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.

Humans ; Triple Negative Breast Neoplasms/genetics* ; MicroRNAs/genetics* ; Oncogenes ; Cell Line, Tumor ; Cell Proliferation ; Gene Expression Regulation, Neoplastic ; Cell Movement

Hepatolithiasis is a common biliary tract disease in China and other Asian countries.It has insidious onset,recurrent disease,and may lead to biliary cirrhosis or even cancer in the late stage without inter-vention.At present,surgery is considered to be the best choice for treatment.In the 21st century of minimally inva-sive surgery,traditional procedures such as partial hepatectomy,choledochotomy,cholangioenterostomy and liver transplantation can be performed with the assistance of laparoscopy and da Vinci robots,and emerging endoscopic techniques such as endoscopic retrograde cholangiopancreatography(ERCP)and percutaneous transhepatic cho-ledochoscopic lithotripsy(PTCSL)have also been developed,bringing better treatment for patients with hepatoli-thiasis.As treatment options are becoming more varied,there are also some clinical problems that need to be addressed.In this article,we would like to briefly review the current surgical treatment modalities in order to provide a theoretical basis for optimizing the treatment modalities.

The dorsal lingual epithelium, which is composed of taste buds and keratinocytes differentiated from K14⁺ basal cells, discriminates taste compounds and maintains the epithelial barrier. N6-methyladenosine (m⁶A) is the most abundant mRNA modification in eukaryotic cells. How METTL3-mediated m⁶A modification regulates K14⁺ basal cell fate during dorsal lingual epithelium formation and regeneration remains unclear. Here we show knockout of Mettl3 in K14⁺ cells reduced the taste buds and enhanced keratinocytes. Deletion of Mettl3 led to increased basal cell proliferation and decreased cell division in taste buds. Conditional Mettl3 knock-in mice showed little impact on taste buds or keratinization, but displayed increased proliferation of cells around taste buds in a protective manner during post-irradiation recovery. Mechanically, we revealed that the most frequent m⁶A modifications were enriched in Hippo and Wnt signaling, and specific peaks were observed near the stop codons of Lats1 and FZD7. Our study elucidates that METTL3 is essential for taste bud formation and could promote the quantity recovery of taste bud after radiation.
Animals ; Epithelium/metabolism* ; Homeostasis ; Methylation ; Methyltransferases/metabolism* ; Mice ; RNA ; Taste Buds/metabolism*

Objective:To investigate the typing and clinical value of posterior group renal calyces.Methods:From April 2020 to June 2021, 640 patients (320 men and 320 women) who underwent CTU examination in our hospital with kidneys on both sides and normal or only mild hydronephrosis in the collecting system were analyzed. A total of 1 280 renal CTU three-dimensional reconstructed images were counted.The patients aged 52.4±11.9 years. The patients' CTU images were reconstructed in three dimensions using the spine as a marker to rotate the collecting system images in stereoscopic space to simulate a prone position. A two-person review was taken to observe the imaging morphology of the renal calyces in the prone position, and the 640 renal calyces in the posterior group of the left and right sides were counted for staging. Based on the morphology of the renal calyces and the influence on the establishment of surgical access, the posterior group of renal calyces was divided into 3 major types. Pot-belly type: the renal pelvis is shaped like a pot-belly, and the renal pelvis is directly connected to the cup-shaped minor calyces without a distinct major renal calyces. Classically branched: 2 or more major renal calyces are branched and converge to form the renal pelvis. Elongated branched: the major calyces are branched, with at least one major calyces having an axis length ≥0.9cm and a neck width ≤0.3cm.The classic branching type is divided into three types, a, b, and c, including seven subtypes, based on the relationship of the posterior group of the minor calyces to the major calyces. Type a is derived from group 1 major calyces only, type b is derived from group 2 major calyces at the same time, and type c is derived from the upper, middle and lower groups of major calyces at the same time. Type a contains 3 subtypes.Type a1 is derived from the upper group of major calyces only, type a2 is derived from the middle group of major calyces only, and type a3 is derived from the lower group of major calyces only. Type b is also divided into 3 subtypes. Type b1 is derived from the upper and middle groups of major calyces at the same time, type b2 is derived from the middle and lower groups of major calyces at the same time, and type b3 for the upper and lower renal major calyces. Type c had no corresponding subtype.Results:Statistical findings revealed that all kidneys had posterior group calyces. The morphological typing of the posterior group of calyces was 8.83% (113/1 280) for the pot-bellied type, which had the highest occurrence of 2 minor calyces (5.63%, 72/1 280). 71.25% (912/1 280) had the classically branched type, which had the highest occurrence of 3 minor calyces (31.17%, 399/1 280). 19.92% (255/1 280) had the elongated branched type, with the highest percentage of 3 occurring in the calyces (9.92%, 127/1 280). The anatomical typing of the classical branching type occurred in 20.50% (187/912) for type a, 66.45% (606/912) for type b, and 13.05% (119 /912) for type c. The percentage of occurrence of type a1/a2/a3 was 4.06% (37/ 912), 6.14% (56/ 912), and 10.31% (94/912). b1/b2/b3 types occurred in 2.03% (21/912), 7.46% (68/912), and 56.69% (517/912), respectively.Conclusions:The posterior group of calyces is structurally complex and extremely variable. In this study, the posterior group calyces were found to be present in all patients, and the posterior group calyces were morphologically divided into 3 types, with the highest percentage of occurrence of the classical branching type and the highest percentage of 3 posterior group minor calyces. The classical branching anatomical typing was highest in type b with the highest percentage of type b3, which combined with stone distribution, made it easy to choose the puncture location. The typing of the posterior group of calyces can provide an anatomical basis for PCNL puncture from the posterior group.

Objective:To analyze the clinical features and mutation of myeloid differentiation factor 88 (MYD88) L265P in patients with diffuse large B-cell lymphoma (DLBCL) of central nervous system (CNS).Methods:The clinicopathological materials of 45 cases of DLBCL of CNS were retrospectively collected in Xuanwu Hospital, Capital Medical University from September 2014 to February 2017. The clinicopathological data were retrospectively analyzed, combined with immunohistochemistry, EB virus in situ hybridization, imaging and medical history. The mutation of MYD88 L265P gene was detected by pyrosequencing and its clinical significance was analyzed. Results:The age of the patients ranged from 42 to 82 years [(57.6±8.8) years], including 24 males and 21 females. Totally 93.3% (42/45) of the patients had supratentorial tumours, which were single or multiple. The cerebral hemisphere (31/45, 68.9%) was the most common involved site, and 21 cases (21/45, 46.7%) had multiple lesions. Histologically, DLBCL in the CNS showed diffuse infiltration of tumor tissue, some of which grew around blood vessels in a "sleeve" arrangement. CD 20 and CD 79a were diffusely and strongly positive. Thirty-nine cases (39/45, 86.7%) were non-germinal center B cell (non-GCB) subtype and 6 cases (6/45, 13.3%) were germinal center B cell (GCB) subtype. MYD88 L265P mutation was found in 64.4% (29/45) patients. There was statistically significant difference between non-GCB type (71.8%, 28/39) and GCB type DLBCL (1/6, P=0.017). Compared with the operation/biopsy group without chemotherapy, operation+chemotherapy, biopsy+chemotherapy, operation/biopsy+chemotherapy+stem cell transplantation can improve the survival and prognosis ( HR=0.05, 95% CI 0.01-0.33 , P=0.002; HR=0.04, 95% CI 0.01-0.36 , P=0.004; HR=0.01, 95% CI 0.00-0.17 , P=0.001; respectively). Conclusions:DLBCL of the CNS is aggressive tumor with poor prognosis, the clinical manifestations are complex and diverse, and the diagnosis is challenging. MYD88 L265P is a common and specific gene mutation in primary CNS lymphoma(PCNSL), which is of great significance in the diagnosis and treatment of lymphoma. The MYD88 L265P mutation was more frequently detected in non-GCB than GCB subtype. Chemotherapy can improve the survival rate of PCNSL patients. If chemotherapy achieves complete remission and autologous hematopoietic stem cell transplantation is performed, there may be a chance of long-term survival.

Objective:To investigate the feasibility and effect of applying the island pre-expanded supratrochlear artery flap to treat mid-facial giant nevus near the nose in children.Methods:From January 2019 to January 2021, 10 cases of midfacial giant nevus patients were treated with the island pre-expanded supratrochlear artery flap in the Department of Burn and Plastic Surgery of Children’s Hospital of Nanjing Medical University. The process of treatment was divided into three stages. Stage 1: The expander capacity was determined according to the lesion size. The expander was implanted under the frontal muscle, and the flap was regularly expanded postoperatively. Stage 2: The expander was removed, and the lesion was excised. The expanded flap was designed according to the shape and size of the lesion. Stage 3: The transferred flap was trimmed. The postoperative complications and the blood supply after flap transfer were observed. The treatment effect was evaluated during the follow-up after the operation.Results:A total of 10 children were included in this group, including six males and four females, aged 4-12 years, with an average age of 7.8 years. Six patients underwent three-stage surgery, and four patients underwent two-stage surgery. During the first stage, a 100-400 ml renal expander was implanted, and tissue expansion was conducted once or twice a week. The expansion lasted 10 to 12 weeks (average, 11.4 weeks). Complications such as leakage, angle, and blood supply obstruction were not observed during the expansion process. The size of the expanded frontal flap was 7 cm × 6 cm ~ 12 cm ×10cm. Venous congestion occurred at the distal end of the flap in 2 cases, which was treated by partial suture removal and acupuncture bleeding treatment. No flap necrosis occurred. The donor sites were closed directly. No recurrence was observed during the 3-month to 1-year follow-up period. All expanded flaps had no obvious contraction with a good match of color and texture.Conclusions:The island pre-expanded supratrochlear artery flap provides an ideal selection of donor site for a large mid-facial defect with a reliable effect. The scar in the middle face and secondary deformities can be avoided.

Objective:To investigate the treatment of autologous fat grafting (AFG) for breast reconstruction of soft tissue defects in pediatric Poland syndrome (PS) with computer-assisted calculation.Methods:Patients with PS were recruited in Children’s Hospital of Nanjing Medical University from January 2016 to January 2021. The children were divided into two groups: CT-assisted group and control group. CT-assisted group were examined by CT scan before operation. The imaging data were imported to 3D Slicer Software. Three -dimensional (3D) reconstruction of thoracis soft tissue in defected side were created in the software with the healthy side served as controls. The obtained 3D image was divided into six sections and the volume of each section was calculated. The interest 3D model was fabricated by using a 3D resin printer. The autologous fat grafting was made in PS patients under the 3D printing model guidance. Patients in control group for AFG that the volume of fat determined by surgeon experience without CT scan. The following outcomes were studied: postoperative breast contour, local complications and major systemic complications. Patients were reviewed at six months postoperatively. The satisfaction scores were made by physicians and patient’s guardians, respectively. The scores were analyzed by the independent samples t-test. P< 0.05 was considered statistically significant. Results:18 patients is in CT-assisted group, 8 males, 12 females, the age range from 3-12 years, mean age: 8.3 years. 10 cases underwent once injection, 6 cases underwent twice injections and 3 times in 2 cases, the average is 1.5 times. 18 patients are in control group, 4 males, 14 females, the age range from 4-14 years, mean age: 8.1 years. 8 cases underwent once injection, twice in 5 cases, and 3 times in 5 cases, the average is 1.8 times. The follow-up ranged from 1 to 2 years. The chests were essentially symmetrical and upper limb and thoracic functions were unaffected, no serious local and systematic complications were observed in the CT-assisted group. Thoracic deformities were improved to various degrees in control group. There was chest induration in two cases at 6-month follow-up, which disappeared at 1-year follow-up without any treatment. The physician satisfaction score grades in the control group and CT-assisted group: very satisfied 7 and l2 cases, satisfied 8 and 6 cases, general 3, respectively. The patient’s satisfaction score grades in the control group and CT-assisted group: very satisfied 7 and l2 cases, satisfied 10 and 6cases, general 1 , respectively. The physician satisfaction scores in the CT-assisted group and control group were 83.56±7.90, 75.67±13.63, respectively, which showing statistically significant differences ( t=2.13, P=0.041). Furthermore, the patient’s guardian satisfaction scores in the CT-assisted group and control group are 84.39±7.77, 78.28±9.82, respectively, which showing statistically significant differences ( t=2.07, P=0.046). Conclusions:AFG under computer guidance is an individualized surgical method based on children’s own characteristics in improving chest deformity of PS patients, following with high postoperative satisfaction.

Objective:To investigate the feasibility and effect of applying the island pre-expanded supratrochlear artery flap to treat mid-facial giant nevus near the nose in children.Methods:From January 2019 to January 2021, 10 cases of midfacial giant nevus patients were treated with the island pre-expanded supratrochlear artery flap in the Department of Burn and Plastic Surgery of Children’s Hospital of Nanjing Medical University. The process of treatment was divided into three stages. Stage 1: The expander capacity was determined according to the lesion size. The expander was implanted under the frontal muscle, and the flap was regularly expanded postoperatively. Stage 2: The expander was removed, and the lesion was excised. The expanded flap was designed according to the shape and size of the lesion. Stage 3: The transferred flap was trimmed. The postoperative complications and the blood supply after flap transfer were observed. The treatment effect was evaluated during the follow-up after the operation.Results:A total of 10 children were included in this group, including six males and four females, aged 4-12 years, with an average age of 7.8 years. Six patients underwent three-stage surgery, and four patients underwent two-stage surgery. During the first stage, a 100-400 ml renal expander was implanted, and tissue expansion was conducted once or twice a week. The expansion lasted 10 to 12 weeks (average, 11.4 weeks). Complications such as leakage, angle, and blood supply obstruction were not observed during the expansion process. The size of the expanded frontal flap was 7 cm × 6 cm ~ 12 cm ×10cm. Venous congestion occurred at the distal end of the flap in 2 cases, which was treated by partial suture removal and acupuncture bleeding treatment. No flap necrosis occurred. The donor sites were closed directly. No recurrence was observed during the 3-month to 1-year follow-up period. All expanded flaps had no obvious contraction with a good match of color and texture.Conclusions:The island pre-expanded supratrochlear artery flap provides an ideal selection of donor site for a large mid-facial defect with a reliable effect. The scar in the middle face and secondary deformities can be avoided.

Objective:To investigate the treatment of autologous fat grafting (AFG) for breast reconstruction of soft tissue defects in pediatric Poland syndrome (PS) with computer-assisted calculation.Methods:Patients with PS were recruited in Children’s Hospital of Nanjing Medical University from January 2016 to January 2021. The children were divided into two groups: CT-assisted group and control group. CT-assisted group were examined by CT scan before operation. The imaging data were imported to 3D Slicer Software. Three -dimensional (3D) reconstruction of thoracis soft tissue in defected side were created in the software with the healthy side served as controls. The obtained 3D image was divided into six sections and the volume of each section was calculated. The interest 3D model was fabricated by using a 3D resin printer. The autologous fat grafting was made in PS patients under the 3D printing model guidance. Patients in control group for AFG that the volume of fat determined by surgeon experience without CT scan. The following outcomes were studied: postoperative breast contour, local complications and major systemic complications. Patients were reviewed at six months postoperatively. The satisfaction scores were made by physicians and patient’s guardians, respectively. The scores were analyzed by the independent samples t-test. P< 0.05 was considered statistically significant. Results:18 patients is in CT-assisted group, 8 males, 12 females, the age range from 3-12 years, mean age: 8.3 years. 10 cases underwent once injection, 6 cases underwent twice injections and 3 times in 2 cases, the average is 1.5 times. 18 patients are in control group, 4 males, 14 females, the age range from 4-14 years, mean age: 8.1 years. 8 cases underwent once injection, twice in 5 cases, and 3 times in 5 cases, the average is 1.8 times. The follow-up ranged from 1 to 2 years. The chests were essentially symmetrical and upper limb and thoracic functions were unaffected, no serious local and systematic complications were observed in the CT-assisted group. Thoracic deformities were improved to various degrees in control group. There was chest induration in two cases at 6-month follow-up, which disappeared at 1-year follow-up without any treatment. The physician satisfaction score grades in the control group and CT-assisted group: very satisfied 7 and l2 cases, satisfied 8 and 6 cases, general 3, respectively. The patient’s satisfaction score grades in the control group and CT-assisted group: very satisfied 7 and l2 cases, satisfied 10 and 6cases, general 1 , respectively. The physician satisfaction scores in the CT-assisted group and control group were 83.56±7.90, 75.67±13.63, respectively, which showing statistically significant differences ( t=2.13, P=0.041). Furthermore, the patient’s guardian satisfaction scores in the CT-assisted group and control group are 84.39±7.77, 78.28±9.82, respectively, which showing statistically significant differences ( t=2.07, P=0.046). Conclusions:AFG under computer guidance is an individualized surgical method based on children’s own characteristics in improving chest deformity of PS patients, following with high postoperative satisfaction.