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 construct an acute toxoplasma encephalitis mouse model by observing the pathological changes in the hippocampus of mice infected with Toxoplasma gondii strain RH. 【Methods】 The quantitative RH Toxoplasma gondii (100, 500, and 1 000 trophozoites) were injected into the hippocampal CA1 region of mice by the stereotaxic surgery; the survival status of mice was observed. Giemsa staining was used to observe the changes of toxoplasma in mouse ascites and brain tissue homogenates. Nissl staining and HE staining were used to observe the pathological changes of hippocampal nerve tissue. The distribution of Toxoplasma gondii in brain tissue was observed by immunohistochemical ABC method. 【Results】 The RH Toxoplasma gondii infected mice showed obvious symptoms such as arched back, bristling hair, abdominal distension, subtle tremor and hemiplegia on the fourth day of infection. The survival of mice in 100 trophozoites group was longer, no trophozoites of Toxoplasma gondii were found in ascites, a few pseudocysts were found in brain tissue homogenates after infected for 96 hours, and more trophozoites were found after death. Nysl staining and HE staining showed more tissue necrosis foci and loss of nerve cells in CA1 area after infected 144 h. The injury aggravated with the prolongation of infection time. Toxoplasma trophozoites were found in ascites and brain homogenates of mice in 500 and 1000 trophozoites groups. Nissl staining revealed neuronal loss and massive necrosis in the hippocampus. HE staining showed necrosis and inflammatory cell infiltration. The brain tissue injury significantly aggravated compared with 100 trophozoites group. The distribution of Toxoplasma gondii in the necrotic foci was confirmed by immunohistochemistry. 【Conclusion】 The survival of 100 trophozoite mice infected with Toxoplasma gondii strain RH was longer, and the pathological changes of brain tissue gradually aggravated. The damage was relatively confined to the brain tissue, and the mice showed typical symptoms of toxoplasma encephalitis. Therefore, the mouse model of acute toxoplasma encephalitis can be constructed by localized infection of 100 toxoplasma trophozoites, which can lay a foundation for future research on the mechanism of toxoplasma injury to cranial nerves.

Objective:To investigate the distribution and related factors of lipoprotein(a) [Lp(a)] level in healthy Tajik and Kazak adults in China.Methods:A cross-sectional study was conducted from May to October 2021 and March to June 2022, and blood samples were collected from 2, 637 healthy Tajik adults [1 010 men, average age: (40.08±14.74) years; 1 627 women, average age: (38.27±12.90) years] in Tashkurgan Tajik Autonomous County and 1 911 healthy Kazak adults [720 men, average age: (42.10±12.26) years; 1 191 women, average age: (38.27±12.90) years] in Fuyun County of Xinjiang. Fasting blood glucose (FBG), creatinine (Cr), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and Lp(a) were measured. The distribution of Lp(a) levels in different sex and age groups was compared. The Lp(a) level of Tajik and Kazakh ethnic groups was compared by Mann-Whitney U test, and correlation factors of Lp(a) level were analyzed by multiple logistic regression. Results:The distribution of Lp(a) level in Tajik and Kazak population was skewed. Lp(a) levels of Tajik and Kazak ranged from the lowest 0.40 mg/L and 0.62 mg/L to the highest 1 229.40 mg/L and 2 108.58 mg/L, respectively, and the median Lp(a) level was 78.90 (38.60, 190.20) mg/L and 103.30 (49.57, 234.27) mg/L, respectively. Median Lp(a) level of Kazak was significantly higher than that of Tjik ( P<0.001). The median Lp(a) levels of Tajik males and females were similar: 77.45 (39.80, 187.10) mg/L and 79.90 (38.60, 192.30) mg/L ( P=0.948). The median Lp(a) levels of Kazakh males and females were also similar: 109.42 (50.49, 230.38) mg/L and 99.01 (49.11, 237.25) mg/L, respectively ( P=0.578). After pooling the data of Tajik and Kazak and adjusting for age, sex, BMI, smoking, drinking, blood pressure, blood glucose and other factors, Lp(a) level was correlated with ethnic (standard partial regression coefficient 0.066, P=0.008) and LDL-C level (standard partial regression coefficient 0.136, P<0.001). Conclusions:Lp(a) level in healthy Tajik and Kazak adults varied greatly among individuals, and Kazak residents had a higher Lp(a) level than Tajik residents. There was no significant sex difference in Lp(a) level among Tajik and Kazakh, and LDL-C and ethnicity are independent factors related to Lp(a) level.

Background::NOTCH1 mutation is an essential molecular biologic aberration in chronic lymphocytic leukemia (CLL). CLL patients with NOTCH1 mutation have shown an unfavorable survival and a poor response to chemoimmunotherapy. This study aims to present the mechanisms of adverse prognosis caused by NOTCH1 mutation from the perspective of the splicing factor heterogeneous nuclear ribonucleoprotein A1 (hnRNPA1). Methods::The microarray data in Gene Expression Omnibus datasets were analyzed by bioinformatics and the function of hnRNPA1 was checked by testing the proliferation and apoptosis of CLL-like cell lines. Afterward, quantitative reverse transcription-polymerase chain reaction and Western blotting were applied to explore the relationship among NOTCH1, c-Myc, and hnRNPA1.Results::RNA splicing was found to play a vital part in NOTCH1-mutated CLL cells; hence, hnRNPA1 was selected as the focus of this study. Higher expression of hnRNPA1 validated in primary NOTCH1-mutated CLL samples could promote proliferation and inhibit apoptosis in CLL. The expression of hnRNPA1 increased when NOTCH1 signaling was activated by transfection with NOTCH1 intracellular domain (NICD)-overexpressed adenovirus vector and declined after NOTCH1 signaling was inhibited by NOTCH1-shRNA. Higher expression of c-Myc was observed in NICD-overexpressed cells and hnRNPA1 expression was downregulated after applying c-Myc inhibitor 10058-F4. Moreover, in NICD-overexpressed cells, hnRNPA1 expression decreased through c-Myc inhibition. Conclusion::Overexpression of c-Myc-dependent hnRNPA1 could promote proliferation and inhibit apoptosis in NOTCH1- mutated CLL cells, which might partly account for the poor prognosis of patients with NOTCH1 mutation.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Objective In order to know the baseline data of water iodine and the iodine nutritional status of 8-10 years old children in Chaoyang District of Beijing,to evaluate the current status of iodine deficiency disorders so as to provide a basis for taking targeted preventive measure and adjusting the intervention strategies scientifically.Methods Multi-stages sampling method was used to select drinking water samples from 43 subdistricts or townships in Chaoyang,and the water iodine content in the drinking water was determined.A cluster sampling method was applied to select 8-10 years old children from primary schools in 5 subdistricts or townships,and the iodine contents of urine and salt were determined.And B ultrasonic examination was carried out for diagnosis of thyroid disease.Results The median iodine content of drinking water in Chaoyang was 4.85 μg/L,the iodine content of self-provided wells (5.65 μg/L) was higher than that of municipal water (3.80 μg/L,Z =-3.469,P ＜ 0.05).The coverage rate of iodized salt was 88.06％ (177/201) and the qualified rate of iodized salt was 81.59％ (164/ 201).The median urinary iodine was 165.00 μ g/L,median urinary iodine in boys (174.00 μg/L) was higher than that of girls (146.00 μg/L Z =-2.434,P ＜ 0.05).The goiter rate diagnosed by B ultrasound was 1.49％ (3/201),the thyroid nodule rate was 24.88％ (50/201).Conclusions The iodine content of drinking water in the Chaoyang District is low,and it is still in the external environment of iodine deficiency (＜ 10 μg/L).The 8-10 years old children of Chaoyang show a good iodine nutritional status,however,neither the coverage rate nor the qualified rate of iodized salt has reached the standard of elimination of iodine deficiency disorders,and scientific iodine can not be ignored.

Objective To evaluate the diagnosis value of the percentage of Tie 2-expressing monocytes(TEMs)in CD14+CD16+monocytes of peripheral blood from hepatocellular carcinoma(HCC) patients with negative AFP and tumor size≤3 cm.Methods Flow Cytometry(FCM)was used to determine the percentage of TEMs in CD14+CD16+monocytes of peripheral blood from patients with HCC(n=82), liver cirrhosis(n=29), chronic hepatitis B(n=28), and healthy controls(n=31).Abbott i2000 microparticle chemiluminescence immunoassay analyzer was used to determine the plasma alpha -fetoprotein (AFP)levels.The difference among multi groups was analyzed by the Kruskal-Wallis H test.Two independent groups were analyzed by the Mann-Whitney U test.The chi-square test was used in the rate comparison.The correlation between TEMs and AFP was analyzed by Spearman rank correlation analysis. Morever, the areas under the receiver operating characteristic curves(ROC-AUC), sensitivity and specificity of TEMs or AFP in differentiating HCC, HCC with AFP negative or tumor size≤3 cm were analyzed.Results The percentage of TEMs in CD14 +CD16 +monocytes of peripheral blood from HCC or HCC with negative AFP or HCC with tumor size≤3 cm was significantly higher than that in patients with liver cirrhosis,chronic hepatitis B and healthy controls(P<0.05).ROC-AUC of TEMs and AFP in the diagnosis of HCC were 0.701(95% CI 0.626-0.768)and 0.712(95% CI 0.638-0.779) respectively.When the cut-off values of TEMs and AFP were 4.95%and 20 μg/L,the sensitivities of TEMs and AFP were 71.95%and 45.12%,and the specificities of TEMs and AFP were 70.45%and 85.23%. The sensitivity of TEMs in the diagnosis of HCC was significantly higher than that of AFP(χ2=12.16,P=0.000).The specificity of AFP was significantly higher than that of TEMs(χ2=5.57,P=0.018).There was a highest sensitivity(89.02%)in TEMs/AFP method,and there was a highest specificity(93.18%) in TEMs+AFP method in the diagnosis of HCC.There was no significant difference between the ROC-AUC for the TEMs and the AFP in the diagnosis of 26 patients with tumor size≤3 cm HCC(0.776 vs 0.645,Z=1.805,P=0.071),TEMs/AFP had the highest sensitivity(84.62%),while TEMs+AFP had the highest specificity(93.18%)in the diagnosis of tumor size≤3cm HCC.The ROC-AUC for the TEMs in the diagnosis of 45 patients with AFP negative HCC was 0.739(95%CI 0.648-0.829).The sensitivity and specificity of TEMs were 80.0% and 70.45% respectively.There was no correlation between the level of plasma AFP and the percentage of TEMs(r=-0.169, P=0.129)determined by Spearmans rank correlation coefficient.Conclusions TEMs is valuable in the diagnosis of HCC with negative AFP and tumor size≤3cm,and the two tests of TEMs and AFP can complement each other in the diagnosis of patients with HCC.

Objective: To investigate the association of fruit and vegetable intake with long-term changes of serum lipid levels in middle-aged Chinese and older Chinese population. Methods: The study analyzed the data collected in the 2004 and 2007-2008 cohorts of China Multicenter Collaborative Study of Cardiovascular Epidemiology. Finally, 4 495 participants from 10 groups in various regions of China, who both were followed up in the two cohorts, were included for data analysis. They were aged 41-66 years in 2004. Fruit and vegetable consumption were collected with a simple food frequency questionnaire. The percent changes (Δ%) of serum TC, TG, HDL-C and LDL-C between the two surveys were calculated. Multivariate linear regression models were used to estimate the association of fruit and vegetable intake in 2004 with percentage changes of serum lipid levels during the two surveys. Results: The proportions of individuals who consumed fruits <250, 250-499 and ≥500 g/week were 24.0%, 21.8% and 54.2%, respectively. The proportions of individuals who consumed vegetables <500 and ≥500 g/day were 76.7% and 23.3%, respectively. Compared with fruit intake <250 g/week, the regression coefficients (95% CI) of ΔTC% in 250-499 and ≥500 g/week group were -1.54 (-2.71, -0.37) and -1.77 (-2.79, -0.76). And the regression coefficients (95% CI) of ΔLDL-C% were -2.43 (-4.39, -0.48) and -2.89 (-4.59, -1.19). Compared with vegetable intake <500 g/d, the regression coefficients (95%CI) of ΔTC% and ΔLDL-C% in vegetable intake ≥500 g/d group were -1.01 (-1.95, -0.06) and -1.83 (-3.41, -0.24). However, fruit and vegetable intake had no relationship with ΔTG% and ΔHDL-C%. Conclusion The consumption of fruit and vegetable was inversely related to long-term changes of TC and LDL-C in middle-aged and older population, but no association was found for changes of TG and HDL-C.

Objective To investigate the factors influencing the image quality of prostate magnetic resonance spectroscopy (MRS),and to put forward quality control measures to improve MRS in success ratio and image quality.Methods Totally 1 255 patients with prostate diseases confirmed pathologically from October 2009 to December 2015 had their MRS data analyzed retrospectively.MRS was executed with multi-voxel 3D chemical shift imaging technique,and special-purpose software was involved in for post processing.Re-scanning would be performed in case of baseline clutter,low SNR and etc.Results There were 1 218 patients had MRS executed well in preparedness,positioning,parameters setup,post processing,baseline and chemical shift,one patient underwent unsuccessful MRS due to incorrect bed mode,9 ones due to unstable baseline resulting from unsatisfactory preparedness,26 ones due to unstable baseline resulting from bad shimming and 1 case due to non-standard post processing.Conclusion Prostate SRS depends on patient preparedness,positioning,parameters setup,shimming and post processing.

Objective This study was to analyze the early and long-term effect of completion pneumonectomy.Methods Retrospective analysis was made on the patients who underwent completion pneummonectomy in Shanghai Chest Hospital.Results There were totally 56 cases patients underwent completion pneumonectomy during January 2003 to July 2013.Among them,45 patients received CCP,and other 11 patients received RCP.CCP refers to the complete removal of lung tissue remaining after an initial ipsilateral partial pulmonary resection.RCP refers to the complete removal of residual lung due to the severe complications after pneumonectomy.The mortality and morbidity rate of CCP were 4.4％ and 33.3％ respectively.In the case of CCP,the incidence of benign lesions is significantly higher than the incidence of malignant tumor(80.0％ vs 27.5％,P =0.04).The mortality and morbidity rate of RCP were 27.3％ and 90.9％ respectively.In the case of RCP,higher postoperative mortality often occurs in aged patients (P =0.046) and patients with preoperatie mechanical ventilation (P =0.03).Overall five-year survival rate for patients with benign lesions was 80％,and for malignant lung cancer patients,the number was 30％.Survival time differs according to the TNM staging(a median of 60.0 months,35.0 months,10.0 months,stage Ⅰ,stage Ⅱ,stage Ⅲ,P ＜0.01),and survival rate was higher when the time interval(between the initial pulmonary resection and the completion pneumonectomy) ＞ 2 years(a median of 60.0 months,18.0 months,P ＜ 0.01).Conclusion Completion pneumonectomy is a high-risk surgery,especially RCP.Advanced age and preoperative mechanical ventilation are associated with higher postoperative mortality rate for RCP.As for CCP,higher postoperative risk exists in patients with benign lesions,but the survival rate is also higher.In patients with malignant lung tumor,survival rate is higher when the time interval (between the initial pulmonary resection and the completion pneumonectomy) ＞2 year.