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 investigate the regulatory effect of follistatin-like 1 protein (FSTL1) on the differentiation of mesenchymal stem cells (MSCs) into myofibroblasts in renal tissue and on renal fibrosis induced by renal ischemia-reperfusion injury (IRI).Method:In animal experiments, a unilateral renal IRI-induced fibrosis model was established by clamping the left renal pedicle (IRI 7 d group, n=3), with a sham-operated group as control (Sham 7 d group, n=3). Twelve male C57BL/6 mice were randomly assigned to sham operation (Sham group, n=4), model (IRI group, n=4) and FSTL1 treatment (IRI+FSTL1 group, n=4) groups. The Sham group underwent laparotomy sham surgery, while the IRI group and IRI+FSTL1 group underwent unilateral renal IRI surgery. From 1 day before surgery to 7 days after surgery, mice received daily intraperitoneal injections of phosphate buffered saline (Sham group and IRI group) or recombinant FSTL1 protein (IRI+FSTL1 group). The mice were sacrificed 14 days after surgery. Renal histopathological damage was evaluated by hematoxylin-eosin (HE) staining. Collagen fiber deposition and fibronectin (FN) accumulation in renal interstitium were assessed by Sirius red staining, Masson’s trichrome staining and immunohistochemical staining. The co-expression level of stem cell antigen-1 (SCA-1) and α-smooth muscle actin (α-SMA) was detected by double immunofluorescence staining. The mRNA expression levels of fibrosis-related genes ( Col1a1, Col3a1, Fn1) and myofibroblast marker gene ( Acta2) were detected by real time quantitative polymerase chain reaction (RT-qPCR). In cell experiments, a differentiation model of mouse MSCs into myofibroblasts was established through TGF-β1 induction (MSC+TGF-β1 group, n=3), with a blank control group (MSC group, n=3) set up for comparison. Bone marrow MSCs from C57BL/6 mice were randomly divided into 4 groups: the TGF-β1 induction group (MSC+TGF-β1, n=6), the FSTL1 treatment group (MSC+TGF-β1+FSTL1, n=6), the negative control siRNA transfection group (MSC-siNC+TGF-β1, n=6), and the Fstl1-targeted siRNA transfection group (MSC-si Fstl1+TGF-β1, n=6). The mRNA and protein expression levels of Col1a1, Col3a1, Fn1 and Acta2 were detected by RT-qPCR and Western blot respectively. The concentration of FSTL1 protein in cell culture supernatant was measured by enzyme-linked immunosorbent assay. Result:The expression of Col1a1 and Acta2 mRNA in the kidney tissue of IRI 7 d group mice was higher than that of the Sham 7 d group (both P<0.05), successfully establishing a mouse model of renal fibrosis. The mRNA expression of Fstl1 in kidney tissues of the IRI 7 d group mice was upregulated ( P<0.01). Immunofluorescence double staining revealed increased co-expression of SCA-1/α-SMA and SCA-1/FSTL1 in the renal interstitium. At 14 days after surgery, HE staining results showed reduced pathological damage in kidney tissues of the IRI+FSTL1 group compared to the IRI group, and Sirius Red and Masson staining revealed decreased collagen fiber deposition in the renal interstitium, while immunohistochemical staining demonstrated reduced FN accumulation in the renal interstitium (all P<0.05). The mRNA expression levels of Col1a1, Col3a1, Fn1 and Acta2 in renal tissue of IRI+FSTL1 group were lower than IRI group (all P<0.05). Double immunofluorescence staining showed a decrease in the co-expression of SCA-1 and α-SMA in renal interstitium. In cell experiments, the mRNA expression levels of Col1a1, Col3a1, Fn1, and Acta2 in the MSC+TGF-β1 group were higher than those in the MSC group (all P<0.05), confirming successful TGF-β1-induced myofibroblast differentiation of MSCs. Additionally, both intracellular FSTL1 protein expression and FSTL1 protein concentration in the cell supernatant were elevated in the MSC+TGF-β1 group (both P<0.05). Compared with MSC+TGF-β1 group, the mRNA levels of Acta2 and Col1a1 in MSC+TGF-β1+FSTL1 group were decreased (both P<0.01), and the protein expression levels of collagen Ⅰ and α-SMA were significantly decreased (both P<0.001). Compared with MSC-siNC+TGF-β1 group, the protein level of FSTL1 in cell culture supernatant of MSC-si Fstl1+TGF-β1 group were decreased ( P<0.001), while the protein expression levels of FN and α-SMA were increased (both P<0.001), and the mRNA expression levels of Fn1 and Acta2 were increased (both P<0.05). Conclusions:During unilateral renal IRI-induced renal fibrosis, MSCs in renal interstitium may differentiate into myofibroblasts. FSTL1 may alleviate renal fibrosis after unilateral renal IRI by inhibiting the differentiation of MSCs into myofibroblasts.

Objective: To explore the correlation between allogeneic red blood cell (RBC) transfusion and healthcare-associated infections (HAIs) in patients undergoing coronary artery bypass grafting (CABG) during the perioperative period. Methods: A single-center retrospective cohort of 1,170 patients undergoing isolated CABG was analyzed. Multivariable logistic regression and restricted cubic splines (RCS) were employed to explore the nonlinear association between perioperative RBC transfusion (from intraoperative period to 72 hours postoperatively) and HAIs. Results: Among the 1,170 CABG patients, 109 patients (9.2%) received RBC transfusion during the operation or within 3 days after the operation. The risk of HAIs in those who received ≥4 units of RBCs during and within 3 days after the operation was 6.89 times higher than that in the non-transfusion group (95% CI: 3.65-17.20). Furthermore, there was a nonlinear threshold effect between the blood transfusion volume and postoperative HAIs (inflection point: 7.8 units). When the transfusion volume was ≤7.8 units, the risk of HAIs increased by 61% for each additional unit transfused (OR=1.61, 95% CI: 1.21-2.15). Beyond this threshold, no statistically significant association was observed (P=0.289). Conclusion: Perioperative RBC transfusion in CABG patients is associated with an increased incidence of HAIs. The perioperative blood transfusion volume has a curvilinear relationship with the risk of postoperative HAIs. When the blood transfusion volume is ≤7.8 units, the blood transfusion volume has a dose-dependent relationship with postoperative infection, with higher blood transfusion volumes correlating with greater postoperative infection risk. When the blood transfusion volume is >7.8 units, the relationship between the two is not statistically significant. The preventive effect of reducing RBC transfusion on HAIs requires further validation in the future.

Objective:To investigate the regulatory effect of follistatin-like 1 protein (FSTL1) on the differentiation of mesenchymal stem cells (MSCs) into myofibroblasts in renal tissue and on renal fibrosis induced by renal ischemia-reperfusion injury (IRI).Method:In animal experiments, a unilateral renal IRI-induced fibrosis model was established by clamping the left renal pedicle (IRI 7 d group, n=3), with a sham-operated group as control (Sham 7 d group, n=3). Twelve male C57BL/6 mice were randomly assigned to sham operation (Sham group, n=4), model (IRI group, n=4) and FSTL1 treatment (IRI+FSTL1 group, n=4) groups. The Sham group underwent laparotomy sham surgery, while the IRI group and IRI+FSTL1 group underwent unilateral renal IRI surgery. From 1 day before surgery to 7 days after surgery, mice received daily intraperitoneal injections of phosphate buffered saline (Sham group and IRI group) or recombinant FSTL1 protein (IRI+FSTL1 group). The mice were sacrificed 14 days after surgery. Renal histopathological damage was evaluated by hematoxylin-eosin (HE) staining. Collagen fiber deposition and fibronectin (FN) accumulation in renal interstitium were assessed by Sirius red staining, Masson’s trichrome staining and immunohistochemical staining. The co-expression level of stem cell antigen-1 (SCA-1) and α-smooth muscle actin (α-SMA) was detected by double immunofluorescence staining. The mRNA expression levels of fibrosis-related genes ( Col1a1, Col3a1, Fn1) and myofibroblast marker gene ( Acta2) were detected by real time quantitative polymerase chain reaction (RT-qPCR). In cell experiments, a differentiation model of mouse MSCs into myofibroblasts was established through TGF-β1 induction (MSC+TGF-β1 group, n=3), with a blank control group (MSC group, n=3) set up for comparison. Bone marrow MSCs from C57BL/6 mice were randomly divided into 4 groups: the TGF-β1 induction group (MSC+TGF-β1, n=6), the FSTL1 treatment group (MSC+TGF-β1+FSTL1, n=6), the negative control siRNA transfection group (MSC-siNC+TGF-β1, n=6), and the Fstl1-targeted siRNA transfection group (MSC-si Fstl1+TGF-β1, n=6). The mRNA and protein expression levels of Col1a1, Col3a1, Fn1 and Acta2 were detected by RT-qPCR and Western blot respectively. The concentration of FSTL1 protein in cell culture supernatant was measured by enzyme-linked immunosorbent assay. Result:The expression of Col1a1 and Acta2 mRNA in the kidney tissue of IRI 7 d group mice was higher than that of the Sham 7 d group (both P<0.05), successfully establishing a mouse model of renal fibrosis. The mRNA expression of Fstl1 in kidney tissues of the IRI 7 d group mice was upregulated ( P<0.01). Immunofluorescence double staining revealed increased co-expression of SCA-1/α-SMA and SCA-1/FSTL1 in the renal interstitium. At 14 days after surgery, HE staining results showed reduced pathological damage in kidney tissues of the IRI+FSTL1 group compared to the IRI group, and Sirius Red and Masson staining revealed decreased collagen fiber deposition in the renal interstitium, while immunohistochemical staining demonstrated reduced FN accumulation in the renal interstitium (all P<0.05). The mRNA expression levels of Col1a1, Col3a1, Fn1 and Acta2 in renal tissue of IRI+FSTL1 group were lower than IRI group (all P<0.05). Double immunofluorescence staining showed a decrease in the co-expression of SCA-1 and α-SMA in renal interstitium. In cell experiments, the mRNA expression levels of Col1a1, Col3a1, Fn1, and Acta2 in the MSC+TGF-β1 group were higher than those in the MSC group (all P<0.05), confirming successful TGF-β1-induced myofibroblast differentiation of MSCs. Additionally, both intracellular FSTL1 protein expression and FSTL1 protein concentration in the cell supernatant were elevated in the MSC+TGF-β1 group (both P<0.05). Compared with MSC+TGF-β1 group, the mRNA levels of Acta2 and Col1a1 in MSC+TGF-β1+FSTL1 group were decreased (both P<0.01), and the protein expression levels of collagen Ⅰ and α-SMA were significantly decreased (both P<0.001). Compared with MSC-siNC+TGF-β1 group, the protein level of FSTL1 in cell culture supernatant of MSC-si Fstl1+TGF-β1 group were decreased ( P<0.001), while the protein expression levels of FN and α-SMA were increased (both P<0.001), and the mRNA expression levels of Fn1 and Acta2 were increased (both P<0.05). Conclusions:During unilateral renal IRI-induced renal fibrosis, MSCs in renal interstitium may differentiate into myofibroblasts. FSTL1 may alleviate renal fibrosis after unilateral renal IRI by inhibiting the differentiation of MSCs into myofibroblasts.

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.

Autophagy is a conservative biological process of maintaining internal balances through degrading damaged proteins, organelles and intracellular pathogens.It may promote cell survival and accelerate cell death.Ferroptosis is a newly discovered regulated form of cell death characterized by lipid peroxidation and membrane damage in 2012.In recent years, more and more studies have demonstrated complex interactions between autophagy and ferroptosis.Various forms of cell death are regulated during the progression of kidney diseases.And autophagy and ferroptosis play important roles.However, potential connections between autophagy and ferroptosis in renal injury disease has not been fully elucidated.This review focused upon on the regulatory role of autophagy in ferroptosis and its possible link to renal injury, providing new theoretical rationales for researches on acute or chronic kidney injury.

Objective:To explore the significance of coagulation and platelet function analysis (Sonoclot) in monitoring coagulation function, severity evaluation and blood transfusion indication of perioperative liver transplant (LT) recipients.Methods:A total of 95 perioperative LT recipients received Sonoclot, thromboelastography (TEG), routine coagulation panel, liver function panel, blood routine, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scoring and model for end-stage liver disease (MELD) scoring between January 2021 and October 2022.The correlation analysis of the above parameters was performed.According to the scores of APACHE Ⅱ and MELD, they were assigned into three groups of low-risk, medium-risk and high-risk.The levels of Sonoclot parameters in each group were compared.They were divided into two groups of transfusion (n=31) and non-transfusion (n=64) according to the necessity or non-necessity of transfusion..The risk factors for blood transfusion were examined by Logistic regression and receiver operating characteristic (ROC) curve.Results:Pearson's correlation analysis indicated that activated clotting time (ACT) value was correlated positively with the levels of prothrombin time (PT), prothrombin time ratio (PTR), international standard ratio (INR), R/K value, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactic dehydrogenase (LDH)( r=0.279 1, P=0.006 2; r=0.280 2, P=0.006 5; r=0.3, P=0.003 5; r=0.642 8, P<0.000 1; r=0.452 8, P<0.000 1; r=0.377 6, P=0.002; r=0.349 6, P=0.000 6; r=0.271 4, P=0.018 3) and yet negatively with the levels of platelet (PLT), MA, CI and α ( r=-0.339 1, P=0.000 8; r=-0.573 3, P<0.000 1; r=-0.656 3, P<0.000 1; r=-0.632 6, P<0.000 1); CR value was correlated positively with the levels of maximal amplitude (MA), coagulation index (CI), α and ALT ( r=0.466 8, P=0.000 6; r=0.482 7, P=0.000 4; r=0.514 8, P=0.000 1; r=0.229 2, P=0.027 1) and yet negatively with the level of R/K value ( r=-0.366 9, P=0.010 3; r=-0.356 9, P=0.011 0); platelet function (PF) value was correlated positively with the levels of PLT, MA, CI, α and alkaline phosphatase (ALP)( r=0.481 9, P<0.000 1; r=0.630 7, P<0.000 1; r=0.623 5, P<0.000 1; r=0.593 0, P<0.000 1; r=0.223 1, P=0.032 5) and yet negatively with the level of R/K value ( r=-0.421 5, P=0.002 8; r=-0.530 7, P<0.000 1). CR value was correlated negatively with APACHE Ⅱ score ( r=-0.212 3, P=0.038 9) while ACT value was correlated positively with MELD score ( r=0.244, P=0.04). ACT values spiked in low, middle and high-risk groups of APACHE Ⅱ and MELD scores while PF value declined gradually by grouping these recipients based upon scoring systems.CR values decreased merely in MELD score.Logistic regression analysis indicated that ACT was a risk factor for necessity of blood transfusion in perioperative LT recipients ( OR=1.010, 95% CI 1.000-1.019, P<0.05). The maximal area under the curve of ROC curve analysis plus ACT, hemoglobin (Hb) and hematocrit (Hct) was 0.896. Conclusions:Sonoclot parameters of perioperative LT recipients have some certain correlation with thromboelastographic and conventional coagulation parameters.Both may serve as a supplementary means.Associated with liver function parameters and liver scores, Sonoclot parameters are significant for early clinical evaluations.Sonoclot parameters plus Hb/Hct detection have some guiding significance for perioperative LT recipients with necessity for blood transfusion and blood products.

In order to solve the difficulties and challenges in the implementation of the original blood distribution and collection regulations caused by the expansion of hospital area, the extension of blood transfer time, the changeability of blood transfer environment, and the strain of personnel due to the increase of workload, as well as to ensure the accuracy of the information throughout blood remote verification and distribution and the safety of clinical blood transfusion, , Shanghai experts related to clinical transfusion and blood management had made a systematic study on the applicable scope and management rules of remote verification of blood distribution and collection, and formulated this Expert Consensus combined with the development status of digital, intelligent and remote communication technologies, so as to provide corresponding guidance for clinical medical institutions in line with the changes in reality.

Objective:To explore the in vitro antiviral activity of Mizoribine (Miz) against BK polyomavirus (BKV) and analyze preliminarily the replication stage during inhibition.Methods:The solvent of Miz, was employed as a negative control, while Sirolimus (Sir) with in vitro anti-BKV activity was applied as a positive control. Firstly, the half maximal inhibitory concentrations (IC50) of Miz and Sir were analyzed in different cell lines. Then, prior to BKV infection, cells were treated with a gradient of drug concentrations according to the IC50 results. At different timepoints post-infection, BKV replication curves were measured by quantitative detection of its DNA in supernatant while the cells were subjected to immunofluorescence for detecting the infection rate. Finally 293FT cells treated with drugs was infected by BKV single-round pseudovirus for determining the effects of Miz on the early stage of BKV infection.Results:As compared with control group, immunofluorescence showed a lowered infection rate of BKV in a Miz dose-dependent manner, viral replication curve was significantly inhibited according to the quantitative detection of viral DNA in cell supernatant. The inhibitory effect of Sir on the level of BKV infection and replication was similar to that of Miz. However, neither Miz nor Sir exhibited a significant effect on the early stage of BKV infection.Conclusions:Miz has anti-BKV activity at cellular level and the inhibitory effect does not appear in the early stage of viral infection.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.