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 preoperative pulmonary artery pressure on perioperative prognosis of the recipients with end-stage heart failure undergoing heart transplantation. Methods Clinical data of 105 recipients receiving heart transplantation were retrospectively analyzed. The mean pulmonary artery pressure (mPAP) was used as the diagnostic criterion. The optimal cut-off value of mPAP for predicting perioperative prognosis of heart transplant recipients was determined. According to the optimal cut-off value of mPAP, all recipients were divided into the low mPAP group (n=66) and high mPAP group (n=39). Intraoperative indexes (cardiopulmonary bypass time, aortic occlusion time, assisted circulation time and cold ischemia time of donor heart) and postoperative indexes [intra-aortic balloon pump (IABP) support rate, IABP support time, extracorporeal membrane oxygenation (ECMO) support rate, ECMO support time, mechanical ventilation time, length of ICU stay, incidence of moderate and severe tricuspid regurgitation and perioperative mortality rate] were compared between the low and high mPAP groups. The prognosis of the two groups was compared. Results The optimal cut-off value of mPAP in predicting clinical prognosis of heart transplant recipients was 30.5 mmHg. In the high mPAP group, the ECMO support rate and perioperative mortality rate were higher than those in the low mPAP group (both P < 0.05). No significant differences were observed in the cardiopulmonary bypass time, aortic occlusion time, assisted circulation time, cold ischemia time of donor heart, IABP support rate, IABP support time, ECMO support time, mechanical ventilation time, length of ICU stay and incidence of moderate and severe tricuspid regurgitation between two groups (all P > 0.05). No significant differences were noted in the 1-, 2-, 3- and 4- survival rates between two groups (all P > 0.05). Conclusions Preoperative mPAP in patients with end-stage heart failure is intimately correlated with perioperative prognosis of heart transplant recipients. The optimal cut-off value of mPAP in predicting perioperative prognosis of heart transplant recipients is 30.5 mmHg. In the high mPAP group, perioperative ECMO support rate and perioperative mortality rate are high, which do not affect the medium and long-term prognosis of the recipients undergoing heart transplantation.

Objective:To describe the characteristics of genotype and phenotype in 3 families with X-linked retinoschisis (XLRS) due to RS1 mutations. Methods:A cross-sectional approach was adopted.Three XLRS families at the Ningxia Eye Hospital from October 2017 to March 2019 were included.Clinical data and peripheral blood of patients and related families were collected and clinically staged were formulated through a comprehensive eye examination.The disease-causing genes screened by panel sequencing underwent conservative analysis, pathogenicity analysis and protein structure prediction by software tools.Analysis of the mutations pathogenicity was performed according to the American College of Medical Genetics and Genomics guidelines.The research was approved by Medical Ethics Committee of the People's Hospital of Ningxia Hui Autonomous Region and followed the Declaration of Helsinki.Written informed consent was obtained from each participant.Results:Total 5 young male patients and 1 middle-aged patient in these three families.The optical coherence tomography(OCT) findings of 5 young patients showed typical macular retinoschisis, which were characterized by stage I of XLRS.One middle-aged patient (Ⅱ-9) showed a stage Ⅲ lesion of macular atrophy.The mutations of c. 668G>A, c.618G>A and exon 1 deletion in RS1 gene were found in the three families.C223 and W206 were verified to be highly conserved in mammals and were predicted to be pathogenic mutations by software and the change of protein structure.Conservation analysis and prediction of protein structure were not performed for the mutation of exon 1 deletion.All the mutations were pathogenic variants according to the ACGM guidelines. Conclusions:Mutations of c. 668G>A/p.C223Y, c.618G>A/p.W206X and exon 1 deletion in RS1 gene are pathogenic mutations in Chinese XLRS families.The combination of Panel sequencing with pathogenicity analysis and protein structure prediction have important effect to diagnosis and identify the causative genes for the hereditary retinal diseases.

Objective To explore the factors, characteristics and imaging manifestations of ankle joint injury in amateur marathoners (no formal training and no marathon career). Methods From December 2018 to March 2019, the amateur marathon runners in Guangdong Zhuhai had been recruited as research subjects according to the study inclusion and exclusion criteria. The questionnaires were used to collect relevant data, and the subjects underwent MRI scans of the ankle joint. The ankle joint special phased array coils were used to perform fast spin echo sequence (TSE) coronal T1WI and proton density?weighted fat?suppression sequence (PDWI?FS). Axial, coronal and sagittal scans, three?dimensional?double echo steady?state sequence (3D?DESS) and three?dimensional variable flip angle fast spin echo sequence (3D?SPACE) scans were also acquired. The results of the examination were independently analyzed by two radiologists (5 and 17 years of work experience, respectively) on the ligament, tendon, bone marrow and ankle joint injuries. When they had inconsistent views, the diagnosis provided by the third radiologist (27 years of work experience) was considered a final diagnosis. The relationship between ankle injury and different running postures, the number of participating in marathons and training intensity was analyzed, and the independent sample χ2 was used for statistical analysis. The consistency of two radiologists was tested by Kappa test. Results According to the inclusion and exclusion criteria, 39 subjects were included, with 64 ankles totally, 35 right ankles and 29 left ankles. MRI showed that (1) Ligament injuries: 28 ankles were anterior talofibular ligament injuriy;50 ankles were posterior talofibular ligament injury; 60 ankles the calcaneofibular ligament injuries and 54 ankles were deltoid ligament injuries, without complete injury. (2) Tendon sheath effusion and injuries: peritendinous effusion was common, with 47 flexor hallucis longus tenosynovitis, 49 posterior tibialis tenosynovitis, 37 flexor digitorum longus tenosynovitis, 7 peroneus longus tenosynovitis and 5 peroneus brevis tenosynovitis. (3) Synovitis effusion: 43 posterior ankle synovitis and local effusion. (4) Others: cartilage injury in 2 ankles, bone marrow edema in 8 ankles, and among them stress fracture in 2 ankles. The two radiologists had good consistency with the Kappa value of 0.91. Regarding the running posture, the incidence of ligaments injuries was obviously higher in those who landed on the hind foot than in those landed on front and middle foot,and the difference was statistically significant(P=0.013, χ2 value was 6.191).The incidence of tendon injuries was higher in those who landed on the front middle foot than in those landed on the hind foot, and the difference was statistically significant (P=0.029, χ2 value was 4.775). Those with larger training (training running ≥300 km/month) had significant ankle injury (P=0.005, χ2 value was 7.844). Conclusion The MRI features of ankle joint injuries in amateur marathon volunteers are related to different running postures and training intensity.

Objective: To explore the factors, characteristics and imaging manifestations of ankle joint injury in amateur marathoners (no formal training and no marathon career). Methods: From December 2018 to March 2019, the amateur marathon runners in Guangdong Zhuhai had been recruited as research subjects according to the study inclusion and exclusion criteria. The questionnaires were used to collect relevant data, and the subjects underwent MRI scans of the ankle joint. The ankle joint special phased array coils were used to perform fast spin echo sequence (TSE) coronal T₁WI and proton density-weighted fat-suppression sequence (PDWI-FS). Axial, coronal and sagittal scans, three-dimensional-double echo steady-state sequence (3D-DESS) and three-dimensional variable flip angle fast spin echo sequence (3D-SPACE) scans were also acquired. The results of the examination were independently analyzed by two radiologists (5 and 17 years of work experience, respectively) on the ligament, tendon, bone marrow and ankle joint injuries. When they had inconsistent views, the diagnosis provided by the third radiologist (27 years of work experience) was considered a final diagnosis. The relationship between ankle injury and different running postures, the number of participating in marathons and training intensity was analyzed, and the independent sample χ² was used for statistical analysis. The consistency of two radiologists was tested by Kappa test. Results: According to the inclusion and exclusion criteria, 39 subjects were included, with 64 ankles totally, 35 right ankles and 29 left ankles. MRI showed that (1) Ligament injuries: 28 ankles were anterior talofibular ligament injuriy;50 ankles were posterior talofibular ligament injury; 60 ankles the calcaneofibular ligament injuries and 54 ankles were deltoid ligament injuries, without complete injury. (2) Tendon sheath effusion and injuries: peritendinous effusion was common, with 47 flexor hallucis longus tenosynovitis, 49 posterior tibialis tenosynovitis, 37 flexor digitorum longus tenosynovitis, 7 peroneus longus tenosynovitis and 5 peroneus brevis tenosynovitis. (3) Synovitis effusion: 43 posterior ankle synovitis and local effusion. (4) Others: cartilage injury in 2 ankles, bone marrow edema in 8 ankles, and among them stress fracture in 2 ankles. The two radiologists had good consistency with the Kappa value of 0.91. Regarding the running posture, the incidence of ligaments injuries was obviously higher in those who landed on the hind foot than in those landed on front and middle foot,and the difference was statistically significant(P=0.013, χ² value was 6.191).The incidence of tendon injuries was higher in those who landed on the front middle foot than in those landed on the hind foot, and the difference was statistically significant (P=0.029, χ² value was 4.775). Those with larger training (training running ≥300 km/month) had significant ankle injury (P=0.005, χ² value was 7.844). Conclusion The MRI features of ankle joint injuries in amateur marathon volunteers are related to different running postures and training intensity.

Objective To investigate the effect of 3S jejunal interposition anastomosis in digestive tract reconstruction after radical resection for early gastroesophageal junction adenocarcinoma. Methods One hundred and eighteen patients of early gastroesophageal junction adenocarcinoma who were planned to receive radical proximal gastrectomy from February 2011 to August 2015 were prospectively enrolled and randomly divided into two groups by table of random number, including observation group (3S jejunal interposition) and control group (esophageal remnant gastric posterior wall anastomosis), with 59 patients in each group. Postoperative complications, operative time, nutritional parameters and postoperative quality of life were compared between two groups. Results The operation time in observation group was (152.3 ± 13.1) min, in control group was (146.0 ± 12.5) min, and there was no significant difference (P>0.05). The rate of complication in observation group was 8.5%(5/59), in control group was 13.6%(8/59), and there was no significant difference (P>0.05). The levels of total protein, albumin, hemoglobin, and Vitamin B126, 12, and 18 months after operation in observation group were significantly higher than those in control group (P<0.05). The rate of reflux esophagitis 6, 12 and 18 months after operation in observation group was significantly lower than that in control group (P<0.05). The gastric emptying time 6, 12 and 18 months after operation in observation group was significantly prolonged, compared with that in control group (P<0.05). The scores of whole quality of life, emotional function, body function, pain, tired, appetite, nausea and vomiting, diarrhea and constipation 6 and 18 months after operation in observation group were significantly better than those in control group (P<0.05). Conclusions The 3S jejunal interposition anastomosis in digestive tract reconstruction after radical resection for early gastroesophageal junction adenocarcinoma is a better method. The effect of antirelux is better and can improve the nutriture and quality of live for long time.

Objective To evaluate the effects of Acorustatarinowii Schott(ATS)on chronic restraint stress mice and its possible mechanisms. Methods Chronic stressed mice underwent a repeated 8h/d constraint in a specific behavior blocker ,however ,only CSA mice received once gavages of 4.5 g/(kg · d)ATS decoction for con-secutive 28 days. Morris water maze(MWM)task was conducted for evaluating learning and memory of the mice. ELISA was used to examine the levels of plasma corticosteroid. Results ATS dramatically ameliorated cognitive impairments and decreased serum corticosteroid level in the stressed mice(P<0.01). Conclusion ATS improves cognitive deficits provoked by chronic stress in mice ,which may attribute to decreasing plasma corticosteroid levels.

Objective To investigate the effect of the Kolb experience learning theory applied in Surgical Nursing teaching.Methods 120 students were selected randomly and were divided into 2 groups,the observation group operated the teaching mode based on the Kolb experience learning theory,the control group operated traditional teaching.After the experiment,using the theory test,the skill test,the questionnaire survey to evaluate the teaching effectiveness.Results The two groups showed statistical difference in theory exam results,learning effect of each dimension and evaluation of teaching effect.Conclusions The teaching mode based on the Kolb experience learning theory can improve the students' interest in learning and study effect,and push forward the reform of teaching implementatiou.

Objective To investigate the antireflux effect of esophagogastrostomy combined with modified Nissen fundoplication after esophageal middle cancer resection.Methods Eighty-two patients with esophageal middle cancer were divided into 2 groups by random digits table method,41 cases underwent esophagogastrostomy with a stapler only (control group),41 cases underwent esophagogastrostomy with stapler combined with modified Nissen undoplication (observation group).Three months after surgery,the patients of the 2 groups completed the research of EORTC QLQ-C30 questionnaire,and examined with esophageal manometry and gastroscopy.Results There was no statistical difference in incidence of postoperative complication between the 2 groups (P ＞ 0.05),death was not found during peroperative period.The scores of heart burn and regurgitation in observation group [(13.2 ± 6.1) and (16.9 ± 3.9) scores] were significantly lower that those in control group [(25.6 ± 7.2) and (26.6 ± 4.2) scores],there were statistical differences (P ＜ 0.05),but there was no statistical difference in score of dysphagia between the 2 groups (P ＞ 0.05).The resting pressure of anastomotic site in observation group [(3.5 ± 2.3) mmHg,1 mmHg =0.133 kPa] was significantly higher than that in the stomach [(2.7 ± 2.1) mmHg],there was statistical difference (P＜ 0.05).The DeMeester score was (54 ± 32) scores,control group was (141 t 84) scores,there was statistical difference (P ＜ 0.05).The incidence of reflux esophagitis in observation group was 48.8％(20/41),in control group was 75.6％(31/41),there was statistical difference (P ＜ 0.05).Conclusions Esophagogastrostomy combined with modified Nissen fundoplication after esophageal middle cancer resection significantly increases the pressure at the anastomotic site,thus reduces the extent of gastroesophageal reflux,which leads to the reduction of the extent of reflux esophagitis and the improvement of the quality of life.

Objective To study and compare the effects of Fentanyl transdermal pain patches and Pethidine in postoperative analgesia of malignant tumor and its nursing methods.Methods 100 patients with malignant tumor in our hospital from January 2008 to November 2010 were selected as research object,all the patients were randomly divided into group A (Fentanyl transdermal pain patches group) and group B (Pethidine group)with 50 cases in each group,then the VAS score 2,4,8,24 and 48h after the surgery,incidence of adverse reactions,satisfaction rate and serum catecholamine,cortisol,blood glucose before and after the surgery were analyzed and compared,and all the patients were given corresponding nursing measures.Results The VAS score of group A at 2,4,8,24 and 48h after the surgery were all better than those of group B,incidence of adverse reactions was lower than that of group B,satisfaction rate was higher than that of group B,serum catecholamine,cortisol,blood glucose after the surgery were all lower than those of group B,there were significant differences.Conclusions The effects of Fentanyl transdermal pain patches in postoperative analgesia of malignant tumor is stable,and it gets good reputation from the patients,the effects is obvious combined with nursing.