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 construct a key nursing technology system for the treatment of patients exposed to nuclear radiation in hospitals,and provide technical guidance and support for emergency nursing rescue in hospitals of nuclear radiation accidents.Methods A research group was composed of a team with rich experience in nuclear radiation accidents.Based on 4 scenarios of nuclear radiation accidents(including external irradiation,internal irradiation,external contamination,internal contamination),the literature search was conducted to form the first draft of the system.Delphi method was used to complete 2 rounds of expert letter consultation,and the final draft of the key nursing technology system for hospital treatment of patients with nuclear radiation exposure was constructed according to the revised opinions of experts.Results A total of 16 experts completed 2 rounds of correspondence.The effective recovery rates were 100％and 80％;the recommendation rates were 65％and 50％;the authority coefficients(Cr)were 0.778 and 0.797;the coefficient of variation(CV)of the 2 rounds of expert letter consultation was ≤0.25.Finally,a key nursing technology system for in-hospital treatment of patients with nuclear radiation exposure was formed,including 5 first-level indicators,26 second-level indicators and 74 third-level indicators.Conclusion The constructed key nursing technology system for hospital treatment of patients with nuclear radiation exposure is highly practical and scientific,and it is conducive to the formation of standardized nuclear radiation exposure treatment procedures,and provides a theoretical basis for the training and evaluation of nursing staff related to nuclear radiation exposure.

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:To explore the cognition of medical and nursing staff on prevention and management of gestational diabetes mellitus (GDM), so as to provide reference for the construction of a standardized GDM prevention and management system.Methods:This study was a descriptive qualitative study. From June 2022 to November 2023, purposive sampling was used to select 22 clinical medical and nursing experts engaged in GDM management from ten Class Ⅲ Grade A general hospitals and six community health service centers in Beijing as the research subject. Semi-structured interviews were used to collect data, and thematic analysis was used for data analysis.Results:Through the analysis and summarization of interview data, two themes were proposed, namely the challenges faced by GDM prevention and management (lack of standardized management system, lack of quality evaluation indicators, lack of professional medical and nursing staff, weak prevention awareness of medical and nursing staff, insufficient training), and the role of the GDM prevention management system (including the leading role of the government, responsibility subject role of hospitals, outpost role of community health service institutions, auxiliary role of society, collaborative management role of families, execution subject role of individuals) .Conclusions:GDM prevention management practices face multiple challenges. China should enhance the construction of the GDM prevention and management system, establish a quality evaluation index system, strengthen education and training for medical and nursing staff, and pay attention to the role of government, hospitals, community health service institutions, families and individuals in the GDM prevention and management system.

Objective:To explore the incidence of low anterior resection syndrome (LARS) in patients undergoing sphincter-preserving surgery for rectal cancer and analyze related factors.Methods:This study was a cross-sectional survey. From 2021 to 2023, convenience sampling was used to select 195 patients with rectal cancer who underwent sphincter-preserving surgery at Peking University Third Hospital as participants. The patients were surveyed using the General Information Questionnaire, LARS Scale, Visual Analog Score, and Chinese version of Insomnia Severity Index.Results:A total of 195 questionnaires were distributed, and 156 valid questionnaires were collected, with a valid response rate of 80.00% (156/195). The incidence of LARS in 156 rectal cancer patients with sphincter-preserving surgery was 36.54% (57/156), and the incidence of severe LARS was 15.38% (24/156). Binomial Logistic regression analyses showed that gender ( OR=0.445, P=0.034) and preoperative neoadjuvant chemoradiotherapy ( OR=6.343, P<0.01) were influencing factors for the occurrence of LARS in patients with rectal cancer after sphincter-preserving surgery. Preoperative neoadjuvant chemoradiotherapy ( OR=3.322, P=0.047) and intraoperative prophylactic stoma ( OR=4.855, P=0.035) were influencing factors for severe LARS. LARS score was positively correlated with anxiety score ( r=0.238, P=0.003) and total insomnia score ( r=0.168, P=0.036) in patients with rectal cancer who underwent sphincter-preserving surgery. Conclusions:Preoperative neoadjuvant chemoradiotherapy is an independent risk factor for postoperative LARS and severe LARS in rectal cancer patients undergoing sphincter-preserving surgery. LARS is correlated with patients' anxiety and insomnia.

Osteonecrosis of the femoral head （ONFH） is a painful and debilitating disease caused by impaired blood supply to the femoral head and cellular and tissue degeneration， leading to gradual destruction of the bone structure and progressive collapse of the femoral head. The main pathological mechanism of ONFH is the disruption of the balance between bone absorption and the reconstruction of new bone， resulting from microcirculation damage and decreased cellular tissue ability. This imbalance leads to biomechanical changes and accelerates the pathological progression of ONFH. In the early stages， clinical manifestations may not be obvious， mainly presenting as pain or discomfort in the hip or groin area， which can be relieved after rest. In the later stage of the disease， pain intensifies， and limb shortening， lower limb weakness， difficulty walking， or limping may occur. Currently， western medicine commonly uses osteogenic agents， anticoagulants， and artificial joint replacement for treatment， but there are also many issues such as prosthesis loosening and infection. Research has shown that traditional Chinese medicine （TCM） treatment of ONFH takes a holistic approach and employs multi-functional， multi-target， and multi-system Chinese medicine therapies， ensuring the safety and effectiveness of the treatment. The osteoprotegerin （OPG）/receptor activator of nuclear factor-κB （RANK）/RANK ligand （RANKL） signaling pathway plays a crucial role in maintaining the dynamic balance of bone remodeling. TCM treatments utilize this pathway to promote apoptosis of osteoclasts， reduce bone resorption， and accelerate bone formation， thereby playing an important role in the prevention and treatment of ONFH. This paper reviewed the role of OPG/RANK/RANKL signaling pathway and related cytokine expression in ONFH by reviewing relevant literature in China and abroad and research status of Chinese medicinal monomers， Chinese medicinal formulations， and combinations with physical therapy in increasing osteoblast secretion， promoting OPG expression， enhancing cytokine expression levels， and inhibiting osteoclast activity for the prevention and treatment of ONFH. This paper is expected to provide new ideas and directions for TCM in the prevention and treatment of ONFH.

【Objective】 To analyze the efficacy of scrotum cold compress combined with antibiotics on necrospermia patients with seminal tract infection. 【Methods】 We made a retrospective analysis of the patients who were confirmed as necrospermia by more than 2 times of semen examination and positive by sperm bacteria culture at the Andrology Department of our center from January 2019 to September 2022. The experiment group patients who were cured by scrotum cold compress combined with sensitive antibiotics and L-carnitine were divided into experiment group A (1 time/day) and experiment group B (2 times/day) according to the daily times of scrotum cold compress. Meanwhile, only sensitive antibiotics and L-carnitine were administered in the control group patients. We recorded the improvement of sperm parameters and the number of negative sperm bacterial cultures in different groups at 4 weeks, 8 weeks, and 12 weeks of treatment. 【Results】 A total of 145 patients were enrolled in the study. According to the principle of randomization, 49 patients in group A, 49 patients in group B, and 47 patients in the control group were enrolled. After 4 weeks of treatment, there was no significant difference between the experiment group and the control group in terms of abstinence time, the number of negative sperm bacterial cultures, semen pH, sperm ratio of forward motility, or the sperm survival rate (all P>0.05). In terms of the sperm survival rate, group B (53.1±14.1) was superior to group A (46.2±16.4) (P<0.05). In the results of the treatment at 8 weeks, the number of negative sperm bacterial cultures was significantly higher in the experiment group (74/98) than in the control group (26/47) (χ²=5.14, P<0.05). Sperm ratio of forward motility was higher in the experiment group (26.5±11.9) than in the control group (22.8±12.6). The experimental group (53.1±14.6) also had a significantly higher sperm survival rate than the control group (47.6±13.4) (P<0.05). However, the number of negative sperm bacterial cultures, sperm ratio of forward motility, and the sperm survival rate were lower in experiment group A (35/49, 25.5±10.3, 51.1±15.0) than in experiment group B (39/49, 27.5±13.2, 55.1±14.2), but there was no statistical difference between the two groups (all P>0.05). After 12 weeks of treatment, the number of negative sperm bacterial cultures in the experimental group (67/98) was significantly higher than that in the control group (21/47) (χ²=6.11, P<0.05). Sperm ratio of forward motility in the experiment group (30.9±11.2) was higher than that in the control group (24.7±13.4) (P<0.05). The experiment group (56.3±13.0) had a significantly higher sperm survival rate than the control group (46.7±12.0, P<0.01). However, in terms of the number of negative sperm bacterial cultures, sperm ratio of forward motility, and the sperm survival rate, there were no statistical differences between group A (31/49, 28.8±10.0, 55.9±12.7) and group B (36/49, 32.8±12.1, 56.7±13.4) (all P>0.05). 【Conclusion】 Scrotum cold compress combined with antibiotics is superior to only antibiotic treatment on necrospermia patients with seminal tract infection, especially in the sperm ratio of forward motility and sperm survival rate, but it has little relationship with the times of cold compressions per day. Therefore, the method deserves application in this type of patients’ diagnosis and treatment.

Objective To investigate the effects of high concentration of semen samples in detection by fully automated sperm quality analyzer for sperm concentration,progressive motility(PR),non-progressive motility(NP)and percentage of immotile sperm(IM).Methods The semen samples from the patients who visited the reproductive clinic in our hospital from February 2023 to May 2023 were analyzed using the fully automated sperm quality analyzer.A total of 155 semen samples with initial sperm concentration ≥100× 106/mL and semen volume ≥1.5 mL were set as the high concentration semen group(group A).The semen samples with self seminal plasma dilution group(group B)and 37 ℃ normal saline dilution group(group C)were prepared with their own seminal plasma and normal saline at 1∶2 dilution ratio respectively.The sperm concentration of group A was detected by the manual method as the control.The sperm concentration and motility parameters of each group were detected.The differences of sperm concentration and the values of PR,NP and IM among the group A,B and C were analyzed.The correlations between sperm concentration and PR,NP and IM were also assessed.Results The sperm concentration of group A was significantly lower than that of the control group and groups B and C(all P＜0.05).There was no statistically significant difference for the results between group B and group C(P＞0.05).The PR in group C was significantly lower than that in groups A and B(all P＜0.05),and there was no significant difference of PR between group A and group B(P＞0.05).The values of NP in group A was significantly higher than that in groups B and C(all P＜0.05),and there was no significant difference in NP between group B and group C(P＞0.05).The IM in group A was significantly lower than that in groups B and C(all P＜0.05),and there was no statistical difference of IM values between group B ang group C(P＞0.05).Conclusion The direct analysis of undiluted semen samples with high sperm concentration may lead to lower results of sperm concentration,increased percentage of NP sperm and decreased percentage of IM sperm.The dilution of semen samples may improve the accuracy of the detec-tion results.The dilution with 37 ℃ normal saline can lead to decrease of the percentage of PR sperm.The self seminal plasma should be recommended as the first choice of diluent for the semen samples with high sperm concentration.

Objective:To analyze the medical knowledge map of lifestyle medicine based on Web of Science database.Methods:“Lifestyle medicine” “lifestyle intervention” “lifestyle medicine strategy” and “lifestyle factor” were used as Mesh terms to search the core collections of Web of Science database. The time span was from January 1st, 2000 to December 31st, 2021. The statistical function of Web of Science database was used for bibliometric analysis, and VOS Viewer software was used for co-occurrence analysis of authors, countries, institutions, keywords, and cited literature, then the visual knowledge maps were drawn.Results:A total of 5 717 articles were included, and the number of published articles from 2000 to 2021 showed an increasing trend. The top 10 authors were from the United States (nine authors) and Finland (one author); high producing countries included the United States (2 882 papers), the United Kingdom (1 254 papers) and Australia (781 papers), and China ranked sixth (499 papers). The most productive institutions were the Union of European Research Universities (946 articles), Harvard University (677 articles), University of California (313 articles), etc. The papers are mainly published in Diabetes, Circulation, BMC Public Health, Obesity, PLoS One, Med Sci Sports Exerc, etc. Five clusters were obtained by co-occurrence of key words, which were “health status” “lifestyle intervention” “lifestyle risk factors” “exercise and weight” and “chronic disease research”. The national cooperation network involves 67 countries. Conclusions:Recently, the research on lifestyle medicine shows a rapid growth trend. The current research interests include behavioral sciences, psychology, nutrition, endocrinology and metabolism, healthcare services, internal medicine, public health, pathology, cardiovascular medicine and geriatrics. Research hotspots include chronic disease and disease burden, whole life-cycle health, nutrition and exercise intervention and behavior change.

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.