Intraoperative cell salvage (IOCS) has been widely applied as an important blood conservation measure in surgical operations. However, there is currently a lack of clinical practice guidelines for the implementation of IOCS in patients with malignant tumors. This report aims to provide clinicians with recommendations on the use of IOCS in patients with malignant tumors based on the review and assessment of the existed evidence. Data were derived from databases such as PubMed, Embase, the Cochrane Library and Wanfang. The guideline development team formulated recommendations based on the quality of evidence, balance of benefits and harms, patient preferences, and health economic assessments. This study constructed seven major clinical questions. The main conclusions of this guideline are as follows: 1) Compared with no perioperative allogeneic blood transfusion (NPABT), perioperative allogeneic blood transfusion (PABT) leads to a more unfavorable prognosis in cancer patients (Recommended); 2) Compared with the transfusion of allogeneic blood or no transfusion, IOCS does not lead to a more unfavorable prognosis in cancer patients (Recommended); 3) The implementation of IOCS in cancer patients is economically feasible (Recommended); 4) Leukocyte depletion filters (LDF) should be used when implementing IOCS in cancer patients (Strongly Recommended); 5) Irradiation treatment of autologous blood to be reinfused can be used when implementing IOCS in cancer patients (Recommended); 6) A careful assessment of the condition of cancer patients (meeting indications and excluding contraindications) should be conducted before implementing IOCS (Strongly Recommended); 7) Informed consent from cancer patients should be obtained when implementing IOCS, with a thorough pre-assessment of the patient's condition and the likelihood of blood loss, adherence to standardized internally audited management procedures, meeting corresponding conditions, and obtaining corresponding qualifications (Recommended). In brief, current evidence indicates that IOCS can be implemented for some malignant tumor patients who need allogeneic blood transfusion after physician full evaluation, and LDF or irradiation should be used during the implementation process.

Objective To evaluate cardiac involvement in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) using echocardiography combined with electrocardiography. Methods A retrospective analysis was performed on the detailed medical records of AAV patients treated in Jining First People’s Hospital between January 2020 and December 2024. Eighty patients were enrolled in the AAV group, and the risk of heart disease was compared between the AAV group and a control group with 80 subjects matched for age, sex, and cardiovascular disease risk factors. Results Electrocardiographic abnormalities were observed in 78.75% of patients in the AAV group, while significant electrocardiographic abnormalities only occurred in symptomatic patients in the control group. There were no differences in left atrial enlargement or interventricular septal thickening between the AAV group and the control group. The overall left ventricular systolic function in the AAV group was lower than that in the control group (8.75% vs. 0). The incidence of reduced diastolic function in the AAV group was significantly higher than that in the control group (37.5% vs. 15%). The incidence rates of tricuspid regurgitation, mitral regurgitation, aortic regurgitation, and pericardial effusion in the AAV group were significantly higher than those in the control group. Pericardial thickening, aortic stenosis, pulmonary hypertension, and rare periaortic granulomas were found in the AAV group, but not in the control group. Conclusion Echocardiography and electrocardiography are important examination methods for evaluating cardiac involvement in AAV. These methods have key roles in disease screening, diagnosis and treatment, follow-up, and prognosis judgment.

Sepsis is a common and severe infectious disease, and its associated coagulation dysfunction can cause disseminated intravascular coagulation (DIC) and organ failure, leading to a significant increase in mortality. Pyroptosis is a form of programmed cell death mediated by caspase-1 in the classical pathway and caspase-4/caspase-5/caspase-11 in the non-classical pathway, along with the effector molecule gasdermin (GSDM) family. Recent studies have shown that pyroptosis plays an important role in the development of coagulation disorders in sepsis. Pyroptosis leads to the formation of cytoplasmic membrane pores, cell swelling and membrane rupture, as well as the release and enhanced activity of procoagulant contents, strongly promoting the development of systemic coagulation activation and DIC in sepsis. Therefore, exploring the role and molecular mechanisms of pyroptosis in sepsis-related coagulation disorders is of great significance for the prevention and treatment of sepsis. This article provides a review of the mechanisms involved in pyroptosis and coagulation disorders in sepsis, as well as the role and mechanisms of pyroptosis in sepsis-associated coagulation disorders to provide new ideas for sepsis related research.

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.

Self-sampling is a method by which the subject collects the own specimens for disease detection. It has the advantages of strong privacy, convenient and simple operation, free time and place, etc. It can improve the compliance of people in remote areas, affected by traditional concepts, limited by working hours and underdeveloped transportation and medical treatment to participate in disease detection and screening. With the development of "Internet+health care" and "Internet+nursing service", home-based self-sampling testing will become a developing situation for disease detection and screening. Human immunodeficiency virus and Human papillomavirus infection bring a heavy burden to individuals and society. In the absence of effective and widespread primary prevention, secondary prevention, namely "early detection, early diagnosis and early treatment" is an effective measure to control the adverse consequences. At present, there are many researches on HPV and HIV self-sampling test, whose test results are highly reliable and highly accepted in the population, and is of great significance for improving the coverage rate of cervical cancer screening and the diagnosis rate of HIV carriers.
Female ; Humans ; Papillomaviridae ; Early Detection of Cancer/methods* ; Uterine Cervical Neoplasms/prevention & control* ; Alphapapillomavirus ; Self Care/methods* ; Papillomavirus Infections/prevention & control* ; Specimen Handling/methods* ; Mass Screening/methods* ; HIV Infections/diagnosis* ; HIV ; Vaginal Smears/methods*

Objective To investigate the clinical effect of 125I seeds implantation on bone metastasis from radioactive iodine-refractory differentiated thyroid carcinoma (RAIR-DTC).Methods A total of 9 RAIR-DTC patients with bone metastases (4 males,5 females,age range:42-87 years) between April 2014 and December 2016 were enrolled in this prospective study.Treatment plan was developed through treatment planning system (TPS).125I seeds implantation was performed under CT guidance.After 2 and 4 months,metastasis size,serum thyroglobulin (Tg) and verbal rating scale (VRS) pain score changes were recorded.Paired t test and two-sample t test were used for data analysis.Results VRS pain score decreased 2 months post-treatment comparing with that before treatment (2.56±0.88 vs 5.22±2.44;t =4.28,P＜0.01).VRS pain score at 4 months post-treatment was 1.78±0.83,which was lower than that at 2 months post-treatment (t =3.48,P＜0.01).The maximum tumor diameters before the implantation and 2 months post-treatment were (6.47± 1.84) cm and (5.08±2.11) cm,respectively (t =9.14,P＜0.01).The maximum tumor diameter at 4 months post-treatment showed a decreasing trend but it was not statistically different compared to that at 2 months post-treatment:((4.52±2.16) cm;t =2.19,P＞0.05).Serum Tg level reduced 2 months after the implantation (lgTg:2.71±0.85 vs 2.94±0.82;t =4.82,P＜0.01).Serum Tg level at 4 months post-treatment (lgTg:2.56±0.81) was lower than that at 2 months post-treatment (t =2.69,P＜0.05).Conclusions 125I seeds implantation is an effective method for treating bone metastasis from RAIR-DTC.It can help to shrink bone metastasis,alleviate pain and improve patients' quality of life.

Objective: To evaluate the effect of cervical lifting suture in treatment of placenta previa with increta and percreta. Methods: From January 2016 to June 2017, 65 cases (0.78%, 65/8 322) were diagnosed placenta previa with increta and percreta by prenatal ultrasonic score system and confirmed by intraoperative findings in the department of obstetrics and gynecology of Peking University Third Hospital. Totally 62 cases (0.75%, 62/8 322) were included, because 3 cases underwent hysterectomy with placenta in situ. According to ultrasonic score system, 62 cases were divided into two groups, score 5-9 group (n=42, 67.7%) and score≥10 group (n=20, 32.3%) , cervical lifting suture techniques were all performed in cesarean sections. Demographic and clinical data were collected and compared. Results: (1) There were no significant differences between two groups in age, gravidity, parity, cesarean section history ratio and gestational week of termination (all P>0.05) . (2) In score≥10 group, the median intraoperative bleeding volume was 4 000 ml (1 200-13 000 ml) , while in score 5-9 group, it was 1 600 ml (700-10 000 ml) , intraoperative blood transfusion volume was 2 000 ml (800-8 800 ml) in score≥10 group, while 1 200 ml (0-8 000 ml) in score 5-9 group. The median operation time was 240 minutes (108-1 200 minutes) in score≥10 group, significantly higher than that in score 5-9 group, which was 135 minutes (69-335 minutes; all P< 0.05). In 8 cases for hysterectomy (12.9%,8/62) , 3 cases in score 5-9 group, 5 cases in score≥10 group. (3) In score≥10 group, the rate of postoperative ICU registration was 80% and mean hospitalization time was (6.3±1.7) days, were significantly different, compared with those in score 5-9 group, which were 26%, (4.9±1.9) days. No serious postpartum complications were found in both groups, and there were no significant differences in Apgar score and weight of newborns (all P>0.05) . Conclusion Cervical lifting suture in placenta previa with increta and percreta could significantly reduce postpartum hemorrhage and retain uterine.

Objective To explore the value of ultrasound scoring system in predicting the type and risk of placenta accreta.Methods Clinical data of 180 placenta accreta patients who delivered in the Peking University Third Hospital between January 2005 and November 2014,were retrospectively analyzed.Prenatal ultrasonographic features were analyzed,including position and thickness of the placenta,disappearance of hypoechoes in posterior placenta,continuousness of bladder line,existence of lacuna,condition of the subplacental vascularity,completeness of cervical morphology,existence of cervical sinus,and history of cesarean section.A score of 0,1 or 2 was given to each item,and a sum-up was calculated for each patient.The cut-off scores of patients with placenta accreta,placenta increta and placenta percreta were calculated by receiver operating characteristic carve,respectively.At the same time,blood loss and hysterectomy rate were compared among the three groups.Variance analysis,rank sum or Chi-square tests were used for statistical analysis.Results Among the 180 cases,there were 115 cases of placenta accreta,38 of planceta increta and 27 of placenta percreta.Placenta increta and percreta were defined as the severe type.Blood loss in placenta accreta was lower than in the severe type [200 (100-4 000) ml vs 3 025 (100-15 000) ml,P＜0.01].There was no difference in blood loss between patients with placenta increta or percreta (P=0.350).No hysterectomy was performed for patients with placenta accreta,the rate being lower than in the severe type [0 vs 29.2％ (19/65),P＜0.01].Among the severe type,18.4％ (7/38) of the placenta increta patients underwent hysterectomy,the rate being lower than in placenta percreta patients [44.4％ (12/27),P＜0.01].The score in placenta accreta was lower than in the severe type [(1.88± 1.45) vs (7.01 ±2.15) scores,P＜0.01].In the severe type,the score in placenta increta was lower than in placenta percreta [(6.08 ± 2.62) vs (8.74 ± 2.75),P＜0.01].The receiver operating characteristic curve showed that the cut-off score of placenta accreta and the severe type was 5 [area under the curve (AUC)=94.3％,the score ≥ 4.5,the sensitivity=81.5％,and the specificity=95.7％],the cut-off score of placenta accreta and increta was 3 (AUC=91.1％,score ≥ 2.5,the sensitivity=92.1％,and the specificity=75.7％),and the cut-off score of placenta increta and percreta was 10 (AUC=74.6％,score ≥ 9.5,the sensitivity=55.6％,and the specificity=89.5％).Conclusions Ultrasound scoring system is effective in assessing types of placenta accreta and predicting its associate risks,and alerting the possibility of hysterectomy.It also facilitates preoperative planning and guides physicians in formulating subsequent treatment plans.Placenta accreta and the severe type (placenta increta and percreta) can be distinguished by cut-offscores ≥ 5,and a score ≥ 10 implies a higher risk of placenta percreta.