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 prevalence and influencing factors of job burnout among medical staff in secondary and lower-level public hospitals in a suburban area of Shanghai City. Methods A total of 1 959 in-service medical staff from 15 grade Ⅱ and lower-level public hospitals were selected as the research subjects using cluster sampling method. The Maslach Burnout Inventory-Human Service Survey was used to investigate their job burnout situation. Results The median and the 25th and 75th percentiles of job burnout scores for the research subjects were 2.7 (2.1, 3.1) points, and the detection rate of job burnout was 56.6% (1 109/1 959). The detection rate of mild, moderate, and severe job burnout was 26.7%, 18.5%, and 11.4%, respectively. The results of multiple linear regression analysis showed that medical staff aged 20-<31、31-<41、41-<51 had a higher risk of job burnout than those the age of ≥51 (P<0.01), unmarried medical staff had a higher risk of job burnout than married medical staff (P<0.05), intermediate professional title medical staff had a higher risk of job burnout than senior professional title medical staff (P<0.05), medical staff in grade Ⅱ hospitals had a higher risk of job burnout than those in gradeⅠ hospitals (P<0.01), and medical and nursing staff had a higher risk of job burnout than pharmaceutical and technical staff (P<0.01), after excluding confounding factors such as gender, professional title, educational level, and management position. Conclusion Job burnout is prominent among medical staff in grade Ⅱ and lower-level public hospitals in suburban Shanghai City. Age, marital status, professional title, hospital level, and job type are the independent influencing factors of their job burnout.

It collected relative policy documents systematically and analyzed the development process and policy objective evolution of Chinese basic medical insurance system.Based on this,it determined the performance assessment objectives of the designated medical institutions of basic medical insurance and constructed the assessment framework guided by the goal realization.Then,from the perspective of contract management and performance management,it determined the assessment elements of contract enforcement assessment system of designated medical institutions and the logical relationship between the elements,and to construct a conceptual model,which provides a reference for guiding the research of the contract enforcement assessment of the designated medical institutions of basic medical insurance.

OBJECTIVE To explore the application value of indocyanine green combined with near-infrared autofluorescence imaging technique in identifying pathological parathyroid glands during surgery for primary hyperparathyroidism (PHPT). METHODS Data from 40 patients with PHPT treated in Beijing Tongren Hospital,Capital Medical University were collected,including 10 patients in the indocyanine green treated group and 30 patients in the non-treated group. All patients underwent surgical treatment to remove the affected parathyroid glands. Near-infrared autofluorescence imaging was used for image acquisition,and ImageJ software was used for fluorescence intensity analysis. RESULTS The fluorescence intensity of the pathological parathyroid glands in the indocyanine green-treated group was significantly higher than that in the non-treated group(142.7±23.7 vs. 94.5±31.4,t=-4.434,P=0.000);the fluorescence ratio of pathological parathyroid glands/thyroid glands was significantly higher than that in the non-treated group(1.6±0.3 vs. 1.2±0.4,t=-3.162,P=0.004). There was no correlation between the fluorescence intensity of parathyroid glands in the non-treated group and preoperative blood calcium(r=0.029,P=0.088) and preoperative PTH level(r=-0.142,P=0.455),and there was also no correlation between the fluorescence intensity of parathyroid glands in the treated group and preoperative blood calcium(r=0.206,P=0.568) and preoperative PTH level(r=0.160,P=0.658). The detection rate of near-infrared light in the non-treated group was 53.3％(16/30),while that in the treated group was 100％(10/10). The average detection time for the non-treated group was (71.0±16.9)minutes,while that for the treated group was (52.7±11.1)minutes,with a significant difference between the two groups(t=3.187,P=0.003). CONCLUSION The combination of indocyanine green and near-infrared autofluorescence imaging technique is helpful for identifying the diseased parathyroid glands during the surgical treatment of PHPT.

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.

The recognition of the innate immune system is the first line of defense for host protec-tion against invading microbes.Toll-like receptors(TLRs)are well-characterized pattern recogni-tion receptors that are critical for recognizing pathogen-associated molecular pattern(PAMP)and regulating the activation of antigen-presenting cells and key cytokines.Recognition of protozoon parasite genomic DNA by TLR9 activates transcription factors such as NF-κB,IRF3/7,and MAPK,which then induce the production of pro-inflammatory cytokines and type Ⅰ interferons.During parasite infection,MyD88 serves as a critical adapter protein for TLR9 to recognize PAMPs.Here,we review the TLR9-MyD88 pathways and their importance in the inflammatory re-sponse in some common protozoan parasite infections.We also discuss the impact of the subcellular localization of TLR9 in parasitic infectious diseases.By emphasizing current developments in these fields,the review aims to lay the foundation for future research on both the complexity of host-par-asite interactions and the prevention of protozoan parasitic diseases.

Feces and intestinal contents of pigs suspected with porcine epidemic diarrhea virus were collected from a farm in Minqin County,Gansu Province,China.After the suspected positive sam-ples were detected by RT-PCR,Vero cells were used to isolate and culture them in vitro.The suc-cessfully isolated virus was identified in the laboratory,and its whole genome sequence was ana-lyzed for genetic evolution.The pathogenicity was evaluated by animal regression test.The results showed that typical syncytial lesions could be observed when the PEDV-positive treatment solu-tion was inoculated with Vero cells in the 4th generation,and the virus titer in the 6th generation reached 10-4 75TCID50/mL.PEDV-like virions with a diameter of about 100 nm and a round shape with obvious capsular membranes and spikes were observed by electron microscopy.Whole genome sequencing analysis showed that the total length of this strain was 28 085 bp,which was far from the G1 subtype represented by the classical strain CV777(96.6％),and had a high homology with the G2b strains BC-2011-1,IA1,USA/Colorado/2013 and WELL(98.6％).This indicated that the strain belonged to the G2b epidemic strain.The animal regression test showed that the 5-day-old piglets developed vomiting,acute watery diarrhea,emaciation and mental depression within 12 h after the attack,and the symptoms worsened and died within 24 h.After autopsy,the infected piglets could be observed with stomach swelling,high intestinal heave,thin and transparent intesti-nal wall,and undigested milk clots inside.In summary,a PEDV G2b epidemic strain was success-fully isolated and identified in this study,and its whole genome sequence and pathogenicity were analyzed,providing research materials for future studies on PEDV gene function,pathogenic mech-anism and vaccine development.

In order to solve the problems that the universal screwdriver of loaner medical instruments cannot be disassembled during cleaning and the backwash rate,the structure of the universal screw driver for loaner medical instruments was improved.By removing the protrusion at the end of the of the screwdriver,the inner core and outer sheath of the screwdriver could be separated,enabling the screwdriver to be disassembled for cleaning.The cleaning pass rate of the universal screwdriver with improved structure was significantly higher than that of the control group,the difference was statistically significant(x2=529.343,P<0.001).The improved structure of the universal screwdriver can effectively improve the cleaning quality of the universal screwdriver and ensure the safety of the patient's surgery.

Reasonable disciplinary planning is an important prerequisite for the high-quality development of multi-campus hospitals. In order to promote the rational layout and homogeneous management of multi-campus hospitals, a large public hospital explored multi-campus discipline planning from 2021 to 2022 based on preliminary research, following the principles of management integration, layout differentiation, resource optimization, maximum efficiency, and high-quality development, as well as according to the functional positioning of each hospital(headquarters, south, west, north, and infectious disease hospital), the needs of surrounding residents, and resource allocation. This practice had improved the development of advantageous specialties of sub-campus, promoted the innovation of technologies, and improved the overall medical service capacity of the hospital. The number of outpatients/emergency patients in the hospital had increased from 5.013 million in 2020 to 6.7 million in 2023, and the average length of stay had been shortened from 7.76 days to 6.17 days. It had initially achieved a disciplinary development strategy of " grouping, differentiation, and integration", which could provide reference and guidance for other public hospitals to promote the discipline development and construction for multi-campus hospitals.

Objective:In order to explore the impact of corona virus disease 2019(COVID-19)on the hospitalization of children with bronchiolitis and to improve clinicians′ understanding of the characteristics of bronchiolitis during the COVID-19 epidemic.Methods:This was a multicenter clinical study, and the data have been collected from 23 children′s medical centers in China.All the clinical data were retrospectively collected from children with bronchiolitis who were hospitalized at each study center from January 1, 2019 to December 31, 2021.The results included gender, age at hospitalization, length of stay, respiratory syncytial virus(RSV) test results, severity rating, ICU treatment, and the total number of children hospitalized with respiratory tract infection during the same period.The clinical data of children with bronchiolitis in 2019 before COVID-19 epidemic and in 2020、2021 during COVID-19 epidemic were statistically analyzed and compared.Results:According to a summary of data provided by 23 children′s medical centers, there were 4 909 cases of bronchiolitis in 2019, 2 654 cases in 2020, and 3 500 cases in 2021.Compared with 2019, the number of bronchiolitis cases decreased by 45.94% in 2020 and 28.70% in 2021.In 2019, 2020 and 2021, there were no significant differences in gender ratio, age, and duration of hospitalization.Compared with 2019, the ratio of bronchiolitis to the total number of hospitalizations for respiratory tract infection decreased significantly in 2020 and 2021( χ2=12.762, P<0.05; χ2=84.845, P<0.05).The proportion of moderate to severe bronchiolitis cases in both 2020 and 2021 was lower than that in 2019, and the difference was statistically significant ( χ2=4.054, P<0.05; χ2=8.109, P<0.05).There was no statistically significant difference in the proportion of bronchiolitis cases requiring ICU treatment between 2019, 2020, and 2021 ( χ2=1.914, P>0.05).In 2019, a total of 52.60%(2 582/4 909) of children with bronchiolitis underwent RSV pathogen testing, and among them, there were 708 cases with RSV positive, accounting for 28.00%.In 2020, 54.14%(1 437/2 654) of children with bronchiolitis underwent RSV pathogen testing, and there were 403 cases with RSV positive, accounting for 28.04%.In 2021, 66.80%(2 238/3 500) of children with bronchiolitis underwent RSV pathogen testing, and there were 935 cases with RSV positive, accounting for 41.78%.Compared with 2019 and 2020, the RSV positive rate in 2021 showed a significant increase( χ2=99.673, P<0.05; χ2=71.292, P<0.05). Conclusion:During the COVID-19 epidemic, the implementation of epidemic prevention and control measures reduced the hospitalization rate and severity of bronchiolitis, but did not reduce the positive rate of RSV detection.