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.

With the development of high technology, people spend more and more time on screens. Most screens contain a lot of blue light. As one of the important components of visible light, blue light has high energy. It may lead to many ocular diseases, such as myopia, cataract, dry eye, glaucoma and keratitis when eyes exposure to blue light for a long time. At present, the harm of blue light and how to prevent blue light have become a hot topic. Its mechanism mainly includes increasing the photosensitivity of lipofuscin, destroying the mitochondria, lysosome, lens and tear film. According to the mechanism of blue light damage, physical protective measures can be adopted. And the antioxidant, free radical scavengers, anti-inflammatory drugs and gene therapy can be used to protect eye tissue. This paper mainly summarizes the harmful mechanism of blue light to eye and the corresponding prevention and treatment measures.

Genipin (Gen) is an important antioxidant that plays a crucial role in the process of intracellular resistance to oxidative stress. In order to study the effect of genipin on MIN6 cells injured by high glucose, the CCK-8 method was used to detect the cell survival rate. The cell viability of the high-glucose injury group decreased (P <0. 05). But after genipin acted on the cells injured by high glucose, the cell viability increased (P <0. 05). The mouse insulin detection kit and ATP content detection kit found that the insulin release in the high glucose injury group decreased (P < 0. 001) and the ATP content decreased (P <0. 001). After genipin was given, the insulin release increased (P <0. 01), ATP content increased (P <0. 01). The fluorescent probe DCFH-DA detected the intracellular reactive oxygen species (ROS) level and found that the ROS content in the high glucose-injury group was significantly increased (P <0. 01). After genipin was administered, ROS content decreased (P < 0. 05). Glutathione(GSH) / oxidized glutathione (GSSG), intracellular malondialdehyde (MDA), superoxide dismutase(SOD) and catalase (CAT) and lactate dehydrogenase (LDH) activity in the cell supernatant revealed that the GSH / GSSH ratio, SOD and CAT levels in the high glucose injury group decreased (P <0. 05), and the intracellular MDA and LDH levels were significant increased (P<0. 001) .After administration of genipin, the GSH / GSSH ratio, SOD and CAT levels increased (P <0. 01), MDA and LDH levels were significantly reduced (P <0. 01). Mitochondrial membrane potential (MMP) levels decreased in the highglucose injury group (P <0. 01). After genipin acted on the cells injured by high glucose, the MMP level increased (P < 0. 05). Western blot detected uncoupling protein 2 (UCP2), antioxidative proteinsglutathione reductase (GR) and glutaredoxin 1 (Grx1) contents. The results showed that UCP2 contents in the high glucose injury group increased (P <0. 01) and the content of oxidized protein decreased (P < 0. 01). After genipin was administered, the expression of UCP2 decreased (P < 0. 05), and the expression of antioxidative protein increased (P < 0. 05). Experiments suggest that genipin has anantioxidant protective effect on MIN6 cells damaged by high glucose and maintains the function of MIN6cells to promote insulin secretion. This experiment provides experimental data for the antioxidation of genipin on MIN6 cells injured by high glucose, and also provides new ideas for the follow-up study of genipin in the treatment and prevention of diabetes.

Objective A/H1N1(pdm09) viruses were the dominant strains in Shanghai during 2018-2019 influenza surveillance year.This study is to provide a scientific reference for clinical drug use by investigating the susceptibility of A/H1N1(pdm09) viruses to neuraminidase inhibitors(NAIs). Methods Sixty strains of A/H1N1(pdm09) viruses were randomly selected for testing the susceptibility and drug resistance to Oseltamivir and Zanamivir by means of neutaminidase inhibition and neuraminidase (NA) gene sequencing. Results The 60 epidemic strains all proved to be susceptible to Oseltamivir and Zanamivir and the susceptibility was not observed to be decreased or remarkably decreased.In genetic sequencing, NA was not observed to present amino acid mutation at the key sites and auxiliary sites in catalytic activity, which confirmed the results of the phototypic detection of neuraminidase inhibition. Conclusion The subtype influenza viruses A/H1N1(pdm09) circulating in Shanghai during 2018-2019 surveillance year are still sensitive to NAIs, which provides a scientific reference for clinical use of drugs.However, we monitored only a number of strains and think that the work monitoring antiviral susceptibility should be continued with the wide use of the drugs.

Objective To assess the effectiveness of traditional Chinese Medicine (TCM ) syndrome differentiation treatment for diabetic nephropathy in elderly patients. Methods A total of 96 elderly patients with diabetic nephropathy admitted to our hospital from January 2015 to December 2017 were recruited and divided into a regular care group (n= 48)and a TCM group(n= 48).Both groups received conventional treatment ,with TCM syndrome differentiation treatment added to the TCM group. The effectiveness of the treatment modalities was compared. Results In the regular care group ,significant effectiveness was observed in 12 patients ,effectiveness in 24 patients ,and ineffectiveness in 12 patients ,with a total effectiveness rate of 75％ .In the TCM group ,significant effectiveness was seen in 18 patients ,effectiveness in 27 ,and ineffectiveness 3 ,with a total effectiveness rate of 93％. The total effectiveness rate of the TCM group was higher than that of the regular care group(χ2 =6.400 ,P=0.011).After treatment ,fasting blood glucose ,2 h postprandial blood glucose , urea nitrogen ,creatinine ,and 24 h urine protein in the TCM group were significantly lower than in the regular care group and than pre-treatment levels(P<0.05). Conclusions TCM differentiation can not only significantly improve the treatment effectiveness in elderly patients with diabetic nephropathy ,but also relieve the clinical symptoms.

Objectives To investigate the efficacy of the shear wave velocity (SWV) based on acoustic radiation force impulse (ARFI) elastography in the differentiation of normal population with chronic kidney disease (CKD) and acute kidney injury (AKI) in middle aged and elderly patients.Methods Sixty-four middle aged and elderly patients referred to China-Japan Friendship Hospital and Zhejiang Provincial People's Hospital with AKI or CKD were enrolled in this study from February 2015 to December 2016 (kidney disease group).Among them,43 patients were CKD (CKD group),and 21 patients were AKI (AKI group,15 patients combined with prior CKD,6 patients without prior CKD).Twenty-nine middle aged and elderly healthy volunteers from China-Japan Friendship Hospital were enrolled at the same time (healthy control group).The SWV values of the renal middle pole cortex were acquired using the ARFI elastography.The differences of the kidney length,cortical thickness and SWV values among healthy control group,AKI and CKD group were compared by variance analysis.The LSD-t analysis was used for the advanced comparison between any two groups.The differences of cortical SWV values among healthy control group,AKI combined with prior CKD group,AKI without prior CKD group and CKD group were compared by variance analysis.The LSD-t analysis was used for the advanced comparison between any two groups.The receiver operating characteristic (ROC) curves of the cortical SWV values for diagnosing kidney disease was drawn.Results The mean cortical SWV values of healthy control group,AKI and CKD groups were (2.88±0.63),(2.42±0.83) and (2.06±0.72) m/s,respectively.The SWV values of AKI and CKD groups were significantly lower than that of healthy control group (t=2.158,P=0.033;t=5.234,P ＜ 0.001).The SWV values of CKD group were lower than that of AKI group,but there were no significant differences.The SWV values of AKI without previous CKD group and AKI combined with prior CKD group were (2.60±0.84) and (1.80±0.45) m/s,respectively.The SWV values of AKI combined with prior CKD group and CKD group were significant lower than that of healthy control group and AKI without prior CKD group (compared with healthy control group:t=2.916,P=0.004 and t=5.318,P ＜ 0.001;compared with AKI without prior CKD group:t=2.054,P=0.043 and t=-2.517,P=0.013).But there were no significant differences between AKI combined with prior CKD group and CKD group,so as to the AKI without prior CKD group and healthy control group.The cutoff value of cortical SWV for diagnosing kidney disease was 2.40 m/s,with an area under ROC curve was 0.767 (95％ CI 0.689-0.898,P=0.000).The sensitive and specificity were 57.1％ and 81.9％,respectively.Conclusions The SWV values of kidneys in middle aged and elderly CKD and AKI patients were significantly lower than those of apparently normal kidneys.The SWV values of AKI patients combined with prior CKD were lower than AKI patients without prior CKD.Determining cut-off SWV values based on ARFI elastography between normal and damaged renal parenchyma can help in the diagnosis of kidney disease in middle aged and elderly patients.

Objective To explore the effect of cognitive behavioral intervention on quality of life and distress of cancer patients. Methods The research was a random control study, and computer randomized grouping, the experimental group and control group contained 64 cases, 66 cases, respectively. The control group only accepted health education, while experimental group accepted cognitive behavioral intervention twice a week. Before and after the research, the patients were investigated with quality of life and distress scale. Results After the study of cognitive behavioral intervention, quality of life of experimental group scored (71.7±17.5) points which showed greater improvement than the control group scored (63.9±18.3) points (t=2.2,P<0.05), the distress score of experimental group was (2.6±0.6) points which was significant lower than the control group scored (3.9 ±0.7) points (t=11.8, P<0.05), and the proportions of distress problems contained anxiety [42.2% (27/64)], pain [29.7% (19/64)], depression [35.9% (23/64)] and sleep [23.4% (15/64)] in the experimental group were all significant lower than the control group [60.6% (40/66), 47.0% (31/66), 53.0% (35/66), 39.4% (26/66)]( X2=4.4, 4.1, 3.9, 4.5, P<0.05). Conclusions Short-term group cognitive behavioral intervention can alleviate the distress and pain, improve their negative emotions and sleep, eventually improve the quality of life of cancer patients.

OBJECTIVETo retrospectively analysis the curative effect of wrist scaphoid bone fracture,and explore the causes and preventive methods of misdiagnosis.

METHODSFrom September 2007 to September 2010,16 patients with wrist scaphoid bone fractures were treated with plaster cast and cannulated screws fixation. There were 10 males and 6 females,ranging in age from 26 to 44 years with an average of 35 years. Among them, 12 cases manifested swelling pain of radial lateral wrist, tenderness at snuffbox area, wrist pain aggravated when stretching wrist joint, thumb or forefinger; 4 cases manifested no obviously symptoms and limited movement; 9 cases were early diagnosed; 5 cases were treated by plaster cast; 4 cases were treated with cannulated screws fixation; Among 7 cases with misdiagnosis, there were 4 cases without obvious symptoms and they were dealt with activating blood to dissipate swelling and pain process in preliminary stage. Four cases were treated with plaster cast and 3 cases with cannulated screws fixation.

RESULTSAll the patients were followed up from 3 months to 39 months (averaged 21 months). Among 16 patients, 9 cases were early diagnosis, 7 cases were misdiagnosis and the rate of misdiagnosis was 43.8%. Seven cases with screws fixation were no wound infection. There was 1 case with occurred chronic pain and declining wrist mobility in both plaster cast and screw group, and both of them were misdiagnosed. According to curative effect rating criteria,these 2 cases were classified into moderate, other 14 cases were excellent.

CONCLUSIONWrist scaphoid bone fracture are easy to misdiagnose, so early diagnosis and treatment is particularly important. The main causes of misdiagnosis are nonspecific symptoms at early stage, combination with other injuries, lack of knowledge and ignorance of the further examination. Therefore, detailed inquiries and particular examination, multi-dimensional radiography and CT scan or MRI scan are the main measures for prevention.

Adult ; Bone Screws ; Casts, Surgical ; Diagnostic Errors ; prevention & control ; Female ; Fractures, Bone ; diagnosis ; surgery ; Humans ; Male ; Retrospective Studies ; Scaphoid Bone ; injuries

OBJECTIVETo study the relationship of mesorectum with fasciae and nerves in the pelvic cavity and to specify the proper planes of dissection in total mesorectal excision.

METHODSTwenty-four pelvises (12 males and 12 females) harvested from cadavers were studied by dissection.

RESULTSThere were three planes surrounding the rectum as the visceral fascia, vesicohypogastric fascia and parietal fascia. The pelvic plexus and its branches situated between the visceral fascia and the vesicohypogastric fascia. Pelvic splanchnic nerves and hypogastric nerves were observed between the visceral fascia and the parietal fascia.

CONCLUSIONSThe posterior plane of total mesorectal excision lies between the visceral fascia and the parietal fascia. The lateral dissection should be conducted in a plane between the visceral fascia and the vesicohypogastric fascia. The proper planes for posterior and lateral resection can be identified by the hypogastric nerve and the pelvic plexus respectively.

Fascia ; anatomy & histology ; Fasciotomy ; Female ; Humans ; Male ; Mesentery ; anatomy & histology ; surgery ; Pelvis ; anatomy & histology ; surgery

OBJECTIVETo explore the scan technique and image quality of coronary angiography with dual source computed tomography (CT) without oral metoprolol preparation.

METHODSPlain and enhanced dual source CT coronary angiography without oral metoprolol preparation was prospectively performed in 600 patients. Calcium scoring with plain scan images as well as multi-planar reconstruction (MPR), maximum intensity projection (MIP), and volume rendering technique (VRT) reconstruction with enhanced scan images were performed in all cases. The scan technique and post-reconstruction experience was summarized. The image quality was classified as 1 to 4 points, and coronary segments classified according to the American Heart Association standards were evaluated.

RESULTSThe average calcium score of the 600 cases was 213.6 +/- 298.7 (0-3,216.5). The average heart rate of the enhanced scan was 82.1 +/- 16.2 (47-139) bpm. The post-reconstruction methods with which coronary segments could be shown as best as possible consisted of single phase reconstruction method, two or more phases supplemented method, and electrocardiogram editing method. Altogether 8,457 coronary segments were evaluated, among which 97.2% were evaluated as point 1, 1.7% point 2, 0.5% point 3, and 0.6% point 4. The coronary segments in 261 cases were completely normal, while 360 segments were diagnosed with < 50% stenosis and 625 segments with > or = 50% stenosis.

CONCLUSIONSExcellent coronary artery image can be obtained with dual source CT in patients with any heart rate without oral metoprolol preparation. Heart rate is not a major source of the artifact, coronary segments can be well shown with single or multiple-phase reconstruction method.

Adult ; Coronary Angiography ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods