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 explore the risk factors of postoperative depression in patients with esophageal cancer, and to develop a risk prediction model which providing a theoretical basis for the early detection of depression in high-risk groups by clinical staff.Methods:From September 2022 to March 2023, at the South Campus of Affiliated Hospital of Jiangnan University, 269 hospitalized patients with esophageal cancer (191 in depression group, 78 in non-depression group) were selected as the model construction set. From March to May 2023, at the South Campus of Affiliated Hospital of Jiangnan University, 78 hospitalized patients with esophageal cancer were selected as the external validation set. The patients with Beck depression inventory-Ⅱ score ≥5 and depression diagnosed by two experts (chief psychiatrists of the Department of Psychiatry of Affiliated Hospital of Jiangnan University) were considered as depression and included in the depression group, and the other patients were enrolled in the non-depression group. The general data, blood routine examination, high-sensitivity C-reactive protein (hs-CRP), blood electrolytes, blood lipids, clinical symptoms (gastroesophageal reflux, sleep disturbance, appetite, etc.) and depression score were compared between the depression group and the non-depression group. Independent sample t-test and Mann-Whitney U test were used for statistical analysis. Multiple logistic regression model was performed to analyze the independent risk factors of postoperative depression in patients with esophageal cancer, and a risk warning model was constructed. The Hosmer-Lemeshow test and receiver operating characteristic curve (ROC) were used to evaluate the fitting degree and predictive efficiency of the model, and the cross-validation method was used to verify the effectiveness of the model. Results:The incidence of postoperative depression in patients with esophageal cancer was 71.0% (191/269). The total white blood cell count, hs-CRP, blood phosphorus β 2 microglobulin and the proportion of sleep disorders of the depression group were higher than those of the non-depression group (1.3 (1.1, 5.4) ×10 9/L vs. 0.9 (0.3, 1.1) ×10 9/L, 75.8 (54.8, 102.1) mg/L vs. 60.8 (3.6, 61.5) mg/L, (1.33±0.32) mmol/L vs. (1.02±0.19) mmol/L, (2.17±0.72) mg/L vs.(2.12±0.49) mg/L, 84.3% (161/191) vs. 33.3% (26/78), and the differences were statistically significant ( Z=9.24, 7.88, t=9.24, χ2=67.87 t=1.98; all P<0.001); hemoglobin, total platelet count, high-density lipoprotein (HDL) and the proportion of poor appetite were lower than those of the non-depression group ((119.91±24.51) g/L vs. (122.09±22.97) g/L, (203.43±58.45)×10 9/L vs. (311.55±83.54)×10 9/L, (1.04±0.30) mmol/L vs. (1.43±0.23) mmol/L, 73.3% (140/191) vs. 84.6% (66/78)), and the differences were statistically significant ( t=-2.00, -8.42 and -8.48, χ2=3.96; P=0.047, <0.001, <0.001, =0.047). The results of multifactorial logistic regression model analysis showed that sleep disorder ( OR=3.976, 95% confidence interval (95% CI 1.601 to 9.872)), loss of appetite ( OR=0.271, 95% CI 0.092 to 0.791), white blood cell count ( OR=31.808, 95% CI 2.879 to 351.401), hs-CRP ( OR=1.031, 95% CI 1.017 to 1.044), platelet count ( OR=0.990, 95% CI 0.982 to 0.997), and HDL ( OR=0.017, 95% CI 0.001 to 0.242) were independent influencing factors of postoperative depression in patients with esophageal cancer. The formula of risk warning model was probability of depression=1-1/{1+ exp[1.544+ 1.380×sleep disturbance (yes=1, no=0)-1.307×loss of appetite (yes=1, no=0)-0.010×platelet count (×10 9/L)-4.063×HDL (mmol/L)+ 0.030×hs-CRP (mg/L)+ 3.460×white blood cell count (×10 9/L)]}. The results of Hosmer-Lemeshow test showed that the model has a good fit ( χ2=2.01, P=0.981), with an area under the ROC of 0.949, a sensitivity of 0.874, and a specificity of 0.872. The cross-validation of the external validation set showed that the accuracy of the risk warning model was 67.9%. Conclusion:This study is a preliminary study on the risk warning model of postoperative depression in patients with esophageal cancer, which provides a novel approach for screening depression in patients with esophageal cancer after surgery.

Objective:To investigate the risk factors of acute lung injury (ALI) caused by Staphylococcus aureus infection, and to construct a risk warning model. Methods:Patients with Staphylococcus aureus infection confirmed by sputum or blood culture admitted to the Affiliated Hospital of Jiangnan University from January 1, 2020 to May 10, 2022 were enrolled and divided into ALI group and non-ALI group. The age, smoking status, C-reactive protein (CRP), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), albumin, oxygenation index and other clinical data were compared between the two groups. Univariate analysis was performed by using independent sample t test and chi-square test. Binary logistic regression analysis was used to screen the independent risk factors of ALI caused by Staphylococcus aureus infection, and a risk warning model was constructed. The receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of the model. Results:There were 96 cases of Staphylococcus aureus infection, including 68 cases (70.8%) in ALI group, of which 41 cases (60.3%) were positive in sputum culture and 27 cases (39.7%) were positive in blood culture. Compared with the non-ALI group, the proportion of patients aged ≥60 years in ALI group was lower (58.8%(40/68) vs 64.3%(18/28)), the proportion of smoking was higher (58.8%(40/68) vs 35.7%(10/28)), and the differences were both statistically significant ( χ2=0.76 and 0.03, respectively, both P<0.05). The levels of CRP, PCT and NLR in the ALI group were all higher than those in non-ALI group, while oxygenation index and albumin level were both lower, and the differences were all statistically significant ( t=-5.28, -3.46, -9.87, 12.83 and 3.08, respectively, all P<0.05). Binary logistic regression analysis showed that CRP (odds ratio ( OR)=1.973, 95% confidence interval (95% CI) 0.956 to 2.989), PCT ( OR=3.734, 95% CI 1.014 to 13.746), NLR ( OR=1.152, 95% CI 1.058 to 2.254) and albumin ( OR=1.527, 95% CI 1.110 to 2.102) were independent risk factors for ALI caused by Staphylococcus aureus infection. The areas under the ROC curve of CRP, PCT, NLR, albumin and the risk warning model constructed from the combination of four risk factors were 0.69, 0.81, 0.83, 0.78 and 0.93, respectively. The sensitivities were 65.14%, 89.91%, 84.40%, 56.88% and 98.17%, respectively. The specificities were 62.37%, 60.22%, 65.59%, 80.64% and 93.55%, respectively. The accuracy of the effectiveness test of the risk warning model was 84.97%. Conclusions:CRP, PCT, NLR and albumin are the independent risk factors for ALI caused by Staphylococcus aureus infection. The risk warning model based on the above factors has a good early warning effect on ALI caused by Staphylococcus aureus infection.

Objective:To explore the value of diffusion tension imaging (DTI) in the evaluations of hepatic ischemia-reperfusion injury (WIRI) regulation of liver regeneration after partial hepatectomy.Methods:Thirty healthy adult male New Zealand white rabbits were randomly divided into five groups of control and 10/20/30/40 min warm ischemia time (A0-A4)( n=6 each). Routine magnetic resonance (MR) and diffusion tensor imaging (DTI) were performed at 6 h, 3 d, 7 d, 14 d, 30 d post-keratectomy. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) were measured at Day 30 post-keratectomy. The levels of malondialdehyde (MDA), myeloperoxidase (MPO), superoxide dismutase (SOD), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and proliferating cell nuclear antigen (PCNA) in frozen liver tissues were examined and histopathological examination was performed. The values of apparent diffusion coefficient (ADC), fractional anisotropy (FA) and liver volume were measured and liver regeneration rate (LRR) was calculated. Repeated measurement analysis of variance was employed for comparing the difference of DTI and LRR in different groups at different follow-up times. One-way analysis of variance was utilized for comparing the differences of DTI and LRR between groups at the same follow-up time. Pearson or Spearman correlation analysis was employed for evaluating the correlation between DTI, LRR and biochemical parameters. Results:The interaction between time and warm ischemic factor ( P<0.05) and the effect of both alone ( P<0.001) had statistically significant effects on ADC values. FA value and LRR interaction were not significant between time and warm ischemic factor. However, the dominant effect of time factor was significant ( P<0.05). A significant positive correlation existed between ADC value and LRR in the same warm ischemia group ( P<0.01). FA and LRR were negatively correlated ( P<0.05), except for A3 group. FA had a weak correlation with IL-6 at Day 30 post-operation. Conclusions:DTI can non-invasively and quantitatively evaluate the effect of hepatic WIRI on liver regeneration after partial hepatectomy in rabbits. A certain degree of WIRI (≤30 min) can promote liver regeneration after partial hepatectomy. The longer warm ischemia time, the more obvious promotion effect. However, the promotion effect declines significantly after 30 min.

Objective:To investigate the effect of R2* value on the evaluation of different degrees of hepatic warm ischemia-reperfusion injury (WIRI) and liver regeneration after partial hepatectomy in rabbits.Methods:Thirty healthy adult male New Zealand White rabbits were randomly divided into five groups. Hepatic caudal lobectomy was performed in both the control and the warm ischemia time-dependent variation group. After reperfusion, routine MRI and BOLD MRI scans were performed for each group at 6 h, 3 d, 7 d, 14 d and 30 d, respectively, and then R2* value and liver regeneration rate (LRR) were measured and calculated. After 30 days of scanning, the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH), malondialdehyde (MDA), superoxide dismutase (SOD), myeloperoxidase (MPO), tumor necrosis factor - α (TNF - α), interleukin-6 (IL-6) and proliferating cell nuclear antigen (PCNA) were detected in frozen rabbit liver tissues, and the pathological sections were collected. Repeated measures analysis of variance was used to evaluate the changes of R2* value, LRR and its influencing factors at different follow-up time and warm ischemia time in each group. Pearson’s or Spearman’s correlation analysis was used to evaluate the correlation of R2* value with LRR and various biochemical indexes.Results:The interaction between different follow-up time and warm ischemia time ( F = 24.600, P < 0.001) and the single effect of the both on the R2* value had statistically significant difference ( P < 0.05). The interaction of different follow-up time and different warm ischemia time had no effect on LRR, and the difference was not statistically significant ( F = 0.925, P = 0.528), but the difference in the main effect of the both on LRR was statistically significant ( P < 0.05). At the same follow-up time, except for the 40-min ischemia group, the R2* values ??were significantly positively correlated with LRR (3, 7, 14, 30 days after operation, r = 0.510, 0.681, 0.612, 0.541 respectively, P < 0.05). At the same warm ischemia time, the R2* value were significantly negatively correlated with LRR (3, 7, 14, 30 and 40 days after operation, r = - 0.800, -0.852, -0.893, -0.648, -0.853, respectively, P < 0.05). There was no correlation between R2 * value and biochemical indexes at 30 days after operation ( P > 0.05). Conclusion:The R2* value may be used for noninvasive and quantitative evaluation of microstructural changes of WIRI and affect liver regeneration after partial hepatectomy in rabbits. A certain degree of WIRI (≤30 min) after partial hepatectomy can promote liver regeneration in rabbits. Furthermore, as the warm ischemia time prolongs, the promoting effect becomes more pronounced, and if the warm ischemic time exceeds 30 minutes, the promoting effect is significantly reduced.

Objective: To understand the iodine content of drinking water in Jiuquan City, and provide a theoretical basis for effective prevention and control of iodine deficiency disorders (IDD). Methods: In 92 townships (towns, streets) of 7 counties (cities, districts) in Jiuquan City, the investigation was carried out in 2017. According to different water supply methods, that was unified centralized water supply, partial centralized water supply, and distributed water supply, stratified sampling method was used to collect water samples, and water iodine content was determined. At the same time, in the two animal husbandry counties of Subei County and Akesai County with spring water and river water as water sources, the administrative villages were taken as units, and water samples were collected to analyze the difference of iodine content in water of different water sources and different wells. According to the "Division Standard for Iodine Deficiency Disorders" (GB 16005-2009), the iodine content of drinking water < 10 μg/L could be divided into areas of iodine deficiency. Results: A total of 392 water samples were collected from 273 administrative villages in 92 townships (towns, streets) in 7 counties (cities, districts) of Jiuquan City. The median water with iodine contents was 2.6 μg/L, ranging from 0.1 to 16.6 μg/L. And 372 water samples iodine < 10 μg/L, accounted for 94.90%; 20 samples ≥10 μg/L, accounted for 5.10%. Among the 392 water samples, 33 were centralized water supply samples, 311 were partial centralized water supply, and 48 were completely distributed water supply. The median water iodine was 1.6, 2.5, and 4.3 μg/L, respectively. There was a statistically significant difference in the median water iodine between different water supply methods (Z = 24.064, P < 0.01). In Subei County and Akesai County, 108 water samples were collected. Among them, there were 64 water samples with surface water (spring water and river water) as the water source. The median water iodine content was 5.4 μg/L. And 44 water samples using ground water as the water source, the median water iodine content was 5.2 μg/L. There was no significant difference in the median iodine content between surface water and ground water (Z = -1.745, P > 0.05). There was a statistically significant difference in the median water iodine content between different depths of well water (Z = 11.113, P < 0.05), but all < 10 μg/L. Conclusions The median water iodine in different water supply modes, different water source types and different wells in Jiuquan City are < 10 μg/L, Jiuquan City is a serious iodine-deficient area in external environment. The prevention and treatment of IDD by iodized salt should be carried out for a long time.

BACKGROUND: Bronchopulmonary carcinoid (BPC) is a rare neuroendocrine tumor, the clinical studies on treatment and prognostic factors of BPC are somewhat controversial. Our purpose was to evaluate the clinical efficacy of surgery on BPC, and to analyze the prognostic factors affecting the survival of BPC. METHODS: We retrospectively collected the clinical data of patients with BPC admitted to the Chinese PLA General Hospital between January 2000 and December 2017. The Kaplan-Meier method was used to calculate the survival rate of patients and to map the survival curve. Then the effects of different factors like pathological classification, gender, age, on prognosis were compared by univariate analysis and multivariate analysis was made by Cox proportional hazard model. RESULTS: A total of 98 patients had a diagnosis of BPC were included in the study. There were 41 patients with typical carcinoid (TC) and 57 patients with atypical carcinoid (AC). The 1-yr, 5-yr, and 10-yr overall survival rates of BPC were 96.9%, 80.0% and 73.6%, respectively. Univariate analysis showed age (P=0.000,1), smoking history (P=0.005), pathological subtype (P<0.000,1), T stage (P=0.000,2), TNM stage (P<0.000,1) were the prognostic factors. Multivariate analysis showed that age (P=0.005) and tumor stage (P=0.017) were independent prognostic factors. CONCLUSIONS BPC occurred more in middle-aged men. Surgery is the main treatment for lung cancer, and the overall prognosis is good. Age and TNM stage were independent risk factors for long-term survival after lung cancer surgery.

Objective The objective of this study was to investigate the role and molecular mechanism of AtractylenolideⅠin the progression of lung cancer. Methods qRT-qPCR and immunohistochemistry were used to detect the expression of TLR4 and MyD88 at levels of mRNA and protein in lung cancer and adjacent tissues. Transwell and MTT assays were used to detect effects of at-ractylenolide I(100 μM)on the invasion,migration and proliferation of A549 cells. Western blot was also used to detect the effect of atractylenolide I on the expression of TLR4 and MyD88 proteins. Results The expression of TLR4 and MyD88 at levels of mRNA and protein was highly expressed in lung cancer tissues when compared to adjacent tissues(P<0. 05). Compared with the control group,the invasion ability of A549 cells in the Atractylenolide I group was significantly decreased,and the proliferative activity was in-hibited(P<0. 05). Atractylenolide I inhibited the expression of TLR4 and MyD88 protein in A549 cells( P<0. 05). Conclusion

Objective To quantitatively evaluate the diagnostic value of blood oxygen leveldependent (BOLD) MRI in the diagnosis of different degrees of liver warm ischemia-reperfusion injury (WIRI) in rabbits and evaluate the intervention effect of liposomal prostaglandin E1 (Lipo-PGE1).Methods Seventy healthy adult New Zealand white rabbits were randomly divided into sham -operated group (A0),thermal ischemic groups (A1～A3) and intervention groups (A4～A6).All experimental rabbits were scanned by routine MR and BOLD MRI after 6-hour reperfusion.R2* images were calculated by two radiologists.The levels of alanine aminotransferase (ALT),asparate aminotransferase (AST) and lactate dehydrogenase (LDH) were examined.And liver pathological sectioning was performed.All data were processed by one-way,Spearman's correlation and receiver operating characteristic curve analyses.Results The intraclass correlation coefficient (ICC) was 0.805 of two measurements suggesting that the repeatability of the outcome was decent.R2* values among sham-operated,thermal ischemia and intervention groups were statistically significant (P＜0.05).R2 * values in sham-operated and ischemia groups were statistically significant (P＜0.05).As warm ischemia time elapsed,R2* value showed a rising trend.R2* values in sham-operated and intervention groups were statistically significant (P＜0.05).R2* values of sham-operated group at the same timepoint of thermal ischemia and intervention groups were statistically significant (P＜0.05).Under the same ischemic time,R2* values of intervention groups were smaller than those of thermal ischemia groups.With the prolongation of ischemia time,reduction of R2* values became more pronounced.However,it did not reach the level of A0 group.R2* values were significantly positively correlated with ALT,AST and LDH (r＞0.5,P＜0.05).ROC analysis indicated that R2* had an excellent diagnostic performance.Conclusions BOLD MRI may be applied for noninvasive assessment of liver ischemia-reperfusion injury in different degrees.Lipo-PGE1 alleviates ischemia -reperfusion injury and BOLD MRI can evaluate the relieving degree of Lipo-PGE1.

Objective To prospectively investigate the changes of hepatic CT perfusion parameters and the correlation with serum amylase (AST,ALT,LDH,SOD,MAD and MPO) in rabbits hepatic warm ischemia-reperfusion injury (WIRI) models undergoing different warm ischemia time.Methods New Zealand rabbits underwent 40 min and 60 min of right posterior lobe ischemia followed by 6 h reperfusion (n =10 each),named as W1,W2 groups respectively.Ten rabbits served as normal controls (W0).All the rabbits were given CT perfusion protocol.The perfusion indices of arterial flow (AF),portal flow (PF),and perfusion index (PI) were measured after obtaining perfusion index maps on the workstation.Blood samples were taken from the rabbit ear vein to measure the levels of ALT,AST,and LDH.The contents of SOD,MDA and MPO in liver tissues were determined,and histopathological changes were examined.Results Significant differences were found between the group W0,W1and W2 in the infarcted areas and non-infarcted areas by PI and AF and PF (P＜0.05),except that in the infarcted areas the AF value betwween the group W0 and W2,the PF value between the group W1 and W2 had no statistical difference,and in the non-infarcted areas the difference of the PI and AF value betwween the group W1 and W2,the PF value between the group W0 and W2 was not significant eihter.In the infracted area,PI and PF of WIRI groups positively correlated with biochemical parameters.AF was not correlated with biochemical parameters.In the non-infracted area,PI,AF was correlated with biochemical parameters,PF was not correlated with biochemical parameters.The PI and PF value could efficiently diagnose rabbit hepatic WIRI in the infarcted area (for PI,AR and PR,AUC=0.965,0.736 and 1.00 respectively),and PI and AF value could efficiently diagnose rabbit hepatic WIRI in the non-infarcted area (for PI,AF and PF,AUC=0.938,0.993 and 0.618 respectively).Conclusion CT perfusion can dynamically monitor the hemodynamic changes after WIRI and may suggest potential microcirculatory disturbances.