With the increasing proportion of critically ill pregnant and postpartum women, extracorporeal membrane oxygenation (ECMO) has become the ultimate treatment for severe obstetric diseases. However, the application of ECMO for pregnant and postpartum women in China is facing the prominent contradiction of " unbalanced growth between quantity and quality system construction", which is manifested as systemic challenges such as uneven regional development, inconsistent treatment capabilities, and lack of unified standards. To address the above issues, this paper proposes the construction of a regional ECMO treatment system for pregnant and postpartum women based on the " Hub-and-Spoke" model. This system aims to achieve early identification, rapid transportation, and homogeneous and efficient treatment of critically ill pregnant and postpartum women by concentrating high-quality medical resources, establishing standardized multidisciplinary team (MDT) diagnosis and treatment processes, and setting up professional mobile ECMO transportation teams. The construction of this regional treatment system is a key measure to improve the success rate of treating critically ill pregnant and postpartum women and reduce maternal mortality in China, and is of great significance for ensuring maternal and infant safety.

Objective:To explore the application indications, clinical characteristics and influencing factors of extracorporeal membrane oxygenation (ECMO) in the treatment of critically ill pregnant and postpartum women in Bao′an district, Shenzhen, and summarize regional experience.Methods:A retrospective analysis was conducted on 5 cases of pregnant and postpartum women who received ECMO treatment at the CUHK Women′s and Children′s Medical Centre (Shenzhen) and the Shenzhen Bao′an People′s Hospital from 2020 to 2024. Baseline characteristics, ECMO parameters, complications and maternal-infant outcomes of the patients were collected.Results:The patients′ age was 29(24, 36) years old, gestational age was 39(31, 39) weeks, and ECMO maintenance time was 8(4, 8) days. ECMO indications included 2 cases of cardiac arrest, 1 case of respiratory and circulatory failure, 1 case of cardiogenic shock, and 1 case of acute respiratory distress syndrome. There were 4 cases of veno-arterial (VA)-ECMO and 1 case of veno-venous (VV)-ECMO. Complications included 3 cases of bleeding, 4 cases of acute renal failure, 2 cases of thrombosis, and 2 cases of infection. Both maternal and infant survival were 3 cases. Successful cases benefited from the multidisciplinary rapid response team and regional transportation cooperation, while failed cases were mostly accompanied by severe bleeding and disseminated intravascular coagulation.Conclusions:ECMO improves the success rate of treating critically ill pregnant and postpartum women in Bao′an District. Amniotic fluid embolism and severe pulmonary hypertension are the main indications. Regional multidisciplinary cooperation, accurate initiation timing and individualized anticoagulation management are the keys. It is recommended to establish a national ECMO registration system for pregnant and postpartum women to optimize treatment strategies and improve maternal and infant prognosis.

Objective:This study aimed to analyze the prognostic risk factors for hepatoid adenocarcinoma of the stomach (HAS) and construct two nomogram-based clinical prediction models to predict overall survival (OS) and recurrence-free survival (RFS) in patients with HAS.Methods:Data were retrospectively collected from 82 patients (64 males, 18 females; mean age 60.3 ± 9.4 years) who underwent radical gastrectomy and were pathologically diagnosed with gastric hepatoid adenocarcinoma at the First Medical Center of the PLA General Hospital between February 2006 and September 2023. Statistical analyses were conducted using SPSS 25.0 and R 4.3.2. Survival analyses were performed using the Kaplan-Meier method, and univariate analyses were used to identify clinical and pathological factors associated with prognosis. Variables with P<0.05 in the univariate analysis were included in multivariate Cox regression models to identify independent risk factors for OS and RFS. These factors were incorporated into the prediction models to construct nomograms. The discriminatory power of the models was assessed using the area under the curve (AUC) of receiver operating characteristic (ROC) analyses, while calibration curves, decision curve analysis (DCA), and comparisons with the 8th edition of the TNM staging system of the American Joint Committee on Cancer (AJCC) were employed to evaluate model performance. Results:Among the 82 patients, 36 (43.9%) exhibited vascular infiltration, 61 (74.4%) had nerve infiltration, and lymph node metastasis was observed in 60 cases (73.2%). Pathological stages I, II, III, and IV were distributed as 11 (13.4%), 26 (31.7%), 44 (53.7%), and 1 (1.2%) cases, respectively. Inflammatory markers included neutrophil-to-lymphocyte ratio (NLR) ≥ 4.33 in 22 cases (26.8%), platelet-to-lymphocyte ratio (PLR) ≥ 142.2 in 50 cases (61.0%), monocyte-to-lymphocyte ratio (MLR) ≥ 0.411 in 22 cases (26.8%), α-fetoprotein (AFP) ≥ 2.48 μg/L in 64 cases (78.0%), and C-reactive protein (CRP) ≥ 7.506 mg/L in 12 cases (14.6%). Among the 82 patients, 3 cases (3.6%) were lost to follow-up. The median follow-up time was 52 (range: 8–147) months, with a median OS of 61(2–147) months. The 1-year and 3-year OS rates were 78.5% and 58.5%, respectively, while the 1-year and 3-year RFS rates were 77.3% and 60.3%, respectively. Multivariate analysis identified several independent risk factors influencing OS in patients with HAS: advanced pathological stage, MLR ≥ 0.411, AFP ≥ 2.545 μg/L, and CRP ≥ 7.51 mg/L. The hazard ratios (HRs) and 95% confidence intervals (CIs) were as follows: 5.218 (1.230–22.143), 2.610 (1.287–5.294), 2.950 (1.013–8.589), and 2.594 (1.145–5.877), respectively (all P < 0.05). For RFS, advanced pathological stage, PLR ≥ 152.0, and MLR ≥ 0.411 were independent risk factors, with HRs (95% CIs) of 4.735 (1.080–20.760), 3.759 (1.259–11.226), and 2.714 (1.218–6.048), respectively (all P < 0.05). The AUC values for OS prediction at 1 year, 3 years, and 5 years were 0.7765, 0.7525, and 0.7702, respectively. For RFS, the AUC values were 0.7304, 0.8137, and 0.8307 at 1 year, 3 years, and 5 years, respectively. The calibration curves demonstrated strong agreement between nomogram- predicted outcomes and observed survival data. DCA indicated that both TNM staging and the nomogram-based clinical prediction models provided a net positive benefit in predicting OS and RFS in HAS patients, with the nomogram model demonstrating superior performance. Conclusion:The nomogram-based clinical prediction models developed in this study demonstrated robust performance in predicting long-term OS and RFS in patients with HAS.

With the increasing proportion of critically ill pregnant and postpartum women, extracorporeal membrane oxygenation (ECMO) has become the ultimate treatment for severe obstetric diseases. However, the application of ECMO for pregnant and postpartum women in China is facing the prominent contradiction of " unbalanced growth between quantity and quality system construction", which is manifested as systemic challenges such as uneven regional development, inconsistent treatment capabilities, and lack of unified standards. To address the above issues, this paper proposes the construction of a regional ECMO treatment system for pregnant and postpartum women based on the " Hub-and-Spoke" model. This system aims to achieve early identification, rapid transportation, and homogeneous and efficient treatment of critically ill pregnant and postpartum women by concentrating high-quality medical resources, establishing standardized multidisciplinary team (MDT) diagnosis and treatment processes, and setting up professional mobile ECMO transportation teams. The construction of this regional treatment system is a key measure to improve the success rate of treating critically ill pregnant and postpartum women and reduce maternal mortality in China, and is of great significance for ensuring maternal and infant safety.

Objective:To explore the application indications, clinical characteristics and influencing factors of extracorporeal membrane oxygenation (ECMO) in the treatment of critically ill pregnant and postpartum women in Bao′an district, Shenzhen, and summarize regional experience.Methods:A retrospective analysis was conducted on 5 cases of pregnant and postpartum women who received ECMO treatment at the CUHK Women′s and Children′s Medical Centre (Shenzhen) and the Shenzhen Bao′an People′s Hospital from 2020 to 2024. Baseline characteristics, ECMO parameters, complications and maternal-infant outcomes of the patients were collected.Results:The patients′ age was 29(24, 36) years old, gestational age was 39(31, 39) weeks, and ECMO maintenance time was 8(4, 8) days. ECMO indications included 2 cases of cardiac arrest, 1 case of respiratory and circulatory failure, 1 case of cardiogenic shock, and 1 case of acute respiratory distress syndrome. There were 4 cases of veno-arterial (VA)-ECMO and 1 case of veno-venous (VV)-ECMO. Complications included 3 cases of bleeding, 4 cases of acute renal failure, 2 cases of thrombosis, and 2 cases of infection. Both maternal and infant survival were 3 cases. Successful cases benefited from the multidisciplinary rapid response team and regional transportation cooperation, while failed cases were mostly accompanied by severe bleeding and disseminated intravascular coagulation.Conclusions:ECMO improves the success rate of treating critically ill pregnant and postpartum women in Bao′an District. Amniotic fluid embolism and severe pulmonary hypertension are the main indications. Regional multidisciplinary cooperation, accurate initiation timing and individualized anticoagulation management are the keys. It is recommended to establish a national ECMO registration system for pregnant and postpartum women to optimize treatment strategies and improve maternal and infant prognosis.

Objective:This study aimed to analyze the prognostic risk factors for hepatoid adenocarcinoma of the stomach (HAS) and construct two nomogram-based clinical prediction models to predict overall survival (OS) and recurrence-free survival (RFS) in patients with HAS.Methods:Data were retrospectively collected from 82 patients (64 males, 18 females; mean age 60.3 ± 9.4 years) who underwent radical gastrectomy and were pathologically diagnosed with gastric hepatoid adenocarcinoma at the First Medical Center of the PLA General Hospital between February 2006 and September 2023. Statistical analyses were conducted using SPSS 25.0 and R 4.3.2. Survival analyses were performed using the Kaplan-Meier method, and univariate analyses were used to identify clinical and pathological factors associated with prognosis. Variables with P<0.05 in the univariate analysis were included in multivariate Cox regression models to identify independent risk factors for OS and RFS. These factors were incorporated into the prediction models to construct nomograms. The discriminatory power of the models was assessed using the area under the curve (AUC) of receiver operating characteristic (ROC) analyses, while calibration curves, decision curve analysis (DCA), and comparisons with the 8th edition of the TNM staging system of the American Joint Committee on Cancer (AJCC) were employed to evaluate model performance. Results:Among the 82 patients, 36 (43.9%) exhibited vascular infiltration, 61 (74.4%) had nerve infiltration, and lymph node metastasis was observed in 60 cases (73.2%). Pathological stages I, II, III, and IV were distributed as 11 (13.4%), 26 (31.7%), 44 (53.7%), and 1 (1.2%) cases, respectively. Inflammatory markers included neutrophil-to-lymphocyte ratio (NLR) ≥ 4.33 in 22 cases (26.8%), platelet-to-lymphocyte ratio (PLR) ≥ 142.2 in 50 cases (61.0%), monocyte-to-lymphocyte ratio (MLR) ≥ 0.411 in 22 cases (26.8%), α-fetoprotein (AFP) ≥ 2.48 μg/L in 64 cases (78.0%), and C-reactive protein (CRP) ≥ 7.506 mg/L in 12 cases (14.6%). Among the 82 patients, 3 cases (3.6%) were lost to follow-up. The median follow-up time was 52 (range: 8–147) months, with a median OS of 61(2–147) months. The 1-year and 3-year OS rates were 78.5% and 58.5%, respectively, while the 1-year and 3-year RFS rates were 77.3% and 60.3%, respectively. Multivariate analysis identified several independent risk factors influencing OS in patients with HAS: advanced pathological stage, MLR ≥ 0.411, AFP ≥ 2.545 μg/L, and CRP ≥ 7.51 mg/L. The hazard ratios (HRs) and 95% confidence intervals (CIs) were as follows: 5.218 (1.230–22.143), 2.610 (1.287–5.294), 2.950 (1.013–8.589), and 2.594 (1.145–5.877), respectively (all P < 0.05). For RFS, advanced pathological stage, PLR ≥ 152.0, and MLR ≥ 0.411 were independent risk factors, with HRs (95% CIs) of 4.735 (1.080–20.760), 3.759 (1.259–11.226), and 2.714 (1.218–6.048), respectively (all P < 0.05). The AUC values for OS prediction at 1 year, 3 years, and 5 years were 0.7765, 0.7525, and 0.7702, respectively. For RFS, the AUC values were 0.7304, 0.8137, and 0.8307 at 1 year, 3 years, and 5 years, respectively. The calibration curves demonstrated strong agreement between nomogram- predicted outcomes and observed survival data. DCA indicated that both TNM staging and the nomogram-based clinical prediction models provided a net positive benefit in predicting OS and RFS in HAS patients, with the nomogram model demonstrating superior performance. Conclusion:The nomogram-based clinical prediction models developed in this study demonstrated robust performance in predicting long-term OS and RFS in patients with HAS.

Objective:To investigate the risk factors of pathological complete response(pCR)after neoadjuvant therapy for locally advanced gastric cancer(LAGC)and assess the value of gastric tumor markers for predicting pCR in LAGC patients.Methods:We retrospectively ana-lyzed the clinical and pathological characteristics of 213 patients who underwent radical gastrectomy and gastric tumor marker analysis after neoadjuvant therapy at The Chinse PLA General Hospital First Medical Center,between January 2020 and April 2024(20 and 193 cases in the pCR and non-pCR groups,respectively).The interrelationships among pCR,tumor markers,and clinicopathological features were compared,and independent risk factors for pCR were analyzed.A nomogram was constructed to predict the pCR.Results:Among 213 patients,20(9.4% )achieved pCR.Univariate analysis showed that age(P=0.067),tumor bed diameter(P<0.001),gastrin-17 levels(P=0.005),CA72-4 levels(P=0.073),pepsinogen ratio(P=0.024),and neoadjuvant immunotherapy(P=0.022)were strongly associated with pCR in LAGC pa-tients.Multivariate analysis showed that neoadjuvant immunotherapy,CA72-4 levels<2.5 U/mL,gastrin-17 levels<1.48 pmol/L,and tumor bed diameter<2.85 cm were independent predictive factors for pCR in LAGC patients(P<0.05).These indicators were incorporated into a nomogram prediction model;an receiver operating characteristic curve(ROC)was plotted with an AUC(95% CI)of 0.863(0.785-0.942).The calibration and decision curves suggested that the nomogram was well calibrated and had a good net benefit.Conclusions:Gastric tumor markers can effectively predict pCR after neoadjuvant therapy in LAGC patients.Our nomogram showed a good predictive ability for pCR.Thus,our findings can serve as a useful reference for clinical decision making for LAGC patients.

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.

Pregnancy with autoimmune diseases is a challenging area that involves multidisciplinary management of immunology, rheumatology, and obstetrics. During pregnancy, the maternal immune system dynamically regulates the balance between maintaining immune tolerance to the fetus and autoimmune. However, for women with common systemic autoimmune diseases such as systemic lupus erythematosus, antiphospholipid syndrome, and rheumatoid arthritis, this balance can be upset, leading to exacerbation or recurrence of the disease and significantly increasing the risk of pregnancy complications. This paper describes the adaptive changes of the immune system during pregnancy and the effects of systemic autoimmune diseases on pregnancy outcomes, proposes multidisciplinary management strategies and challenges in perinatal pregnancy, and aims to provide references for optimizing clinical practice and improving pregnancy outcomes.

Objective:To design and develop a portably minimally invasive diagnostic and therapeutic device for abdominally warfare trauma,which aimed at a scene of rescue environment at frontline,and its feasibility was evaluated preliminarily through animal experiment.Methods:Based on the actual demands of the rescue environment at frontline,a set of portably minimally invasive diagnostic and therapeutic device for abdominally warfare trauma(abbreviation:minimally invasive diagnostic and therapeutic device)was researched,developed and assembled,which included portably integrated host,disposable flexible lens of endoscope,disposable apparatus of minimally invasive surgery,extendable channel device of avoiding pneumoperitoneum and so on.A male Bama miniature pig was selected,and it received two different surgeries included portably minimally invasive diagnostic and therapeutic device,and conventionally laparoscopic surgery after it received general anesthesia.The damage controls included hemostasis of intraoperative parenchyma organ,sealing and repairing of gastrointestinal perforation and drainage of indwelling catheter in abdominal and pelvic cavity between two groups were compared,and the difference of the mobility performance between them also was compared.The operational evaluation of minimally invasive surgery of damage control surgery and the potential of its clinical conversion were conducted.Results:Compared to conventional laparoscopy,this minimally invasive diagnostic and therapeutic device had better mobility,and the transfer time of this device was(3.3±1.0)min,which was significantly shorter than(14.5±3.2)min of conventional laparoscopy,and the difference of that between two device was significant(t=-5.786,P<0.05).The minimally invasive diagnostic and therapeutic device could successfully realize a series of operation of damage control surgery included exploration,flushing,suction,hemostasis,repair and drainage under the pneumoperitoneum or without pneumoperitoneum,which operation was safety and feasibility.Conclusion:The portably minimally invasive diagnostic and therapeutic device for abdominally warfare trauma can realize integration and optimization,and mobility and portability on the basis of the current laparoscopic platform,which can successfully realize the operation of damage control surgery.It has favorable application prospects and capabilities of clinical conversion.