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 effect of Doula delivery combined with labor analgesia on the delivery process and delivery outcomes of primiparas.Methods:Retrospectively selected 200 primiparas treated in Beijing Friendship Hospital, Capital Medical University from January 1, 2019 to September 30, 2019 as the research objects.All patients underwent labor analgesia, and were divided into 100 cases in the Doula group and 100 cases in the control group (without Doula delivery) according to whether or not Doula delivery was performed.T test of two independent samples and chi square test were used to compare the labor process and delivery outcome of the two groups.Results:The natural delivery rate in the Doula group was 76%(76/100), which was significantly higher than the control group (61%(61/100)), and the difference was statistically significant (χ 2=5.214, P=0.022). The time of the first, second and third stage of labor in Doula group was (8.35±3.59), (1.07±0.26), (0.54±0.19) h, and that in the control group was (10.94±4.76), (1.86±0.63), (0.78±0.21) h, respectively.There were significant differences between the two groups (t value were 10.354, 5.312 and 8.169, respectively; P value were 0.016, 0.042 and 0.039, respectively). The neonatal asphyxia rates of Doula group and control group were 1% (1/100) and 3% (3/100) respectively, and there was no significant difference between the two groups ( P=0.621). The incidence of postpartum hemorrhage in the Doula group and the control group was 3% (3/100) and 10% (10/100) respectively, and the incidence of postpartum urinary retention was 0 (0/100) and 6% (6/100), respectively.The success rate of early sucking was 98% (98/100) and 90% (90/100) respectively, and the difference between the two groups was statistically significant (P value were 0.045, 0.029 and 0.017, respectively). The hospitalization time of Doula group was (3.17±0.85) d, which was significantly shorter than that of the control group (5.64±1.29) d)( t=6.359, P=0.031). The visual analogue pain score of 2 h postpartum in Doula group was 3.49±0.98, which was significantly lower than the control group (5.82±1.06)( t=9.327, P<0.001). Conclusion:Doula delivery combined with labor analgesia can effectively reduce the pain of uterine contraction, promote natural delivery, reduce the rate of cesarean section, help to improve the quality of obstetric medical service, improve patient satisfaction, it is worth promoting in the condition of the hospital.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world, and the new cases of HCC in China account for more than half of the global cases every year. High incidence mortality and limited treatment methods are the main challen-ges for HCC prevention and treatment in China. Immunotherapy has brought new treatment options and hope of prolonging the survival to patients with advanced HCC. Data from the IMbrave 150 study published in the New England Journal of Medicine in May 2020 showed that the median overall survival of all patients was 19.2 months, and the median overall survival of the Chinese subgroup was 24.0 months, which suggested significant efficacy in prolongating patient survival and controlling tumor. Interven-tional therapy has been playing an important role in the treatment of HCC, and more and more clinical studies have adopted systematic therapy combined with interventional therapy. Interven-tional therapy and systematic therapy have synergistic efficacy which lead to significant clinical efficacy. The authors introduce the diagnosis and treatment of an advanced HCC patient undergoing interventional therapy combined with bevacizumab plus attilizumab treatment, which lead to signifi-cant clinical efficacy of tumor controlling.

Objective To investigate the clinical short-term efficacy and safety of transarterial chemoembolization (TACE) by using CalliSpheres drug-eluting beads combined with blank microspheres (8 Spheres) in treating advanced hepatocellular carcinoma (HCC) . Methods The clinical data of 98 HCC patients, who were treated at authors′ hospital during the period from July 2016 to November 2017, were retrospectively analyzed. The patients were divided into DEB-TACE group (receiving TACE by using CalliSpheres drug-eluting beads combined with 8 Spheres embolic microspheres, n =50) and cTACE group (receiving TACE by using opium poppy ethyl iodized oil together with 8 Spheres embolic microspheres, n =48) . The disease remission rate, control rate and incidence of complications as well as preoperative and 3-day postoperative hepatic function indexes were collected, and the results were compared between the two groups. Results No statistically significant differences in baseline data existed between the two groups (P>0.05) . Both the 3-month and the 6-month disease remission rates in DEB-TACE group were remarkably higher than those in cTACE group (P<0.05), besides, the 6-month disease progression rate and the incidence of elevated serum AFP in DEB-TACE group were lower than those in cTACE group, the short-term efficacy of DEB-TACE group was better than that of cTACE group (P<0.05) . Three days after treatment, the levels of ALT and AST in cTACE group were strikingly higher than those in DEB-TACE group (P<0.05) . No serious adverse reactions occurred in both groups. Conclusion In treating advanced HCC with TACE, the short-term efficacy and safety of CalliSpheres drug-eluting beads combined with 8 Spheres embolic microspheres are superior to those of opium poppy ethyl iodized oil together with 8 Spheres embolic microspheres.

Objective: To investigate whether the combination of oral propranolol and topical 0.5% timolol maleate cream is more effective than oral propranolol alone for treating infantile hemangioma (IH). Methods: From September 2015 to July 2016, 14 patients with proliferative IH, visited the infantile hemangioma outpatient clinic of the Department of Plastic and Reconstructive Surgery of Shanghai 9th People′s Hospital, were enrolled in this study. All patients took oral propranolol. Half of each IH lesion was treated with 0.5% timolol maleate cream. There were 5 male patients and 9 female patients, aged from 1.5 to 5.0 months. After 4 months of treatment, the color, size, extent, volume and the overall clinical outcomes of each lesion were measured, and the side effects were recorded. The therapeutic outcomes of oral propranolol alone and the combination of propranolol and timolol were analyzed and compared using Wilcoxon matched-pair signed-rank nonparametric tests. Results: Both oral propranolol alone and oral propranolol combined with topical 0.5% timolol maleate cream were proved to effectively improve the regression of IH with minor side effects. The color VAS score of oral propranolol alone group was 6.92±2.63, while the combination group was 6.88±2.33 (Z=0.043, P=0.966). The volume VAS score of oral propranolol alone group was 6.94±2.00, while the combination group was 6.98±2.11(Z=-0.051, P=0.959). Conclusions Oral propranolol combined with topical application of 0.5% timolol maleate could not increase the efficacy in the treatment of IH, compared with oral propranolol alone in the short-term observation.

Objective To provide midwives evidence for the evaluation of pregnant women during the process of vaginal birth after cesarean delivery (VBAC) by analyzing the clinical data of perinatal outcome of VBAC, so as to develop supporting interventions, ensure maternal safety and improve the success rate of vaginal delivery. Methods Totals of 284 pregnancy women who were pregnant after cesarean section and admitted from April 2015 to July 2016 were selected. According to the perinatal outcome of delivery, they were divided into VBAC group (n=119), elected repeat cesarean delivery (ERCS) group (n=106), and the unsuccessful trial of labor after cesarean (TOLAC) group (n=59). Maternity outcomes were compared among these three groups. Results In 284 cases, 62.7% (178 cases) selected vaginal delivery, of which 119 were successful, with a success rate of 66.85%, and the remaining 59 cases transferred to cesarean section. Compared with the ERCS group, the VBAC group had lighter prenatal weight, higher cervical score, and shorter postpartum hospitalization time, with a statistical difference (P<0.05). Compared with the unsuccessful TOLAC group, the cervical score and the natural fertility rate of the fetus of the VBAC group were higher (P< 0.05). Conclusions Midwives can conduct a comprehensive assessment of pregnant women who are pregnant after cesarean according to their individual problems, and provide targeted nursing management and support during delivery. It is recommended prenatal knowledge education should be given in outpatient clinic to promote the success of the VBAC.

OBJECTIVETo clarify the clinical, cytogenetical and molecular characteristics and prognosis of Ph(+) ALL patients with ABL kinase domain mutations (ABL-KDMs), and to evaluate the therapeutic value of allogeneic hematopoietic stem cell transplantation (allo-HSCT) combined with tyrosine kinase inhibitor (TKI) in these patients.

METHODSRetrospective analysis of clinical features, molecular genetic characteristics, mutation distribution and prognosis of newly diagnosed Ph(+) ALL patients with ABL-KDMs from February 2010 to August 2014 were performed, and the efficacy of treatment regimen of allo-HSCT combined with different TKIs was compared.

RESULTSOf 88 Ph(+) ALL patients during maintenance treatment stage for ABL-KDMs monitoring, mutation was detected in 42 patients with median time of 8 months from diagnosis to mutation occurrence. The median age of mutation group was 40-year-old, older than that of non-mutation group (32.5-year-old) (P=0.023). The incidence of complex chromosome abnormality of mutation group was higher than that of non-mutation group (P=0.043), with alternations in chromosome 7, 5 and +Ph more frequently observed. There were 21 types of mutation at 18 locations detected, with T315I mutation ranking the top followed by E255K/V, Y253H/F and E459K. Mutation group featured no significant difference in complete remission (CR) rate in contrast to nonmutation group, but was remarkably lower in major molecular remission (MMR) rate than non-mutation group. The 2 year and 5 year overall survival rate of mutation group was 45.4% and 35.0% respectively, much shorter than that of non-mutation group (67.8% and 63.3%), (P=0.047). The median survival of patients with T315I and E255K/V was 19 and 10 months, significantly shorter than that of patients with other mutations. Among the 42 patients with mutations, 14 underwent allo-HSCT, and the median survival was 29 months, longer than that of patients received chemotherapy alone (17 months) (P=0.024). Fourteen allo-HSCT patients were given nilotinib or dasatinib at the time of mutation occurrence, and there was no significant difference in the overall survival in contrast to patients who continue to take imatinib.

CONCLUSIONSABL kinase domain mutations are closely related to the older age and high genomic instability in the newly diagnosed Ph(+) ALL patients. Mutation types showed diversity and complexity, which remarkably affected patients' prognosis and survival. T315I and E255K mutations account for more than half of all cases, characterized by a less favorable prognosis. Currently, allo-HSCT is the only method that has the potential of elongating life expectancy, but the utility of second-generation TKI during relapse does not necessarily have an edge on survival over imatinib.

Chromosome Aberrations ; Dasatinib ; therapeutic use ; Hematopoietic Stem Cell Transplantation ; Humans ; Imatinib Mesylate ; therapeutic use ; Mutation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; genetics ; Prognosis ; Protein Kinase Inhibitors ; therapeutic use ; Proto-Oncogene Proteins c-abl ; genetics ; Pyrimidines ; therapeutic use ; Remission Induction ; Retrospective Studies ; Survival Rate

Objective To investigate whether early goal-directed therapy ( EGDT ) could lower the mortality rate in patients with severe sepsis and septic shock. Methods Articles with items sepsis, severe sepsis, septic shock, EGDT were retrieved from MEDLINE, EMBASE, Cochrane, Wanfang Data and CNKI. Inclusion criteria included randomized controlled trial, subjects concerning patients with severe sepsis or septic shock, endpoints with short-term mortality [ in-hospital, intensive care unit ( ICU ) or 28-day ] and long-term mortality ( 60-day or 90-day ). Related risk ( RR ) and 95% confidence interval ( 95%CI ) were used as indices to judge the difference in mortality rate between EGDT group and standard treatment group. RevMan 5.2 software was used for Meta analysis. Results There were 8 studies meeting inclusive criteria with a total of 4 853 patients. For patients with severe sepsis and septic shock, compared with the group with routine treatment, EGDT showed a decrease in the short-term mortality ( RR = 0.74, 95%CI=0.66-0.82, P<0.000 01 ), but did not decrease the long-term mortality ( RR=0.99, 95%CI=0.92-1.06, P=0.81 ). Conclusion EGDT strategy may decrease the short-term mortality in patients with severe sepsis and septic shock, but it showed no influence on the long-term mortality.

Objective To observe plasma vascular endothelial growth factor(VEGF) levels and related factors in patients with unstable angina pectoris (UAP).Methods A total of 108 consecutive patients with chest pain hospitalized in our department from October to December 2014 were included.They were divided into UAP (n =78) and non-CHD group (n =30) bv the result of coronary angiography (CAG).Coronary artery lesion was assessed according to the Gensini score,serum lipids,homocysteine (Hcy) levels and other biochemical indicators were also determined.The peripheral arterial tonometrv was evaluated by reactive hyperemia index (RHI) measured by Endo-PAT2000 Noninvasive Diagnostic System.The level of plasma VEGF was detected in patients with unstable angina pectoris.Multiple linear regression analysis was used to analyze the correlations between VEGF and various related factors.Results Percent of male gender,triglyceride (TG) and Hcy levels were significantly higher in UAP group than in no-CHD group(all P ＜ 0.05).VEGF values was significantly higher ((102.1 ± 55.7) ng/L vs.(80.9 ± 38.1)ng/L,P ＜ 0.05),while RHI was significantly lower (1.53 ± 0.27 vs.1.65 ± 0.32,P ＜ 0.05) in UAP group than in no-CHD group.Multiple linear regression analvsis showed that VEGF value was significantly correlated with degree of coronary artery stenosis,Gensini score and RHI (β =38.03,P ＜ 0.01;β =0.51,P ＜ 0.01;β =-69.30,P =0.03;respectively).Conclusion VEGF levels are significantly increased in patients with unstable angina pectoris,and VEGF level is significantly associated with the degree of coronarv artery stenosis,Gensini score and RHI.VEGF level might serve as a new biochemical indicator for coronary artery lesion in patients with UAP.

Objective To investigate the influence and mechanism of erythropoietin (EPO) in renal blood flow after limb ischemia reperfusion (LIR). Methods Thirty male SD rats were randomly divided into control group, LIR group and EPO+LIR group with ten in each group. The values of renal blood flow, plasma creatinine (Cr), urea nitrogen (BUN) content in plasma, kidney tissue wet to dry ratio (W/D), nitric oxide (NO), nitric oxide synthase (NOS) and endothelin-1 (ET-1) in re-nal tissue were detected in three groups. The immunohistochemistry assay was used to detect the expression of intercellular adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1) in renal tissue. The morphological changes of renal tissue were observed with light microscope. Results The renal blood flow was significantly decreased, while the val-ues of Cr, BUN, W/D, NO, ET-1, NOS, expressions of ICAM-1 and VCAM-1 was significantly increased in LIR group than those of control group (P<0.05). Broaden interstitial and infiltration of inflammatory cells were observed in the renal tissue under light microscope. In the EPO+LIR group, the renal blood flow increased, the values of Cr, BUN, W/D, NO, ET-1 and NOS, expressions of ICAM-1 and VCAM-1 decreased significantly compared with those of LIR group (P<0.05). The patho-logical changes were alleviated in EPO+LIR group. Conclusion EPO can improve renal function, increase renal blood flow in rats after LIR. The mechanism may be related to the decreased edema, changed renal vasomotor function and decreased in-flammation.