There is a certain correlation and interaction between circulating tumor cells and recurrence-metastasis of colorectal cancer. The circulating tumor cells hidden in the human body can lead to the recurrence and metastasis of colorectal cancer， and the recurrence and metastasis of colorectal cancer can in turn cause a sharp increase in the number of circulating tumor cells， which is consistent with the characteristics of latent pathogens in traditional Chinese medicine leading to diseases. Starting from the theory of latent pathogens， this article summarized the etiology and disease mechanism of recurrence-metastasis of colorectal cancer as harmed healthy qi， latent pathogenic qi， prolonged latent pathogens， and triggering healthy qi deficiency. This article also proposes four major treatment methods as reinforcing healthy qi， assisting yang， opening the exterior， and expelling pathogen， in order to provide ideas and methods for the prevention and treatment of recurrence and metastasis of colorectal cancer.

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 develop a self-assessment scale of home volume management for patients with chronic heart failure(CHF),and to test its reliability and validity.Methods With the self-care theory as the theoretical framework,the initial scale was developed through literature analysis,qualitative interview and expert consultation.A questionnaire survey was conducted on 598 patients with CHF who were treated or reviewed in a tertiary hospital in Hangzhou from September 2022 to January 2023 to test the reliability and validity of the scale.Results The exploratory factor analysis extracted 4 common factors with the cumulative variance contribution rate of 61.268％.The results of confirmatory factor analysis showed that the main evaluation indicators were all within the acceptable range of the judgment standard.The item-level content validity index ranged from 0.853 to 1.000;the scale-level content validity index/average was 0.951.The Cronbach's a coefficient,half reliability and retest reliability of the overall scale were 0.930,0.723 and 0.867,respectively.Conclusion The self-rating scale of home volume management for CHF patients has good reliability and validity,and it can effectively assess the level of home volume management for CHF patients.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Anti neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a systemic disease characterized by small vessel wall inflammation and cellulose necrosis mediated by ANCA. Renal injury caused by AAV is called ANCA-associated glomerulonephritis (AAGN). The paper reported a case of AAV with renal damage combined with human immunodeficiency virus (HIV) infection. The patient was an elderly male with clinical manifestations of hematuria and uremia. Renal pathological examination showed AAV and renal injury. This case is the first report in China while reviewing the relevant literature, and it is still inconclusive whether this is an overlap of the two diseases or a specific pathological type of HIV-associated nephritis. We believe that AAV has the potential to occur in HIV-infected patients, so clinicians should not ignore the phenomenon of ANCA positivity in HIV-infected patients, and the follow-up of such patients needs to be enhanced. Clinical and renal pathological examinations are the main methods to diagnose HIV infection with AAV. At the same time, there are no clear guideline guidelines on how to administer immunosuppressive therapy for such patients who have immunodeficiency and are at higher risk of opportunistic infections, and in whom to make the best possible outcomes.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Objective:To investigate the efficacy of laparoscopic myomectomy with a baseball-style suture technique in the treatment of hysteromyoma.Methods:Sixty patients with hysteromyoma who received treatment in the Department of Obstetrics and Gynecology, The Second People's Hospital of Hefei, China between July 2018 and July 2020 were included in this study. They were randomly assigned to observation and control groups with 30 patients per group. The observation group was subjected to laparoscopic myomectomy with a baseball-style suture technique. The control group was given laparoscopic myomectomy with a continuous suture technique. Intraoperative indices and postoperative complications were compared between the two groups.Results:Operative time in the observation group was significantly shorter than that in the control group [(98.06 ± 35.41) minutes vs. (119.39 ± 33.65) minutes, t = 2.39, P < 0.05]. Intraoperative blood loss in the observation group was significantly less than that in the control group [(28.33 ± 9.56) mL vs. (46.17 ± 13.08) mL, t = 6.36, P < 0.05]. The percentage of intraoperative needle-hole bleeding in the observation group was significantly lower than that in the control group [16.67% (5/30) vs. 46.67% (14/30), χ 2 = 6.23, P < 0.05). The time to anal exhaust and the time to drainage in the observation group were (19.21 ± 5.77) hours and (59.07 ± 18.85) hours, respectively, which were significantly shorter than (25.39 ± 9.65) hours and (77.22 ± 27.07) hours in the control group ( t = 3.01, 3.02, both P < 0.05). The incidence of postoperative fever in the observation group was significantly lower than that in the control group [3.33% (1/30) vs. 26.67% (8/30), χ 2 = 4.70, P < 0.05]. Conclusion:Laparoscopic myomectomy with a baseball-style suture technique is highly effective on hysteromyoma. It can improve the safety of operation and has a great clinical value.

Objective:To explore the status quo of support needs among the caregivers of patients with advanced breast cancer and analyze its influencing factors to provide reference for improving the quality of life of patients with advanced breast cancer and their caregivers.Methods:Totally 168 caregivers of patients with advanced breast cancer admitted at the First Affiliated Hospital of Zhengzhou University were selected by convenient sampling and investigated with the general information questionnaire and Comprehensive Needs Assessment Tool in Cancer for Caregivers (CNAT-C) . Multiple linear regression analysis was used to analyze the influencing factors.Results:The total CNAT-C score of the 168 caregivers of patients with advanced breast cancer was (96.13±8.06) . The result of multiple linear regression analysis showed that the fertility status, monthly family income, and the payment method of medical expenses were the influencing factors of the support of the caregivers of patients with advanced breast cancer ( P<0.05) . Conclusions:Nursing staff should pay attention to the support needs of caregivers of patients with advanced breast cancer and take targeted intervention measures based on their influencing factors to improve the quality of life of patients with advanced breast cancer and their caregivers.

Objective:To explore the effects of early warning nursing on preventing the incidence of venous thrombosis in patients with breast cancer after chemotherapy.Methods:Totally 103 patients with breast cancer admitted at the First Affiliated Hospital of Zhengzhou University from January to December 2018 who received routine nursing were included into the routine group, and 103 patients with breast cancer admitted at the First Affiliated Hospital of Zhengzhou University from January to December 2019 who underwent early warning nursing were included into the early warning group. The incidence of venous thrombosis 1 month after chemotherapy was compared between the two groups. Color Doppler ultrasonography was used to detect axillary blood flow before and 1 month after chemotherapy.Results:The incidence of venous thrombosis in the early warning group after chemotherapy was lower than that in the routine group, and the difference was statistically significant ( P<0.05) . The maximum blood flow rate and average blood flow rate in the armpit after chemotherapy in the early warning group were higher than those in the routine group, with statistically significant difference ( P<0.05) . Conclusions:Early warning nursing has a positive effect on the incidence of venous thrombosis in patients with breast cancer after chemotherapy, which can improve their hemagglutination.

Background: Granular cell tumor (GCT) is an uncommon tumor, and gastrointestinal tract GCT is even more rare. Aims: To investigate the clinicopathological characteristics, treatment and prognosis of gastrointestinal tract GCT. Methods: Nine cases of gastrointestinal tract GCT from January 2017 to June 2021 at the 903rd Hospital of Joint Logistics Support Force, PLA and Jinhua Municipal Central Hospital Medical Group were retrieved. The clinical data, histopathological characteristics, treatment, and prognosis were retrospectively analyzed. Results: In the 9 patients with gastrointestinal tract GCT, ratio of male to female was 2:1, age at diagnosis was 19-60 years, with a median age of 52 years. Six GCT were found in esophagus, 2 in colorectum and 1 in anus. Endoscopic results showed submucosal protrusion or sessile polyps ranging in size from 2-12 mm with a median of 5 mm. Histology results showed that tumors were located in mucosa and/or submucosa, arranged in solid sheets or nests, with an infiltrative margin and inflammatory infiltrates. Tumor cells were mainly plump and polygonal with abundant cytoplasm and eosinophilic granules. Nuclei were small, the nuclear-cytoplasmic ratio was very low. Mitotic figure was rare. Immunohistochemistry results showed that S100 and CD68 proteins were positive in all patients, SOX10, CD56, Calretinin and Syn were positive in some patients, and CKp, Desmin, SMA, CD117, CD34, Dog1, and α-inhibin were negative in all patients. Esophageal and colorectal GCT patients received endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The anal GCT patient underwent local resection. Recurrence or metastasis were not observed during 9-53 months of follow-up. Conclusions: Gastrointestinal tract GCT is rare with non-specific clinical symptoms and submucosal protrusion or sessile polyps under endoscopy. Gastrointestinal tract GCT has special pathomorphology and immunophenotype. EMR or ESD is recommended for small and superficial lesions. Long-term follow-up should be performed.