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 compare the efficacy of double filtration plasmapheresis(DFPP),centrifugal therapeutic plasma exchange(cTPE)and centrifugation-filtration plasmapheresis(CFPP)in improving renal insufficiency after kidney transplantation,as well as the differences in inducing plasma exchange-related adverse reactions.Methods Clinical data from 46 patients who underwent plasma exchange after renal transplantation in our hospital were retrospectively collected,and patiens were divided into DFPP group(n=33),cTPE group(n=7)and CFPP group(n=6).Changes in peripheral blood creatinine,albumin,hemoglobin,platelets,fibrinogen levels and urine volume before and after TPE were compared and analyzed among the three groups.Results Among the DFPP group,cTPE group and CFPP group,the creatinine after TPE decreased by(31.40±25.38)%,(58.91±19.75)%and(39.44±28.64)%,respectively,with cTPE group significant-ly higher than the DFPP group(P＜0.05),but no significant differences between the DFPP group and cTPE group(P＞0.05);the urine volume after TPE increased by(49.33±30.03)%,(54.62±39.32)%and(68.89±23.00)%,showing no significant differences(P＞0.05);the hemoglobin after TPE decreased by(11.97±5.94)%,(20.17±5.75)%and(9.65±8.75)%,respectively,with the cTPE group significantly higher than the DFPP group and CFPP group(P＜0.05),but no significant difference between the DFPP group and CFPP group(P＞0.05).The platelet count after TPE decreased by(37.88±18.39)%,(24.56±12.36)%and(21.40±12.51)%,respectively,with no significant differences between the three groups(P＞0.05);the fibrinogen after TPE decreased by(0.57±0.20)%,(0.14±0.06)%and(0.26±0.22)%,re-spectively,with the DFPP group significantly higher than the cTPE group(P＜0.05),but the CFPP group had no significant difference with cTPE group or DFPP group(P＞0.05);the albumin after TPE decreased by(11.41±5.97)%,(14.67±6.52)%and(25.18±5.10)%,respectively,with cTPE group and DFPP group significantly lower than the CFPP group(P＜0.05,P＜0.001),but with no significant difference between the DFPP group and cTPE group(P＞0.05).Conclusion The effect of three plasma exchange methods varies on renal function,anemia and coagulation function of patients after kid-ney transplantation.It is necessary to consider the the patient's disease characteristics and treatment needs,as well as the laboratory′s technical conditions and plasma supply when selecting TPE methods.

Venous thromboembolism (VTE) is a complication in children with acute lymphoblastic leukemia (ALL). The Chinese Children's Cancer Group-ALL-2015 protocol was carried out in China, and epidemiology, clinical characteristics, and risk factors associated with VTE were analyzed. We collected data on VTE in a multi-institutional clinical study of 7640 patients with ALL diagnosed in 20 hospitals from January 2015 to December 2019. First, VTE occurred in 159 (2.08%) patients, including 90 (56.6%) during induction therapy and 108 (67.92%) in the upper extremities. T-ALL had a 1.74-fold increased risk of VTE (95% CI 1.08-2.8, P = 0.022). Septicemia, as an adverse event of ALL treatment, can significantly promote the occurrence of VTE (P < 0.001). Catheter-related thrombosis (CRT) accounted for 75.47% (n = 120); and, symptomatic VTE, 58.49% (n = 93), which was more common in patients aged 12-18 years (P = 0.023), non-CRT patients (P < 0.001), or patients with cerebral thrombosis (P < 0.001). Of the patients with VTE treated with anticoagulation therapy (n = 147), 4.08% (n = 6) had bleeding. The VTE recurrence rate was 5.03% (n = 8). Patients with VTE treated by non-ultrasound-guided venous cannulation (P = 0.02), with residual thrombus (P = 0.006), or with short anticoagulation period (P = 0.026) had high recurrence rates. Thus, preventing repeated venous puncture and appropriately prolonged anticoagulation time can reduce the risk of VTE recurrence.
Humans ; Child ; Venous Thromboembolism/etiology* ; East Asian People ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology* ; Risk Factors ; Thrombosis/chemically induced* ; China/epidemiology* ; Anticoagulants/adverse effects* ; Recurrence

〓 Objectives: To analyze the pathological and clinical features of nasal respiratory epithelial adenomatoid hamartoma（REAH）, and summarize the diagnostic points, to improve the experience of diagnosis and treatment. Methods:The clinical data of 16 patients with REAH were analyzed retrospectively. The clinical manifestations, pathological features, imaging features, surgical treatment and prognosis were summarized. Results:16 cases of REAH were studied, 10 cases（62.50%） were associated with sinusitis, 1 case（6.25%） was associated with inverted papilloma, 1 case（6.25%） was associated with hemangioma. 5 cases（31.25%） had a history of nasal sinus surgery, including 1 case with 3 times of nasal sinus surgery, 1 case with 2 times of nasal sinus surgery, 3 cases with 1 time of nasal sinus surgery; 10 cases（62.50%） occurred in the bilateral olfactory cleft, 2 cases（12.50%） in the unilateral olfactory cleft, 3 cases（18.75%） in the unilateral middle turbinate, 1 case（6.25%） in the nasopharynx. All 16 patients were pathologically diagnosed as REAH. In the patients with lesions located in bilateral olfactory fissures, symmetrical widening of olfactory fissures and lateral displacement of middle turbinate were observed on preoperative sinus CT. The average width of bilateral olfactory fissures was （9.9±2.70） mm. The ratio of wide to narrow olfactory cleft was 1.21 ± 0.19. There was no significant difference in Lund-Mackay score between the two sides（P>0.05）. All patients underwent surgery under general anesthesia and nasal endoscopy. The follow-up period ranged from 1 to 66 months, and no recurrence occurred. Conclusion:Preoperative diagnosis of REAH is facilitated by the combination of clinical manifestations and endoscopic and imaging features. Endoscopic complete resection can achieve a good therapeutic effect.
Humans ; Nasal Polyps/complications* ; Retrospective Studies ; Paranasal Sinuses/pathology* ; Adenoma ; Endoscopy/methods* ; Hamartoma/surgery*

Objective To study epigenetic diversity of Astragalus mongolicus by methylation-sensitive amplification polymorphism(MSAP)technique,and to establish and optimize the response system of MSAP technique applicable to Astragalus Mongolicus.Methods Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge.)Hsiao was used as material.The single factor and orthogonal design method were used to optimize the key influencing factors of the reaction system of Astragalus Mongolian methylation-sensitive amplification polymorphism(MSAP)technique,and the best reaction system of Astragalus Mongolian MSAP was established.Results 0.5 μL each of EcoR I and Msp I/Hpa II were added to the 20 μL double-enzyme digestion reaction system,and the digestion was completed in a water bath at 37℃for 6 h to complete the digestion;the optimal ligation system was 25 μL,including 10 μL digestion product,0.2 μL T4 DNA Ligase,1 μL EcoR I-adapter,1 μL Hpa II/Msp I-adapter,2.5 μL 10×T4 Buffer;25 μL optimal pre-amplification reaction system,including 2.5 μL 10×PCR buffer,0.5 μL dNTP,2.0 μL ligation product,0.3 μL Taq DNA polymerase,1.0 μL upstream and downstream primers;25 μL optimal selective amplification system,including 2 μL 20-fold diluted pre-amplification product,1.0 μL 10×PCR buffer,1.0 μL dNTP,0.2 μL Taq DNA polymerase,0.8 μL primers.Conclusion The optimized MSAP system was detected by polyacrylamide gel electrophoresis,which showed that the polymorphism was good,the system was stable,the bands were clear and repeatable,which laid the foundation for the subsequent MSAP analysis of Astragalus mongolica.

Objective To investigate the application value of transjugular liver biopsy (TJLB) in the diagnosis and treatment of complicated and severe liver diseases. Methods A retrospective analysis was performed for the clinical data of 31 patients who underwent TJLB in The Fifth Medical Center of Chinese PLA General Hospital, including indication for puncture, success rate, and final diagnosis. Results Among the 31 patients, there were 15 male patients and 16 female patients. Percutaneous liver biopsy was unsuitable for 8 patients with liver failure and disturbances of blood coagulation, 13 with liver cirrhosis and ascites, and 10 with liver cirrhosis and thrombocytopenia (< 50×10 9 /L), which were the indications for TJLB. The success rate of TJLB puncture was 100%, with 2-4 passes for puncture. No serious adverse event was observed. Of all 31 patients, 26 (83.87%) had a definite diagnosis at discharge, among whom there were 5 patients with idiopathic portal hypertension, 9 patients with drug-induced liver failure or liver cirrhosis, 5 patients with autoimmune liver disease, and 7 patients with liver cirrhosis or liver failure due to other causes, and 5 patients had unknown etiology. In addition, 3 patients underwent biopsy to confirm the diagnosis and decision of whether liver transplantation should be performed. Conclusion TJLB plays an important role in the diagnosis and treatment of complicated and severe liver diseases and still has certain limitations, and therefore, suitable patients should be selected in clinical practice.

Objective To analyze the clinical manifestation,imaging data and genetics mutation variants of late onset familial Alzheimer's disease concomitant with a novel mutation of presenilin 1.Methods The clinical manifestations and auxiliary examination recordings of the pedigree were analyzed.DNA was extracted from peripheral blood samples of the proband and her sons.Mutational analysis was performed by the next-generation sequencing technology and the mutation event was confirmed by Sanger sequencing technology.Results Two patients of the family presenting as Alzheimer's dementia were late onset.MRI of the proband showed extensive cerebral microbleeds.The gene detection showed p.S289P mutation in the exon 8 of presenilin 1 of the proband.Conclusion Mutation of p.S289P in the presenilin 1 gene may contribute to late onset Alzheimer's disease accompanied by amyloid angiopathy.

Objective To investigate the prognostic factors of renal cell carcinoma and to establish a prognostic model for patients with non-metastasis renal cell carcinoma (RCC) after operation.Methods We retrospectively reviewed the clinical data of patients with RCC who underwent radical or partial nephrectomy from January 2008 to December 2012,including 392 males (67.6％) and 188 females (32.4％),with an average age of 56 years(range 24-86 years).The average diameter of tumor was 4.8 cm (range 1.5-17.5 cm).The pathological slides of tumor tissue were reviewed by pathologist,and the tissue microarray (TMA) were constructed.The immunohistochemical staining of TMA were carried out.All patients were followed up the prognosis information of the overall survival (OS),cancer specific survival (CSS) and progression free survival (PFS).Based on these data,univariate and multivariate analysis and survival analysis were performed.Independent prognostic factors related to different follow-up endpoints of patients were screened out.A Nomogram prognostic model for RCC was established and verified.Internal validation were performed by boots value analysis.Results Among 580 cases,160 cases (27.6％) accepted nephron sparing surgery and 420 cases (72.4％) radical nephrectomy,included 514 cases (88.6％) of laparoscopic surgery and 66 cases (11.4％) of open surgery.There were 468 cases of clear cell carcinoma (80.7％),56 cases of papillary carcinoma (9.7％),32 cases of chromophobe cell carcinoma (5.5％),24 patients with other subtypes of cancer cells (4.1％).In pathological staging,stage Ⅰ,Ⅱ,Ⅲ,Ⅳ were 442 cases (76.2％),88 cases (15.2％),48 cases (8.3％),2 cases (0.3％),respectively.There were 424 cases (73.1％) with high expression of CA9,and 156 cases (26.9％) with low expression.The median followup was 66 (4-82) months,and 41 cases (7.1％) were lost of follow-up.For 3 and 5 years,OS,CSS and PFS were 83.4％,88.2％,72.4％ and 69.6％,73.0％,55.8％ respectively.Multivariate analysis showed that tumor pathological subtypes,tumor stage,tumor diameter and positive expression of carbonic anhydrase 9 (CA9) were independent prognostic factors associated with the survival of RCC patients.The Nomogram prognostic model was established by the above four factors.The established Nomogram prognostic model for RCC patients was verified by Harrell's consistency index,and the c-index of OS,CSS and PFS of RCC patients were 0.72 (95％ CI 0.69-0.75),0.77 (95％ CI 0.74-0.81),0.79 (95％ CI 0.76-0.83),respectively.Conclusions Tumor pathological subtypes,staging,tumor diameter and CA9 are independent risk factors for patients with non metastatic renal cell carcinoma.The established Nomogram prognostic model certified by internal validation should be tested by large samples and multicenter studies need tested.

Objective To study the distribution of intestinal autofluorescent microorganisms in the rat intestine at different developmental stages. Methods The distribution of intestinal autofluorescent microorganisms in rat intestine at va-rious developmental stages was tested and evaluated using a small animals living imaging system. First, standard E. coli strain was tested by fluorescence detection in vitro. Then, the distribution of E. coli under the same test conditions was tested. The intestinal autofluorescent bacteria distribution was detected in the SD rats at 3 days,14 days and 60 days of age. After expanding the range of excitation wavelength fluorescence detection,removing the background of fluorescence feed and feces and other foreign autofluorescent substances. Results E. coli can be excited in the range of 485 -535 nm wave?length and to emit fluorescence. E. coli mainly existed in the stomach and only a few E. coli were found in the ileum of 3?days old SD rat. . In the 14?days old rats, E. coli mainly existed in the stomach and cecum, and only a few E. coli were found in the ileum. In the 60-days old SD rats, E. coli mainly existed in the ileum, and only a few E. coli were found in the colon, cecum and jejunum. After the expansion of the excitation light wavelength range of fluorescence detection, E. co?li were observed mainly in the ileum, and only a few E. coli were found in the stomach in 3?days old SD rat. E. coli mainly existed in the stomach, then the cecum and only a few E. coli were found in the ileum and jejunum in 14-days old SD rats. E. coli could be found in the whole intestinal system but mainly in the ileum and cecumin of the 60-days old rats. Conclu?sions Examining the intestinal autofluorescent microbes with the small animal in vivo imaging system can be helpful and make guidance to study the distribution of intestinal microbes in the host at different developmental stages, and to provide a basis for studying the relationship of intestinal microbes with its host and the gastrointestinal drug administration.

Objective:To validate an enzyme linked immunosorbent assay (ELISA) method for the quantification of rhCNB in long-tailed macaque sera.Methods: The linear,sensitivity,accuracy,precision and recovery were determined using ELISA.Results:The present ELISA method had high linearity within 0.195 ng/ml-12.5 ng/ml,the working curve of rhCNB was Y=15.1X-0.26, R2=0.996 8 , the method showed good sensitivity of 0.195 ng/ml, the accuracy were in the range of 91.9%-108.8%, and the Coefficient of variation ( CV) for inter-assay were 3.55%,1.39%and 4.71%,the intra-assay were 1.59%,3.2%and 3.8%,all less than 10%, the recoveries were in the range of 88.5% -108.3%, <110% .Thus the method was coincidence with requirement.Conclusion:Double antibody sandwich ELISA assay of rhCNB in long-tailed macaque sera has good sensitivity ,accuracy, precision and recovery and it can be used to measure rhCNB concentration in biological samples .