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 the safety and efficacy of CT-guided percutaneous transhepatic gallbladder drainage(PTGBD)in treatment of high-risk acute cholecystitis(AC)patients.Methods CT-guided PTGBD was performed in 29 patients with high-risk AC.The therapeutic results were evaluated by comparing the preoperation and postoperation clinical manifestations and laboratory results.Results The implantation of PTGBD catheter was successfully accomplished with single procedure in all patients.Complica-tions occurred in 2 cases,including abdominal pain in 1 case and a small amount of gallbladder bleeding in 1 case,and the incidence of complications was 6.9%.Compared with preoperation,the pain number rating scale(NRS)score,temperature(T),white blood cell count(WBC),C-reactive protein(CRP),total bilirubin(TBIL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were significantly decreased 3 days after PTGBD(P<0.001).Except for 1 case of choledocholithiasis with continuous abdominal pain after PTGBD,the postoperation symptoms of the other patients were significantly relieved.Followed up for 3 months,2 cases of calculous AC recurred after PTGBD,and the recurrence rate of cholecystitis was 25.0%.Conclusion For high-risk AC,the CT-guided PTGBD is a safe and effective treatment method,and it can remarkably relieve the clinical symptoms.Patients with calculous AC have higher risk of recurrence and might benefit from definitive cholecystectomy.

Objective:To construct a structured education course for patients with neurogenic bladder during the rehabilitation period.Methods:This study consisted three stages of current situation survey, literature search, and expert consultation. From February 2022 to February 2023, a current survey was conducted on the self-management needs of 62 patients with neurogenic bladder. In April 2023, a literature search was conducted to summarize the best evidence on nursing and management of neurogenic bladder, and form the initial version of course indicators and content. From April to May 2023, 14 experts were selected for consultation, and the Delphi method was used to demonstrate the course indicators and content, and to construct the final draft of the course.Results:A total of 62 patients with neurogenic bladder were included, they have requirements for water management, bladder function training, and dietary requirements, etc. A total of 2 053 articles were retrieved, and 14 articles were ultimately included, including eight guidelines, four evidence summaries, one expert consensus, and one systematic review. The expert authority coefficients for the two rounds of expert consultation were 0.93 and 0.92, respectively. The Kendall coordination coefficient of various indicators in the second round of expert consultation was 0.227 to 0.288 ( P<0.01). After two rounds of expert consultation, a structured education course for patients with neurogenic bladder during the rehabilitation period was finally developed, including six primary indicators, 21 secondary indicators, and 30 tertiary indicators. Conclusions:The structured education course for patients with neurogenic bladder during the rehabilitation period, based on current situation survey, high-quality evidence, and expert consultation, is comprehensive in content and reasonably designed, which can provide supportive assistance for future nursing health education and management for patients with neurogenic bladder.

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:To construct a prognostic model for severe acute pancreatitis (SAP) based on CT scores and inflammatory factors, and to evaluate its efficacy.Methods:128 patients with SAP diagnosed admitted to the First Hospital Affiliated to Hebei North College from March 2019 to December 2021 were enrolled and given Ulinastatin combined with continuous blood purification therapy. The levels of C-reactive protein (CRP), procalcitonin (PCT), interleukins (IL-6, IL-8), tumor necrosis factor-α (TNF-α), and D-dimer were measured before and on the third day of treatment. An abdominal CT was performed on the third day of treatment to assess the modified CT severity index (MCTSI) and extra-pancreatic inflammatory CT score (EPIC). Patients were divided into the survival group ( n = 94) and the death group ( n = 34) according to the 28-day survival prognosis after admission. The risk factors for the SAP prognosis were analyzed using Logistic regression, which was then used to build nomogram regression models. The value of the model was evaluated using the concordance index (C-index), calibration curves and decision curve analysis (DCA). Results:Before treatment, the levels of CRP, PCT, IL-6, IL-8 and D-dimer in the death group were higher than those in the survival group. After treatment, the levels of IL-6, IL-8 and TNF-α in the death group were higher than those in the survival group. MCTSI and EPIC scores in the survival group were lower than those in the death group. Logistic regression analysis shows that, pre-treatment CRP > 140.70 mg/L, D-dimer > 2.00 mg/L, and post-treatment IL-6 > 31.28 ng/L, IL-8 > 31.04 ng/L, TNF-α > 31.04 ng/L, and MCTSI > 8 points were all independent risk factors for SAP prognosis [odds ratios ( OR) and 95% confidence intervals (95% CI) were 8.939 (1.792-44.575), 6.369 (1.368-29.640), 8.546 (1.664-43.896), 5.239 (1.108-24.769), 4.808 (1.126-20.525), 18.569 (3.931-87.725), all P < 0.05]. Model 1 (consisting of pre-treatment CRP, D-dimer, and post-treatment IL-6, IL-8 and TNF-α) had a lower C-index than that model 2 (consisting of pre-treatment CRP, D-dimer, and post-treatment IL-6, IL-8 and TNF-α, and MCTSI; 0.988 vs. 0.995). The mean absolute error (MAE) and mean square error (MSE) of model 1 (0.034, 0.003) were higher than those of model 2 (0.017, 0.001). When the threshold probability was in the range of 0-0.66 or 0.72-1.00, the net benefit of model 1 was lower than that of model 2. When the threshold probability was in the range of 0.66-0.72, the net benefit of model 1 was higher than that of model 2. In addition, model 2 had a higher C-index than acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) and bedside index of acute pancreatitis severity (BISAP, 0.995 vs. 0.833, 0.751). Model 2 had a lower MAE (0.017) and MSE (0.001) than APACHEⅡ (0.041, 0.002). Model 2 had a lower MAE than BISAP (0.025). Model 2 had a higher net benefit than both APACHEⅡ and BISAP. Conclusion:The prognostic assessment model of SAP consisting of pre-treatment CRP, D-dimer, and post-treatment IL-6, IL-8 and TNF-α, and MCTSI has high discrimination, precision and clinical application value, and is superior to APACHEⅡ and BISAP.

Objective:To investigate the efficacy of hemodiafiltration combined with hemoperfusion in the treatment of secondary hyperparathyroidism (SHPT) in patients undergoing maintenance hemodialysis (MHD).Methods:A total of 40 patients with SHPT undergoing MHD who received treatment at the Blood Purification Center of The First Affiliated Hospital of Anhui University of Science and Technology from February 2021 to March 2023 were included in this prospective cohort study. They were randomly divided into a control group and an observation group ( n = 20/group).The control group received a single high flux hemodialysis, while the observation group used a combination of hemodialysis filtration and hemoperfusion for 3 months. In both groups, the changes in hemoglobin, blood urea nitrogen, serum creatinine, serum calcium, serum phosphorus,and parathyroid hormone levels were compared before and after dialysis. Results:After dialysis, the hemoglobin level in the observation group was (119.45 ± 5.27) g/L, which was significantly higher than (106.30 ± 6.52) g/L in the control group ( t = -7.02, P < 0.001). The serum phosphorus level in the observation group was (1.18 ± 0.17) mmol/L, which was significantly lower than (1.52 ± 0.22) mmol/L in the control group ( t = 5.49, P < 0.001). The parathyroid hormone level in the observation group was (122.14 ± 40.57) ng/L, which was significantly lower than (168.78 ± 78.27) ng/L in the control group ( t = 2.39, P = 0.023). Conclusion:Hemodiafiltration combined with hemoperfusion can reduce clinical symptoms, increase hemoglobin level, and reduce phosphorus and parathyroid hormone levels in patients with SHPT undergoing MHD, which deserves clinical promotion.

Objective:To explore the influence of different size related parameters of common CT scanned body parts on body-specific dose estimate (SSDE) , in order to establish rapid conversion factors for SSDE.Methods:A total of 189 clinical cases were collected from 6 common CT scanned body parts, including head, nasal bone, sinus, neck, chest, abdomen and pelvis, at Beijing Tongren Hospital, Capital Medical University from March 8 to May 10, 2021. Batch-processing of image was carried out by using Matlabcode. The axial images′area, anteroposterior (AP) dimension, lateral (LAT) dimension and average CT values were calculated. The conversion factors for estimating body-specific dose values were obtained from the real effective diameter ( De) and water equivalent diameter ( Dw) of the clinical cases, and the differences in values were compared between SSDE ED and SSDE WED. Based on the information on AP, LAT, AP + LAT, estimated De, the real De and Dw obtained in clinical practices, the SSDE rapid correction factors for adult body parts were established. The convenient conversion relation between Dw and De was obtained. Based on the correction factors for Dw, the relative errors of the correction factors for various sizes related parameters were compared. Results:The SSDE fast conversion factors for the real De of the 6 body parts were 1.01, 1.01, 1.01, 0.97, 1.28, 1.32, and those for Dw were 0.87, 0.97, 0.98, 0.99, 1.42, 1.36, respectively. The relative errors of different conversion factors ranged from 0.68% to 18.05%. The conversion factors for abdomen and pelvis had the smallest difference, and those for AP and LAT of the chest had the smallest error. The differences between CTDI vol, SSDE ED and SSDE WED in sinus, chest and abdomen were statistically significant ( tsinus=2.44, 4.23, tchest=17.67, 17.00, tabdomen and pelvis =17.93, 18.75, P<0.05) . The differences between CTDI vol and SSDE WED in head, nasal bone, were statistically significant ( t=-22.27, 2.80, P<0.05) , but not with SSDE ED ( P>0.05) . The difference between CTDI vol and SSDE ED in neck was statistically significant ( t=-3.06, P<0.05) but without statistical insignificance in camparison with SSDE WED ( P>0.05) . Conclusions:SSDE WED can be used to accurately evaluate the body-specific dose estimatates, and different size related parameters can be selected for correction in different scanned body parts. The rapid conversion factor can be easily used in clinical practice to improve the accuracy of estimated radiation dose.

Objective:To understand main problems existing in the construction of advanced stroke centers in China and put forward solutions, for reference in promoting the standardization construction of advanced stroke centers and improving the efficiency of acute stroke treatment.Methods:The data were derived from relevant data of on-site export guidance in the construction of advanced stroke centers at 175 tertiary hospitals from 2020 to 2021, and the scores of on-site evaluation indicators for the establishment of stroke centers and their formal approval were compared and analyzed. Based on on-site investigation and expert consultation, the common problems existing in the construction of advanced stroke centers were summarized. All data were analyzed by descriptive analysis, the scores of on-site evaluation indicators were expressed by ± s, and paired t test was used for comparison between groups. Results:Compared with the total score(693.04±72.06) of on-site evaluation at the stage of project launch, the total score(747.94±78.10) of on-site evaluation for formal approval of stroke centers of 70 hospitals was higher, and the difference was significant( P<0.01). There were seven common problems in the construction of stroke centers in 175 hospitals, including insufficient attention paid by hospitals, lack of effective performance incentive policies, imperfect treatment procedures and medical norms, and so on. Conclusions:Experts on-site guidance plays an important role in the construction of stroke centers in China. At present, there were still problems to tackle in the construction of stroke centers in hospitals. In order to promote the standardized construction of stroke centers in China and improve the efficiency of stroke treatment, the authors suggest fuorther strengthening the importance attached by hospital leadership and the coordination and organization of functional departments, establishing stroke center models conforming to the actual situation of the hospital, seting up the post of brain and heart health manager, and improving the regional prevention and treatment level of acute stroke.

Objective:To form a nursing standard for shoulder-hand syndrome (SHS) after stroke in accordance with the clinical situation by expert argumentation in the best evidence systematically retrieved and screened for SHS after stroke with the method of Delphi expert consultation.Methods:According to the level of evidence, we systematically retrieved and screened relevant guidelines, evidence summary, systematic reviews, original studies and expert consensus. Two researchers who had received Joanna Briggs Institute (JBI) evidence-based training used the Appraisal of Guidelines for Research & Evaluation (AGREE) Ⅱ, JBI quality evaluation tools for systematic reviews, randomized controlled trials/experimental studies and expert consensus to evaluate the included guidelines, systematic reviews, original studies and expert consensus. The included literature was classified and summarized, and recommendations and conclusions related to SHS after stroke were screened and extracted. According to the results of the literature summary, the first draft of the clinical nursing standard for SHS after stroke was formed. Using the Delphi method, 25 experts in related fields were selected for two rounds of expert consultation to demonstrate the contents of the first draft.Results:This study included 8 guidelines including 1 evidence summary, 2 systematic reviews, 7 original studies and 2 expert consensus. The overall quality of the guidelines was Grade B; one piece of evidence summary was of good quality and was Grade B; the overall quality of two systematic reviews was low, and the overall quality of seven original studies was average. The first draft of the clinical nursing standard for SHS after stroke included 6 content frameworks and 29 recommendations. Two rounds of expert consultation were conducted, the questionnaire response rates were 89.28% and 100%, and the expert authority coefficients were 0.864 and 0.894, respectively. The Kendell's W of important content framework and recommended in the second round of expert consultation were 0.118 ( P<0.05) and 0.188 ( P<0.001) . According to the results of the expert consultation, the clinical nursing standard for SHS after stroke was formed, including 6 content frameworks and a total of 31 recommendations. Conclusions:The clinical nursing standard for SHS after stroke is based on the best available evidence and expert argumentation, which is in line with the clinical situation in my country and can be sed in clinical nursing work.

Objective To investigate the influencing factors of the cognitive deficits in schizophrenic patients with diabetes.Methods 578 inpatients with schizophrenia and 400 healthy adults were collected.578 schizophrenic patients were divided into schizophrenia group with type 2 diabetes (combined group,n=277) and schizophrenia without type 2 diabetes (single disease group,n=301).The cognitive function of all subjects were examined by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).The clinical symptoms of patients with schizophrenia were measured with the Positive and Negative Syndrome Scale (PANSS).Fasting glucose,lipids,hemoglobin A1c (HbA1c) and insulin levels were measured.Results The total score and factor scores of RBANS in the combined group were lower than those in the healthy control group (total score (70.51 ± 14.43) vs (80.04 ± 15.14),immediate memory (62.65 ± 16.81) vs (75.66± 17.33),visual span(83.60±20.81) vs (87.61 ± 15.61),verbal function(85.58± 14.64) vs (93.88± 13.10),attention function (73.66± 17.52) vs (87.42±20.37),delayed memory(75.27± 17.80) vs (86.27± 15.27),all P＜0.05).The total score of RBANS,immediate memory and attention function factor were lower in the combined group than that in the single disease group ((70.51±14.43) vs (75.02±15.25),(62.65±16.81) vs (67.37±19.12),(73.66±17.52) vs (84.17±15.22),all P＜0.05).Multiple linear stepwise regression analysis showed that education,negative symptoms,positive symptoms,BMI,HbAc 1,course of disease and antipsychotic type were the influencing factors of cognitive impairment in schizophrenic patients with diabetes.Conclusion The cognitive impairment of schizophrenic patients with diabetes is more serious and affected by many factors.Targeted early intervention can help reduce cognitive impairment.