Objective:To evaluate the clinical value and safety of an intraperitoneal chemotherapy port technique in patients with gastric cancer and peritoneal metastases undergoing intraperitoneal chemotherapy.Methods:This was a retrospective, descriptive case analysis. From November 2022 to October 2024, patients diagnosed with gastric cancer and peritoneal metastases at Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine with an expected survival >3 months, underwent laparoscopic exploration combined with implantation of an intraperitoneal chemotherapy port [PORT-A-CATH II system (Model 21-4055-24)] implantation. The procedure was as follows: (1) after laparoscopic exploration, a 4-cm skin incision was made at a predetermined site and a subcutaneous pocket created by dissecting to the muscle fascia and removing subcutaneous fat as needed to position the port septum 0.5-1.0 cm from the skin surface; (2) under direct laparoscopic visualization, the abdominal cavity was punctured and a guidewire inserted, followed by an 8.5 Fr sheath, through which a catheter with three trimmed side holes was placed after removal of the sheath; (3) the catheter length in the abdominal cavity was adjusted to 25–30 cm and the catheter trimmed, and connected to the port base, ensuring it extended beyond the connector's visible hole; (4) the whole port was placed within the subcutaneous pocket, and non-absorbable sutures used to create a double purse-string suture at the catheter's abdominal entry, forming an anti-reflux ring; (5) non-absorbable sutures were used to securely fix the port to the fascia through its four base holes and the exposed catheter segments on the fascia sutured and buried; (6) patency was confirmed by injecting saline and followed by intermittent skin closure provided there was no bleeding; and (7) the catheter tip was positioned in the pelvic cavity under laparoscopic guidance. Postoperatively, the patients underwent normothermic intraperitoneal and systemic treatment. The port infusion protocol involved disinfecting the skin (>10 cm diameter) around the port, confirming the puncture site, inserting a Huber needle vertically at 90° to the port base, infusing 100 mL saline to ensure patency, followed by continuous infusion of 1000 mL paclitaxel solution, and sealing with 20 mL saline before removing the needle. No saline flushing was required between chemotherapy infusions. The primary outcomes were the incidence and management of complications post-port implantation.Results:The study cohort comprised 225 patients with gastric cancer and peritoneal metastases. Using standardized port implantation and postoperative puncture procedures, the complication rate during follow-up was 14.2% (32/225), including effusion in 14 patients (6.2%), port infection in 10 (4.4%), incision dehiscence in four (1.8%), port inversion in two (0.9%), hematoma in one (0.4%), and catheter rupture in one (0.4%). Seventy-five percent (24/32) of patients with complications recovered and continued using the port after conservative treatments (e. g., aspiration of effusions, antibiotic therapy, incision management), whereas the remaining 25.0% (8/32) with complications required surgical removal of the port because the treatment was ineffective. The presence of preoperative ascites ( P=0.019) and peritoneal cancer index score>15 ( P=0.038) were significantly associated with development of complications. Conclusions:Our standardized procedure for intraperitoneal chemotherapy port implantation is safe and feasible for patients with gastric cancer and peritoneal metastases, having a low overall complication rate. Most complications can be successfully managed with conservative treatment, the device thus providing reliable support for intraperitoneal chemotherapy.

Salmonella has demonstrated considerable potential as a vaccine vector,exhibiting robust immunogenicity,ease of oral administration,and cost-effective production.Live attenuated Salmo-nella carrying heterologous antigens can induce both localized mucosal immunity and systemic a-daptive immune responses in hosts after successfully reaching the intestinal tract via oral delivery.Recent advances such as permanent deletion of virulence genes,regulated-delayed attenuation and lysis systems,have initially achieved a balance between the safety and immunogenicity of these vaccine platforms.Nevertheless,practical applications of such vaccine vectors remain constrained by challenges related to gastrointestinal barrier obstruction,inefficient antigen delivery,and im-mune tolerance.With the rapid advancement of multidisciplinary technologies,these limitations are anticipated to be progressively addressed.This review presented a comprehensive summary and dis-cussion of the immune mechanisms,development strategies,current applications,advantages,and challenges associated with oral live attenuated Salmonella vaccine vectors.It also delineated the fu-ture direction of research and development,with a view to providing theoretical references for re-lated research.

Salmonella has demonstrated considerable potential as a vaccine vector,exhibiting robust immunogenicity,ease of oral administration,and cost-effective production.Live attenuated Salmo-nella carrying heterologous antigens can induce both localized mucosal immunity and systemic a-daptive immune responses in hosts after successfully reaching the intestinal tract via oral delivery.Recent advances such as permanent deletion of virulence genes,regulated-delayed attenuation and lysis systems,have initially achieved a balance between the safety and immunogenicity of these vaccine platforms.Nevertheless,practical applications of such vaccine vectors remain constrained by challenges related to gastrointestinal barrier obstruction,inefficient antigen delivery,and im-mune tolerance.With the rapid advancement of multidisciplinary technologies,these limitations are anticipated to be progressively addressed.This review presented a comprehensive summary and dis-cussion of the immune mechanisms,development strategies,current applications,advantages,and challenges associated with oral live attenuated Salmonella vaccine vectors.It also delineated the fu-ture direction of research and development,with a view to providing theoretical references for re-lated research.

Objective:To evaluate the clinical value and safety of an intraperitoneal chemotherapy port technique in patients with gastric cancer and peritoneal metastases undergoing intraperitoneal chemotherapy.Methods:This was a retrospective, descriptive case analysis. From November 2022 to October 2024, patients diagnosed with gastric cancer and peritoneal metastases at Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine with an expected survival >3 months, underwent laparoscopic exploration combined with implantation of an intraperitoneal chemotherapy port [PORT-A-CATH II system (Model 21-4055-24)] implantation. The procedure was as follows: (1) after laparoscopic exploration, a 4-cm skin incision was made at a predetermined site and a subcutaneous pocket created by dissecting to the muscle fascia and removing subcutaneous fat as needed to position the port septum 0.5-1.0 cm from the skin surface; (2) under direct laparoscopic visualization, the abdominal cavity was punctured and a guidewire inserted, followed by an 8.5 Fr sheath, through which a catheter with three trimmed side holes was placed after removal of the sheath; (3) the catheter length in the abdominal cavity was adjusted to 25–30 cm and the catheter trimmed, and connected to the port base, ensuring it extended beyond the connector's visible hole; (4) the whole port was placed within the subcutaneous pocket, and non-absorbable sutures used to create a double purse-string suture at the catheter's abdominal entry, forming an anti-reflux ring; (5) non-absorbable sutures were used to securely fix the port to the fascia through its four base holes and the exposed catheter segments on the fascia sutured and buried; (6) patency was confirmed by injecting saline and followed by intermittent skin closure provided there was no bleeding; and (7) the catheter tip was positioned in the pelvic cavity under laparoscopic guidance. Postoperatively, the patients underwent normothermic intraperitoneal and systemic treatment. The port infusion protocol involved disinfecting the skin (>10 cm diameter) around the port, confirming the puncture site, inserting a Huber needle vertically at 90° to the port base, infusing 100 mL saline to ensure patency, followed by continuous infusion of 1000 mL paclitaxel solution, and sealing with 20 mL saline before removing the needle. No saline flushing was required between chemotherapy infusions. The primary outcomes were the incidence and management of complications post-port implantation.Results:The study cohort comprised 225 patients with gastric cancer and peritoneal metastases. Using standardized port implantation and postoperative puncture procedures, the complication rate during follow-up was 14.2% (32/225), including effusion in 14 patients (6.2%), port infection in 10 (4.4%), incision dehiscence in four (1.8%), port inversion in two (0.9%), hematoma in one (0.4%), and catheter rupture in one (0.4%). Seventy-five percent (24/32) of patients with complications recovered and continued using the port after conservative treatments (e. g., aspiration of effusions, antibiotic therapy, incision management), whereas the remaining 25.0% (8/32) with complications required surgical removal of the port because the treatment was ineffective. The presence of preoperative ascites ( P=0.019) and peritoneal cancer index score>15 ( P=0.038) were significantly associated with development of complications. Conclusions:Our standardized procedure for intraperitoneal chemotherapy port implantation is safe and feasible for patients with gastric cancer and peritoneal metastases, having a low overall complication rate. Most complications can be successfully managed with conservative treatment, the device thus providing reliable support for intraperitoneal chemotherapy.

OBJECTIVE To observe the clinical efficacy of Yangyin Jiedu Decoction in the prevention and treatment of acute ra-diation-induced oral mucositis(RTOM).METHODS A total of 80 inpatients who were diagnosed with head and neck tumors by pathological examination and received radiotherapy in the Department of Radiotherapy,Affiliated Hospital of Nanjing University of Chi-nese Medicine from November 2021 to September 2023 were selected and randomly divided into an observation group and a control group with 40 cases in each group.The control group was given mouthwash treatment from the onset of RTOM symptoms until the symp-toms disappeared;the observation group was given Yangyin Jiedu Decoction from the first day of radiotherapy on the basis of the treat-ment of the control group until the end of radiotherapy.During the treatment,the onset time,duration and incidence of grade Ⅱ-ⅣRTOM in the two groups were observed;the pain numerical rating scale(NRS)score,Karnofsky performance status(KPS)score,body mass index(BMI)changes were evaluated;and the levels of serum inflammatory factors[C-reactive protein(CRP),interleukin 6(IL-6),interleukin 1β(IL-1β),tumor necrosis factor α(TNF-α)]were detected.RESULTS After radiotherapy,RTOM ap-peared in both groups to varying degrees.The incidence of grade Ⅱ-Ⅳ RTOM,the onset time,duration and NRS score of RTOM in the observation group were significantly better than those in the control group(P<0.05,P<0.01).After radiotherapy,the levels of se-rum CRP,IL-6,IL-1β and TNF-α in the observation group were lower than those in the control group(P<0.05,P<0.01).After radiotherapy and 1 month of follow-up,the KPS score and BMI in the observation group were higher than those in the control group(P<0.05,P<0.01).CONCLUSION Yangyin Jiedu Decoction can decrease the incidence and severity of RTOM in patients with head and neck tumors,shorten its duration,improve the quality of life of patients,downregulate the level of inflammatory cytokines,and has a preventive effect on RTOM caused by radiotherapy in patients with head and neck tumors.

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 A HPLC fingerprint method of Alpiniae Oxyphyllae Fructus(AOF)before and after salt-processing was established,to compare the differences of chemical components between raw and processed AOF combined with chemical pattern recognition.Methods HPLC method was used to establish the fingerprint of raw and salt-processed AOF.Principal component analysis(PCA)and orthogonal partial least squares discriminant analysis(OPLS-DA)were applied to explore the different components of raw and salt-processed AOF in different batches.Results Totally 30 and 32 common peaks in the HPLC fingerprint from the raw and salt-processed AOF were detected,respectively.And 8 of them were identified by comparison with the standards.They were peak X2(5-hydroxymethylfurfural),peak 1(protocatechuic acid),peak 2(protocatechualdehyde),peak 4(epicatechin),peak 21(chrysin),peak 22(kaempferide),peak 25(tectochrysin)and peak 26(nootkatone).The results of PCA and OPLS-DA showed that raw and salt-processed AOF can be grouped into two categories.A total of 12 components,which were considered as differential markers of raw and salt-processed AOF,were screened by method of variable importance in projection(VIP).The 12 components were peak X1,peak 26(nootkatone),peak 16,peak 3,peak X2(5-hydroxymethylfurfural),peak 25(tectochrysin),peak 15,peak 12,peak 8,peak 10,peak 17 and peak 20.Conclusion The combination of HPLC fingerprint and chemical pattern recognition can be used to analyze the quality differences of AOF before and after salt-processing.

Objective:To investigate the association between serum bone turnover marker osteocalcin and the distal symmetric poly neuropathy(DSPN) in male diabetic patients.Methods:Clinical data from 370 male diabetic patients who admitted to Zhongshan Hospital, Fudan University from January 2020 to November 2021 were collected. These patients were grouped into tertiles by serum osteocalcin level: T1 group(osteocalcin<9.2 ng/mL, n=123), T2 group(osteocalcin 9.2-13 ng/mL, n=122), and T3 group(osteocalcin≥13 ng/mL, n=125). The percentage ratios of DSPN were compared among these groups. Using logistic regression model, the adjusted odds ratio ( OR) for DSPN was calculated. Results:There were 50(40.7%), 29(23.8%), 49(39.2%) patients with DSPN in T1, T2, and T3 group respectively. The ratio of patients with DSPN in osteocalcin T2 group were lower than that in the T1 and T3 groups. Further logistic regression showed a 133.9%( OR=2.339, 95% CI 1.097-4.988, P=0.028) and a 134.2%( OR= 2.342, 95% CI 1.040-5.275, P=0.039) increased risk for DSPN in the T1 and T3 group respectively compared with the T2 group, even after adjusted for age, diabetic duration, HbA 1C, diabetic complications, β cross-linked C-telopeptide of type Ⅰ collagen(CTXβ), 25-hydoxy vitamin D(25-OHD), bone mineral density, and treatment. Conclusions:The serum levels of bone turnover marker osteocalcin were associated with the occurrence of DSPN in male diabetic patients, a moderate level of bone turnover(the serum osteocalcin level of between 9.2 and 13 ng/mL for instance) might be protective for male diabetic patients from DSPN.

Objective: To explore the correlation between BMI and gut microbiota of college students in Inner Mongolia,and to provide a reference basis for revealing the relationship between intestinal flora and obesity. Methods: Totally 88 college students from Inner Mongolia Medical University were enrolled, Height and weight were measured,and the feces samples were collected. The bacterial metagenome was extracted from dry feces samples for the concentration detection in per gram of dry feces,expressed as μg/μL. Correlation between BMI and metagenomics concentration of gut microbiota was statistically analyzed. Meanwhile,the metagenomics concentration of gut microbiota in different BMI groups was compared with each other. Results: There was a negative correlation between BMI and the metagenomics concentration of gut microbiota(r=-0.27,P<0.05). Significant difference in the concentration of gut microflora was observed between the normal group and the obesity group,the normal group and the overweight/obesity group(F=3.62,P<0.05). Among the female volunteers,there were significant differences between normal group and overweight group,between normal group and obesity group(F=1.87,P<0.05). No significant differences in metagenomics concentration of gut microbiota were found in different BMI groups(F=0.60, P>0.05). Conclusion There is a correlation between BMI and gut microbiota of college students in Inner Mongolia，the concentration of gut microflora metagenome in overweight and obese people decreased significantly.

Objective:To investigate the effect of clinical nursing pathway in prevention of contrast induced nephropathy in percutaneous coronary intervention patients.Methods:A total of 118 cases of coronary heart disease patients who had undergo percutaneous coronary intervention in hospital from May 2018 to May 2019 were randomly divided into the intervention group ( n=59) and the control group ( n=59). Participants in the control group received routine nursing, while the intervention group carried out clinical nursing pathway nursing method. The renal index such as serum creatinine, blood urea nitrogen, urine β 2 microglobulin, N-acetyl-beta-D-glucosidase (NAG) were compared before and after intervention between two groups, the incidence of CIN were also compared. Meanwhile, the psychology status and sleep quality was assessed by self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Pittsburgh sleep quality index (PSQI), respectively. Results:The 3 rd day after the operation, serum creatinine, serum urea nitrogen, urine β 2 microglobulin, NAG in the intervention group and control group were (81.06±15.60) μmol/L, (9.43 ± 2.73) mmol/L, (256.87 ± 18.99) μg/L, (19.56 ± 2.44) U/L and (87.87 ± 19.60) μmol/L, (10.55 ± 2.18) mmol/L, (270.45 ± 40.85) μg/L, (20.60 ± 2.13) U/L, respectively. The levels of serum creatinine, serum urea nitrogen, urine β 2 microglobulin, NAG were significantly increased in the intervention group compared to the control group ( t=2.087-2.464, P<0.05). The incidence of CIN in the intervention group were 3.4% (2/59) and 13.6% (8/59) in the control group, the differences had statistical significance ( χ2=3.933, P<0.05). In addition, the scores of SAS, SDS and sleep quality, sleep time, sleep duration, daytime function and total PSQI score were (44.71 ± 8.20), (41.36 ± 6.52), (0.78 ± 0.11), (1.02 ± 0.15), (1.20 ± 0.19), (0.97 ± 0.27), (6.42 ± 0.54), those index were (48.85 ± 6.52), (46.49 ± 8.29), (1.03 ± 0.21), (1.23 ± 0.28), (1.44 ± 0.30), (1.30 ± 0.28), (7.79 ± 0.69), the differences had statistical significance ( t=3.033-12.016, P<0.05). Conclusion:Clinical nursing pathway can improve renal function, reduce the incidence of contrast-induced nephropathy, and improve psychological status and sleep quality of percutaneous coronary intervention patients.