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.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

ObjectiveTo evaluate the success of Qi-deficiency model of Balb/C-nu mice established by swimming exhaustion test from the view of biomarkers and metabolic pathways by metabonomics. MethodBalb/C-nu mice were randomly divided into the normal group and Qi-deficiency group， Qi-deficiency model was established by swimming with 5% body weight metal fixed at the tail for 15 consecutive days until exhaustion （nose tip immersion time>5 s）. The urine metabonomics was analyzed by ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry （UPLC-Q-TOF/MS）， and the mobile phase was acetonitrile （A）-0.1% formic acid aqueous solution （B） for gradient elution （0-1 min， 5%-8%A； 1-4 min， 8%-8.5%A； 4-5 min， 8.5%-12%A； 5-10 min， 12%-40%A； 10-12 min， 40%-100%A； 12-15 min， 100%A）， the flow rate was 0.3 mL·min^-1， the injection volume was 10 μL， electrospray ionization （ESI） in positive and negative ion modes was used in MS analysis， the MS data were acquired in full-scan mode from m/z 50-1 000. Principal component analysis （PCA）， orthogonal partial least squares-discriminant analysis （OPLS-DA）， human metabolome database （HMDB）， high collision energy ion fragments collected by MS^E and tandem MS （MS/MS） ion information were used to identify potential biomarkers. Kyoto Encyclopedia of Genes and Genomes （KEGG） database and MetaboAnalyst 5.0 were used to analyze the corresponding metabolic pathways and pathway enrichment of biomarkers. ResultEndogenous substances in urine of mice in normal group and Qi-deficiency group were obviously separated， and there were 24 biomarkers with significant difference. The metabolic pathways involved in these biomarkers were tricarboxylic acid cycle， glycolysis metabolism， amino acid metabolism， fatty acid metabolism， pyrimidine metabolism， steroid hormone biosynthesis and tryptophan metabolism. Among them， the metabolic pathways related to energy were tricarboxylic acid cycle， glycolysis metabolism， amino acid metabolism， fatty acid metabolism， pyrimidine metabolism and steroid hormone biosynthesis. ConclusionThrough the investigation of urine metabonomics， combined with the physical signs， the Qi-deficiency model established by swimming exhaustion test in Balb/C-nu mice is successfully evaluated， and it is also verified that there is a close correlation between Qi-deficiency and energy metabolism.

Objective:To investigate effects of different doses of dexmedetomidine on postoperative cognitive function in elderly colon cancer patients undergoing the general anesthesia.Methods:A total of 80 elderly colorectal cancer patients aged 65 to 80 years old who received the surgery with the American Society of Anesthesiologists (ASA) grade Ⅱ-Ⅲ in Benxi Central Hospital of Liaoning Province were selected. According to the random number table, all patients were divided into 4 groups: the experiment group (group DD, group DM, group DX grouped by the dose of dexmedetomidine) and the control group. All groups were intravenously injected with 0.5 μg/kg loading dose dexmedetomidine in 10 minutes before induction of anesthesia; after induction of anesthesia, group DD was continuously pumped into 0.7 μg·kg -1·h -1, group DM was continuously pumped into 0.5 μg·kg -1·h -1, group DX was continuously pumped into 0.2 μg·kg -1·h -1, and all patients had drug withdrawal in 30 min before the end of the surgery. Under the same condition, group NS was injected with the same volume of 0.9% saline. The levels of serum S-100β protein and neuron specific enolase (NSE) of all groups were measured at the day before operation and 30 min, 3 h, 6 h, 12 h, 24 h after operation; Mini-mental state examination (MMSE) score was performed in all groups at the day before operation and 1 d, 3 d, 7 d after operation. The change of postoperative cognitive function and adverse reactions of all groups were also compared. Results:After screening, 72 out of 80 patients met the criteria (19 patients in group DD, 17 patients in group DM, 18 patients in group DX and 18 patients in the control group). There were no statistically significant differences in levels of serum S100β protein and NSE among 4 groups before operation (all P > 0.05), while there were statistically significant differences in levels of S100β protein and NSE at different time points after operation among all groups (all P < 0.05). The levels of S100β protein and NSE after operation in all groups at different time points were higher than those before operation (all P < 0.05). On the 1st day after operation, MMSE scores of 4 groups were significantly different ( P < 0.05); 3 d after operation, the difference in MMSE score was statistically significant when the control group was compared with group DD and group DX (all P < 0.05); 7 d after operation, the difference was statistically significant between the control group and group DX ( P < 0.05). Cognitive function decline or perioperative neurocognitive disorders (PND) occurred in 2 cases in group DD, 1 case in group DM, 2 cases in group DX, 8 cases in the control group. The rate of cognitive function changes in group DD, group DM and group DX was lower than that in the control group ( P < 0.05). Adverse reactions occurred in 9 patients in group DD, 7 patients in group DM, 4 patients in group DX, and 3 patients in the control group, and there was no significant difference in the incidence of adverse reactions among all groups ( P > 0.05). Conclusions:Dexmedetomidine can slow the decline in postoperative cognitive function after general anesthesia and reduce the incidence of PND for elderly patients with colorectal cancer. Furthermore, dexmedetomidine’s improvement on postoperative cognitive function has no dose-dependence.

Enrichment of trace bioactive constituents and metabolites from complex biological samples is chal-lenging. This study presented a one-pot synthesis of magnetic polydopamine nanoparticles (Fe3O4@-SiO2@PDA NPs) with multiple recognition sites for the magnetic dispersive solid-phase extraction (MDSPE) of ginsenosides from rat plasma treated with white ginseng. The extracted ginsenosides were characterized by combining an ultra-high-performance liquid chromatography coupled to a high-resolution mass spectrometry with supplemental UNIFI libraries. Response surface methodology was statistically used to optimize the extraction procedure of the ginsenosides. The reusability of Fe3O4@-SiO2@PDA NPs was also examined and the results showed that the recovery rate exceeded 80％ after recycling 6 times. Furthermore, the proposed method showed greater enrichment efficiency and could rapidly determine and characterize 23 ginsenoside prototypes and metabolites from plasma. In com-parison, conventional methanol method can only detect 8 ginsenosides from the same plasma samples. The proposed approach can provide methodological reference for the trace determination and charac-terization of different bioactive ingredients and metabolites of traditional Chinese medicines and food.

Objective:To explore the effect of mirror visual feedback combined with exercise relearning in rehabilitation of upper extremity dysfunction after stroke.Methods:Patients with upper extremity dysfunction received stroke rehabilitation treatment in the Nanyang No. 9 People's Hospital from August 2016 to August 2018 were enrolled prospectively. According to the random number table method, they were divided into either mirror visual feedback combined with exercise relearning group (mirror therapy group) or exercise relearning alone group (control group). The rehabilitation treatment was 1-2 times a day, 5 d a week, and 1 week was a course of treatment, for a total of 4 courses. Fugl-Meyer Assessment (FMA) was used to assess upper extremity function. Carroll Upper Extremity Function Test (UEFT) was used to assess hand function. Action Research Arm Test (ARAT) was used to assess upper extremity operability and flexibility. Motor Assessment Scale (MAS) was used to assess the motor function of hands, fingers and upper extremities. Visual Analogue Scale (VAS) was used to assess upper extremities pain. The modified Barthel Index (MBI) was used to assess self-care ability in daily life. The modified Ashworth Spasm Scale was used to assess the degree of spasm of shoulder joints, wrist joints, and elbow joints. According to the FMA score, the clinical efficacy of both groups of patients was evaluated, and a score of >31 was defined as excellent.Results:A total of 60 stroke patients with upper extremity dysfunction were enrolled ( n=30 in the mirror therapy group and n=30 in the control group). There were no statistical differences between the two groups in age, gender, course of disease, stroke type, and stroke location, as well as each baseline score. After treatment, the FMA score, UEFT score, ARAT score, MAS score, MBI score and the proportion of the modified Ashworth grade Ⅰ and grade Ⅰ + were significantly higher than those before treatment in both groups (all P<0.05), while VAS score and the proportion of modified Ashworth grade Ⅲ and grade Ⅳ was significantly lower than those before treatment (all P<0.05). After treatment, FMA score, UEFT score, ARAT score, MAS score, MBI score, as well as the proportion of Ashworth grade Ⅰ and grade Ⅰ + in the mirror therapy group was significantly higher than that in the control group (all P<0.05), while VAS score and the proportion of modified Ashworth grade Ⅲ were significantly lower than those in the control group ( P<0.05). According to the FMA score, the excellent and good rate of treatment in the mirror therapy group was significantly higher than that in the control group (93.3% vs. 70.0%; χ2=5.455, P=0.020). Conclusions:The curative effect of mirror visual feedback combined with exercise relearning is superior to exercise relearning alone in rehabilitation therapy for upper extremity dysfunction after stroke.

Objective:To observe the clinical efficiency, duration of action and adverse reactions of lip contour after local injection of type A botulinum toxin into the orbicularis oculi muscle.Methods:From March 2019 to June 2019, a total of 11 patients (6 males and 5 females, mean age 42.2 years) received superficial injection of botulinum toxin A in the orbicular muscle in our hospital. The change of lip thickness was assessed by Medicis lip fullness scale (MLFS) and the 3D structured light camera was used to collect and analyze the facial data. Pre- and post-treatment effects, duration of action and complications were evaluated.Results:Improvement of upper lip thickness was noted in 11 cases (100%). The average onset time after injection was 14.6 days and average effect maintenance time was 124.1 days. The height of the red lips ( Z=-2.940, P<0.05), the distance from the upper lip to the Ricketts line ( Z=-2.137, P<0.05) and nasolabial angle ( Z=-2.137, P<0.05) were significantly changed one month after the injection. No allergic reaction was observed, and the adverse reactions were mild and reversible. Conclusion:Local injection of botulinum toxin type A can achieve mild lip augmentation.

Objective:Based on an investigation of an outbreak of COVID-19 in Nanchang, to understand the transmission process, analyze the infectivity of the cases in incubation period and asymptomatic carrier, and evaluate the transmission risks in different exposures.Methods:Case investigation was based on the traditional epidemiological survey, combined with analysis based on big data about population movement trajectories. Transmission chain was identified to indicate transmission relationship.Results:A total of 27 cases were found in this cluster epidemic, including 25 confirmed cases, 1 suspected case (index case) and 1 asymptomatic carrier. A total of 347 close contacts were found. The secondary attack rate was 7.2% (25/347). The infection rates in close contacts of the first, second, third and fourth generation cases were 52.6% (10/19), 6.1% (13/213), 2.3% (2/88) and 0.0% (0/27), respectively. Asymptomatic carrier caused household transmission. The infection rates in close contacts after having meals, sharing rooms/beds, having work contacts, having neighbor contacts, having same time medical services or sharing wards and sharing vehicles with the patients were 10.6%(17/160), 10.0%(20/201), 5.3%(5/94), 0.0%(0/30), 0.0%(0/18) and 0.0%(0/17), respectively.Conclusions:The infection source of this cluster epidemic was a suspected case from Wuhan. Analysis based on big data about population movement trajectories can help to search the cases and close contacts accurately. The proposed epidemic prevention and control measures based on this investigation were effective.

Objective: To investigate the effect of early-stage training combined with the ultrashort wave therapy on the functional recovery of rats after a spinal cord injury, and to observe the expression of aquaporin protein-4 (AQP-4) and glial fibrillary acidic protein (GFAP). Methods: Fifty female Sprague-Dawley rats had spinal cord injury (SCI) induced using the modified Allen′s method. After successful modeling, 40 were randomly divided into a sham operation group, a control group, an ultrashort wave group, a treadmill group and a combined group, each of 8. Motor function in their hind limbs was evaluated 4 weeks after the operation using BBB scoring. GFAP and AQP-4 immunohistochemical staining were used to determine the integral optical density (IOD) of the protein expression. Results: The average BBB score of the sham operation group was 21, while the other four groups averages were all less than 1 on the 1st day after the operation. They gradually increased with time, and by 4 weeks the increases were significant. Compared with the control group at the same time point, the average BBB scores of the treadmill and the combined groups were significantly higher. Compared with the ultrashort wave group, the average BBB score of the treadmill group was higher after 4 weeks, and the combined group′s average was significantly higher at 2, 3 and 4 weeks after the operation. Four weeks after the SCI modeling, the average AQP-4 IOD and GFAP IOD levels of the ultrashort wave group, the treadmill group and the combined group were lower than that of the control group, while the average AQP-4 and GFAP IOD levels of the combined group were significantly lower than those of the ultrashort wave group. Compared with the treadmill group, the combined group had a significantly lower average GFAP level. Conclusions Both treadmill training and ultrashort wave treatment promote motor function recovery after a spinal cord injury. The mechanism may be related to downregulation of AQP-4 and GFAP expression at the injured site. Combining the two treatments gives better effects.

Objective: To optimize the method of simultaneous determination of four aflatoxins (B1, B2, G1 and G2) of ginger by the ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method and high-throughput method. Methods: The aflatoxins were extracted from ginger by methanol-water (80:20, V/V) solution, concentrated and dried with nitrogen. The aflatoxins were detected by UPLC-MS/MS by using Waters Acquity UPLC BEH C18 chromatographic column. The mobile phase was 0.1% formic acid water (A phase) -0.1% formic acid methanol (B phase), gradient elution, flow rate 0.35 ml/min, mass spectrometry was electrospray ion source, positive ion scanning mode, multi reaction ion monitoring were using. Results: Quantification of four aflatoxins by matrix matching standard curve. The linear was good in the range of 0.125-20.000 ng/ml, and the correlation coefficients were all greater than 0.999 0. The ginger sample detection was 0.125-0.300 μg/kg and 0.125-1.000 μg/kg, respectively. The average recoveries were 81.7%-96.0%, and the relative standard deviation (RSD) was lower than 7.53%. Conclusions This method is simple, rapid, sensitive and low limit of detection, which can meet the requirements for the detection of trace aflatoxins residues in ginger.