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.

Bluetongue virus is an arbovirus that seriously harms ruminants such as sheep,this study aims to investigate the molecular mechanism of bluetongue virus infection and host cell interferon antiviral immune response.The study was conducted to characterize the mRNA expression of inter-feron pathway genes by real-time fluorescence quantitative PCR,as well as Western blot analysis of MDA5,TRAF3,RIG-Ⅰ,and TBK1 protein expression in BHK-21 cells induced by BTV with a multiplicity of infections(MOI)of 1 for 18,24,and 36 h.The results showed that the most pro-nounced changes in the expression of interferon signaling pathway genes were observed at 24 h of induction,the gene mRNA expression levels of the IFN-α,IFN-β,RIG-Ⅰ,TBK1,MDA5,VISA,and TRAF3 genes were upregulated.However,the mRNA expression levels of IKKε and TRAF6 genes were downregulated.At the protein level,MDA5 and TBK1 proteins were upregulated while RIG-1 and TRAF3 proteins were downregulated,which showed that BTV infection induces a typeⅠ interferon immune response in BHK-21 cells.This study lays the foundation for further exploring the antiviral immunity mechanism of IFN-Ⅰ signaling pathway regulatory genes in host cells infected with BTV infection.

【Objective】 To analyze ABO system hemolytic disease of the fetus and newborn (HDFN) and its influencing factors in Obstetrics Department of our hospital. 【Methods】 The blood samples of 1 040 neonates and their mothers in the obstetric department of our hospital were retrospectively analyzed from September 2022 to January 2023, including ABO and RhD blood group of the neonates and mothers, as well as 3 tests of HDFN, Hb, total bilirubin (TBIL) and indirect bilirubin(IBIL) of the neonates. Relevant clinical data of the neonates and mothers were collected, including maternal and neonatal age, neonatal sex, maternal pregnancy history, gestational age and delivery mode, and their influences on ABO-HDFN were analyzed. 【Results】 Among 1 040 HDFN samples, 298 were ABO incompatibility, among which 113 were HDFN positive, with a positive rate of 37.9% (113/298); the positive rate of HDFN in neonates born to mothers with type O was significantly higher than that in neonates born to mothers with type A and B (71.4% vs 8.2%, P<0.05); the positive rate of HDFN in neonates with antigen-A incompatibility was significantly higher than that in neonates with antigen-B incompatibility (48.7%vs 26.7%, P<0.05), which was the highest in neonates with O-A incompatibility [83.6% (61/73)], followed by O-B incompatibility [58.2% (39/67)]. There was no significant difference in Hb and bilirubin among the other groups except for the difference of Hb between the O-A incompatibility HDFN positive group and the HDFN negative group [(145.0±16.0) vs(153.4±13.2), P<0.05)]. The levels of Hb, TBIL and IBIL in the "direct antiglobulin test+ indirect antiglobulin test+release test+" group were significantly different from those in the HDFN negative group[(144.9±21.6) vs (153.3±13.2), P <0.05; (36.9±11.8) vs (29.6±6.1), P<0.05; (30.6±12.7) vs (23.0±6.9), P<0.05, respectively]. Logistic regression analysis showed that maternal delivery frequency, mother-neonate incompatible antigen and maternal blood type were independent risk factors for HDFN. 【Conclusion】 ABO-HDFN occurred mainly in neonates born to O-type mothers, and the positive rate was the highest in neonates with O-A incompatibility. The severity of HDFN had little relationship with the mother-neonate blood type, but had relationship with the result of 3 tests of HDFN. Maternal delivery frequency, mother-neonate incompatible antigen and maternal blood type were independent risk factors for HDFN.

OBJECTIVE: To explore the molecular basis for an A subtype of the ABO blood group. METHODS: The forward and reverse typing of the ABO blood group were identified by gel card and test tube methods. The ABO gene of the patient was detected by PCR-sequence specific primer (PCR-SSP). Exons 1 to 7 of the ABO gene was amplified by PCR and sequenced. The ABO gene was also subjected to subclone sequencing for haplotype analysis. RESULTS: The patient's red cells showed weak agglutination with anti-A but non-agglutination with anti-B. The patient's serum showed 1+ agglutination with A cells and 4+ agglutination with B cells. Based on above serological characteristics, the patient was defined as Aw subtype of the ABO blood group. Sequencing analysis showed that the patient was heterozygous for c.106G>T, c.188G>A, c.189C>T, c.220C>T, c.297A>G, c.467C>T, c.543G>C, c.646T>A, c.681G>A, c.771C>T, c.829G>A, in addition with a c.261G deletion. Combined with the result of subclone sequencing, the ABO genotype of the patient was determined as ABO*AW.33. new/O.01.02, which harbored c.467C>T and c.543G>C variants compared with ABO*A1.01 and c.543G>C variant compared with ABO*A1.02. The novel allele has been submitted to GenBank with an accession number of MK302122. CONCLUSION A novel allele of Aw33 subtype has been identified with its GTA transferase gene harboring c.467C>T and c.543G>C variants compared with A1.01.
ABO Blood-Group System ; genetics ; Alleles ; Exons ; genetics ; Genotype ; Humans ; Phenotype

Objective:To explore the effect of the Six Sigma management in reducing the pre-examination and triage error rate of emergency acute abdominal diseases.Methods:Data of 367 misdiagnosed patients in Emergency Department of Shanxi Bethune Hospital from January to June 2018 were collected. Six Sigma management method was applied to the management of emergency acute abdomen triage. After analyzing the causes of errors, improvement measures were formulated and implemented.A total of 118 patients who were triaged from September 2018 to February 2019 were taken as the intervention group to evaluate the effect.Results:After the implementation of Six Sigma management, the errors of acute abdomen diagnosis were significantly reduced from 9.92%(367/3 698) to 2.80%(118/4 219), and there was a significant difference before and after the implementation ( χ2 value was 174.082, P < 0.05). Conclusions:The application of Six Sigma management method can effectively reduce the misdiagnosis rate of emergency acute abdomen triage and realize standardized management of acute abdomen triage, which has the value of popularization and application.

Objective: To explore the effect of Teach-back health education model on health education for patients after percutaneous coronary intervention (PCI). Methods: Eighty patients after PCI operation in cardiology were selected, 40 patients selected from February to March as control group and 40 patients selected from April to May as observation group according to the time of admission in 2018. The control group used the routine health education method, based on this, the observation group used the "Teach-back" health education model to healthy educate patients. Three months after the intervention, the results of body mass index (BMI), triglycerides, total cholesterol, low-density lipoprotein, Seattle angina questionnaire (SAQ), and Morisky questionnaire were evaluated. Results: After 3 months of intervention, the triglyceride, total cholesterol, and low-density lipoprotein in the observation group were (1.35±0.43), (3.99±0.57), and (2.32±0.24) mmol/L, which were lower than the control group (1.63±0.38), (4.31±0.73), (2.61±0.28) mmol/L, the difference between the two groups was statistically significant (t=3.082, 2.717, 5.048, P<0.01 or 0.05). After 3 months of intervention, evaluate the SAQ score of the observation group, the degree of physical limitation, the stability of angina pectoris, the degree of angina pectoris, the satisfaction of treatment, and the disease cognition were respectively (76.16±5.03), (88.75±14.92), and (84.25±12.17), (84.76±5.11), (82.79±9.64) points, which were higher than the control group (68.94±9.80), (80.63±17.44), (76.25±12.34), (70.80±7.00), (70.50±13.85) points, the differences were statistically significant (t=-4.145, Z=-5.848--2.166, P < 0.05). After 3 months of intervention, the Morisky questionnaires of the observation group and the control group were (2.43±0.78) and (3.80±0.41) points, and the difference was statistically significant (Z=-6.848, P<0.05). Conclusion The application of Teach-back health education model to patients after PCI has a good effect.

Objective To investigate the status quo of oral nursing in the emergency department of top three hospitals in Shanxi province, and to analyze the existing problems so as to provide the basis and reference for improving the clinical operation standard. Methods In the form of WeChat questionnaire, a questionnaire survey was conducted to investigate 190 nurses who met the requirements in emergency departments of 6 top three hospitals in Shanxi province. Results All the 6 hospitals surveyed did not incorporate oral care into the nurse examination program; 28.42％(73/190) of the subjects had oral assessments of endotracheal intubation according to their clinical experience;chlorhexidine (70.00％,133/190) and physiological saline (65.79％,125/190) were the most commonly used oral care solutions in clinic;48.42％(92/190) of nurses performed this operation for 6-10 min;91.58％(114/190) of nurses believed that oral care played an important role in the recovery of these patients. Conclusions The oral care and oral care of the patients in the emergency department are mostly clinical experience, so it is urgent to establish a unified standard of implementation on the basis of evidence. The professional knowledge of oral nursing of the patients undergoing oral trachea intubation is low, so it is suggested that the training of emergency nurses be strengthened and the operation should be included in the assessment of nursing operations.

Objective To construct an evaluation index system which is suitable for the competence standard of specialized nurses in Shanxi province and provide reference for the construction of competence standard for nurses from different departments. Methods Two rounds of expert consultations were conducted on 54 nursing directors of the class III grade A hospitals in Shanxi province, to determine the indexes and weights of the competence evaluation index system of specialized nurses. Results The capability index system of various specialized nursing ability standards including 8 primary indexes and 27 secondary indexes was established. Among those indexes, the experts' criterion coefficient, familiarity degree and authority coefficient were 0.89, 0.75 and 0.82 respectively. The Kendall Concorde coefficient of the competence standard showed W=0.143, χ2=201.314,P< 0.001. Conclusions Experts have a high level of enthusiasm, authority and good coordination. The standardized evaluation index system of specialized nurses can provide the basis for the training, assessment and evaluation of the competence standard of specialized nurses.

Objective:To construct the lentiviral vector over-expressing Staphylococcus aureus enterotoxin C3 and detect the expression of target gene in vitro.Methods:SEC3 gene were amplificatied by polymerase chain rcaction( PCR).The GV365 lentiviral vectors were digested by AgeⅠenzyme,which was linked to SEC3 gene and then constructed the GV365-SEC3 lentiviral vetor.Positive clones of vectors were identificd by PCR.Then the positive lentiviral vectors were transfected into 293T cells for lentivirus package.The expression of lentiviral vectors was tested by observating cell fluorescence and Western blot.The virus titer was determined by HIV-1 p24 ELISA.Results: SEC3 gene was amplified and successfully bound to the GV365 lentivirus vectors.The sequences of the recombinant plasmid were confirmed correct by PCR and DNA scqucncing.A large mass of green fluorescent cells were observed after transfecting.And the resulting size of 29 kD protein band of protein electrophoresis, which was consistent with the target gene protein.Viral vector titer was 5×108 TU/ml by ELISA detection.Conclusion: Lentiviral vector over-expressing Staphylococcus aureus enterotoxin C3 was successfully constructed,laid the foundation of observing its effect and mechanism against to tumor in vivo and in vitro for later research.