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.

Aim To explore the effect of Danggui Shaoyao San on edema in rats with nephrotic syndrome and the underlying mechanism.Methods Rats were randomly divided into control group,model group,Danggui Shaoyao San group(17.2 g·kg-1·d-1),losartan group(30 mg·kg-1·d-1)and tolvaptan group(3 mg·kg-1·d-1).The rat model of nephrot-ic syndrome was established by tail vein injection of adriamycin.After four weeks of treatment,the levels of renal function and 24 h urinary protein were detected.The distribution of aquaporin 2(AQP2)and pS256-AQP2 in renal tissue was detected by immunohisto-chemistry.The levels of plasma arginine vasopressin(AVP)and angiotensin Ⅱ(Ang Ⅱ)were measured by radioimmunoassay.The expressions of renal AQP2,pS256-AQP2,angiotensin type 1 receptor(AT1R),arginine vasopressin receptor 2(V2R)protein and mRNA were measured by Western blot and RT-PCR,respectively.Results The three drugs could improve renal function,reduce proteinuria,decrease plasma AVP and Ang Ⅱ levels,and down-regulate AQP2 and pS256-AQP2 protein and mRNA expression in model rats.Danggui Shaoyao San and tolvaptan were more ef-fective than losartan in reducing plasma AVP levels.Conclusions Danggui Shaoyao San may regulate the expression of AQP2 by reducing the levels of AVP and Ang Ⅱ,and improve the edema of nephrotic syndrome rats.

Purpose To explore the value of contrast-enhanced ultrasound(CEUS)in the differential diagnosis of gallbladder polypoid lesions(GPLs)(diameter≥10 mm).Materials and Methods A prospective enrollment of 229 patients with GPLs who underwent cholecystectomy in 17 hospitals from December 1 2021 to June 30 2024 was conducted to analyze the relationship between general data,conventional ultrasound,CEUS characteristics and the nature of GPLs.Multivariate Logistic regression was employed to identify independent risk factors for neoplastic polyps,the differential diagnostic value of different indicators was compared.Results Among 229 patients with GPLs,there were 108 cases of cholesterol polyps,102 cases of adenoma and 19 cases of gallbladder cancer.Age(Z=-4.476,P<0.001),polyp number(χ2=15.561,P<0.001),diameter(Z=-8.149,P<0.001),echogenicity(χ2=9.241,P=0.010),vascularity(χ2=23.107,P<0.001),enhancement intensity(χ2=47.610,P<0.001),enhancement pattern(χ2=6.468,P=0.011),vascular type(χ2=84.470,P<0.001),integrity of gallbladder wall(χ2=7.662,P=0.006)and stalk width(Z=-9.831,P<0.001)between cholesterol polyps and neoplastic polyps were statistically significant.Age,location,diameter,echogenicity,enhancement pattern,vascular type and stalk width between adenoma and gallbladder cancer were statistically significant(Z=-4.333,-3.902,-5.042,all P<0.05).Multivariate Logistic regression analysis showed that hyper-enhancement,branched vascular type and stalk width were independent risk factors for neoplastic polyps(OR=4.563,5.770,3.075,all P<0.001).The combination of independent risk factors was better than single factor and diameter in the differential diagnosis of cholesterol polyps and neoplastic polyps(all P<0.01).Conclusion CEUS can effectively identify the nature of GPLs and provide a valuable imaging reference for the selection of treatment methods.

[Purpose]To analyze the epidemic characteristics and survival trends of upper gas-trointestinal cancer in Fujian cancer registration areas from 2011 to 2020.[Methods]Cancer regi-stration data in Fujian Province was collected to calculate the crude incidence and mortality rate,age-standardized incidence/mortality rates by Chinese standard population(ASIRC,ASMRC)and by world standard population(ASIRW,ASMRW)and cumulative rate of 0～74 years old of upper gastrointestinal cancer(including esophageal and gastric cancers)as well as the corresponding temporal trends from 2011 to 2020.Using the Joinpoint software to calculate the annual percent-age change(APC)and average annual percentage change(AAPC)to analyze the trends.The data were divided into two time periods(2011-2015 and 2016-2020)to compare the 5-year relative survival rates of upper gastrointestinal cancer.[Results]From 2011 to 2020,there were 26 286 new cases of upper gastrointestinal cancer in Fujian cancer registration areas,accounting for 20.28％of all malignant tumors.The incidence rate,ASIRC and ASIRW of upper gastrointestinal cancer was 56.52/105,42.55/105,and 42.75/105,respectively,and the cumulative incidence rate(0～74 years old)was 5.32％.Incidence of upper gastrointestinal cancer was higher in men than that in women.The incidence of upper gastrointestinal cancer showed an decreasing trend from 2011 to 2020,with an AAPC of ASIRC of-4.7％(95％CI:-6.6％～-2.9％).There were 11 680 new cases of esophageal cancer in Fujian cancer registration areas,the crude incidence,ASIRC,ASIRW and cumulative incidence(0～74 years old)of esophageal cancer were 25.12/105,18.67/105,18.97/105,and 2.32％,respectively.There were 14 606 gastric cancer new cases in Fujian cancer registration areas during 2011-2020,the crude mortality,ASMRC,ASIRW and cumulative mortality(0～74 years old)of gastric cancer were 31.41/105,23.88/105,23.78/105,and 3.00％,respectively.There were 20 133 upper gastrointestinal cancer deaths during 2011-2020 in Fujian cancer registration areas,accounting for 26.05％of all cancer deaths.The crude mortality,ASMRC and ASMRW of upper gastrointestinal cancer was 43.29/105,31.95/105,and 31.89/105,respectively,the cumu-lative mortality rate(0～74 years old)was 3.84％.The mortality of upper gastrointestinal cancer was higher in men than that in women.The mortality rate of upper gastrointestinal cancer showed a trend of first increase and then decrease,with an APC of 3.5％(95％CI:-0.5％～11.3％)from 2011 to 2014 and-5.2％(95％CI:-8.4％～3.7％)from 2014 to 2020.There were 9 643 deaths of esophageal cancer during 2011-2020 in Fujian cancer registration areas.The crude mortality,ASMRC,ASMRW and cumulative mortality rate(0～74 years old)of esophageal cancer was 20.74/105,15.20/105,15.35/105,and 1.83％,respectively.There were 10 490 deaths of gastric cancer dur-ing 2011-2020 in Fujian cancer registration areas.The crude mortality,ASMRC,ASMRW and cumulative mortality rate(0～74 years old)of gastric cancer was 22.56/105,16.75/105,16.54/105,and 2.00％,respectively.The 5-year relative survival rate for upper gastrointestinal cancer patients during 2011-2015 and 2016-2020 were 24.74％(95％CI:23.92％～25.56％)and 25.49％(95％CI:24.65％～26.34％),respectively.The 5-year relative survival rate for esophageal cancer patients during 2011-2015 and 2016-2020 were 17.15％(95％CI:16.10％～18.22％)and 18.72％(95％CI:17.59％～19.88％),respectively.The 5-year relative survival rate for gastric cancer patients during 2011-2015 and 2016-2020 were 30.90％(95％CI:29.71％～32.10％)and 30.76％(95％CI:29.56％～31.97％),respectively.There was a decreasing trend in 5-year survival of upper gastroin-testinal patients with increasing age,with lower survival rate in patients over 65 years old.[Con-clusion]The incidence and mortality of upper gastrointestinal cancer in Fujian cancer registration areas showed an overall decreasing trend,and the 5-year relative survival rate improved slightly,while the disease burden of upper gastrointestinal cancer remains heavy.Incidence and mortality of upper gastrointestinal cancer of men were higher than those of women,and the elderly patients with upper gastrointestinal cancer had a poorer prognosis.Fujian should pay close attention to the prevention and control of gastric cancer among key groups,and strengthen its comprehensive pre-vention and control ability of upper gastrointestinal cancer.

[Purpose]To analyze the preliminary screening and follow-up results of the early diag-nosis and treatment program for upper gastrointestinal cancer in rural areas of Fujian Province from 2013 to 2022.[Methods]Screening data from the early diagnosis and treatment program for upper gastrointestinal cancer in Fujian Province from 2013 to 2022 were collected and organized.The positive case detection rate,early diagnosis rate,and treatment rate of the screening population were calculated.SPSS 22.0 software was used to test the trend Chi-square test of the annual changes in detection rate,early diagnosis rate and treatment rate.The Chi-square test was used to compare the detection rate and early diagnosis rate between different groups.[Results]From 2013 to 2022,a total of 26 823 screenings and follow-ups were completed in Fujian Province,with de-tection rate,early diagnosis rate,and treatment rate of 1.41％,56.20％,and 92.61％,respec-tively.The early diagnosis rate showed an increasing trend from 2013 to 2022(P＜0.05).The initial screening detected rate and early diagnosis rate were 1.38％and 55.59％,respectively,while fol-low-up detection rate and early diagnosis rate were 5.36％and 75.00％.The detection rates for esophagus,cardia,and stomach cases were 0.70％,0.15％,and 0.58％,respectively,with early diagnosis rates of 64.86％,53.66％,and 46.41％,respectively.The differences in detection rates and early diagnosis rates for each site were statistically significant(all P＜0.05).[Conclusion]With the development of early diagnosis and treatment of upper gastrointestinal cancer in rural areas of Fujian Province and the improvement of residents'awareness of cancer prevention,the detection rate and early diagnosis rate of upper gastrointestinal cancer in Fujian Province have been im-proved,which plays an important role in improving the survival rate of patients.

The growth of three plague phages from Qinghai Plateau in two Yersinia pestis strains(plague vaccine strains EV76 and 614F)and four non-Yersinia pestis strains(Yersinia pseudotuberculosis PTB3,PTB5,Escherichia coli V517,and Yersinia enterocolitica 52302-2)were detected through a micromethod based on the OmniLogTM microbial identification system and by the drop method,to provide a scientific basis for future ecological studies and classification based on the host range.For plague vaccine strains EV76 and 614F,successful phage infection and subsequent phage growth were observed in the host bacte-rium.Diminished bacterial growth and respiration and a concomitant decrease in color were observed with the OmniLogTM mi-crobial identification system at 33 ℃ for 48 h.Yersinia pseudotuberculosis PTB5 was sensitive to Yersinia pestis phage 476,but Yersinia pseudotuberculosis PST5 was insensitive to phage 087 and 072204.Three strains of non-Yersinia pestis(Yersinia pseudotuberculosis PTB3,Escherichia coli V517,and Yersinia enterocolitica 52302-2)were insensitive to Yersinia pestis pha-ges 087,072204,and 476 showed similar growth curves.The growth of phages 476 and 087,as determined with the drop method,in two Yersinia pestis strains(plague vaccine strains EV76 and 614F)and four non-Yersinia pestis strains(Yersinia pseudotuberculosis PTB3,Escherichia coli V517,and Yersin-ia enterocolitica 52302-2)showed the same results at 37 ℃,on the basis of comparisons with the OmniLogTM microbial i-dentification system;in contrast,phages 072204 did not show plaques on solid medium at 37 ℃ with plague vaccine strains EV76 and 614F.Determination based on the OmniLogTM detection system can be used as an alternative to the traditional determination of the host range,thus providing favorable application val-ue for determining the interaction between the phage and host bacteria.

Objective To comprehensively analyze the clinical outcomes of total cavopulmonary connection (TCPC) in the treatment of functional single ventricle combined with heterotaxy syndrome (HS). Methods A retrospective analysis was conducted on the patients with functional single ventricle and HS who underwent TCPC (a HS group) in Guangdong Provincial People's Hospital between 2004 and 2021. The analysis focused on postoperative complications, long-term survival rates, and identifying factors associated with patient survival. Early and late postoperative outcomes were compared with matched non-HS patients (a non-HS group). Results Before propensity score matching, 55 patients were collected in the HS group, including 42 males and 13 females, with a median age of 6.0 (4.2, 11.8) years and a median weight of 17.0 (14.2, 28.8) kg. Among the patients, there were 53 patients of right atrial isomerism and 2 patients of left atrial isomerism. Eight patients underwent TCPC in one stage. TCPC procedures included extracardiac conduit (n=39), intracardiac-extracardiac conduit (n=14), and direct cavopulmonary connection (n=2). Postoperative complications included infections in 27 patients, liver function damage in 19 patients, and acute kidney injury in 11 patients. There were 5 early deaths. The median follow-up time was 94.7 (64.3, 129.8) months. The 1-year, 5-year, and 10-year survival rates were 87.2%, 85.3%, and 74.3%, respectively. After propensity score matching, there were 45 patients in the HS group and 81 patients in the non-HS group. Compared to the non-HS group, those with HS had longer surgical and mechanical ventilation time, higher infection rates (P<0.05), and a 12.9% lower 10-year survival rate. Multivariate Cox regression analysis identified asplenia was a risk factor for mortality (HR=8.98, 95%CI 1.86-43.34, P=0.006). Conclusion Compared to non-HS patients, patients with HS have lower survival rates after TCPC, and asplenia is an independent risk factor for the survival of these patients.

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

Objective To discuss the efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS)for portal hypertension with portal vein thrombosis(PVT).Methods A total of 31 patients with portal hypertension complicated by PVT,who underwent TIPS at the Chinese PLA General Hospital between December 2017 and October 2022,were enrolled in this study.The clinical data,including preoperative laboratory tests,operation pattern,intraoperative portal vein pressure(PVP),postoperative follow-up ultrasound or enhanced CT examination findings,and the presence or absence of hepatic encephalopathy(HE),were collected.Paired t-test was used to compare the differences in PVP before and after stenting,Kaplan-Meier curve was used to analyze the postoperative shunt patency rate,rebleeding rate,incidence of HE,and survival rate.Log-rank test was used to analyze the differences in follow-up results between the patients having cavernous transformation of portal vein(CTPV)and the patients having no CTPV.Results The technical success rate of TIPS procedure was 93.55％(29/31).In the 29 patients with successful surgery,the mean PVP value decreased from preoperative(30.15±4.61)mmHg to postoperative(20.84±5.57)mmHg,the difference was statistically significant(t=8.975,P＜0.05).The postoperative median follow-up time was 22.90 months(range of 4.50-61.80 months).During the follow-up period,24.14％of patients(7/29)developed shunt tract dysfunction,17.24％of patients(5/29)developed rebleeding,17.24％of patients(5/29)developed HE,and 5 patients(5/29,17.24％)died.Ten patients(10/29,34.48％)with PVT were complicated by CTPV,among them 5 patients had shunt dysfunction,3 patients had rebleeding,one patient developed HE,and 3 patients died.Of the 19 patients who having no coexisting CTPV,shunt dysfunction was seen in 2,rebleeding in 2 and HE in 4,and 2 patients died.The incidences of shunt tract dysfunction and rebleeding in the patients having CTPV were obviously higher than those in the patients having no CTPV(both P＜0.05),while no statistically significant differences in the incidences of HE and death existed between the two groups(both P＞0.05).Conclusion TIPS can effectively reduce the PVP in patients with PVT.The incidences of shunt tract dysfunction and rebleeding in the PVP with coexisting CTPV are remarkably higher than those in the PVT patients with no coexisting CTPV.(J Intervent Radiol,2024,33:537-542)

Gouty arthritis is a type of metabolic rheumatic disease caused by autoimmune abnormalities. Currently, the use of Western medicine in the clinical treatment of gouty arthritis has been associated with a high risk of adverse reactions. Therefore, there is a growing interest in exploring therapeutic drugs from traditional Chinese medicine as a potential alternative. According to the theory of traditional Chinese medicine, gouty arthritis has been classified as damp-heat arthralgia syndrome. Shirebi granules has been found to have good clinical efficacy in treating gouty arthritis. However, its underlying pharmacological mechanisms remain unclear. To address this problem, the study first established the interaction network of candidate targets for Shirebi granules, which is used to treat damp-heat syndrome of gouty arthritis. Then, the key candidate targets of Shirebi granules for treating gouty arthritis with damp-heat syndrome were screened by calculating the topological features of the network nodes. Then, the functional mining of the key candidate targets revealed that the candidate targets of Shirebi granules may intervene in the biological process of inflammatory response and lipid metabolism through the crosstalk of Wnt/β-catenin signaling. To verify the effectiveness of Shirebi granules in treating gouty arthritis with damp-heat syndrome, a rat model was established. The results demonstrated that the granules significantly improved the severity of arthritis in rats with this condition, reduced joint inflammation, gait score, swelling index, increased mechanical pain threshold (P < 0.05), and reduced the content of serum inflammatory factors IL-1β, IL-6, and TNF-α in gouty arthritis rats with damp-heat syndrome (P < 0.01) gouty. It was also found that Shirebi granules effectively alleviated the symptoms of dampness heat syndrome such as local joint fever and dry mouth by reducing the temperature of the joints in acute gouty arthritis with damp-heat syndrome (AD) rats, increasing the threshold of heat pain, increasing water intake (P < 0.01), and inhibiting abnormal changes in the content of fatty acid oxidation related enzymes (P < 0.01). Western blot analysis showed that Shirebi granules increased the protein expression levels of Wnt and β-catenin (P < 0.01) while decreasing the protein expression of p65, p-p65 and PPARγ (P < 0.01) in rats with gouty arthritis and damp-heat syndrome. The results showed that Shirebi granules may reverse the "inflammation-immune" imbalance and lipid metabolism disorder by regulating the crosstalk of Wnt/β-catenin signaling, and play a role in alleviating the severity of the disease. This study provides a methodological reference for elucidating the pharmacological mechanisms of traditional Chinese medicine formulas. It also presents research ideas for the appropriate clinical use of Chinese patent medicines and the development of new clinical drugs for gouty arthritis therapy. The animal welfare and experiment procedures of this study were performed in accordance with the regulations of the Experimental Animal Ethics Committee of Experimental Research Center, China Academy of Chinese Medical Sciences (grant No. ERCCACMS11-2302-08).