ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Young Adult

Objective Throush identify biochemical characteristics and virulence factors of 2 strains suspected Yersinia pestis(Y.pestis)isolated from the dead Marmota himalayana(M.himalayana)to confirm the nature epidemic focus in Dege County,Sichuan Province.Methods Y.pestis was analyzed by specific staining and shape,culturing characteristics,splitting-test by bacteriophage,test of biochemical characteristics and glycolysis ability,virulence factors,virulence,nutritional requirement,plasmid,genetic test and genetic type. Results The tested strains were Gram staining bacilus.The main biochemical characteristics were Arabinose(+)、 Rhamnose(-),Maltose(+),Melibiose(-),Glycerol(+),Denitrification(+).The virulence factors with FI+.VW+, Pgm+,Pst I+;and with the common 6.0×106,45.0×106,65.0×106 plasmids,also with the virulence-relative plasmid gene.Both their absolutely lethal dose(LD100)in mice were 50 bacteria.The nutritional requirement appeared which were depended on Phenylalanine and Methionine.With the Genomovar 5 genotype characteristics of M.himalayana plague foci of Qinghai-Tibet plateau.The difference between tested strains and Yersinia pseudotubercuosis on the 3 different culture medium was obvious.The tested strains had a Y.pestis' specific 3a fragment,Pst I and FI-Ag,at 22 ℃,the strains could be split by bacteriophage completely.Conclusions According to the diagnostic criteria of plague in China,the 2 suspected strains isolated from Dege County,Sichuan Province ale confirmed as Y.pestis.both with powerful virulenceand with the characteristics of the Y.pestis of M.himahtyana in Qinghai-Tibet plateau plague natural focus.