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 observe the effects of high index of nutritional quality (INQ) enteral nutrition on clinical outcomes in elderly patients with acute heart failure. Methods:70 elderly patients with acute heart failure who had nutritional risk and needed nasal-feeding from the Department of Geriatrics of Hangzhou Ninth People's Hospital and the 903 Hospital of PLA Joint Support Force Hospital were randomly divided into observation group (n=35) and control group (n=35). Patients in the observation group was treated with high INQ enteral nutrition. After 4 weeks of intervention, the difference of energy and protein supply, parenteral nutrition use, nutrition index, cardiac function index and incidence of gastrointestinal adverse reaction were compared between the two groups. Results:After intervention, the energy and protein supply of nasal-feeding in the observation group were significantly higher than those in the control group (P<0.05) , and the amount of parenteral nutrition used in the observation group was significantly lower than that in the control group (P<0.05). The nutritional indexes and cardiac function indexes of the two groups were significantly improved compared with those before intervention, and the nutritional status of the patients in the observation group was improved more significantly (P<0.05). There was no significant difference in the incidence of gastrointestinal adverse reactions between the two groups (P>0.05) . Conclusion:High INQ enteral nutrition can meet the nutritional requirements of elderly patients with heart failure, reduce the use of parenteral nutrition, improve the nutritional status, and promote the recovery of cardiac function.

Objective To develop a multicolor photoelectroencephalography evoked flash to identify photosensitive epilepsy patients during the selection of naval aircraft pilots.Methods The multicolor photoelectroencephalography evoked flash was composed of a main body,a control box and a bracket.There were four rows of LED lights in the main body,which emitted four colors of light including red,yellow,green and orange,respectively;there were three sockets for signal,light and power and one color changeover switch on the body of the control box,and a control circuit board was fixed at the bottom inside the control box;the bracket had a double-jointed arm folding structure.The flash developed was compared with the coventional photoelectroencephalography evoked flash to verify its effect for inducing photosensitive epilepsy.Results There were no significant differences between the two flashes in the numbers of identified cases with photosensitive epilepsy when the subjects were under awake and closed-eye conditions(P＞0.05).Condusion The flash developed can make up for the deficiency of the coventional photoelectroencephalography evoked flash when selecting naval aircraft pilots.[Chinese Medical Equipment Journal,2024,45(7):112-114]

Objective:To analyze the application effect of nano-carbon lymphatic tracer technology in laparoscopic colon cancer (CC) radical resection based on propensity matching.Methods:Retrospective case-control study was performed in this study. From January 2016 to April 2021, 714 cases of CC patients who underwent laparoscopic CC radical resection in Kunshan Second People′s Hospital were divided into groups according to whether or not the nano-carbon lymphatic tracing technique was applied. Seventy-eight cases in group A were applied with nano-carbon lymphatic tracing technique, while 636 cases in group B were not applied with nano-carbon lymphatic tracing technique. The initial data were matched 1∶3 by the propensity score matching method, and finally group A (73 cases) and group B (219 cases) were obtained. The detection of lymph nodes in the two groups after propensity score matching was compared.Results:By comparing the baseline data of the two groups after propensity score matching, it was found that there were no significant differences in gender, height, weight, body mass index, tumor T stage, tumor N stage, tumor TNM stage, preoperative chemotherapy, or tumor location ( P>0.05). The total number of lymph nodes in group A was higher than that in group B: (22.24 ± 7.08) pieces vs. (19.03 ± 6.29) pieces, and the difference was statistically significant ( t = 3.66, P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis in group A were not significantly different from those in group B ( P>0.05). Tumor T stage T 3, tumor N stage N 0, tumor TNM stage Ⅱ, and preoperative chemotherapy, the total number of lymph nodes in group A was higher than that in group B: 23 (6, 60) pieces vs. 19 (4, 54) pieces , 20 (3, 62) pieces vs. 18 (3, 75) pieces, 23 (6, 59) pieces vs. 20 (7, 54) pieces, 22 (5, 45) pieces vs. 14 (4, 46) pieces, and the difference was statistically significant ( Z = 2.43, 2.70, 2.64 and 3.32; P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis of tumor N stage N 2 in group A were lower than those in group B: 4 (4, 9) pieces vs. 6 (4, 25) pieces , 16 (10, 42) pieces vs. 32 (19, 100) pieces, and the difference between groups was statistically significant ( Z = -2.53 and -2.87, P<0.05). Followed up to April 2022, among the 292 patients, 5 were lost to follow-up, the 3-year disease-free survival rates of 72 patients in group A and 215 patients in group B were 83.33% (60/72) and 91.16% (196/215) respectively, there was no significant difference between two groups ( P>0.05). Conclusions:The number of lymph nodes detected in laparoscopic CC radical resection increases after the application of nano-carbon lymphatic tracing technology.

Objective    To analyze the results and rationality of the lesion-focused strategy with subsegment as the pulmonary anatomical unit for pulmonary nodules with a diameter of ≤2 cm which require surgery. Methods    Clinical data of 246 patients with pulmonary nodules who underwent surgery in the Department of Thoracic Surgery of The First Affiliated Hospital of Nanjing Medical University from January 2017 to October 2018 were retrospectively analyzed, including 76 males and 170 females, with an average age of 53.30±11.82 years. The patients were divided into four groups, a single segmentectomy group, a segmentectomy combined with adjacent subsegmentectomy group, a single subsegmentectomy group and a combined subsegmentectomy group, according to the different surgical approaches, to compare preoperative, intraoperative, and postoperative related data. Results    There was no perioperative death. Among the four groups, there was no statistical difference in gender (P=0.163), age (P=0.691), diameter of the nodule (P=0.743), longitudinal position of the nodule (depth ratio, P=0.831), postoperative pulmonary leakage (P=0.752), intraoperative blood loss (P=0.135), pathological type (P=0.951) or TNM stage (P=0.995); there were statistical differences in transverse position of the nodule (P<0.001) and number of subsegments involved (P<0.001). The results of multivariate logistic regression analysis showed that compared with combined subsegmentectomy, the odds ratio (OR) of the lung nodule in segmentectomy combined with adjacent subsegmentectomy as intersegment nodules was 5.759 (95%CI 1.162 to 28.539, P=0.032). Conclusion     The surgical strategy of lesion  focused and subsegment as anatomical unit is safe and feasible for surgical treatment of pulmonary nodules with diameter ≤2 cm. The transverse position of the nodules is an important factor affecting the choice of surgical method for the middle and lateral nodules with a diameter of ≤2 cm, and the longitudinal location of the nodule is not an influencing factor. For nodules in inner zone, the diameter also is one of the factors influencing the choice of surgical method.

OBJECTIVE: To explore the influencing factors of low back pain and the relationship of the influence of bad working posture, weight load and frequency of load and the dose-response relationship among the occupational workers of key industries in China. METHODS: A total of 57 501 employees from 15 key industries in China were selected as research subjects using stratified cluster sampling method. The occurrence of low back pain in the past one year, as well as occupational factors such as job type, labor organization and work posture were investigated by using the Chinese version Musculoskeletal Disorders Questionnaire. RESULTS: The prevalence of low back pain in the occupational population of key industries in China was 16.4%(9 448/57 501). Multivariate Logistic regression analysis showed that the risk of low back pain in females was higher than that in males(P<0.01). Married, obese, occasional and frequent smokers, and a history of lower back disease were associated with increased risk of low back pain(all P<0.05). The risk of low back pain was associated with older age, higher education level, and lower frequency of physical exercise(all P<0.01). The risk of low back pain was higher with longer working time, greater back curvature, and the high frequency of long standing and sitting position work, uncomfortable working posture, repeated operation per minute, and lifting>5 kg weight(all P<0.01). CONCLUSION: The influencing factors of low back pain in the occupational population of key industries in China include bad working posture, high frequency load, weight load and other individual factors. There is a dose-response relationship with low back posture load and frequency of load.

Objective:To explore the incidence and risk factors of intercostal muscular avulsion for pectus excavatum after Nuss procedure.Methods:From April 2012 to April 2019, the clinical data were analyzed retrospectively for 159 hospitalized cases of Nuss procedure for pectus excavatum in Xi'an Children' s Hospital. The age ranged from 3.2 to 17.0 years old, mean(6.8±3.4) years old; 124 males, 35 females. Haller index ranged from 2.7 to 7.5(mean 4.0±1.0); intercostal muscular avulsion was 13 cases, 9 males, 4 females.The age ranged from 3.4 to 18.4 years old, mean(4.8±1.5) years old. Follow-ups were conducted for at least 20 months.Analyzed retrospectively the relevant data included age, gender, haller index, t test and χ2 test was used for statistical analysis.Results:There were statistically significant differences between intercostal muscle avulsion and age after funnel chest operation ( P=0.001), and between intercostal muscle avulsion and typing( P=0.034). Children at young ages and asymmetric pectus excavatum were prone to intercostal muscle avulsion. There were no significant differences in gender, Haller index, surgical method and intercostal muscle avulsion( P>0.05). Conclusion:The cause of intercostal muscle avulsion after postoperative complication of pectus infundibulis Nuss is mostly related to age. Children at young ages, especially asymmetric pectus excavatum are prone to intercostal muscle avulsion. We recommend surgery after the age of 6 for avoid intercostal muscle avulsion after funnel chest operation.

Objective:The present study was to observe the effect of Qianjin Weijingtang on the differentiation of helper T cells 17 （Th17）/T regulatory cell （Treg） and the expressions of related cytokines in the lung tissues of the model rats exposed to cigarette smoke. Method:Totolly 60 male rats were randomly assigned into six groups （control group， model group， acetylcysteine group and Qianjin Weijingtang high， moddle and low dose groups）， with 10 rats in each group. After 30 day's modeling and 30 day's intervention， rats were killed peacefully with their tissues collected. Real-time fluorescent quantitative polymerase chain reaction （Real-time PCR） was used to detect the expression of retinoic acid associated orphan receptor （ROR-γt） and forkhead/pterygoid helix transcription factor 3 （Foxp3） mRNA， enzyme-linked immunosorbent assay （ELISA） was used to check the concentration of interleukin-17（IL-17）， IL-6， IL-10 and transforming growth factor-β₁（TGF-β₁）. Htoxylin eosin （HE） staining was used to observe the pathological changes of lung tissues， while flow cytometry was used to detect Treg（Foxp3⁺CD25⁺）， Th17（CD4⁺IL-17⁺） and Treg/Th17 ratio. Result:As compared with the control group， the ROR-γt mRNA expression in model group was higher（P<0.01）. As compared with the model group， various doses of Qianjin Weijingtang down-regulated the expression（P<0.05，P<0.01）. As compared with the control group， the expression of the Foxp3 mRNA was down-regulated in model group（P<0.05）， but was up-regulated in Qianjin Weijingtang middle and low dose groups（P<0.05）. Compared with the control group， the concentration of IL-17 and IL-6 in the model group were significantly increased， while the concentration of IL-10 and TGF-β₁ in the model group were significantly decreased（P<0.05，P<0.01）. As compared with the model group， intervention with various doses of Qianjin Weijingtang could help to decrease the concentration of IL-17 and IL-6 in lung tissues， and increase the concentration of IL-10（P<0.05）， which were consistent with those of Real-time PCR results. Flow cytometry examination showed that the Th17（CD4⁺IL-17⁺） proportion decreased and Treg/Th17 ratio increased after Qianjin Weijing Tang middle and low dose intervention（P<0.05，P<0.01）. Conclusion:Qianjin Weijingtang could regulate Treg/Th17 ratio and help to achieve Th17/Treg balance.