The Proctor's reporting guideline for implementation strategies represents a landmark framework in the field of implementation science, aiming to address the issue of inconsistent reporting in implementation research by standardizing the naming, definition, and operationalization of implementation strategies, thereby enhancing the credibility and utility of research findings. This paper provides an in-depth interpretation of the core connotations of this reporting guideline and illustrates its application in developing interview outlines and specifying implementation strategies, using a brief smoking cessation intervention project as a case study. Through this reporting guideline, abstract recommendations for implementation are systematically transformed into clear, multidimensional operational guides, significantly improving the transparency of strategy connotations and the replicability of actual execution. Meanwhile, the case study highlights the flexibility of the guideline, which allows researchers to adapt the content and format of strategies based on local resources and cultural contexts, thus enhancing practical adaptability while maintaining scientific rigor. However, the application of Proctor's reporting guideline still faces challenges, primarily manifested in the potential confusion surrounding the constructs of temporality and dose in practice, as well as the challenges that the inherent flexibility of the guideline may pose to the assessment of fidelity and effectiveness. Despite these limitations, the reporting guideline remains a vital tool for implementation research; future efforts should focus on optimizing its application—through refining operational guidelines, standardizing flexible adaptations, and involving stakeholders—to better guide implementation studies and continuously promote high-quality development in the field.

OBJECTIVE To establish the graded management standards for off-label use of Shenqi fuzheng injection. METHODS Systematic searches were conducted in databases including CNKI， PubMed and the Cochrane Library to retrieve guidelines/consensuses， systematic reviews/meta-analyses， and randomized controlled trials （RCTs） of Shenqi fuzheng injection. The quality of evidence was evaluated using AGREE Ⅱ， AMSTAR Ⅱ， and the Risk of Bias 1.0 tool recommended by Cochrane Collaboration， and the graded management standard for off-label use of Shenqi fuzheng injection was developed by using the Thomson grading system. RESULTS A total of 534 articles were involved， including 11 guidelines， 22 systematic reviews/meta-analysis， and 501 RCTs. They covered 79 off-label indications for Shenqi fuzheng injection： cancer-related fatigue， colorectal cancer and breast cancer， all with high-quality evidence were classified under grade A management （grade Ⅰ commendation）， allowing all physicians across the hospital to prescribe relevant treatments； five diseases， such as ovarian cancer， liver cancer， leukemia， heart failure and cerebral infarction， were classified under grade B management （grade Ⅱa commendation）， with prescription restricted to physicians with intermediate or higher professional titles in specific departments； eleven diseases， including sepsis， cervical cancer， esophageal cancer， etc.， were classified under grade C management （grade Ⅱb commendation）， requiring strict evaluation by senior physicians before prescription； the use of Shenqi fuzheng injection for other conditions was explicitly prohibited due to a lack of sufficient evidence. CONCLUSIONS Off-label use of Shenqi fuzheng injection is prevalent. The graded management standard established by evidence-based medical approach provides a scientific basis for standardizing the clinical application of traditional Chinese medicine injections and offers an operable paradigm for implementing differentiated drug use supervision in medical institutions.

OBJECTIVE: To investigate the feasibility and prognostic implications of assessing volume status during early fluid resuscitation in septic patients based on estimated plasma volume status (ePVS). METHODS: A prospective study was conducted. Patients with sepsis admitted to intensive care unit (ICU) of the First Affiliated Hospital of Kunming Medical University from March to December in 2023 were enrolled. The general information and laboratory indicators at ICU admission were recorded, and ePVS, sequential organ failure assessment (SOFA) score, acute physiology and chronic health status evaluation II (APACHE II) score were calculated. The vital signs, arterial blood gas analysis and volume status related indicators before liquid resuscitation (T0h) and 3 hours (T3h) and 6 hours (T6h) of fluid resuscitation were recorded. The diameter and variability of the inferior vena cava (IVC) were measured by ultrasound, and ePVS, percentage change value of estimated plasma volume status (ΔePVS%), difference in central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO₂), and lactate clearance rate (LCR) were calculated. Patients were divided into sepsis group and septic shock group based on the diagnosis at ICU admission, and septic patients were subdivided into survival group and death group based on their 28-day survival status. The differences in clinical data between the groups were compared. The correlation between ePVS or ΔePVS% and volume status related indicators during early liquid resuscitation was analyzed by Spearman rank sum correlation test. The predictive value of each variable for 28-day survival in patients with sepsis was analyzed by receiver operator characteristic curve (ROC curve), and 28-day death risk factors were analyzed by Logistic regression method. RESULTS: Fifty-four septic patients were enrolled in the final analysis, including 17 with sepsis and 37 with septic shock; 34 survived at 28 days and 20 died, with a 28-day survival rate of 63.0%. Compared with the sepsis group, the septic shock group had a lower venous ePVS at ICU admission [dL/g: 4.96 (3.67, 7.15) vs. 7.55 (4.36, 10.07), P < 0.05]. Compared with the death group, the survival group had higher T6h arterial and venous ΔePVS%, and albumin [Alb; T6h arterial ΔePVS% (%): 11.57% (-1.82%, 31.35%) vs. 0.48% (-5.67%, 6.02%), T6h venous ΔePVS%: 9.62% (3.59%, 25.75%) vs. 1.52% (-9.65%, 7.72%), Alb (g/L): 27.57±4.15 vs. 23.77±6.97, all P < 0.05], lower SOFA score, APACHE II score, AST, T0h Lac, and T3h and T6h norepinephrine dosage [SOFA score: 9.00 (8.00, 10.00) vs. 11.50 (9.25, 14.50), APACHE II score: 18.00 (14.75, 21.25) vs. 25.50 (21.00, 30.00), AST (U/L): 34.09 (23.20, 56.64) vs. 79.24 (25.34, 196.59), T0h Lac (mmol/L): 1.75 (1.40, 2.93) vs. 3.25 (2.33, 5.30), norepinephrine dosage (mg): 0.98 (< 0.01, 3.10) vs. 4.60 (1.05, 8.55) at T3h, 1.82 (0.38, 5.30) vs. 8.20 (2.80, 17.73) at T6h, all P < 0.05]. While there were no significantly differences in other basic data and ePVS at all of the time points before and after resuscitation between the two groups. Correlation analysis showed that T6h venous ePVS was significantly positively correlated with T6h IVC variability in septic patients (r = 0.360, P < 0.05), T0h arterial ePVS was significantly negatively correlated with T3h and T6h liquid intake volume (r₁ = -0.367, r₂ = -0.280, both P < 0.05), and venous ePVS at ICU admission was significantly positively correlated with NT-proBNP at ICU admission (r = 0.409, P < 0.05). T6h venous ΔePVS% was significantly positively correlated with T3h liquid intake volume and T6h LCR (r₁ = 0.286, r₂ = 0.286, both P < 0.05), and significantly negatively correlated with T6h urine volume and T6h change value of Pcv-aCO₂ (ΔPcv-aCO₂; r₁ = -0.321, r₂ = -0.371, both P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of T6h venous ΔePVS% for predicting 28-day survival in septic patients was 0.726 [95% confidence interval (95%CI) was 0.578-0.875, P = 0.006], with a sensitivity of 82.4%, a specificity of 60.0%, and an optimal cut-off value of 3.09%. Binary multifactorial Logistic regression analysis showed that an increase in T6h venous ΔePVS% was a protective factor for 28-day death in patients with sepsis on early fluid resuscitation [odds ratio (OR) = 0.900, 95%CI was 0.834-0.972, P = 0.007]. CONCLUSIONS ePVS may have potential for assessing the volume status of septic patients during early fluid resuscitation. The ΔePVS% during early fluid resuscitation may help to identify septic patients with a poor prognosis.
Humans ; Prognosis ; Fluid Therapy ; Sepsis/physiopathology* ; Prospective Studies ; Plasma Volume ; Intensive Care Units ; Resuscitation ; Male ; Female ; Middle Aged ; Shock, Septic/therapy*

To promote the standardization and normalization of perioperative care for follicular unit extraction(FUE) hair transplantation, ensure treatment efficacy, and align with advancements in the specialty, the Nursing Branch of the Chinese Association of Plastic and Aesthetics organized a panel of domestic experts. By integrating evidence-based medicine with clinical practice experience, and following thorough discussions, these experts developed the Clinical Practice Expert Consensus on Perioperative Nursing Care for Follicular Unit Extraction (2025). This consensus provides a comprehensive overview of hair transplantation, covering preoperative preparation, surgical procedures, intraoperative coordination, postoperative management, and complication prevention and treatment. It serves as a key reference and guide for implementing standardized perioperative nursing care in FUE hair transplantation.

Objective: To evaluate the clinical efficacy of a novel autologous blood recovery device during the weaning process from extracorporeal membrane oxygenation (ECMO). Methods: A total of 16 patients who received ECMO support and underwent blood recovery during the weaning process from January 2022 to September 2024 at our hospital were included in the experimental group. In contrast, 58 patients who did not receive blood recovery during the weaning process were assigned to the control group. Transfusion components, costs, and changes in routine blood tests and coagulation functions were compared between the two groups from the day of weaning until 48 hours post-weaning. Results: Significant differences were observed in the volumes of red blood cell transfusions, plasma transfusions, and transfusion costs between the two groups from the day of weaning to 48 hours post-weaning (P<0.05). Additionally, in the experimental group, significant differences were noted in hemoglobin (Hb), platelet (Plt), and activated partial thromboplastin time (APTT) results when comparing values before and after extubation (P<0.05). Conclusion: The application of a novel autologous blood recovery device during ECMO weaning reduces patient costs, minimizes wastage of autologous blood, decreases reliance on exogenous blood transfusions, and mitigates the risks associated with allogeneic blood transfusion. This approach merits further promotion for clinical use.

Objective To investigate the effect of secondary preventive scheme on recurrence rate of ce-rebrovascular event based on China ischemic stroke subclassification(CISS)of intracranial arterial stenosis is-chemic stroke(IS).Methods A total of 192 patients with intracranial arterial stenosis IS were prospectively included and the secondary preventive scheme was formulated according to whether or not based on the patho-genesis.Then the patients were divided into the personalized treatment group and conventional treatment group.The personalized group conducted the classification and was given different the secondary preventive schemes the artery-artery embolism group was given the active lipid-lowering scheme to make the low density lipoprotein(LDL)reaching the standard;the low hypoperfusion group was given the smooth pressure reduc-tion program;the carrier artery occlusion perforating artery group was given the routine secondary prevention program;the mixture mechanism group was given the corresponding schemes superposition according to dif-ferent mechanisms].The conventional treatment group was given the conventional secondary preventive scheme.The difference in the recurrence rate of cerebrovascular events on 90 d was compared between the two groups.Meanwhile the univariate and multivariate logistic regression were used to analyze the influencing fac-tors of recurrence of cerebrovascular events on 90 d in intracranial arterial stenosis IS.Results Among 192 study subjects,there were 90 cases in the personalized treatment group(20 cases of vector artery occlusion and perforator artery,44 cases of arterial-arterial embolization,6 cases of hypoperfusion and 20 cases of mixed mechanism).There were 102 cases in the conventional treatment group(16 cases of perforator artery occlu-sion of the vector artery,52 cases of arterial-arterial embolism,8 cases of hypoperfusion and 26 cases of mixed mechanism).The occurrence rate of cerebrovascular events on 90 d in the personalized treatment group was significantly decreased compared to the conventional treatment group(7.8%vs.17.6%,χ2=4.112,P=0.043).The Logistic regression analysis revealed that the active lipid-lowering scheme for LDL reaching the standard was the independent protective factor of the cerebrovascular event recurrence on 90 d(OR=0.128,95%CI:1.150-71.170).Conclusion The personalized secondary prevention scheme based on pathogenesis reduces the recurrence rate of cerebrovascular event in intracranial arterial stenosis IS,in which making the LDL reaching the standard by the active lipid-lowering scheme is the independent protective factor for cerebro-vascular event recurrence in intracranial arterial stenosis IS.

Objective To investigate the occurrence risk for common complications of internal jugular vein(IJV)and subclavian vein(SCV)catheterization,and provide reference for the prevention and treatment of common com-plications during clinical intravenous infusion therapy.Methods Data from China National Knowledge Infrastruc-ture(CNKI),Wanfang Database,VIP Database,Embase(via OVID),PubMed,Cochrane Library,CINAHL,Web of Science,and ScienceDirect were retrieved,with the search period from database establishment to August 3,2023.Prospective cohort and experimental studies on common complications in patients with IJV and SCV cathete-rization were collected.Meta-analysis on the extracted data was performed with RevMan 5.3 software.Results A total of 29 studies involving 14 096 patients were included in the analysis,including 6 355 patients with SCV cathe-terization(SCV group)and 7 741 patients with IJV catheterization(IJV group).Meta-analysis results showed that the occurrence risk for hemopneumothorax(OR=0.23,95％CI[0.14-0.37])and catheter tip ectopic(OR=0.16,95％CI[0.03-0.85])in SCV group was higher than that in IJV group,and the occurrence risk for central venous catheter-related deep venous thrombosis in IJV group was higher than that in SCV group(OR=2.35,95％CI[1.31-4.21]),with statistically significant differences(all P＜0.01).There were no statistical differences in the occurrence risk of vascular catheter-related bloodstream infection(CRBSI),catheter blockage,and catheter local he-matoma between the two groups(all P＞0.05),there was difference in the combined result of subgroup analysis re-garding catheter bacterial colonization.Conclusion Compared with IJV,patients in SCV group have a higher risk of developing hemopneumothorax and catheter tip ectopic,while patients with catheterization in IJV group have a high-er risk of deep veinous thrombosis.There are no significant differences in the occurrence risk for CRBSI,catheter blockage,and catheter local hematoma between two groups of patients.It is suggested that patient's own conditions and the accessibility of deep vein catheterization should be considered more when selecting the site of deep venous catheterization.

Crohn's disease (CD), a chronic and recurrent inflammatory bowel disease, requires repeated intestinal evaluations. As a non-radioactive, non-invasive, well-tolerated, inexpensive and easily reproducible detection tool, intestinal ultrasound (IUS) has been more and more widely used in the diagnosis and treatment of CD in recent years. Various parameters of IUS, such as bowel wall thickness, bowel wall stratification, color doppler signals, and inflammatory mesenteric fat, provide a lot of critical information in the diagnosis and treatment of CD. IUS can not only accurately diagnose CD and its complications, but also well evaluate CD disease activity and treatment response, and effectively predict CD transmural remission, disease duration, surgical risk, and postoperative recurrence. IUS has demonstrated good accuracy in the diagnosis, evaluation and prediction of CD.

The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

Objective:To evaluate the effect of the degree of neuromuscular blockade on the intraoperative surgical conditions and postoperative recovery quality in patients undergoing lumbar interbody fusion.Methods:In this randomized controlled trial, 100 patients of either sex, aged 18-79 yr, with a body mass index of 18.5-35.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification < Ⅳ, scheduled for elective lumbar interbody fusion at the Affiliated Hospital of Xuzhou Medical University from August to October 2024, were allocated into 2 groups ( n=50 each) using stratified randomization based on the number of lumbar segments: deep neuromuscular blockade group (group D) and moderate neuromuscular blockade group (group M). The intraoperative post-tetanic count was maintained at 1 or 2 in group D, and the intraoperative train-of-four was maintained at 1 or 2 in group M. The scores for surgical conditions, duration of operation, blood loss, length of incision, occurrence of severe hypoxemia after extubation, requirement for rescue analgesia in post-anesthesia care unit, 15-item Quality of Recovery scale score and length of stay were recorded. Results:Compared with group M, the scores for surgical conditions were significantly increased, the rate of rescue analgesia in post-anesthesia care unit was decreased, 15-item Quality of Recovery scale scores were increased at 3 days after surgery ( P<0.05), and no significant changes were found in the duration of operation, blood loss, length of incision, incidence of severe hypoxemia after extubation and length of hospital stay in group D ( P>0.05). Conclusions:Compared with moderate neuromuscular blockade, deep neuromuscular blockade can provide better surgical conditions and improve the quality of early postoperative recovery for patients undergoing lumbar interbody fusion.