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.

The global coronavirus disease 2019 epidemic is still in a pandemic state. Aging population with underlying diseases is prone to become severe, and have a higher mortality. The treatment capacity of the critical care department directly determines the treatment success rate of critical illness. At present, there is still a certain gap between domestic and foreign countries in intensive care unit (ICU), which is not only in the allocation of medical staff, but also in the beds and settings. The current medical model cannot fully meet the needs of development. The experience and lessons of many major public health emergencies suggested that " dual track of peace and war" approach in discipline construction of critical care is the best medical model. Following the concept of "combination of peace and war", strengthening the discipline construction of critical care department in municipal and district designated hospitals, allocating reasonable standard ICU, step-down ICU and combat readiness ICU, establishing rapid response team, and strengthening regular training and scientific management may be the key measures to deal with the epidemic.

【Objective】 To explore the surgical characteristics and clinical efficacy of percutaneous endoscopic visualization trephine for thoracic spinal stenosis. 【Methods】 We made a retrospective analysis of 37 patients with single-segment thoracic spinal stenosis treated with percutaneous endoscopic visualization trephine from January 2019 to June 2020. Among them， there were 14 males and 23 females； their age ranged from 31 to 82 years old， with an average of （57.6±11.8） years old. Their posture， length of hospital stay， length of operation and blood loss were recorded. The visual analogue scale （VAS）， Oswestry disability index （ODI） and the modified Japanese Orthopaedic Association （JOA） score were used to evaluate the preoperative and final conditions of patients and calculate the improvement rate. 【Results】 The operation was successfully completed in all the patients， and no patients developed epidural hematoma， incision infection or postoperative paralysis. Among the 37 patients， 24 ones with ossification of ligamentum flavum （OLF） were in the prone position， and 13 patients had lateral surgery. Among them， thoracic disc herniation （TDH） occurred in 3 cases， OPLL in 5 cases and OLF+OPLL in 5 cases. The hospital stay was （7.2±1.6） days， the operation time was （96.5±20.0） min， and the blood loss was （41.9±10.8） mL. VAS score decreased from （7.0±0.9） to （1.9±0.8）； ODI improved from （41.7±2.1） to （16.1±1.7）； and JOA score increased from （5.8±1.4） to （8.6±1.4）. The preoperative and postoperative differences were statistically significant （P<0.05）. 【Conclusion】 Percutaneous endoscopic visualization of thoracic spinal stenosis is treated by choosing different positions according to the type of compression. The spinal canal is fully decompressed. The surgical method is safe and minimally invasive， and the postoperative effect is satisfactory.

Objective: To explore clustering and risk factors of Staphylococcus aureus (S. aureus) carriage among kindergarten children in Liuzhou. Methods: Two sided nasal swabs were collected from 1 702 children in Liuzhou from April to June 2018. Parents of all the children were investigated by questionnaires. The random effect Logistic regression was used to analyze the clustering and risk factors of S. aureus carriage. Results: The carriage rate of S. aureus among kindergarten children was 16.3%. The randomeffect Logistic regression model indicated that the class-level random effect of S. aureus carriage among children was statistically significant(Z=2.12, P<0.01). Children aged 6 to 7 years (OR=2.18, 95%CI=1.45-3.27) and 5 years (OR=1.65, 95%CI=1.08-2.50) had higher carriage rates of S. aureus than those aged 3-4 years. The history of antibiotic using (OR=1.45, 95%CI=1.05-2.01) and skin and soft tissue infections (OR=1.36, 95%CI=1.04-1.79) in the previous year were risk factors of S. aureus carriage among children. Conclusion The class level clustering of S. aureus carriage is observed in healthy children. Age, history of antibiotic usage and history of skin and soft tissue infections are associated with risk of S. aureus carriage among preschool children.

Objective To investigate the expression and clinical significance of ATAD2 in patients with hilar cholangiocarcinoma (HC) Methods The qRT-PCR,Western blottig and immunohistochemistry were used to detect the expression of ATAD2 in HC and normal bile duct tissues,and the relationship between ATAD2 and the clinicopathological factors,prognosis was analyzed.Results The positive expression rate of ATAD2 in HC tissues was 70％ (57/81),significantly higher than that of normal bile duct tissues 7％ (2/30) (x2 =35.678,P ＜0.01),and ATAD2 expression was associated with lymph node metastasis and TNM staging (respectively x2 =28.619,31.612,all P ＜ 0.01).The 1'-,3'-,and 5-year survival rates of ATAD2 negative HC patients were 87.5％,54.1％,and 33.3％,respectively.The 1'-,3'-,and 5-year survival rates of ATAD2 positive HC patients were 40.3％,14.0％ and 1.7％,respectively (x2 =14.162,P ＜ 0.01).Univariate analysis and multivariate COX regression model analysis showed that microvascular invasion,lymph node metastasis and ATAD2 expression were independent factors influencing the prognosis of patients with HC (respectively F =4.703,4.961,5.013,all P ＜ 0.05).Conclusion The expression of ATAD2 in HC increased,and the overexpression of ATAD2 was closely related to the occurrence,development,invasion,metastasis and poor prognosis of HC.

Objective To study the relationship between heparin-binding protein(HBP) and β2 integrin on the surface of neutrophil in acute lung injury.Methods A total of 30 mice from animal center of Tongji University were divided into control group,CLP group and antibody-treatment group by random number method.Acute lung injury animal model was established by cecal Ligation and puncture in the mice of CLP group and antibody-treatment group.Sham operations were performed on the mice in control group.Mice in antibody-treatment group received anti-CD18 antibody injected via tail vein 30 min before establishing acute lung injury animal model.Twenty-four hours after operation,mice were sacrificed and lung tissue was taken.After HE staining,lung injury were evaluated by Smith score.Lung tissue wet/dry weight ratio,BALF protein level,plasma HBP level and β2 integrin on neutrophil were measured.T test were used to compare the difference among groups.Pearson correlation was used to study the correlation between HBP,integrin and lung injury index.Results Compared with control group,mice in CLP group had higher Smith score(t=10.607,P＜0.01),lung wet/dry ratio(t=3.968,P=0.001),BALF protein level(t=4.331,P＜0.01) and as well as higher plasma HBP(t=3.515,P=0.002) and β2 integrin(t=4.816,P＜0.01) level.After CD18 antibody treatment,anti-treat group mice had lower Smith score (t=2.307,P=0.033),lung wet/dry ratio(t=3.080,P=0.006),BALF protein level(t=2.484,P=0.023) and as well as higher plasma HBP level(t=2.218,P=0.046) than mice in CLP group.Pearson correlation analysis showed HBP had obvious correlation with wet/dry ratio(r=0.527,P=0.017),BALF protein(r=0.508,P=0.022) and as well as β2 integrin(r=0.674,P=0.001).Conclusions Both HBP and β2 integrin involved in the lung injury pathogenesis.HBP level is interrelated with the severity of lung injury.The β2 integrin is associated with the release of HBP by neutrophil.Inhabiting the function of integrin could decrease HBP level and alleviate the severity of lung injury.

Objective To provide reference for drug use in infant patients with Rhodococcus equi(R.equi) infection. Methods By participating in drug therapy for an infant patient with Rhodococcus equi infection,clinical pharmacist assisted physicians to develop treatment plan and provide reasonable pharmaceutical care. Results Therapeutic selection was improved through pharmaceutical care process. Conclusion Participation of clinical pharmacist can fully play their advantages in the field of drug efficacy,and improve the level of clinical treatment.

Objective To investigate the morphological characteristics and proliferation ability of diabetes mellitus-derived adipose-derived stem cells (ADSCs) by comparing with normal-derived ADSCs.Methods The ADSCs could be achieved from diabetes mellitus' adipose tissue by the similar method of normal ADSCs isolation and culture,and then the differnce was compared between the two groups about their morphologies under microscope,and the proliferation ability of two groups was determined by CCK-8.Results ADSCs in patients with diabetes were obvious hypertrophy and irregular in morphology.A values of ADSCs in diabetes and non-diabetes were 0.210+0.002 and 0.390+0.006 in 1st day;0.250+0.015 and 0.443+0.023 in 2nd day;0.368+0.014 and 0.726+0.033 in 3rd day;0.368+0.014 and 0.726+0.033 in 4th day;1.767+0.072 and 3.153+0.067 in 5th day and 1.810+0.072and 3.170+0.021 in 6th day,respectively.The difference was statstically significant at the beginning from 4th day (P＜0.05).Conclusions There is obvious difference of the microscopic morphology between the diabetes mellitus-derived ADSCs and normal-derived ADSCs.The proliferation ability of the diabetes mellitus-derived ADSCs is lower than normal-derived ADSCs.These difference could be closely related to ulcerous non-healing wounds in patients with diabetes mellitus.

Objective To study the role of heparin-binding protein (HBP) in sepsis-associated acute respiratory distress syndrome (ARDS),and to evaluate the prognostic value of HBP in ARDS.Method Sixty seven sepsis patients were enrolled in the prospective study.According to whether present ARDS,patients were divided into two groups:ARDS group and non-ARDS group.Blood samples were obtained within 2 hours after patients were diagnosed with sepsis.We measured the level of interleukin-6,interleukin8 and HBP by ELISA,counted the number of polymorphonuclear neutrophils (PMN),and calculated Acute Physiology and Chronic Health Evaluation Ⅱ score.We compared interleukin-6,interleukin-8,PMN and HBP between two groups by Student's t test.Correlation analysis was studied between HBP and other indicators by Spearman rank correlation coefficient.We also studied the early prognostic value on sepsisassociated ARDS by establishing receiver operating characteristic (ROC) curve.Results Interleukin-6 (t=4.25,P＜0.01),interleukin-8 (t=10.10,P＜0.01),PMN (t=3.47,P=0.0009) and HBP (t =0.0225,P =2.336,all showed significant difference between ARDS group and non-ARDS group.Interleukin-6 (r=0.535,P=0.002),interleukin-8 (r=0.419,P=0.017) and PMN (r=0.419,P =0.017) all had positive correlation with HBP.The area under curve (AUC) of HBP predicting ARDS was 0.796.Conclusions HBP level elevated in sepsis-associated ARDS patients and were correlated with interleuki-6,interleuki-8 and PMN.HBP show a high value on predicting emergence of sepsis-associated ARDS.HBP may play an important role in sepsis-associated ARDS pathological process.From this study we can conclude one of possible ARDS pathogenesis:inflammatory mediators,such as interleuki-6,interleuki8,activate PMN.Subseqoently PMN releases HBP.Then HBP resolts in vascolar leakage,which is one of the basic ARDS pathology.

Objective To investigate the antimicrobial resistance of clinical isolated acinetobacter baumannii against the common antimicrobial agents in Huainan and to direct rational medication in clinical.Methods 160 acinetobacter baumannii strains were isolated from 3 hospitals in Huainan from Oct.2010 to Jun.2012.Bacteria identification and antimicrobial susceptibility testing were detected by VITEK32 of BioMérieux company.Cefoperazone sulbactam susceptibility was detected by Kirby-Bauer method.Results The drug resistant rate of acinetobacter baumannii against 10 antimicrobial agents was beyond 50.0％ and resistant rate of aztreonam was up to 90.1％.The drug resistant rate of only 4 antimicrobial agents was lower than 50.0％.In these 4 drugs,the lowest drug resistant rate was cefoperazone sulbactam (23.4％) and antimicrobial resistant rate of imipenem and meropenem was 26.0％ and 31.2％,respectively.Conclusion The antibiotic resistance and multiple resistance of acinetobacter baumannii in Huainan is serious.Cefoperazone sulbactam and imipenem are the first drugs for clinical therapy of acinetobacter baumannii infection.