Neoadjuvant therapy has become the standard treatment for locally advanced resectable esophageal cancer, significantly improving long-term survival compared to surgery alone. Neoadjuvant therapy has evolved to include various strategies, such as concurrent chemoradiotherapy, chemotherapy, immunotherapy, or targeted combination therapy. This enriches clinical treatment options and provides a more personalized and scientific treatment approach for patients. This article aims to comprehensively summarize current academic research hot topics, review the rationale and evaluation measures of neoadjuvant therapy, discuss challenges in restaging methods after neoadjuvant therapy, and identify the advantages and disadvantages of various neoadjuvant therapeutic strategies.

Objective:The purpose of this study was to analyze the pharmacoeconomic research progress on nutrition therapy for cancer patients in recent ten years and explore the research hotspots in this field.Method:Bibliometric analysis was conducted based on Web of Science core database using CiteSpace, VOSviewer, Gephi and Scimago Graphics.Results:A total of 647 researches in the field of pharmacoeconomics about nutrition therapy for cancer patients published from 2013 to 2022 were included, with the annual publication output peaking in 2022. A total of 286 authors from 94 countries or regions have conducted relevant research. Among the 306 institutions involved in our study, the World Health Organization was with the most citations, and the journal with the most citations was Clinical nutrition. The United States, China and the United Kingdom were the top three countries concerning publication outputs. Harvard University was the most important research institution in this field, and the authors with the highest publication volume was Carli Francesco. Keyword analysis identified colorectal cancer as the most important research topic. Keyword clustering resulted in 16 groups, among which enteral nutrition was the largest, and the burst keyword was enhanced recovery after surgery. Conclusions:This study found that research hotspots in nutrition therapy for cancer patients have mainly focused on colorectal cancer and enhanced recovery after surgery in the past decade, and enteral nutrition is also an important research topic in this field. With the emerging precision medicine, based on big data and individual patient conditions (especially patients with colorectal cancer), tailored whole-course perioperative nutrition management program with superior cost-effectiveness may represent the future research trend.

Objective:To investigate the establishment method, coordination points and safe transport management strategy of vena-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with downtime difficulties during cardiopulmonary bypass (CPB).Methods:A observation study was conducted. The patients admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from January 2020 to October 2022 were enrolled. These patients could not be separated from CPB and received VA-ECMO-assisted CPB surgery. The clinical data of the patients were recorded, including the basic information of the patients, the data of VA-ECMO establishment and transport process, the clinical indicators before and after VA-ECMO installation, the operation data of VA-ECMO and clinical outcomes. The experience was summarized from the aspects of extracorporeal membrane oxygenation (ECMO) establishment, transport process, team cooperation, and adverse events during transport. The clinical indicators before and after ECMO operation were compared. According to whether ECMO was successfully weaned, the patients were divided into a successful weaning group and a failure weaning group, and the clinical data between the two groups were compared.Results:Eighteen patients who underwent VA-ECMO-assisted CPB were enrolled, including 10 males and 8 females. The average age was (56.7±12.3) years old. Preoperative left ventricular ejection fraction (LVEF) was 0.46±0.10, and the main reasons for switching to VA-ECMO assistance included right ventricular systolic weakness in 6 cases, total cardiac systolic weakness in 5 cases, left ventricular systolic weakness in 4 cases, high pulmonary arterial pressure in 2 cases, and intractable ventricular fibrillation in 1 case. Among the 18 patients transferred from CPB to VA-ECMO, 10 cases were successfully weaned and 8 cases failed. In ICU, 8 cases survived, 5 cases died, and 5 cases gave up treatment and discharged. The average time for successful CPB to VA-ECMO establishment was (24.6±7.4) minutes, initial blood flow was (3.3±0.4) L/min, and transit time was (8.4±1.5) minutes. ECMO-assisted duration averaged (82.0±69.3) hours. Adverse events occurred in 9 patients during ECMO establishment and transfer. Post-ECMO onboarding for 4 hours, significant improvements were noted in blood lactic acid (Lac), pH value, mean arterial pressure (MAP), central venous oxygen saturation (ScvO 2) as compared with pre-ECMO onboarding [Lac (mmol/L): 10.5±7.0 vs. 15.2±6.8, pH value: 7.38±0.92 vs. 7.26±0.87, MAP (mmHg, 1 mmHg≈0.133 kPa): 74.9±13.7 vs. 58.4±17.0, ScvO 2: 0.678±0.065 vs. 0.611±0.061, all P < 0.01], and vasoactive-inotropic score (VIS) was also decreased (39.8±29.8 vs. 68.9±64.4, P < 0.01). Compared with successful weaning group, the patients in the failed weaning group exhibited higher pre-machine Lac (mmol/L: 18.8±7.8 vs. 12.3±4.3, P < 0.05), longer CPB time [minutes: 238.0 (208.8, 351.2) vs. 200.0 (185.8, 217.0), P < 0.05], and shorter ECMO-assisted time [hours: 19.5 (11.0, 58.8) vs. 94.5 (65.8, 179.8), P < 0.01]. However, there was no statistically significant difference in pre-machine pH value, ScvO 2, MAP, VIS score, and initial blood flow and establishment time of ECMO between the two groups. Conclusions:VA-ECMO is an effective circulatory aid for CPB surgery that cannot be weaned after CPB. The establishment and transfer of CPB "bridge" to ECMO aid depends on multi-disciplinary treatment (MDT) cooperation. The success rate of ECMO weaning is related to the Lac and CPB duration. If it is not possible to detach from the CPB successfully, VA-ECMO should be initiated as early as possible.

Objective:To integrate the best evidence for early rehabilitation of mechanically ventilated ICU-acquired weakness (ICU-AW) patients using evidence-based methods, providing evidence-based basis for standardized evaluation and intervention of early exercise therapy for mechanically ventilated ICU-AW patients.Methods:A systematic search was conducted on the American Thoracic Society (ATS) Clinical Practice Guidelines, Registered Nurses' Association of Ontario (RNAO), Guidelines International Network (GIN), Canadian Medical Association Clinical Practice Guideline Library (CMACPGL), BMJ Clinical Evidence, UpToDate, Scottish Intercollegiate Guidelines Network (SIGN), PubMed, Cochrane Library, National Guideline Clearinghouse (NGC), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), UM-library, Physiotherapy Evidence Database (PEDro), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Chinese Medical Pulse Guidelines Website, CNKI and Wanfang data and other Chinese and English databases, professional team websites, and guideline websites for expert consensus, guidelines, randomized collected trial (RCT), systematic reviews and other evidence on early exercise rehabilitation for mechanically ventilated ICU-AW patients. The search time limit was from the establishment of the database to December 31, 2023. Literature search, screening, evaluation, information extraction was independently conducted by two evaluators with cross checking, and quality evaluation of the included literature was conducted.Results:A total of 21 literatures were enrolled, including 5 guidelines, 5 systematic reviews, 4 expert consensuses, and 7 RCT, all of which with high evidence level and all were enrolled. They were summarized into seven aspects with assessment screening, exercise safety standards, precautions, setting of exercise time, exercise intensity, exercise sequence, and recommended exercise content as the core, and 32 best evidences.Conclusions:The evidence summarized can provide evidence-based basis for standardized assessment and intervention of early exercise rehabilitation in mechanically ventilated ICU-AW patients. ICU medical practitioners need to combine the actual clinical environment, individual differences and rehabilitation goals of patients, to provide targeted health guidance and intervention for the prevention of ICU-AW in mechanically ventilated patients.

Objective To explore the effect of Rhubarb ultrasonic electrical conduction target penetration therapy on the gastrointestinal function of sepsis patients.Methods A total of 88 cases of inpatient sepsis patients diagnosed and treated at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2021 to June 2023 were selected as the participants and the patients were divided into the treatment group and the control group by a simple random method.Both groups were given routine treatments such as anti-infection,fluid resuscitation,nutritional support,blood sugar management,and prevention of stress ulcers,while the treatment group was treated with ultrasonic conductance target penetration Rhubarb therapy at Shenque point and Zhongwan point on the basis of the control group.The main observational indexes were the number of bowel sounds in the two groups before treatment and after 3 days,and 7 days of treatment.The secondary observational indexes were gastric retention,serum C-reactive protein(CRP),procalcitonin(PCT),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),the first defecation time,time to mechanical ventilation,length of stay in the intensive care unit(ICU),hospitalization cost,and 28 days readmission rate of the two groups.The gastric retention was evaluated and recorded every 4 hours before treatment and 3 days and 7 days after treatment,CRP and APACHE Ⅱ score were evaluated before treatment and 7 days after treatment,the 28-day readmission was followed up by telephone.Results A total of 44 cases in the treatment group and 43 cases in the control group completed the intervention.The difference between the bowel sounds and the amount of gastric retention of the two groups was not statistically significant before treatment,with the prolongation of time,the bowel sounds of the two groups gradually increased and the amount of gastric retention gradually decreased,and the number of bowel sounds in the treatment group increased significantly compared to the control group 3 days and 7 days after treatment[beats/minute:4.49(4.23,4.74)vs.3.07(2.80,3.33)3rd day of and 4.79(4.49,5.10)vs.3.36(3.06,3.66)on the 7th day of treatment,both P<0.01],and the amount of gastric retention was significantly reduced compared with the control group[mL:20.93(9.22,32.64)vs.53.52(41.16,65.88)for 3rd day of and 3.72(0.17,7.28)vs.31.59(24.87,38.31)on the 7th day of treatment,both P<0.01].The first defecation time was significantly shorter in the treatment group than in the control group(hours:25.67±9.99 vs.33.64±11.30,P<0.01).After 7 days treatment,the CRP,PCT,and APACHE Ⅱ score were significantly reduced in the treatment group compared to those in the control group[CRP(mg/L):45.97(35.68,56.26)vs.77.30(57.20,97.38),PCT(μg/L):0.94(0.56,1.31)vs.2.73(1.36,4.09),APACHE Ⅱ score:24.11±7.01 vs.28.06±9.25,all P<0.05],the mechanical ventilation time and ICU length of stay were significantly shortened[mechanical ventilation time(hours):107.05±70.76 vs.168.83±136.62,ICU stay time(days):7.58±3.72 vs.9.70±5.15,both P<0.05],the hospitalization cost and 28-day readmission rate were significantly reduced[hospitalization cost(yuan):80337.89±36483.72 vs.109100.24±87080.84,28-day readmission rate:9.1％(4/44)vs.27.9％(12/43),both P<0.05].Conclusion Rhubarb ultrasonic conductive target penetration therapy is a safe,simple,and effective characteristic therapy of external Chinese medicine that can provide a new basis for the protection of gastrointestinal function in patients with sepsis.

Objective To investigate the effect of Dapagliflozin on high glucose-induced podocyte proliferation and apoptosis through p38 mitogen-activated protein kinase(p38 MAPK)pathway.Methods Human glomerular podocytes(HGPC)were divided into control(Con)group,low/medium/high D-glucose(Glu 10,Glu 20,Glu 30)group,high glucose(HG)group,low/medium/high concentration Dapagliflozin(HG+Dap 12.5,HG+Dap 25,HG+Dap 50)group,Dapagliflozin(HG+Dap)group,inhibitor(HG+ SB 203580)group,Dapagliflozin + inhibitor(HG+Dap+SB 203580)group and Dapagliflozin + activator(HG+Dap+C16-PAF)group.After 24 hours of intervention,the cell viability,proliferation rate,apoptosis rate and levels of related factors were tested.Results Compared with Con group,IL-1β,TNF-α,apoptosis rate,Caspase-3 mRNA and protein expression,p53,p-p38 MAPK protein expression were increased(P＜0.05),while cell proliferation rate,Cyclin D1 mRNA and protein expression were decreased in HG group(P＜0.05).Compared with HG group,the proliferation rate,Cyclin D1 mRNA and protein expression were increased(P＜0.05),while IL-1β,TNF-α,apoptosis rate,Caspase-3 mRNA and protein expression,p53,p-p38 MAPK protein expression were decreased in the HG+Dap and HG+SB 203580 groups(P＜0.05).Compared with HG+Dap group,cell proliferation rate,Cyclin D1 mRNA and protein expression were increased(P＜0.05),while IL-1β,TNF-α,apoptosis rate,Caspase-3 mRNA and protein expression,p53,p-p38 MAPK protein expression were decreased in HG+Dap+SB 203580 group(P＜0.05).In HG+Dap+C16-PAF group,IL-1β,TNF-α,apoptosis rate,Caspase-3 mRNA and protein expression,p53,p-p38 MAPK protein expression were increased(P＜0.05),while cell proliferation rate,Cyclin D1 mRNA and protein expression were decreased(P＜0.05).Conclusion Dagagliflozin can promote HGPC proliferation and inhibit apoptosis and inflammation in high D-glucose environment,and its mechanism may be related to the inhibition of p38 MAPK pathway signal transduction.

"Global cancer statistics 2022" based on the latest GLOBCAN data from the International Agency for Research on Cancer (IARC) was recently released, providing a systematic analysis of the incidence and mortality of 36 types of cancer across 185 countries worldwide. The international burden of cancer is expected to continue to increase over the next 30 years, posing a severe public health and social challenge for many countries, including China. This article offers a key point interpretation of the "Global cancer statistics 2022", focusing on the evolution of cancer epidemiology and future development trends. The aim is to broaden the international perspective on cancer prevention and treatment, with the hope of providing reference and guidance for cancer prevention and treatment efforts in our country.

Standardized reporting is a crucial factor affecting the use of patient guidelines （PGs）， particularly in the reporting and presentation of recommendations. This paper introduced the current status of PG reporting， including the research on PG content and presentation formats， and provided comprehensive recommendations for PG reporting from aspects such as overall framework， recommendations， presentation format， and readability. First， the presentation of PG recommendations should include clearly defined clinical questions， recommendations and their rationale， and guidance on how patients should implement the interventions； for specific content in the PG， such as level of evidence， level of recommendation， it is recommended to explain in text the reasons for giving different levels of recommendation， i.e.， to present the logic behind giving the level of recommendation to the patient； additional information needed in the recommendation framework should be supplemented by tracing references or authoritative textbooks and literature that support the recommendations. Subsequently， the PG text should be written based on the Reporting Checklist for Public Versions of Guidelines （RIGHT-PVG） reporting framework. Finally， to enhance readability and comprehension， it is recommended to refer to the Patient Education Materials Assessment Tool （PEMAT） for translating PG content. To enhance the readability of PGs， it is suggested to present the PG content in a persona-lized and layered manner.

Since the concept of patient versions of guidelines （PVGs） was introduced into China， several PVGs have been published in China， but we found that there is a big difference between the concept of PVG at home and abroad， and the reason for this difference has not been reasonably explained， which has led to ambiguity and even misapplication of the PVG concept by guideline developers. By analyzing the background and purpose of PVGs， and the understanding of the PVG concept by domestic scholars， we proposed the term patient guidelines （PGs）. This refers to guidelines developed under the principles of evidence-based medicine， centered on health issues that concern patients， and based on the best available evidence， intended for patient use. Except for the general attribute of providing information or education， which is typical of common health education materials， PGs also provide recommendations and assist in decision-making， so PGs include both the patient versions of guidelines （PVG） as defined by the Guidelines International Network （GIN） and "patient-directed guidelines"， i.e. clinical practice guidelines resulting from the adaptation or reformulation of recommendations through clinical practice guidelines.

At present， the process and methodology of patient guidelines （PGs） development varies greatly and lacks systematic and standardised guidance. In addition to the interviews with PG developers， we have sorted out the relevant methodology for the adaptation and development of existing clinical practice guideline recommendations and facilitated expert deliberations to achieve a consensus， so as to finally put forward a proposal for guidance on the process and methodology for the development of PGs. The development of PGs can be divided into the preparation stage， the construction stage， and the completion stage in general， but the specific steps vary according to the different modes of development of PGs. The development process of Model 1 is basically the same as the patient version of the guideline development process provided by the International Guidelines Network， i.e.， team formation， screening of recommendations， guideline drafing， user testing and feedback， approval and dissemination. The developer should also first determine the need for and scope of translating the clinical practice guideline into a patient version during the preparation phase. Model 2 adds user experience and feedback to the conventional clinical practice guideline development process （forming a team， determining the scope of the PG， searching， evaluating and integrating evidence， forming recommendations， writing the guideline， and expert review）. Based on the different models， we sort out the process and methods of PG development and introduce the specific methods of PG development， including how to identify the clinical problem and how to form recommendations based on the existing clinical practice guidelines， with a view to providing reference for guideline developers and related researchers.