Objective:To develop a prognostic prediction model for patients with colorectal cancer based on a peripheral blood cell composite score (PBCS) system.Methods:This retrospective observational study included patients who had primary colorectal cancer without distant metastasis, who did not undergo radiotherapy or chemotherapy before surgery, who did not receive leukocyte or platelet-raising therapy within 1 month before surgery, and whose postoperative pathology confirmed colorectal adenocarcinoma with complete tumor resection. Patients with severe anemia, infection, or hematologic diseases before surgery, as well as those with severe heart, lung, or other important organ diseases or concurrent malignant tumors, were excluded. In total, 1021 patients with colorectal cancer who underwent surgical treatment in the Department of Gastrointestinal Surgery of the Fourth Hospital of Hebei Medical University from April 2018 to April 2020 were retrospectively included as the training set (766 patients) and the internal validation set (255 patients). Additionally, using the same criteria, 215 patients with colorectal cancer who underwent surgical treatment in another treatment group from March 2015 to December 2020 were selected as the external validation set. The "surv_cutpoint" function in R software was used to analyze the optimal cut-off values of neutrophils, lymphocytes, and platelets, and a PBCS system was established based on the optimal cut-off values. The scoring rules of the PBCS system were as follows: Neutrophils and platelets below the optimal cut-off value = 1 point, otherwise 0 points; Lymphocytes above the optimal cut-off value = 1 point, otherwise 0 points. The scores of the three cell types were added together to obtain the PBCS. Univariate and multivariate Cox regression analyses were performed to explore the correlation between patients' clinicopathological features and prognosis, and a nomogram was constructed based on the Cox regression analysis to predict patients' prognosis. The accuracy of the nomogram prediction model was validated using the C-index, calibration curve, and decision curve analysis.Results:The optimal cut-off values for neutrophils, lymphocytes, and platelets were 4.40×10 9/L, 1.41×10 9/L, and 355×10 9/L, respectively. The patients were divided into high and low groups according to the optimal cut-off values of these cells. Survival curve analysis showed that a high lymphocyte count (training set: P=0.042, internal validation: P=0.010, external validation: P=0.029), low neutrophil count (training set: P=0.035, internal validation: P=0.001, external validation: P=0.024), and low platelet count (training set: P=0.041, internal validation: P=0.030, external validation: P=0.024) were associated with prolonged overall survival (OS), with statistically significant differences in all cases. Survival analysis of different PBCS groups showed that patients with a high PBCS had longer OS than those with a low PBCS ( P<0.05). Univariate and multivariate Cox regression analysis results showed that aspirin use history, vascular thrombus, neural invasion, CA19-9, N stage, operation time, M stage, and PBCS were independent factors affecting OS (all P<0.05). The PBCS was also an independent factor affecting disease-specific survival ( P<0.05), but not progression-free survival ( P>0.05). The above independent risk or protective factors were included in R software to construct a nomogram for predicting OS. The C-index (0.873), calibration curve, and decision curve analysis (threshold probability: 0.0%–75.2%) all indicated that the nomogram prediction model had good predictive performance for OS. Conclusion:This study demonstrates that the PBCS constructed based on preoperative peripheral blood levels of neutrophils, lymphocytes, and platelets is an independent factor associated with the prognosis of patients with colorectal cancer. The nomogram model constructed based on this score system exhibits good predictive efficacy for the prognosis of these patients.

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 prognostic prediction model for patients with colorectal cancer based on a peripheral blood cell composite score (PBCS) system.Methods:This retrospective observational study included patients who had primary colorectal cancer without distant metastasis, who did not undergo radiotherapy or chemotherapy before surgery, who did not receive leukocyte or platelet-raising therapy within 1 month before surgery, and whose postoperative pathology confirmed colorectal adenocarcinoma with complete tumor resection. Patients with severe anemia, infection, or hematologic diseases before surgery, as well as those with severe heart, lung, or other important organ diseases or concurrent malignant tumors, were excluded. In total, 1021 patients with colorectal cancer who underwent surgical treatment in the Department of Gastrointestinal Surgery of the Fourth Hospital of Hebei Medical University from April 2018 to April 2020 were retrospectively included as the training set (766 patients) and the internal validation set (255 patients). Additionally, using the same criteria, 215 patients with colorectal cancer who underwent surgical treatment in another treatment group from March 2015 to December 2020 were selected as the external validation set. The "surv_cutpoint" function in R software was used to analyze the optimal cut-off values of neutrophils, lymphocytes, and platelets, and a PBCS system was established based on the optimal cut-off values. The scoring rules of the PBCS system were as follows: Neutrophils and platelets below the optimal cut-off value = 1 point, otherwise 0 points; Lymphocytes above the optimal cut-off value = 1 point, otherwise 0 points. The scores of the three cell types were added together to obtain the PBCS. Univariate and multivariate Cox regression analyses were performed to explore the correlation between patients' clinicopathological features and prognosis, and a nomogram was constructed based on the Cox regression analysis to predict patients' prognosis. The accuracy of the nomogram prediction model was validated using the C-index, calibration curve, and decision curve analysis.Results:The optimal cut-off values for neutrophils, lymphocytes, and platelets were 4.40×10 9/L, 1.41×10 9/L, and 355×10 9/L, respectively. The patients were divided into high and low groups according to the optimal cut-off values of these cells. Survival curve analysis showed that a high lymphocyte count (training set: P=0.042, internal validation: P=0.010, external validation: P=0.029), low neutrophil count (training set: P=0.035, internal validation: P=0.001, external validation: P=0.024), and low platelet count (training set: P=0.041, internal validation: P=0.030, external validation: P=0.024) were associated with prolonged overall survival (OS), with statistically significant differences in all cases. Survival analysis of different PBCS groups showed that patients with a high PBCS had longer OS than those with a low PBCS ( P<0.05). Univariate and multivariate Cox regression analysis results showed that aspirin use history, vascular thrombus, neural invasion, CA19-9, N stage, operation time, M stage, and PBCS were independent factors affecting OS (all P<0.05). The PBCS was also an independent factor affecting disease-specific survival ( P<0.05), but not progression-free survival ( P>0.05). The above independent risk or protective factors were included in R software to construct a nomogram for predicting OS. The C-index (0.873), calibration curve, and decision curve analysis (threshold probability: 0.0%–75.2%) all indicated that the nomogram prediction model had good predictive performance for OS. Conclusion:This study demonstrates that the PBCS constructed based on preoperative peripheral blood levels of neutrophils, lymphocytes, and platelets is an independent factor associated with the prognosis of patients with colorectal cancer. The nomogram model constructed based on this score system exhibits good predictive efficacy for the prognosis of these patients.

Objective:To construct the prediction model of knee degeneration in patients with knee osteoarthritis based on bioelectrical impedance index, and evaluate the prediction performance and application efficiency of the model.Methods:This was a cross-sectional study. From May to July 2021, 248 knee joints of 124 patients with knee osteoarthritis at home from Shijiazhuang Yuqiang Community Health Service Center who participated in physical examination were selected by convenience sampling to establish the model. According to Kellgren-Lawrence (K-L) grading system, the knee joints were divided into four groups, namely K-L1 ( n=19) , K-L2 ( n=103) , K-L3 ( n=96) , and K-L4 ( n=30) . The indicators included in the model were selected through analysis of variance or Kruskal-Wallis test, and a prediction model of knee degeneration was established using support vector machine, and the model was optimized using grid parameter optimization method. The prediction performance of the model was evaluated by the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, accuracy, positive predictive value and negative predictive value. Results:The indicators in the model included age, complications, lumbar/back/hip pain, high-risk occupation, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) -pain, WOMAC-function, capacitive reactance and phase angle. The area under the ROC curve of the training set model was 0.999, the prediction accuracy was 0.920, and the 95% confidence interval was 0.868 to 0.957. The area under the ROC curve of the test set model was 0.833, the prediction accuracy was 0.682, and the 95% confidence interval was 0.572 to 0.780.Conclusions:The prediction model of knee degeneration has good prediction performance and is easy to use, which can be used as a screening tool for knee degeneration in patients with knee osteoarthritis.

With the rise of domestic membrane anatomy and preliminary establishment of theoretical framework, the operation concepts supported by membrane anatomy are gaining popularity in surgery, especially in abdominal surgery. However, on account of a deep location and the complexity of organs and tissues around the pancreas and mesangial membrane, there is no unified understanding about the pancreas mesangial by experts and scholars. Meanwhile, few studies on it have been conducted. In addition, the location and extent of total mesangectomy based on the mesangial pancreatic theory are also controversial. The purpose of this article is to summarize the anatomy of pancreatic membrane and its application in surgery, in order to provide support for current studies on pancreatic mesangial anatomy.

With the rise of domestic membrane anatomy and preliminary establishment of theoretical framework, the operation concepts supported by membrane anatomy are gaining popularity in surgery, especially in abdominal surgery. However, on account of a deep location and the complexity of organs and tissues around the pancreas and mesangial membrane, there is no unified understanding about the pancreas mesangial by experts and scholars. Meanwhile, few studies on it have been conducted. In addition, the location and extent of total mesangectomy based on the mesangial pancreatic theory are also controversial. The purpose of this article is to summarize the anatomy of pancreatic membrane and its application in surgery, in order to provide support for current studies on pancreatic mesangial anatomy.

Medication safety is a top concern for medical institutions. Outpatient prescription standard is designed to standardize prescription, dispensing, and supervision for outpatient and emergency prescriptions at medical institutions. The standard covered prescription authorization management, prescription issuance, prescription dispensing, prescription saving and supervision. These four parts focus on risk exposure of patients′medication safety, and aim at safeguarding patient medication safety, which were formulated according to China′s laws and regulations, domestic and international industrial standards and technical specifications, as well as prescription conditions at medical institutions and experts opinions. The standard covers technical requirements and guidance, management measures and system development, serving as an important basis to guide medical institutions on standardize management of outpatient prescription and emergency prescription.

Objective To study the effect of extended hepatectomy for hilar cholangiocarcinoma (HCCA) of the Bismuth-Corlette type Ⅲ and Ⅳ.Methods The clinical data of 73 patients with HCCA of the Bismuth-Corlette type Ⅲ and Ⅳ treated in our department from January,2008 to June,2016 were analyzed retrospectively.The extended hepatectomy group of patients consisted of 29 patients who underwent hepatectomy with half or more than half of the liver removed or/and combined with hepatic caudate lobectomy.The limited hepatectomy group consisted of 44 patients who underwent non-anatomical hepatectomy around the hepatic hilar region.Results Compared with the limited hepatectomy group,patients in the extended hepatectomy group had significantly longer operations with significantly more intraoperative blood loss.However,the complication rate was significantly lower than that of the limited hepatectomy group.There was no perioperative death in the extended hepatectomy group,while 3 perioperative deaths occurred in the limited hepatectomy group.The R0 resection rate was 93.1％ (27 of 29) for the extended hepatectomy group,while it was 54.6％ (24 of 44) for the limited hepatectomy group (P＜0.05).The 1-,3-and 5-year survival rates or the extended hepatectomy group were 81.4％,51.4％ and 19.3％,respectively while the corresponding rates for the limited hepatectomy group were 70.5％,24.4％ and 8.7％,respectively (P＜0.05).Conclusions After adequate preoperative radiological assessments on tumor resectability,and the residual liver volumes,with preoperative biliary drainage to improve liver function,extended hepatectomy effectively increased R0 resection and survival rates with improved prognosis for patients with HCCA of Bismuth-Corlette type Ⅲ and Ⅳ.

Objective To compare the effectiveness of surgical procedures (devascularization,shunt and combined shunt and devascularization) in treating recurrent variceal bleeding and other complications in patients with portal hypertension.Methods A systematic literature search was carried out on patients with portal hypertension,and a Meta-analysis was conducted using Revman 5.3 software to evaluate the effectiveness of different surgical procedures on recurrent esophageal variceal bleeding,hepatic encephalopathy,operative mortality and survival rates.Results A total of 24 trials were finally selected using predetermined inclusion criteria.Meta-analysis showed there was no significant difference among the three operations on operative mortality (P ＞ 0.05).The rebleeding rate of the combined group was significantly lower than the devascularization group (P ＜ 0.05).The encephalopathy rate of the combined group was significantly lower than the shunt group (P ＜ 0.05),and the 1-year and 3-year survival rates of the combined group were better than the devascularization group (both P ＜ 0.05),but there were no significant difference in the 5-year survival rates between these two groups (P ＞ 0.18).The 1-year and 3-year survival rates were not significantly different between the combined and the shunt groups (both P ＞ 0.05).Conclusions Combined shunt and devascularization had better therapeutic effectiveness than either devascularization alone or shunt alone in patients with portal hypertension with a high rebleeding risk.There were no significant difference among the three surgical procedures in operative mortality.The survival rates of combined surgery were significantly better than devascrlarization alone.

Background and purpose:Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Intrahepatic recurrence is the main factor affecting its medium-term survival rate. Therefore, the search for the markers of metastasis is essential. This study aimed to evaluate the relationship of expression of tyrosine kinase phosphorylation Tyr416 of sarcoma (SRC pY416) in HCC with clinical parameters and prognosis. Methods:Immunohistochemical method and Western blot were used to detect the expression of non-receptor tyrosine kinase (SRC pY416) in 112 cases of HCC tissues and 40 cases of corresponding cancer adjacent normal liver tissues. Hepatitis B virus (HBV) DNA and alpha fetoprotein (AFP) in patients were detected with chemiluminescence. In the 12 months Follow-up of the study,the association between SRC pY416 expression and clinical parameters was analyzed. Results:SRC pY416 expressions in HCC (65.40±15.69) were higher than those in cancer adjacent normal liver tissues (11.25±2.73,P<0.001). The expressions of SRC pY416 were all associated with the age, the liver cirrhosis, the complete capsule, the tumor differentiation, the HBV DNA and the AFP value of the patients (P<0.01). 12 months after operation, single factor analysis showed that the recurrence was associated with the tumor differentiation, the HBV DNA, the AFP value and the expression of SRC pY416 of the patient (P<0.01). Multivariate analysis showed that the expression of SRC pY416 was an independent prognostic factor for recurrence and metastasis in patients with HCC in 12 months. Conclusion:SRC pY416 may play an important role in the metastasis of HCC. The expression of SRC pY416 may be the marker for HCC liver metastasis.