Objective To investigate the impact of human leukocyte antigen(HLA)functional epitope mismatch(EM)on the efficacy of platelet transfusion in patients with hematological diseases.Methods HLA genotyping was performed on platelet donors and patients with hematological diseases who applied for platelet serological cross-matching and HLA antigen matching from June 2021 to June 2023 by PCR-SBT method.HLA platelet matching was based on the principle of CREG to se-lect donors for patients.HLA Matchmaker 4.0 software was used to analyze donor-recipient HLA EM information.The expres-sion level and gene distribution of related HLA functional epitope(Eplet)were searched from the international HLA Epitope registry website(www.Epregistry.com.br).Retrospective analysis was conducted on clinical platelet transfusion data to evalu-ate the impact of HLA EM on platelet transfusion effectiveness.Results Platelet transfusion efficacy showed no correlation with gender and age,but it was associated with platelet matching strategy.When the total number of HLA EMs was less than 20,a lower total number of donor-recipient HLA EMs resulted in higher platelet transfusion efficiency(χ2=19.311,P=0.001)and higher average value of 24 h corrected count increment(CCI)(F=7.737,P<0.001).The total number of donor-recipient HLA EMs had negative correlation with actual 24 h CCI(Rho=-0.322,P<0.001).Further statistical analysis re-vealed that 17 Eplets were related to the effectiveness of platelet transfusion.The locus distribution of 17 Eplets might be u-nique to HLA-A(17.6%)or-B(64.7%)or shared between HLA-A and-B(17.6%),and its expression may be high(58.8%)or intermediate(41.2%).Conclusion The total number of donor-recipient HLA EMs is a crucial factor influencing platelet transfusion effectiveness,and several HLA Eplets associated with this effectiveness have been identified.

Objective:To investigate the surgical effect of pedicled upper lip mucosal flap in repairing nasal septal mucosal defects after rhinoplasty.Methods:A retrospective analysis was performed from January 2016 to October 2022, the clinical data of patients with nasal septal mucosal defects after rhinoplasty were collected in the Department of Plastic and Aesthetic (Burn) Surgery at the Second Xiangya Hospital of Central South University. The pedicled upper lip mucosal flap was utilized for repair based on the patient’s medical history and wound condition. The pedicle of the flap was designed 1 cm adjacent to the frenulum of the upper lip, and an appropriate flap was incised based on the size of the wound, with dissection performed up to the superficial layer of the orbicularis oris muscle. The dissection establishes an upper lip tunnel that connects the gingival-buccal groove to the nasal cavity. The pedicled upper lip mucosal flap was elevated and transposed into the nasal cavity via the upper lip tunnel. The position of the flap was adjusted to ensure complete coverage and fixation of the nasal septal defect wound using 5-0 absorbable suture. The visual analogue scale (VAS) and the nasal obstruction symptom evaluation (NOSE) scale were utilized to facilitate patients’ satisfaction evaluation and assessment of nasal obstruction symptoms before surgery and at 6 months post-surgery. The VAS total score was 10 points, with higher scores indicating greater levels of patient satisfaction. The NOSE scale comprises of 5 items, each assigned a score ranging from 0 to 4, denoting absence of symptoms, very mild presence, moderate intensity, relatively severe manifestation, and highly severe indication respectively. The measurement data of VAS and NOSE scores before surgery and at 6 months post-surgery was expressed by Mean±SD, using paired t-test. The score distribution of the NOSE scale was represented by the number of cases, using Mann-Whitney U test. Results:The study included a total of 15 female patients, with an average age of (27.6±2.9) years (ranging from 23 to 33 years). Eleven cases presented with preoperative cartilage exposure, and the size of tissue defect ranged from 0.9 cm×0.5 cm to 1.5 cm×0.7 cm. Nine patients had a history of smoking. Skin grafting was performed in 9 patients, while nasal mucosal metastasis was observed in 8 patients. The dimensions of the flap varied from 4.0 cm×1.2 cm to 7.0 cm×1.5 cm. The postoperative recovery was satisfactory, with successful survival of the skin flaps and no occurrences of infection, hematoma, wound dehiscence, or flap necrosis. The average duration of follow-up was (8.2±2.1) months (ranging from 6 to 12 months). The postoperative VAS score (7.73±0.88) was significantly higher compared to the preoperative score (1.86±0.74) ( P<0.01). Additionally, the postoperative NOSE score (4.66±1.71) showed a significant decrease from the preoperative score (10.73±2.68), with a statistically significant difference ( P<0.01). Among them, after surgery items of stuffy or unbreathable nose (2 cases vs. 15 cases), nasal obstruction (1 case vs. 14 cases), and feeling that the nose was not enough to breathe during exercise or exertion (4 cases vs. 14 cases) scored≥2 points were significantly less than those before operation (all P<0.01). Conclusion:The utilization of pedicled upper lip mucosal flap in the reconstruction of severe nasal septal mucosal defects following rhinoplasty has proven to be highly effective. The postoperative satisfaction of patients is remarkably high, the ventilation function exhibits significant improvement, and no severe complications are observed.

The chest deformity result ing from ear reconstruction using autologous costal cartilage significantly impacts patients’ physical development and overall quality of life. In recent years, numerous scholars have conducted extensive research on the diagnostic and therapeutic processes of chest deformities following costal cartilage surgery. The objective of this article is to comprehensively review and summarize the measurement indicators, mechanism, influencing factors, prevention strategies, and research advancements pertaining to chest deformity following costal cartilage surgery. This will serve as a valuable reference for enhancing clinical practices.

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 investigate the surgical effect of pedicled upper lip mucosal flap in repairing nasal septal mucosal defects after rhinoplasty.Methods:A retrospective analysis was performed from January 2016 to October 2022, the clinical data of patients with nasal septal mucosal defects after rhinoplasty were collected in the Department of Plastic and Aesthetic (Burn) Surgery at the Second Xiangya Hospital of Central South University. The pedicled upper lip mucosal flap was utilized for repair based on the patient’s medical history and wound condition. The pedicle of the flap was designed 1 cm adjacent to the frenulum of the upper lip, and an appropriate flap was incised based on the size of the wound, with dissection performed up to the superficial layer of the orbicularis oris muscle. The dissection establishes an upper lip tunnel that connects the gingival-buccal groove to the nasal cavity. The pedicled upper lip mucosal flap was elevated and transposed into the nasal cavity via the upper lip tunnel. The position of the flap was adjusted to ensure complete coverage and fixation of the nasal septal defect wound using 5-0 absorbable suture. The visual analogue scale (VAS) and the nasal obstruction symptom evaluation (NOSE) scale were utilized to facilitate patients’ satisfaction evaluation and assessment of nasal obstruction symptoms before surgery and at 6 months post-surgery. The VAS total score was 10 points, with higher scores indicating greater levels of patient satisfaction. The NOSE scale comprises of 5 items, each assigned a score ranging from 0 to 4, denoting absence of symptoms, very mild presence, moderate intensity, relatively severe manifestation, and highly severe indication respectively. The measurement data of VAS and NOSE scores before surgery and at 6 months post-surgery was expressed by Mean±SD, using paired t-test. The score distribution of the NOSE scale was represented by the number of cases, using Mann-Whitney U test. Results:The study included a total of 15 female patients, with an average age of (27.6±2.9) years (ranging from 23 to 33 years). Eleven cases presented with preoperative cartilage exposure, and the size of tissue defect ranged from 0.9 cm×0.5 cm to 1.5 cm×0.7 cm. Nine patients had a history of smoking. Skin grafting was performed in 9 patients, while nasal mucosal metastasis was observed in 8 patients. The dimensions of the flap varied from 4.0 cm×1.2 cm to 7.0 cm×1.5 cm. The postoperative recovery was satisfactory, with successful survival of the skin flaps and no occurrences of infection, hematoma, wound dehiscence, or flap necrosis. The average duration of follow-up was (8.2±2.1) months (ranging from 6 to 12 months). The postoperative VAS score (7.73±0.88) was significantly higher compared to the preoperative score (1.86±0.74) ( P<0.01). Additionally, the postoperative NOSE score (4.66±1.71) showed a significant decrease from the preoperative score (10.73±2.68), with a statistically significant difference ( P<0.01). Among them, after surgery items of stuffy or unbreathable nose (2 cases vs. 15 cases), nasal obstruction (1 case vs. 14 cases), and feeling that the nose was not enough to breathe during exercise or exertion (4 cases vs. 14 cases) scored≥2 points were significantly less than those before operation (all P<0.01). Conclusion:The utilization of pedicled upper lip mucosal flap in the reconstruction of severe nasal septal mucosal defects following rhinoplasty has proven to be highly effective. The postoperative satisfaction of patients is remarkably high, the ventilation function exhibits significant improvement, and no severe complications are observed.

The chest deformity result ing from ear reconstruction using autologous costal cartilage significantly impacts patients’ physical development and overall quality of life. In recent years, numerous scholars have conducted extensive research on the diagnostic and therapeutic processes of chest deformities following costal cartilage surgery. The objective of this article is to comprehensively review and summarize the measurement indicators, mechanism, influencing factors, prevention strategies, and research advancements pertaining to chest deformity following costal cartilage surgery. This will serve as a valuable reference for enhancing clinical practices.

[Objective]To present Professor HE Ruoping's clinical experience in treating esophageal cancer.[Methods]Through the follow-up study,relevant medical cases were collected,organized and analyzed to describe the clinical experience of Professor HE Ruoping in the treatment of esophageal cancer in terms of the etiology and mechanism of the disease,and the rules and methods of treatment.A medical record was attached as evidence.[Results]Professor HE Ruoping believes that the pathogenic characteristic of esophageal cancer is a deficiency in origin and an enrichment in symptom.Deficiency in origin indicates weakness in Zang and Fu,while enrichment in symptom suggests there're Qi stagnation,phlegm,blood stasis and hot toxin."Strengthen healthy Qi,eliminate pathogens,and treat according to the symptoms"is the therapeutic approach used to treat esophageal cancer.The aim is to strengthen Zang and Fu,specifically the spleen,stomach and kidney.Treatments for anti-cancer mainly include moving Qi and dissipating mass,eliminating phlegm and removing blood stasis,clearing heat and toxin,etc.It emphasizes that the elimination of pathogenic factors should be carried out in an appropriate manner and should not hurt the body's positive Qi.Treating according to the symptoms means treating patients with various kinds of uncomfortable symptoms after surgery,radiotherapy and local stent placement to improve their quality of life.In the attached medical case,the above three principles were carried through the whole treatment process,and achieved good therapeutic effect.[Conclusion]By expounding the principle of"strengthen healthy Qi,eliminate pathogens and treat diseases according to the symptoms",it has summarized Professor HE Ruoping's clinical experience in the treatment of esophageal cancer,which is of some significance for the clinical treatment of this disease.

[Objective]To introduce Professor HE Ruofeng's clinical experience of treating uterine myoma with Liuwei Dihuang Pills.[Methods]Briefly discussing the meaning of Liuwei Dihuang Pills,summarizing Professor HE's understanding of the pathogenesis and treatment principles of uterine myoma and postoperative patients through learning from the master,compiling medical cases and clinical observation,and presenting case reports to support the conclusion.[Results]Professor HE believes that uterine myoma is a disease caused by dysfunction of the liver,kidney,spleen,abnormal Qi and blood,and deficiency of the body's resistance,with blood stasis accumulated in the uterus.Postoperative patients are weakened by surgery,and are prone to recurrence.Liuwei Dihuang Pills are used as the main treatment,aiming to nourish the kidneys and adrenals,regulate the liver and spleen,and break down blood and tumors.Emphasis is also placed on the psychological factors.The case report showed that Professor HE diagnosed the patient with liver and kidney deficiency and treated her with Liuwei Dihuang Pills modification,achieving good results.[Conclusion]Professor HE's use of Liuwei Dihuang Pills for postoperative uterine myoma patients provides a reference for the integration of traditional Chinese and western medicine,and has clinical value.

Ulcerative colitis(UC)is characterized by chronic relapsing intestinal inflammation.Currently,there is no effective treatment for the disease.According to our preliminary data,1,8-cineole,which is the main active compound of Amomum compactum Sol.ex Maton volatile oil and an effective drug for the treat-ment of pneumonia,showed remarkable anti-inflammatory effects on colitis pathogenesis.However,its mechanism of action and direct targets remain unclear.This study investigated the direct targets and mechanism through which 1,8-cineole exerts its anti-inflammatory effects using a dextran sulfate so-dium salt-induced colitis mouse model.The effects of 1,8-cineole on macrophage polarization were investigated using activated bone marrow-derived macrophages and RAW264.7 cells.In addition,1,8-cineole targets were revealed by drug affinity responsive target stability,thermal shift assay,cellular thermal shift assay,and heat shock protein 90(HSP90)adenosine triphosphatases(ATPase)activity assays.The results showed that 1,8-cineole exhibited powerful anti-inflammatory properties in vitro and in vivo by inhibiting the macrophage M1 polarization and protecting intestinal barrier function.Mech-anistically,1,8-cineole directly interacted with HSP90 and decreased its ATPase activity,also inhibited nucleotide-binding and oligomerization domain-,leucine rich repeat-,and pyrin domain-containing 3(NLRP3)binding to HSP90 and suppressor of G-two allele of SKP1(SGT1)and suppressed NLRP3 inflammasome activation in macrophages.These results demonstrated that 1,8-cineole is a potential drug candidate for UC treatment.

Objective:To investigate the effect of teaching practice under the concept of narrative medicine on improving the empathy level of interns in oral mucosal diseases.Methods:The interns of stomatology in the class of 2018 in School of Stomatology, Shanghai Jiao Tong University, were divided into narrative medicine teaching group (27 interns receiving narrative medicine concepts and methods before and during internship) and traditional teaching group (21 interns received patients directly under the guidance of teachers without the addition of narrative medicine concepts and methods). A questionnaire was used to collect the general information of students, and the Chinese version of Jefferson Scale of Physician Empathy (JSPE) (the version for medical students) was used to measure the empathy level of students. After the end of internship, a statistical analysis was performed for the scores of both groups, and a questionnaire survey was conducted to investigate the acceptance of internship under the guidance of narrative medicine among the students in the narrative medicine teaching group. GraphPad Prism 9.3.0 was used to perform the t-test and the rank sum test. Results:There was a significant difference in JSPE score between the traditional teaching group and the narrative medicine teaching group (92.26±8.23 vs. 104.20±15.65, t=2.70, P=0.005), and in addition, 88.89% (24/27) of the students in the narrative medicine teaching group were interested in participating in internship under the guidance of narrative medicine. However, there was no significant difference in the score of internship between the narrative medicine teaching group and the traditional teaching group (87.28±2.77 vs. 85.47±4.31, t=1.68, P=0.100). Conclusions:Incorporating the concepts and methods of narrative medicine into clinical teaching of oral mucosal diseases can significantly improve the empathy ability of interns and raise the awareness that empathy is as important as scientific literacy among students.