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 evaluate the effect of low-dose esketamine for postoperative analgesia on the postoperative depression in patients with gastrointestinal tumors.Methods:This study was a prospective randomized controlled trial. Eighty patients, aged 18-64 yr, with a body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective radical resection of the gastrointestinal tumor under general anesthesia from June to November 2023 in our hospital, were divided into 2 groups ( n=40 each) using a random number table method: esketamine group (group E) and control group (group C). Each patient received postoperative patient-controlled intravenous analgesia(PCIA). The PCIA solution in group E contained esketamine 0.5 mg/kg, dezocine 0.5 mg/kg, dexmetomidine 1.5 μg/kg and flurbiprofen ester 100 mg in 100 ml of normal saline. The PCIA solution in group C contained dezocine 0.5 mg/kg, dexmetomidine 1.5 μg/kg and flurbiprofen ester 100 mg in 100 ml of normal saline. The Hospital Anxiety and Depression Scale (HADS) was used to assess the patients′ anxiety and depression at 1 day before operation (T 0) and 2 days after operation (T 1). The Quality of Recovery-15 scale was used to evaluate the early postoperative recovery quality. Visual analog scale scores, the pressing times of patient-controlled analgesia and the number of rescue analgesia were recorded within 2 days after operation. The occurrence of drug-related adverse reactions was also recorded. Results:Seventy-eight patients were finally included, with 39 cases in group E and 39 cases in group C. Compared with group C, the postoperative HADS-depression scale score and incidence of depression were significantly decreased, the Quality of Recovery-15 scale score was increased, the visual analog scale scores were decreased ( P<0.05), and no significant changes were found in the postoperative HADS-anxiety scale score and incidence of anxiety, the pressing times of patient-controlled analgesia and the number of rescue analgesia in group E ( P>0.05). Visual hallucination was found at 1 day after operation in one patient and relieved at 2 days after operation in group E. There was no significant difference in the incidence of postoperative dizziness, nausea and vomiting between the two groups ( P>0.05). Conclusions:Postoperative analgesia with 0.5 mg/kg esketamine can alleviate postoperative depressive symptoms, enhance the efficacy of analgesia and improve the early postoperative recovery quality in patients with gastrointestinal tumors.

Objective:To evaluate the efficacy of remimazolam for induction of anesthesia in patients with colorectal cancer.Methods:This was a prospective study. Eighty-two patients scheduled for elective colon and rectal tumor surgery under general anesthesia from June to November 2023 at our hospital, aged 18-80 yr, with body mass index of 18.5-28.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, were divided into 2 groups ( n=41 each) using a random number table method: propofol group (group P) and remimazolam group (group R). Propofol 1.5 mg/kg was intravenously injected in group R and remimazolam 0.3 mg/kg was intravenously injected in group P. When the bispectral index (BIS) value≤60, sufentanil 0.5 μg/kg and cisatracurium 0.2 mg/kg were intravenously injected in both groups. Heart rate and mean arterial pressure were recorded before induction of anesthesia (T 0), 3 min after induction (T 1), immediately after intubation (T 2), and 5 min after tracheal intubation (T 3). The occurrence of hypotension, hypertension, tachycardia and bradycardia during induction, use of vasoactive drugs, and injection pain were recorded. The time to loss of consciousness, time from the beginning of administration to BIS value ≤60, time from the beginning of administration to tracheal intubation, occurrence of BIS value > 60 immediately after intubation and rescue sedation were recorded. Results:Eighty patients were finally included, with 40 in group P and 40 in group R. Compared with group P, the heart rate and mean arterial pressure were significantly increased at T 1 and T 2, the incidence of hypotension and bradycardia was decreased, and the time from the beginning of administration to BIS value ≤60 was prolonged ( P<0.05), and no statistically significant changes were found in the other parameters in group R ( P>0.05). Conclusions:Remimazolam 0.3 mg/kg can be safely and effectively used for anesthesia induction and provides better efficacy in maintaining hemodynamic stability when compared with propofol 1.5 mg/kg in patients with colorectal cancer.

Objective:To evaluate the effect of intravenous infusion of dexmedetomidine before induction of anesthesia on concentrations of blood potassium and blood glucose in the patients with gastrointestinal tumors.Methods:One hundred and twenty patients, irrespective of gender, aged 18-75 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, scheduled for elective radical gastrointestinal tumor surgery, were divided into 3 groups ( n=40 each) using a random number table method: control group (group C), dexmedetomidine 0.5 μg/kg group (group D 1), and dexmedetomidine 1.0 μg/kg group (group D 2). Dexmedetomidine 0.5 and 1.0 μg/kg were intravenously infused prior to anesthesia induction over 10 min in D 1 and D 2 groups, while the equal volume of normal saline 20 ml was intravenously infused instead in group C. Before intravenous infusion (T 0), at 15 min after intravenous infusion (T 1), and at 30 min after intravenous infusion (T 2), blood samples from the radial artery were collected for blood gas analysis, and concentrations of blood potassium and blood glucose were recorded. The occurrence of complications such as hyperglycemia, hypoglycemia, hyperkalemia, hypokalemia, hypotension, hypertension, tachycardia and bradycardia was also recorded. Results:Compared with C group, the blood glucose concentrations were significantly increased at T 1 in D 1 and D 2 groups and at T 2 in D 2 group ( P<0.05). The blood glucose concentrations were significantly higher at T 1, 2 in D 2 group than in D 1 group ( P<0.05). There was no significant difference in blood potassium concentrations at T 0-T 2 among the three groups ( P>0.05). No patients presented with complications such as hyperglycemia, hypoglycemia, hyperkalemia, hypokalemia, hypotension, hypertension, tachycardia and bradycardia. Conclusions:Intravenous infusion of dexmedetomidine before induction of anesthesia exerts no marked effect on blood potassium concentrations and can increase glucose concentrations to a certain extent, but the elevation has no clinical significance in the patients with gastrointestinal tumors.

【Objective】 To investigate the effect of AIDET communication mode in informing blood donors of reactive viral markers results. 【Methods】 Blood donors who came FOR COUNSELLING AFTER NOTIFICATION OF THEIR REACTIVE SCREENING TEST RESULTS from Jan 2018 to Sep 2021 were selected as the subjects. They were divided into two groups according to the blood donation time and notification mode: control group who were notified by a conventional mode(n=128), from Jan 2018 to Dec 2019, and the experimental group(n=92) who were notified by AIDET mode, from Jan 2020 to Sep 2021. The anxiety state and degree of satisfaction to the notification were compared between the two groups. 【Results】 After attending COUNSELLING, the anxiety level of the experimental group was significantly lower, while the degree of satisfaction to the notification was significantly higher than that of the control group (P<0.05). 【Conclusion】 AIDET communication mode established a standardized and effective communication channel and reduced the anxiety of blood donors WHEN NOTIFYING THE REACTIVE SCREENING TEST RESULTS. Moreover, it can enhance the trust and satisfaction between donors and medical staff as well as the quality of notification, which is of great significance to promote the healthy and continuous development of voluntary blood donation.

Objective:To evaluate the impact of the reform of the county medical community on the expenditure of medical insurance funds, and to provide references for maintaining the stability of the medical insurance fund and deepening the reform of the medical community.Methods:Medical insurance data of urban and rural residents in M County, Yunnan province from 2016 to 2019 were collected, and a discontinuous time series model was used to analyze the impact of county medical community reform on medical insurance fund expenditures.Results:Since the reform, the number of patients discharged from county-level hospitals has shown a downward trend, averaging a decrease of 25.996 people per month; yet increases have emerged with the average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure, averaging a monthly increase of 90.931 yuan, 50.014 yuan and 1.528 yuan respectively. The average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure of the township hospitals all showed an upward trend, averaging a monthly increase of 31.191 yuan, 38.678 yuan and 0.085 yuan respectively. The flow of external medical insurance funds of the medical community has shown a continuous upward trend, averaging a monthly increase of hospitalization fund expenditures of 33.005 yuan, and a monthly increase of outpatient overall fund expenditures of 4.896 yuan overall.Conclusions:The M County medical community should further strengthen the top-level design, explore the reform of medical insurance payment methods, improve the regional information platform, standardize the referral system, and strengthen supervision to deepen the construction of the medical community to ensure the sustainable operation of medical insurance funds.

Objective:To evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on sedation in healthy volunteers.Methods:Forty-six healthy volunteers of both sexes, with the Sleep Self-Rating Scale score 10-30, aged 22-28 yr, with the body mass index 18.5-23.0 kg/m 2, were selected and divided into 2 groups ( n=23 each) using a random number table method: TEAS group (E group) and control group (C group). Bilateral Neiguan and Shenmen acupoints were stimulated for 30 min in group E, while the stimulator was only connected, and no current was given in group C. The bispectral index (BIS)value, heart rate, oxygen saturation and mean arterial pressure were recorded at 10 min in the supine position (T 0) during the quiet period, at 10 min intervals during stimulation (T 1, 2) and at 5 min intervals within 15 min after the end of electrical stimulation (T 3-5). Then the condition whether the patient had fallen asleep was observed, and the patients were followed up on the second day for sleep status and related complications. Results:Compared with the baseline at T 0, the BIS value was significantly decreased at T 2-5 in group E ( P<0.05). The BIS value was significantly lower at T 3, 4 in group E than in group C ( P<0.05). There was no significant difference in sleep status during stimulation and at the night of the trial between the two groups ( P>0.05). Heart rate, oxygen saturation and mean arterial pressure were in the normal range at each time point, and no trial-related complications occurred in the two groups ( P>0.05). Conclusion:TEAS can produce certain sedative effect on healthy volunteers.

Objective:To evaluate the effects of different doses of dexmedetomidine infused at nighttime on early postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of malignant gastrointestinal tumors.Methods:Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of either sex, aged 65-75 yr, with body mass index of 18-24 kg/m 2, scheduled for elective radical resection of malignant gastrointestinal tumors, were divided into 4 groups ( n=20 each) using a random number table method: control group (group C) and different doses of dexmedetomidine groups (D 1-3 groups). Dexmedetomidine 0.1, 0.2 and 0.3 μg·kg -1·h -1 (infusion rate 4 ml/h) were intravenously infused from 21: 00 on the day of surgery and the first day after surgery until 6: 00 in the next morning.Normal saline was given instead of dexmedetomidine in group C. The period of sleep and the number of awakening at night were recorded before surgery and at 2 and 7 days after surgery.Cognitive function was assessed at 1 day before surgery and 7 days after surgery.The concentrations of plasma cortisol were measured at 16: 00 before surgery and 2 and 7 days after surgery and at 8: 00 in the corresponding morning of the next day.The difference in the plasma cortisol concentration measured at 8: 00 every day and at 16: 00 of the previous day were calculated. Results:The incidence of POCD was significantly lower in D 2, 3 groups than in group C ( P<0.05). The number of awakening at night was significantly decreased at 2 days after surgery in group D 3 as compared with the other three groups ( P<0.05). The difference in the plasma cortisol concentration was significantly decreased at 2 and 7 days after surgery in D 2, 3 groups when compared with group C and group D 1 ( P<0.05). Compared with group D 2, no significant change was found in the difference in the plasma cortisol concentration at each time point in group D 3 ( P>0.05). There were no significant differences in the incidence of hypotension, hypertension, bradycardia, and tachycardia among the four groups ( P>0.05). Conclusion:Infusing dexmedetomidine 0.2 or 0.3 μg·kg -1·h -1 at the nighttime can reduce the development of POCD in the elderly patients undergoing radical resection of malignant gastrointestinal tumors.

Objective: To explore the use of supporting guide wire to exclude the PICC catheter refolding malposition,and reduce the number of the catheter resetting and the average time of catheter resetting,while reducing the mechanicalness phlebitis and the incidence of symptomatic thrombosis. Methods: A total of 3 513 patients who received PICC from September 2016 to August 2018 were enrolled. The patients were divided into control group (1 757 cases) and observation group (1 756 cases) by random number table method.The control group was treated with conventional B-ultrasound guided modified Sadinger technique PICC. After the observation group was finished on the basis of the control group, the support guide wire was partially withdrawn and re-sent, according to whether the guide wire was re-supplied or not, to determine whether the catheter has a partial fold in the body. The incidence of catheter refolding malposition, the number of reductions, the time of reduction, and the incidence of mechanicalness phlebitis and symptomatic thrombosis were compared between the two groups. Results: The refolding malposition rate of the observation group and the control group were 0 and 3.47%(61/1 757), respectively. The difference was statistically significant (χ²=59.943, P<0.01). Among the 74 patients in the observation group who underwent catheter resetting, 63 patients were reset ≤1 times, 9 patients were reset twice, 2 patients were reset≥third; among the 61 patients in the control group who underwent catheter resetting, 24 patients were reset≤1 times, 6 patients were reset twice, 31 patients were reset≥third, the number of the resetting in two groups were compared,the difference was statistically significant(χ²=42.712, P<0.05). The average reset time of the observation group was (49.66±25.45) s, and the average reset time of the control group was (610.41±206.23) s, the difference was statistically significant (t=18.636, P<0.01).The incidence of mechanical phlebitis in the observation group and the control group were 1.31%(23/1 756) and 3.76%(66/1 757), respectively. The incidence of mechanical phlebitis in the two groups was statistically significant (χ²=20.241, P<0.01). The incidence of symptomatic thrombosis in the observation group and the control group were 0.34%(6/1 756), 1.20%(21/1 757), respectively. The incidence of symptomatic thrombosis in the two groups was statistically significant (χ²=8.261, P<0.05). Conclusions The use of the supportting guide wire to withdraw and re-feed during the catheterization process can effectively eliminate the PICC catheter refolding malposition, reduce the number of catheter reposition and the average reposition time, and reduce the incidence of mechanicalness phlebitis and symptomatic thrombosis. This method is simple and easy to use, it is worthy of clinical application.

This paper aimed at investigating the effects of Xinfukang Oral Liquid on mitochondrial proteomic alterations in rats with heart failure after myocardial infarction and exploring its possible mechanisms. Heart failure models were established by ligating the left anterior descending coronary artery of SD rats. Rats were randomly divided into sham group, model group, Xinfukang group. 8 weeks after drug intervention, the mitochondrial proteomic alterations of myocardial tissue were detected by two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) . Furthermore, expression levels of part of the differently expressed proteins were verified by western blot. Compared with model group, 20 differentially expressed protein spots were detected in Xinfukang group, 13 of which showed increased protein expression and 7 decreased; 13 differentially expressed protein spots were successfully identified by MALDI-TOF-MS. Bioinformatics analysis showed that these differential proteins were mainly associated with energy metabolism, stress reaction, oxidative damage, cyto-skeleton, cell differentiation and proliferation. Western blot results showed that the expression of Stress-70 protein and Nucleophosmin increased and the expression of ATP-αdecreased in model group. The expression of Stress-70 protein and Nucleophosmin decreased and the expression of ATP-αincreased in Xinfukang group, which shows the same results in proteomics. Xinfukang Oral Liquid can partly adjust proteomic alterations of myocardial mitochondrial in HF rats, and its intervention mechanism may involve improving energy metabolism, reliving stress reaction and oxidative damage, as well as regulating cell differentiation and proliferation. The results of comparative proteomic analysis performed by using2-DE and MALDI-TOF-MS are acurate, stable and reliable.