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 explore the application of regional cerebral oxygen saturation(rSO2)-bispectral index(BIS)monitoring anesthesia in children undergoing surgery for supracondylar fractures of the humerus.Methods A total of 60 children with supracondylar fractures of the humerus undergoing surgery in Department of Orthopedi,Jiangxi Provincial Children's Hospital were chosen and randomly number table method segmented into control group and observation group from January 2020 to December 2022,30 cases in each group.After anesthesia,children in observation group were carried out with rSO2-BIS monitoring,while children in control group were given routine anesthesia management.Results The dosage of propofol and long chain fat emulsion/remifentanil injection in observation group were significantly lower than those in control group(P＜0.05),while there was no difference in heart rate,blood oxygen saturation and mean arterial pressure at various time points during awakening(P＞0.05);The recovery rate of postoperative analgesics of observation group was lower than that of control group,and the extubation time of observation group was shorter than that of control group(P＜0.05);The incidence of postoperative adverse reactions and behaviors in observation group were lower than those in control group(P＜0.001).The dosage of propofol and long chain fat emulsion/remifentanil injection,as the independent risk factors inducing the occurrence of postoperative adverse reactions and adverse behaviors were proved by multivariate analysis.rSO2-BIS monitoring is a key factor in reducing postoperative adverse behaviors and reactions in pediatric patients(P＜0.05).Conclusion The use of rSO2-BIS monitoring during surgery for supracondylar fractures of the humerus in children can reduce the incidence rate of postoperative adverse behaviors and adverse reactions,thereby improving postoperative efficacy.

Objective: To screen the differential expression profile of circular RNA (circRNA) in pancreatic cancer and analyze its potential function. Methods: Four pairs of pancreatic cancer tissues and corresponding adjacent pancreatic tissues were selected for high⁃throughput sequencing , and the differentially expressed circRNA was screened according to fold change > 2 and P < 0. 05. qRT⁃PCR was used to detect the expression of 5 randomly selected differentially expressed circRNA in 20 pairs of pancreatic cancer tissue samples. GO and KEGG enrichment analysis of differentially expressed circRNA was performed , and the top 50 circRNA⁃microRNA interaction network was constructed. The relationship between hsa_circ_0046523 and the clinicopathological features of pancreatic cancer was further analyzed , and the effects of hsa_circ_0046523 on the proliferation , migration and invasion of pancreatic cancer cells were observed by functional experiments. Results: A total of 17 182 circRNA were predicted by high⁃throughput sequencing , of which 302 circRNA were differentially expressed including 137 circRNA were upregulated and 165 circRNA were downregulated in pancreatic cancer tissues. The qRT⁃PCR results showed that the expression levels of hsa_circ_0046523 , hsa_circ_0004220 and hsa_circ_0000690 in pancreatic cancer tis⁃sues were significantly upregulated (P<0.05)，while the expression levels of hsa_ ir_0008676 and hisa _ circ_0004416 were significantly downregulated (P<0.05）.which was consistent with the sequencing results.GO analysis indicated that differentially expressed circRNA were mainly involved in substrate-dependent cell migration, protein kinase complex and cytoskeletal protein bindinig.KEGG pathway enrichment analysis showed that differentially expressed circRNA were mainly involved in protein digestion and absorption , ABC transporters , central carbon metabolism in cancer,and glycineserine and threonine metabolism pathways.The expression level of hsa_ circ_0046523 was closely correlated with tumor differentiation (P=0.002),T stage (P=0.006),lymph node metastasis (P=0.011) and TNM stage (P=0.001).Compared with HPDE6-C7 cells the expression of hsa_circ_0046523 significantly inc increased in pancreatic cancer SW1990, Mia PaCa-2BxPC-3 and Capan-2 ceIls (P<0.05). hsa_circ_ 0046523 knockdown significantly inhibited the proliferation, migration and invasion of pancreatic cancer Mia PaCa⁃2 BxPC⁃3 cells (P < 0. 05) . Conclusion There are characteristic differentially expressed circRNAs in pancreatic cancer tissues , and these differentially expressed circRNAs may be involved in the occurrence and development of pancreatic cancer.

Objective To evaluate the immunogenicity and safety of inactivated poliovirus vaccine derived from Sabin strain (sIPV) in Banna mini pigs, and to provide experimental evidence for the new animal model. Methods sIPV vaccines which are listed at Institute of Medical Biology at Chinese Academy of Medical Sciences were used in this study. The groups of intramuscular sIPV and the wild strain IPV injections (IPV derived from wild strain, wIPV) were designed, and the saline group was used as a negative control group. The Banna mini pigs in various groups were immunized at 0, 1 and 2 months. Blood samples were collected before immunization and on days 30 after each immunization. Levels of neutralizing antibodies were tested for evaluating immunogenicity. The safety was evaluated by observation of the status and weight of mini pigs. Results After the three dose immunization schedules in the Banna mini pigs, the seroconversion rates of type Ⅰ,Ⅱ and Ⅲ sIPV experimental groups and wIPV group were all up to 100%. The neutralizing antibody levels in all the three types were much higher than the protective titer 1: 8. The weight of mini pigs increased after vaccination. Conclusions The sIPV vaccine has good immunogenicity and safety in Banna mini pigs. Banna mini pigs could be a new animal model for evaluation of sIPV vaccine.

Objective To investigate the surgical methods and short-term effects of Internal-braceTM technology combined with modified Brostrom procedure for treatment of chronic ankle instability.Methods A retrospective case series study was made on 17 patients with chronic ankle instability treated using the Internal-braceTM technology combined with modified Brostrom procedure from May 2015 to April 2016.There were 10 males and 7 females,at age of 24 and 36 years (mean,31.8 years).A left ankle injury occurred in 6 patients and a right ankle injury in 11 patients.Operation time,postoperative complications and incision healing was documented after operation.Ankle stability was tested using the anterior drawer test and lateral stress test,and ankle range of motion was detected.American orthopedic foot and ankle society (AOFAS) score was used for postoperative efficacy evaluation.Results Operation time was 45 to 84 minutes (mean,64.5 minutes).None of the patients revealed neurological deficits after operation.All incisions healed by the first intension.Full weight bearing was started two weeks after operation.All patients were followed up for mean 3.5 months (range,1-6 months).At the final follow-up,both anterior drawer test and lateral stress test were negative.All patients had a normal range of motion of the ankle after operation.AOFAS score was increased from preoperative (36.2 ± 13.4)points to (91.2 ± 6.7) points at the final follow-up (P ＜ 0.01).According to the AOFAS score,the results were excellent in 15 patients and good in 2 patients,with the good rate of 100％.Conclusion For chronic ankle instability,Internal-braceTM technology comnbined with modified Brostrom procedure benefits wound healing and functional recovery,reduces incidence of complications and exhibits satisfactory short-term outcome.

Objective To analyze the anatomic variation of the portal vein based on magnetic resonance angiography using THRIVE sequence in one-stop examination of the liver.Methods Reconstructed three-dimensional images of 648 cases of hepatic portal vein acquired by THRIVE sequence were analyzed.Anatomic variation of the hepatic portal vein was investigated and the diameters of main portal vein (MPV), splenic vein (SV), superior mesenteric vein (SMV) and inferior mesenteric vein (IMV) were measured.Results (1)Four types of different variations of intrahepatic portal vein were observed, with normal type accounting for 79.2% (514/648), type Ⅰ 8.3% (54/648), type Ⅱ 9.0% (58/648) and type Ⅲ 3.4% (22/648), respectively.(2)Four types of different variations of extrahepatic portal vein were also observed, with type Ⅰ accounting for 37.4% (167/447), type Ⅱ 20.4% (91/447), type Ⅲ 36.2% (162/447) and other 6.0% (27/447), respectively.(3)Diameter of MPV, SV, SMV and IMV were (14.03±2.44) mm, (9.51±2.40) mm, (11.14±1.99) mm and (6.01±0.78) mm, respectively.Conclusion It is feasible to analyze anatomic variation in the hepatic portal vein using reconstructed three-dimensional images acquired by THRIVE sequence in one-stop examination of the liver.

Objectives To explore the prognostic factors of patients with pancreatic ductal adenocarcinoma and synchronous liver metastases ( PALM ) receiving palliative treatment .Methods The clinical characteristics , therapeutic approaches and survival outcomes of 108 consecutive patients with PALM who were pathologically diagnosed and received only palliative treatment at Tianjin Medical University Cancer Hospital from January 2001 to December 2015 .were retrospectively analyzed .Survival rates were calculated by Kaplan-Meier method, and factors influencing the survival were analyzed by univariate and multivariate Cox proportional hazard regression model .Results Of these patients, 68 were male and 40 were female, with an average age of 58 years old.Seventy-seven (71.3%) cases or their relatives refused to receive anticancer therapies.Palliative treatments included choledochojejunostomy and /or gastrojejunostomy after exploratory laparotomy for 5 (4.6%) cases, percutaneous transhepatic biliary drainage (n=22, 19.4%), drug analgesia (n=79, 73.1%), drug analgesia combined with percutaneous neurolytic coeliac plexus block (n=17, 15.7%).The median survival time (MS)was 94 days in all patients.Karnofsky performance score (KPS)<80, lymph node metastases, ascites, fasting blood glucose ≥6.1 mmol/L and lactate dehydrogenase ( LDH ) ≥250 U/L were independent risk factors influencing prognosis of PALM . Three groups were categorized according to the number of the above 5 risk factors for 0~1 in low risk group, 2~3 in middle risk group and 4~5 in high risk group, and the MS of 3 groups was 137, 95 and 48 days, respectively, with an extremely statistical significance (P<0.0001).Conclusions KPS, lymph node metastases, ascites, fasting blood glucose and LDH were the risk factors for prognosis of PALM .Patient stratification according to the above factors is more advantageous for judging individualized prognosis and can provide reference for making clinical decision .

Objective To identify the gene mutations of an inherited coagulation factor Ⅶ deficiency pedigree.Methods PCR and DNA sequencing were used to identify the FⅦ gene mutations in the proband.The identified mutations were validated by PCR followed by restriction fragment length polymorphism technique or DNA sequencing.100 healthy volunteers were chosen randomly as controls. Results R1S2Q and IVS6+1G→T double heterozygous mutations were discovered in the Droband.The pedigree analysis showed that R152Q missense mutation inherited from his father,and IVS6+1G→Twas from his mother. The R1S2Q missense mutation in exon 6 was not found in 100 healthy volunteers. Conclusion The congenital deficiency of F Ⅶ in the proband might be caused by the coinheritance of the R152Q missense mutation in exon 6 and the splicing donor site mutation ( ⅣS6+1G→T)in intron 6.

Facing the inadequate status quo of postgraduate courses teaching methods,evaluation system,the author tries to reform the teaching methods in the required course introduction to research methods of pharmacology.Based on the application of the virtual lab in drug discovery,the author adopted the ways of explaining and publicizing the subject beforhand to let the students retrieve and organize materials,and make presentations in class about the literature they have retrieved within the limited time so that the teacher could give comprehensive evaluation according to their content and performances.Through this reform I realized that the organizating the teaching materials from multi-angles can raise the information quantity,which will help students take initiatives to gain as much information as possible so as to improve their thinking ability,lengthen their attention span,arouse their interest and enhance their study efficiency.So with network technology proping up,it is advisable to adopt such study style of individuation and autonomy.

Objective To investigate the relationship between the expression of the Smad4,TGF-?_1 and T?R II and the possible mechanisms in the development of cholangiocarcinoma. Methods Immunohistochemical SABC method was used to examine the expression of Smad4,TGF-?_1 and T?R II in 49 cases of cholangiocarcinoma and 8 nomal common bile duct.Results The expression rates of Smad4,TGF-?_1 and T?R II in cholangiocarcinoma were (40.82)%(20/49),71.43%(35/49) and 36.73%(18/49) respectively; in normal common bile duct tissues were 87.50(7/8),12.50%(1/8) and 100%(8/8) respectively. There was a significant relationship between the (expression) of TGF-?_1 and clinical stage, and tumor metastasis (P