Objective To establish an early prediction model for the diagnosis of severe acute pancreatitis based on the improved machine learning models,and to analyze its clinical value.Methods A case-control study was conducted on 352 patients with acute pancreatitis admitted to the Gastroenterology and Hepatobiliary Surgery Departments of the Army Medical Center of PLA and Emergency and Critical Care Medicine Department of No.945 Hospital of Joint Logistics Support Force of PLA from January 2014 to August 2023.According to the severity of the disease,the patients were divided into the severe group(n=88)and the non-severe group(n=264).The RUSBoost model and improved Archimead optimization algorithm was used to analyze 39 routine laboratory biochemical indicators within 48 h after admission to construct an early diagnosis and prediction model for severe acute pancreatitis.The task of feature screening and hyperparameter optimization was completed simultaneously.The ReliefF algorithm feature importance rank and multivariate logistic analysis were used to analyze the value of the selected features.Results In the training set,the area under curve(AUC)of the improved machine learning model was 0.922.In the testing set,the AUC of the improved machine learning model reached 0.888.The 4 key features of predicting severe acute pancreatitis based on the improved Archimedes optimization algorithm were C-reactive protein,blood chlorine,blood magnesium and fibrinogen level,which were consistent with the results of ReliefF algorithm feature importance ranking and multivariate logistic analysis.Conclusion The application of improved machine learning model analyzing the laboratory examination results can help to early predict the occurrence of severe acute pancreatitis.

Objective To explore the effect and predictive value of blood lactate level on bronchopulmonary dysplasia(BPD)in newborns with neonatal respiratory distress syndrome(NRDS).Methods A total of 78 children with NRDS admitted to the First People's Hospital of Pingdingshan from January 2019 to December 2022 were selected as the research subjects.Based on whether they had BPD,the children were divided into a BPD group and a non-BPD group.The general clinical data of the children,including gestational age,gender,birth weight,1-minute Apgar score,5-minute Apgar score,and premature rupture of membranes,were collected.At admission,1 mL of arterial blood was extracted from the children,and the blood lactate level,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),pH value,and oxygenation index(OI)were measured using a JM1113-739853 blood gas analyzer;3 mL of peripheral venous blood was extracted from the children,and the level of interleukin-6(IL-6)in the serum was detected by enzyme-linked immunosorbent assay,while the levels of C-reactive protein(CRP)and procalcitonin(PCT)in the plasma were detected by double antibody sandwich method.The general information,blood lactate levels,PaO2,PaCO2,pH value,OI,serum IL-6 levels,plasma CRP and PCT levels of children were compared between the two groups.The correlation between blood lactate levels and NRDS complicated with BPD was determined by point-biserial correlation analysis,the influencing factors of NRDS complicated with BPD was analyzed by logistic regression,and the predictive value of blood lactate levels for NRDS complicated with BPD was analyzed by receiver operating characteristic curve.Results The blood lactate levels of 78 children with RDS ranged from 3.35 to 6.64(5.04±0.72)mmol·L-1.There were 16 children with BPD,with an incidence rate of 20.51％(16/78).The birth weight and OI of children in the BPD group were significantly lower than those in the non-BPD group,while the serum IL-6,plasma CRP,and blood lactate levels were significantly higher than those in the non-BPD group(P＜0.05).There was no statistically significant difference in gestational age,gender,1-minute Apgar score,5-minute Apgar score,premature rupture of membranes,PaO2,PaCO2,pH value,and PCT of children between the two groups(P＞0.05).The point-biserial correlation analysis showed that blood lactate,serum IL-6,and plasma CRP levels were positively correlated with the risk of BPD in children with NRDS(r=0.502,0.475,0.507;P＜0.05);while birth weight and OI were negatively correlated with the risk of BPD in children with NRDS(r=-0.242,-0.403;P＜0.05).Logistic regression analysis showed that blood lactate accumulation,high expression of serum IL-6,high expression of plasma CRP,and decreased OI were risk factors for BPD in children with NRDS(P＜0.05).The area under the curve for predicting BPD in children with NRDS based on blood lactate was 0.865,with a 95％confidence interval of 0.776 to 0.955;when the cut-off value of blood lactate was 5.065 mmol·L-1,the sensitivity and specificity of predicting BPD in children with NRDS were 0.938 and 0.501,respectively.Conclusion There is a positive correlation between blood lactate levels and the risk of BPD in children with NRDS.Blood lactate accumulation is a risk factor for NRDS complicated with BPD,and blood lactate level has a certain predictive value for NRDS complicated with BPD.

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.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

A novel coronavirus pneumonia (NCP) epidemic has occurred in Wuhan, Hubei Province since December 2019, caused by a novel coronavirus (2019-nCoV) never been seen previously in human. China has imposed the strictest quarantine and closed management measures in history to control the spreading of the disease. However, severe trauma can still occur in the NCP patients. In order to standardize the emergency treatment and the infection prevention and control of severe trauma patients with hidden infection, suspected or confirmed infection of 2019-nCoV, Trauma Surgery Branch of Chinese Medical Doctors' Association organized this expert consensus. The consensus illustrated the classification of the NCP patients, severe trauma patients in need of emergency surgery, emergency surgery type, hierarchical protection for medical personnel and treatment places. Meanwhile, the consensus standardized the screening, injury severity evaluation, emergency surgical treatment strategy and postoperative management strategy of severe trauma patients during the epidemic period of NCP, providing a basis for the clinical treatment of such kind of patients.

Objective To investigate the diagnosis and treatment method of complicating acute pulmonary embolism(APE) after surgery in ICU.Methods Ten patients with complicating APE after surgery in ICU of this hospital from July 2014 to November 2016 were selected.Their clinical characteristics,age,basic diseases,clinical diagnosis and treatment process were retrospectively analyzed.Results Ten cases occurred on mean postoperative(2.4 ± 1.1) d,which manifested by different degrees of respiratory failure,circulatory failure,renal function failure,chest pain,hemoptysis and cough.10％ and 40％ respectively.Five cases(50％) used rt-PA thrombolysis,2 cases(20 ％) were treated with low molecular weight heparin anticoagulation and 3 cases (30 ％) were treated with heparin anticoagulation,One case(10 ％) died after treatment,1 case(10 ％) was discharged from hospital and 8 cases (80％)were improved and discharge from ICU.Conclusion Postoperative complicating pulmonary embolism has high probability.The postoperative complicating pulmonary embolism risk should be evaluated for prevention as early as possible.If APE occurs,adopting thrombolysis or anticoagulation therapy has good effect.

An atmospheric pressure chemical ionization mass spectrometry (APCI-MS) method was developed for the direct analysis of triglycerides in edible oils.The edible oil sample was dissolved in acetonitrile.Under the optimal conditions such as positive ion detection,800 μL/h of sample flow rate,250℃ of vaporizer temperature and 5000 nA of corona needle current,the repeatability (RSD) of peak intensity rate of m/z 857.76 to m/z 881.76 was less than 5％.Then,different kinds of oil from different manufacturers were analyzed by the proposed method.After a principal component analysis for the analytical results,the peak intensity rate of m/z 857.76 and m/z 881.76 was selected for oil identification.The adulteration of 5％ lard in corn oil could be recognized directly using the peak intensity rate.Three characteristic triglycerides in edible oil were preliminarily identified by collision induced dissociation (CID) experiments.The method was applied to analyze the swill oil and fried oil samples,and the results showed that the swill oil contained both vegetable oil and animal fat,and the fried oil was also different with commercial vegetable oil.

Objective To explore the effects of different concentrations of propofol postconditioning against glutamate neurotoxicity to brain slices of neonatal rats.Methods The brain slices of neonatal rats were prepared and cultured in complete medium.They were randomly divided into five groups:the normal control group,glutamate injury group(RI group),1 mg/L propofol postconditioning group(PL1+RI group),3 mg/L propofol postconditioning group(PL3+RI group),5 mg/L propofol postconditioning group(PL5+RI group),12 cases in each group.The RI,PL1+RI,PL3+RI,PL5+RI groups were cultured for 6 days,then the brain slices were moved into the culture medium containing glutamate(1 mmol/L) and incubated for 30 minutes.And then,respectively,the brain slices of RI group were put into another complete culture medium,the PL1+RI group,PL3+RI group and PL5+RI group were put into the medium containing corresponding concentrations of propofol medium and long chain fat emulsion injection.All of the above were cultured for 24 hours in order to establish the injury model.The numbers of the Nissl body,the LDH release rates and the brain tissue damage rates of each brain slice were detected to evaluate the effects of propofol postconditioning on the reperfusion injury in the glutamate-damaged brain slices of neonatal rats.Results Compared with the RI group,the numbers of the Nissl body of the PL1+RI group,PL3+RI group and PL5+RI were higher,the LDH release rates and the brain tissue damage rates of the PL1+RI group,PL3+RI group and PL5+RI were lower,the diferences were significant(P<0.05).Among the three PL+RI groups,the LDH release rates and the brain tissue damage rates of the PL3+RI group were lower than those of the other two groups,the diferences were significant(P<0.05),at the same time,the numbers of Nissl body were more than the other two groups,the diferences were significant(P<0.05).Conclusion Propofol postconditioning has protective effects on the reperfusion injury in the glutamate-damaged brain slices of neonatal rats.However,the protective effects are not dose-dependent,and 3 μg/mL is the best dose of propofol to keep the glutamate-damaged brain slices from reperfusion injury in this research.

Objective: To study the clinical features and treatment of children with influenza, and provide evidence for clinical screening and appropriate treatment timely. Methods: Epidemiology, clinical manifestations, laboratory features and drug therapy of 978 pediatric patients with influenza in Beijing New Century International Children's Hospital in 2014 were analyzed retrospectively. Results: Among the 978 pediatric patients with influenza, 90.8%were outpatients, while 9.92% were inpatients. The incidence was the highest in winter (85.28%). The age of most cases ranged from 1 to 5 years (57.16%). The cases with type A influenza accounted for 81.29%. High fever (99.59%) and cough (85.89%) were the two main symptoms. The average count of WBC was 6.86±2.68×10⁹/L, lymphocyte percentage was lower than the proportion of neutrophils. CRP was normal (66.16%) or slightly-increased (19.00± 15.12 mg/l). Compared with type A influenza, digestive tract symptoms were more common in cases with type B (P=0.000). Analysis of 97 hospitalized cases: the main diagnosis was lower respiratory tract infection (71.13%). Nearly 23.71% cases had been detected to have combined infection with other pathogenic agents. Course of fever in cases who started taking oseltamivir after fever of 48 hours was significantly longer than those who took within 48 hours (P=0.000). Seven severe pneumonia cases were mainly in young children, cases with underlying disease or mixed infection, they were all cured by active and comprehensive therapy. Conclusions Influenza in children is characterized by high fever and cough, digestive tract symptoms frequently occurred in patients with type B influenza. Early application of oseltamivir could signficantly shorten the period of fever. Severe cases should be given active and comprehensive treatments.

Objective To investigate the effect and mechanism of necrostatin-1 (Hec-1) on the level of HMGB-1 protein in liver of rats with hemorrhagic-traumatic shock.Methods A number of 96 male SD rats were divided into sham-operated group,dimethyl sulfoxide (DMSO) group and Nec-1 group (n=32in each) by randomized number method.Rat model of hemorrhagic-traumatic shock was made by fracture of femoral bone and tibia bone and exsanguination from femoral vein until 30 mmHg and maintained at 30-40 mmHg for 90 min,then the shed blood was transfused back with Ringer's solution.The rats in shamoperated group were only under anesthesia for separating and ligating blood vessels,without exsanguination to induce hemorrhagic shock and without replenishment with blood.Rats in Nec-1 group were given 1 mg/kg Nec-1 through femoral vein 5 min before replenishment with blood and Ringer' s solution,while the rats in DMSO group were given equal volume of DMSO solution instead.Eight rats in each group were sacrificed separately at 2 h,8 h,16 h and 24 h after replenishment.The serum and liver tissues of rats in each group were collected to detect serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST),and to observe the pathological changes in liver with hematoxylin-eosin (HE) staining.The level of HMGB-1 in serum was detected by using ELISA.The cytoplasm protein and total protein expressions of HMGB-1 were assessed by using western blot analysis.Results Compared with DMSO group,levels of serum ALT at 8 h (P ＜0.05),16 h (P ＜ 0.01) and 24 h (P ＜ 0.01) in Nec-1 group were significantly lower.Level of serum AST in Nec-1 group were lower compared with DMSO group at 8 h (P ＜ 0.01),16 h (P ＜ 0.01) and 24 h (P ＜0.01).Compared with DMSO group,levels of serum HMGB-1 at 8 h (P ＜ 0.05),16 h (P ＜0.01) and 24 h (P ＜ 0.01) in Nec-1 group were significantly lower.Under light microscopy and transmission electron microscope,hepatic lobule destroyed,the blood extravasated,the immunocyte infiltrated and cellular organelle destroyed were found.Compared with DMSO group,the level of HMGB-1 protein in cytoplasm protein in Nec-1 group were significantly decreased at 8 h (P ＜ 0.01),16 h (P ＜0.01) and 24 h (P ＜0.01).The level of HMGB-1 protein in total protein in Nec-1 group were significantly decreased 8 h (P ＜ 0.05) and 24 h (P ＜ 0.05).Conclusions Nec-1 can remarkably protect the liver of rats with hemorrhagic-traumatic shock,decrease the level of HMGB-1,and protect the hepatocyte effectively.