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 evaluate the effect of Pien Tze Huang(PTH)on influenza virus susceptibility in re-straint stress-induced H1N1 influenza susceptibility model in mice with emotional disorders and internal heat,guided by the theory of emotional pathogenesis.Methods Mice were infected with H1N1 influenza vi-rus following 18 h of restraint stress.The signs and weight changes of mice were recorded,and the morbid-ity of mice were analyzed.On the fourth day post viral infection,the lung tissue was collected.The pathologi-cal changes and inflammatory factors in lungs were de-tected by HE staining.The expression of NP was as-sessed by immunohistochemistry and Western blot.The level of lipid peroxidation end products was detected u-sing a commercial kit and western blot.Redox phos-pholipidomics was analyzed in lung tissue by HPLC-MS/MS.Results PTH significantly reduced the mor-tality of influenza-susceptible mice induced by emotion-al stress,inhibited the expression of NP and the re-lease of inflammatory factors,improved inflammation in lung tissue,and alleviated the accumulation of lipid peroxidation end products.Phospholipid oxidation a-nalysis revealed the elevated levels of oxidized phos-pholipid choline and phosphatidylethanolamine in lung tissue of influenza-susceptible mice,which were signif-icantly reduced by PTH administration.Conclusions PTH exhibits promising efficacy in ameliorating influ-enza virus susceptibility induced by internal heat,and its mechanism of action may be related to the regulation of phospholipid peroxidation.

Objective To focus on the imaging features of liposclerosing myxofibrous tumor(LSMFT)and diagnostic chal-lenges to enhance clinical recognition and differential diagnosis accuracy.Methods Retrospective analysis was conducted on the imaging and pathological data from 21 cases diagnosed with LSMFT between January 2014 and November 2022,including 14 males and 7 females(aged from 21 to 73 years;the course of disease ranged from 4 to 48 months).Patient demographics,clinical presentations,and imaging modalities including X-ray,CT,and MRI were reviewed.Pathological findings were corre-lated with imaging features to delineate diagnostic criteria and identify causes of misdiagnosis.Results All 21 patients repre-sented primary lesions,located in 14 bilateral femurs[9 on the right and 5 on the left;12 proximal femurs(intertrochanteric and peripheral)and 2 distal femurs],2 proximal tibia,2 proximal humerus,1 proximal radius,and 1 ilium and 1 calcaneus.On X-ray and CT,all lesions showed cartographical or quasi-circular osteolytic destruction with distinct and sclerotic margins,continuous bone cortex,absence of periosteal reaction and surrounding soft tissue mass.Calcification,bone ridge and varying degrees of fat components were observed in 16 lesions,displaying mixed density;5 lesions showed ground-glass density with minimal bone ridge.On MRI,the signal intensity of the lesion was heterogeneous.T1-weighted imaging showed iso-to slightly high signal intensity,while T2-weighted imaging demonstrated unevenly high signal intensity.Fat-suppressed sequences de-picted significantly elevated signal intensity within lesions,with post-contrast enhancement showing uneven patterns.5 Cases were initially misdiagnosed as fibrous dysplasia.Conclusion LSMFT is an uncommon benign bone tumor,typically localized in the proximal femur but occasionally found in other skeletal sites.Understanding its distinct imaging characteristics is crucial for accurate diagnosis.Typical cases exhibit identifiable imaging patterns,whereas atypical presentations may lead to misdiagnosis as fibrous dysplasia.

Objective:To explore effect of oleanolic acid on allergic rhinitis(AR)and its potential mechanism.Methods:Peripheral blood mononuclear cells(PBMCs)were isolated by density gradient centrifugation.Real-time quantitative PCR was used to detect expressions of Foxp3,IL-17A,Beclin1,and RORγt mRNA in nasal mucosa;flow cytometry was employed to assess proportion of Treg and Th17 cells in PBMCs;Western blot was utilized to determine expressions of RORγt,LC3-Ⅰ,LC3-Ⅱ,Beclin1,and P62 proteins in nasal mucosal.Mice were randomly divided into Control,ovalbumin(OVA),L-oleanolic acid,H-oleanolic acid,DSGC,3-MA and H-oleanolic acid+Rapa groups.Histological changes were observed by HE staining and Periodate Schiff(PAS)staining.Serological changes,expressions of IL-17A,IL-10,eosinophilic cationic protein(ECP)and anti-OVA-specific antibodies were detected by ELISA.Results:AR patients had Th17/Treg imbalance and activated autophagy.Oleanolic acid restored Th17/Treg balance and inhibited autophagy in vitro.In vivo experiments demonstrated that oleanolic acid inhibited OVA-induced allergic nasal symptoms and activation of autophagy pathway,which was same as regulation of 3-MA,while Rapa could weaken effects of high dose of oleanolic acid.Moreover,oleanolic acid reduced infiltration of different inflammatory cells of nasal lavage fluid,prevented damages to epithelial cells,and improved nasal mucosal thickness and mucus secretion.Oleanolic acid regulated balance of mouse Th17/Treg-associated cytokines expressions.Conclusion:Oleanolic acid can be used to treat AR,whose effect is realized through inhibiting autophagy to regulate Th17/Treg balance.

HDAC(histone deacetylase)is a class of epigenetic modifying enzymes that can deacetylate proteins by altering the acetylation status of histones in the nucleus,regulating promoter activation levels,and thereby affecting downstream gene expression.However,expression changes of HDACs during endo-thelial differentiation are still unclear.This study used a three-stage method to induce human induced pluripotent stem cells(hiPSCs)to differentiate into endothelial cells,and qRT-PCR was used to detect the expression changes of class I HDAC(HDAC1,2)and class Ⅱ HDAC(HDAC4,5)genes.It was found that HDAC5 exhibits significant expression changes during endothelial differentiation.It is downreg-ulated by 90％during the mesodermal differentiation stage(P＜0.01),upregulated by 3.7-fold during the vascular precursor stage(P＜0.01),and subsequently downregulated by 70％during the late stage of endothelial differentiation(P＜0.01).Immunoblotting experiments further confirmed that HDAC5 under-goes periodic expression changes during endothelial differentiation.Mechanistic studies have shown that HDAC5 downregulation during the differentiation stage of the mesoderm is mediated by Wnt signaling.CHIR99021 treatment and overexpression of Wnt3a can activate the Wnt signaling pathway,leading to HDAC5 downregulation.Inhibiting the Wnt signaling pathway through IWP-2 promotes the recovery of HDAC5 expression.In addition,it was found that HDAC5 is mainly localized in the nucleus,and IWP-2 restores HDAC5 expression,but it remains in the cytoplasm.Further research suggests that downregu-lation of HDAC5 during mesodermal differentiation may contribute to the expression of the mesodermal marker BraT.Treatment with the HDAC inhibitor BML210 can promote early mesodermal differentiation,interfere with endothelial differentiation of vascular precursor cells,and enhance late-stage endothelial differentiation.In conclusion,HDAC5 displays a stage-specific expression during endothelial differentia-tion,and Wnt signaling activation is the main mechanism regulating the downregulation of HDAC5 during the mesoderm stage.

Objective:To observe the genetic variation of SH2B3 in patients with myeloid neoplasms.Methods:The results of targeted DNA sequencing associated with myeloid neoplasms in the Department of Hematology,Xuanwu Hospital,Capital Medical University from November 2017 to November 2022 were retrospectively analyzed,and the patients with SH2B3 gene mutations were identified.The demographic and clinical data of these patients were collected,and characteristics of SH2B3 gene mutation,co-mutated genes and their correlations with diseases were analyzed.Results:The sequencing results were obtained from 1 005 patients,in which 19 patients were detected with SH2B3 gene mutation,including 18 missense mutations(94.74％),1 nonsense mutation(5.26％),and 10 patients with co-mutated genes(52.63％).Variant allele frequency(VAF)ranged from 0.03 to 0.66.The highest frequency mutation was p.Ile568Thr(5/19,26.32％),with an average VAF of 0.49,involving 1 case of MDS/MPN-RS(with SF3B1 mutation),1 case of MDS-U(with SF3B1 mutation),1 case of aplastic anemia with PNH clone(with PIGA and KMT2A mutations),2 cases of MDS-MLD(1 case with SETBP1 mutation).The other mutations included p.Ala567Thr in 2 cases(10.53％),p.Arg566Trp,p.Glu533Lys,p.Met437Arg,p.Arg425Cys,p.Glu314Lys,p.Arg308*,p.Gln294Glu,p.Arg282Gln,p.Arg175Gln,p.Gly86Cys,p.His55Asn and p.Gln54Pro in 1 case each.Conclusion:A wide distribution of genetic mutation sites and low recurrence of SH2B3 is observed in myeloid neoplasms,among of them,p.Ile568Thr mutation is detected with a higher incidence and often coexists with characteristic mutations of other diseases.

Objective:To explore the clinical effect of perforator pedicled propeller flap (PPPF) in reconstruction of soft tissue defect in ankle and foot, as well as the role of preoperative ultrasonography in assistance of the location of perforators in donor site.Methods:From January 2017 to June 2023, the Department of Microorthopedics of the Second Affiliated Hospital of Luohe Medical College of Higher Education applied PPPF to reconstruct small and medium-sized soft tissue defects in the ankle and foot for 26 patients. The patients were 17 males, 9 females, aged 18 to 68 years old with 46 years old in average. The defect sites were 3 in forefoot and 6 in midfoot and combined with different degrees of tendon and bone exposure, 17 in ankle and heel and combined with various degrees of bone exposure, 12 with ankle open injury and 5 with Achilles tendon exposure. The area of soft tissue defects ranged from 2.5 cm×1.5 cm to 16.0 cm × 6.5 cm. The width of injury was measured before surgery, and a HHD was used to detect the perforators proximal to the defect site, and then high-frequency CDU was used to locate and confirm the location of the perforator and its alignment, blood flow and diameter. The line drawn between the 2 perforators was set as the axis of flap. The donor site was assessed by a "pinching and lifting" method to determine a direct closure of donor site or to have it closed by a flap transfer. The sizes of flap were from 2.8 cm×1.5 cm to 24.0 cm×7.5 cm. Twenty-two donor sites were directly closed and 4 received flap transfers. Four flaps had sutures with the skin nerves in the recipient site. Masquelet technique was performed in 6 patients with bone defects in the surgery. Patients received outpatient reviews with 1-2 weeks of intervals in the first 2 months after surgery, and X-ray reviews per 1-2 months for those with bone implants until bone healing.Results:All flaps survived successfully without any special treatment after surgery, except 1 flap that had blood vessel congestion and showed swelling and poor blood supply to the distal flap at 24 hours after surgery. The blood vessel congestion was revised by removal of part of the suture at the tip of flap pedicle. One week later, the tip of the flap remained with a small area of necrosis, which was then healed after dressing changes. A total of 21 patients were included in postoperative follow-up with 4 months to 3 years. All of the flaps had satisfactory appearance, colour and texture, and without any ulceration. Three cases of nerve suture were also included in follow-up. According to the assessment criteria of British Medical Research Council (BMRC), the sensory recovery of the flaps was found of S 2 in 1 flap and S 3 in 2 flaps. According to the American Orthopaedic Foot and Ankle Society (AOFAS), the ankle-hindfoot function scores, there were excellent in 16 patient and good in 5 patients. Conclusion:With the assistance of ultrasound, the PPPF can be effectively used in reconstruction of soft tissue defects in ankle and foot.

Objective To investigate the dosimetric effects of different calculation grid size(CGS)in helical tomotherapy(HT)planning system on stereotactic body radiation therapy(SBRT)for non-small cell lung cancer(NSCLC).Methods Nine NSCLC patients receiving radiation therapy for the first time at some hospital from March 2019 to December 2022 were selected as the subjects.SBRT planning was carried out through the HT system with three different CGS plans(Fine,Normal,and Coarse)and the same pitch,modulation factor(MF)and optimization conditions,and the target area indexes of the three CGS plans were compared including conformity index(CI),homogeneity index(HI),dosimetric parameters of the organ at risk(OAR),point dose verification pass rate,treatment time,number of monitor units and Sinograms.SPSS 22.0 was used for statistical analysis.Results For target area HI,there weres significant differences between CGS Fine plan and Coarse plan and between CGS Normal plan and Coarse plan(P＜0.05),while no statistical differences were found between CGS Fine plan and Normal plan(P＞0.05).For target area CI,there were significant differences between CGS Fine plan and Coarse plan(P＜0.05),while no statistical differences were found between CGS Fine plan and Normal plan and between CGS Normal plan and Coarse plan(P＞0.05).For OAR dosimetric parameters,CGS Fine plan and Coarse plan had significant differences in heart Dmax and Dmean,esophageal Dmax and Dmean,V5,V20,V30 and Dmean of the whole lung and affected lung,V5 and Dmax of the affected lung and heart V10 and V30(P＜0.05),CGS Normal plan and Coarse plan had obvious differences in esophageal Dmax(P＜0.05),and the remained dosimetric parameters were not statistically significant(P＞0.05).Fine,Normal and Coarse plans had the point dose verifica-tion pass rates being 0.96％,1.50％and 1.77％,respectively.In terms of treatment time and number of monitor units,there were significant differences between Fine plan and Coarse plan(P＜0.05)while no statistical differences were found between Fine and Normal plans and between Normal and Coarse plans(P＞0.05).Sinograms analyses showed Fine plan had evenly distributed segment color gradient,Coarse plan had areas of very dark and very light color gradients and Normal plan was somewhere in between.Conclusion Low CGS has to be used as much as possible to obtain accurate dose distribution during SBRT planning for NSCLC patients,which contributes to the execution of the radiation therapy plan and the prevention of ad-verse effects.[Chinese Medical Equipment Journal,2024,45(2):52-57]

Objective:To investigate the expression of cGAS-STING signaling pathway molecules in labial gland specimen of primary Sj?gren′s syndrome (pSS) patients and its correlation with disease characteristics.Methods:Clinical data and labial gland specimens were collected from 19 patients diagnosed with pSS who visited Xuanwu Hospital, Capital Medical University, from January 2021 to December 2021, along with a control group of 7 gender-and age-matched individuals with isolated xerostomia.We performed immunofluorescence staining for cGAS on labial gland specimens, and Western blot analysis was further utilized to confirm the expression levels of cGAS-STING signaling pathway-related molecules (cGAS, pSTING, pIRF3 and pTBK1) in the labial gland tissues of both groups. For normally distributed data, t test was employed for comparison between groups, while the Mann-Whitney U test was used for non-normally distributed data. And Spearman's correlation analysis was utilized to explore the correlation between clinical characteristics and molecular expression levels. P value<0.05 was considered statistically significant. Results:Immun-ofluorescence analysis showed significant infiltration of cGAS-positive cells in the labial gland tissues of the pSS group, while the control group exhibited no or minimal expression of cGAS-positive cells and there was a statistical difference between the two groups ( t=3.87, P=0.001). Moreover, the expression level of cGAS in labial gland tissues of pSS patients had a positive correlation with the focus scores ( r=0.55, P=0.014). Western blot analysis revealed statistically significant differences in the expression of cGAS and pSTING between the pSS group and the control group in labial gland tissues (0.73±0.39 vs. 0.18±0.05, t=2.38, P=0.049 and 0.91±0.17 vs. 0.23±0.10, t=2.17, P=0.043). Additionally, a correlation between the expression levels of cGAS and pSTING in labial gland tissues was found according to Spearman correlation analysis ( r=0.823, P=0.001). However, there was no correlation between the expression level of cGAS in labial gland tissues and clinical features, serological indicators (IgG level, titer of rheumatoid factor, C3 level and autoantibody positive rate) or disease activity (EULAR Sj?gren′s syndrome disease activity index scores). Conclusion:The cGAS-STING signaling pathway is activated in the labial gland tissue of pSS patients, which may be involved in its pathogenesis.

Objective To investigate different doses of the analgesic effects of dezocine comparing with sufentanil after laryngectomy.Methods A total of 129 patients who underwent elective partial laryngectomy from Feb 2022 to Jan 2023 were randomly assigned to dezocine 0.5 mg/kg group(group D1),dezocine 0.6 mg/kg group(group D2)and sufentanil 2 μg/kg group(group S).Twenty-four hours amount of drugs,the visual analogue scale(visual analogue scale,VAS)and 48 h total pressing times of PCA(patient-controlled intravenous analgesia,PCIA)were compared among the three groups at 6,12,24 and 48 h after operation,and the postoperative adverse reactions(nausea,vomiting,dizziness,urinary retention and respiratory depression)were recorded.Results There was no significant difference in 24 h amount of drugs among the three groups.The VAS score of group D1 was higher than that of group S at 6 h postoperatively(P＜0.05),but did not differ significantly among the three groups at 12,24 and 48 h.There was no significant differences in the number of compressions and postoperative adverse reactions among the three groups.Conclusion Compared with sufentanil,0.6 mg/kg dezocine can provide the same degree of analgesic effect.However,no advantage was found to reduce adverse reactions.