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 The aim of this study was to study the antibiotic resistance and resistance genes of methicillin-resistant Staphylococcus aureus (MRSA) in children from Shanghai area,and to determine the relationship between phenotypic and genotypic resistance profiles.Methods In this study,a total of 37 MRSA strains isolated from clinical specimens of hospitalized patients in Children's Hospital of Fudan University from March 2009 to November 2011 were collected.The mecA,ermA,ermB,ermC,aac (6') /aph (2),aph (3')-Ⅲ,ant (4',4),and qacA genes were detected by polymerase chain reaction (PCR).Resistance to antibiotics was detected by agar dilution tests.The data analysis was done by chi square test.Results Among the 37 MRSA isolates,all (100.0 ％) were mecA gene positive,9 (24.3％) were ermB gene positive,none was ermA/C gene positive,21 (56.8％) were aac (6')/aph (2) gene positive,10 (27.0％) were aph (3')-Ⅲ gene positive,6 (16.2％) were ant(4',4) gene positive,and 9 were qacA gene positive (24.3％).The positive rate of aac(6')/aph(2) in hospital acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) was significantly higher than that of community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) (85.7％ vs18.8％,x2=60.340,P=0.000).Among the 37 MRSAisolates,37 (100.0％) were resistant to penicillin,ampicillin-sulbactam,cefazolin,cefoxitin and cefuroxime.The 37 isolates were all susceptible to teicoplanin,vancomycin,and linezolid.The resistant rates to gentamicin,erythromycin,clindamycin,sulfamethoxazole,fosfomycin,rifampicin,and levofloxacin were 51.4％ (19/37),81.1％ (30/37),51.4％ (19/37),16.2％ (6/37),27.0％ (10/37),37.8％ (14/37) and 54.0％ (20/37),respectively.Compared with CA-MRSA,HAMRSA isolates had significantly higher resistance rates to gentamicin (12.5％ vs 81.0％; x2 =17.033,P=0.000),levofloxacin (31.2％ vs 71.4％; x2 =5.903,P=0.017),and rifampin (6.2％ vs 61.9％; x2=11.959,P=0.001).The rate of gentamicin resistance in aac(6')/aph(2) gene carrying strains was significantly higher than strains not carrying the gene (x2 =29.757,P=0.000).Conclusions MRSA in children carry a variety of drug-resistant genes,showed multi-drug resistance.HA-MRSA carries more resistance genes,and has higher rates resistance to antimicrobials than CA-MRSA.

Objective To evaluate the efficacy of the combined saphenous nerve-great saphenous vein flap and cutaneous branches of posterior tibial artery flap in repairing refractory wounds. Methods Eighteen cases of pedal chronic ulcers were treated with the combinedsaphenous nervegreat Saphenous vein flap and cutaneous branches of posterior tibial artery flap, in which the wounds were treated with vacuum suction techniques before the operation in 6 cases. Wounds were from 8 cm× 13 cm to 1 cm× 17 cm in zine after debricement, and the designed size of the flaps was from 8 cm× 14 cm to 11 cm× 18 cm. Results After the treatment, 18 cases were evaluated as excellent in 10 cases, and good in 8 cases, in which the primary sealing of the wounds was achieved in 17 cases, but one case presented with focal necrosis of smaal size owing to vein drainage disturbance in a distallypedicled flap, and was healed after flap transplantation. Follow-up for 6 months to 2 years showed that all the patients were satisfied with the results. Conclusions The combined flap has reliable blood supply, skin pedicle of the flap is longer, superior texture and satisfied appearance, and incisive area of the flap is larger. It is particularly useful in repairing refractory wound in foot.

Objective To summarize the therapeutic effect of recombinant human growth hormone and early enteral nutrition in severely burned patients. Methods 35 cases were randomly divided into group EN and group PN.Group EN was treated with early enteral nutrition(EEN) and recombiant human growth hormone(rhGH) ,while group PN was given parenteral nutrition. The plasma levels of pre-albumin (PA), C-reactive protein (CRP) , tunmor necrosis factor α(TNFα) ,fasting blood glucose(FBG) were measured after burn injury. Comparision was made in length of hospital stay, wound healing time,incidence of burn sepsis, gastrointestinal stress ulcer bleeding and enteral nutrition intoleranc. Results Incidence of burn sepsis,gastrointestinal stress ulcer bleeding and enteral nutrition intoleranc in group EN were significantly lower than those of group PN(P ＜ 0.05). The serum levels of CRP、TNFα、FBG in group EN were significantly lower than those of group PN (P ＜ 0.05). The serum PA was decreased at all times in two periods and was markedly decreased in group EN(P ＜0.05). Length of hospital stay and the healing time of donor site, deep partial thickness burn wound, skin transplantion area were significantly shortened in group EN compared with group PN. Conclusion Early enteral nutrition was beneficial for the improving of nutrition state of the burn patients,and the reduction of the incidence of burn sepsis and the hospitalization time.

Objective To analyze the effect of nimodipine on prevention and treatment of patients with severe burn sepsis. MethodsTwenty-eight cases were randomized into nimodipine treatment group (n = 14) and routine group (n = 14). Besides general chnical therapy scheme treatment,the treatment group was administrated with saline plus nimodipine (15 μg/(kg · h)), while the routine group was given saline only. The Plasma concentration levels of total calcium (Ca2 +), free calcium (iCa2 +), C-reactive protein (CRP), procalcitonin (PCT), tunmor necrosis factor α (TNF-α), brain natriuretic petide (BNP) and interleukin-6 (IL-6) were measured. The hemodynamic indices of patients with severely burn sepsis were determined by transesophageal echo-Doppler device,hemodynamic indices including aortic blood flow (ABF), left ventricle ejection time (LVET), max acceleration (ACC), total systemic vascular resistance (TSVR). Mean artery pressure (MAP) and heart rate (HR) were measured. ResultsABF, ACC, LVET and TSVR were improved after therapy in the routine group(t = 3.93,3. 37,3.75,7.02) (P ＜ 0.01 or 0.05). ABF, ACC, LVET and TSVR were mproved after therapy in the treatment group (t =6.46,4.98,6.29,4.60) (P ＜0.01 or 0.05). ABF, ACC and LVET were increased after general clinical therapy scheme and was markedly increased in the treatment group (t = 2.29,2.07,2.23)(P＜0.01～0.05).TSVR was decreased after general clinical therapy scheme and was markedly decreased in the treatment group (t =2.14) (P＜0.05). Plasma TNF-α, IL-6 and CRP levels were decreased after therapy in the routine group (t =2.38,2.29,2.45)(P＜0.01 or 0.05). Plasma TNF-α, IL-6 and CRP levels were decreased after therapy in the treatment group (t =4.04,4.04,2.56)(P ＜0.01or 0.05). Plasma PCT and BNP levels were decreased in the treatment group (t =5.45,2. 44) (P ＜ 0.01 or 0.05). TNF-α, IL-6, CRP, PCT and BNP were decreased after generalclinical therapy scheme and was markedly decreased in the treatment group (t = 2.20,2.17,2.19,2.17,2.61) (P ＜0.01 or 0.05). Plasma Ca2+ and iCa2+ levels were decreased. However,MAP were increased in the two groups, although no difference was found between the two group(P ＞0.05). ConclusionsEarly applying of calcium channel blockers (CCB) can markedly inhibit the degree of inflammatory medium in serum, thereby preventing the development of excessive inflammation response and subsequent multiple organ dysfunction syndrome associated with severely burned sepsis. It can effectively inhibit intracellular Ca2+ overload caused by myocadial infection injury,which may contribute to the effect of acupuncture in reducing myocardial injury and protecting myocardial performance and improving prognosis.

Presented herein are the concepts and methodology for the appraisal indicator model of personal performance management in hospitals. Based on studies of mature appraisal indicator models for hospital departments and the particularity in the process of personal performance evaluation, the authors hold that the model of such an appraisal model should comprise an indicators inventory, data warehouse,indicators system, and appraisal database among others. It is also described that the evaluation process is made up of targets identification, indicators selection, weight distribution, performance implementation and data updating, on top of recommendations for building the model.

Objective To analyze the effect of a combined strategy of enteral nutrition in the prevention and treatment of patients with severe bum sepsis. Methods 46 cases were random divided into combined group (group C) and routine group (group R). Besides general supportive treatment,group C was treated with early enteral feeding (EEF) ,recombinant human growth hormone (rhGH) and gluta-mine (Gln), while group R was given general supportive treatment only. The plasma concentration levels of pre-albumin (PA) , C-reactive protein (CRP), procalcitonin (PCT) and tumor necrosis factora (TNFα) were measured immediately after hospitalization and postbum day (PBD)7, 14,28. Results The survival rate of group C was significantly higher than group R. The incidence of sepsis, the complication of heart and gastrointestin in group C was significantly lower than group R ( P < 0. 01 ～ 0.05). The days in hospitalization of group C was shorter than that of group R. Plasma PA levels was decreased in two groups and was markedly decreased in the group R( P < 0. 01 ～ 0.05). Plasma CRP, PCT and TNFαlevels were both increased in two groups and markedly increased in the group R ( P < 0.001 ～ 0.05). Conclusions We have shown that a combined method including rhGH, EEF, Gln and anisodamin can effectively reduce the morbidity and mortality rates of burn sepsis and improve prognosis.

OBJECTIVE To investigate the phylogenetic analysis of Acinetobacter baumannii strains in elderly.METHODS The 33 kinds resistant genes were detected by PCR and cluster analysis.RESULTS The positive rates of AmpC(chromosome type),TEM and PER were 85%,55% and 25%,respectively.The positive rates of aac(3)-Ⅰ,ant(3″)-Ⅰ,aac(3)-Ⅱ,aac(6′)-Ⅰb and armA were 95%,95%,40%,15% and 35%,respectively.The positive rate of qacE△1-sul1 was 75%.There were very high positive percentages of AmpC(chromosome type),TEM,PER,aac(3)-Ⅰ,ant(3″)-Ⅰ,armA and qacE△1-sul1 genes in A.baumannii isolates among elderly.There were clones transmitted phenomenon.CONCLUSIONS The resistance phenotype of A.baumannii isolates among elderly is in accordance with genetic testing.A.baumannii can induce clones transmitted hospital infection.

OBJECTIVE To investigate the ?-lactamase genes in 4 kinds of nonfermenting Gram-negative bacilli isolated from the 98th Hospital of PLA. METHODS Sixty strains of Acinetobacter baumannii,30 strains of Pseudomonas aeruginosa,19 strains of Stenotrophomonas maltophilia,and 15 strains of Flavobacterium were isolated from hospitalized patients.Nine kinds of ?-lactamases genes of TEM,SHV,OXA,CTX-M,PER,VEB,IMP,VIM and GES were analyzed by PCR and verified by DNA sequencing. RESULTS In A.baumannii and(P.aeruginosa),the positive rates of gene of TEM were 100.0% and 66.7%,respectively.SHV gene was positive in 18 of 60 strains of A.baumannii tested,17 of which were SHV-12 subtype ESBLs.The other was a new SHV type ?-lactamase nominated SHV-48.OXA gene was positive in 1 of 30 strains of P.aeruginosa tested,it was an OXA-10 subtype ESBLs.But the rest of genes were all negative. CONCLUSIONS There exist 4 kinds of(?-lactamase) genes at least in nonfermenting Gram-negative bacilli including TEM-1,SHV-12,SHV-48,and(OXA-10.)

OBJECTIVE To investigate the condition of drug-resistant genes in MRSA and MSSA. METHODS The drug-resistant genes mecA,ermA/B/C,aac(6′)/aph(2″),aph(3′)-Ⅲ,ant(4′,4″) and tetM of MRSA and MSSA were detected by polymerase chain reaction(PCR). RESULTS The 5 kinds of drug-resistant genes,such as mecA,ermA/B/C,aac(6′)/aph(2″),(aph(3′)-Ⅲ) and tetM were positive in MRSA. CONCLUSIONS MRSA is a multi-resistant pathogen.