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 explore the diagnosis and treatment strategies for elderly patients with ground-glass opacity (GGO). Methods The imaging features and postoperative pathological findings of the elderly patients with pulmonary GGO receiving surgery in our hospital from 2017 to 2019 were retrospectively analyzed. The patients were divided into an elderly patient group and a non-elderly patient group based on their age. Results Finally 575 patients were included in the study. There were 281 elderly patients, including 83 males and 198 females, with an average age of (67.0±5.3) years. There were 294 non-elderly patients, including 88 males and 206 females, with an average age of (49.1±7.3) years. Compared with the non-elderly patients, elderly GGO patients showed the following distinct clinical features: long observation time for lesions (P=0.001), high proportion of rough edges of GGO (P<0.001), significant pleural signs (P＜0.001) and bronchial signs (P＜0.001), and high proportion of type Ⅱ-Ⅳ GGO (P<0.001), lobectomy type (P=0.013), and invasive lesions reported in postoperative pathology (P<0.001). There was no statistical difference in the average hospital stay between the two groups (P=0.106). Multivariate logistic regression analysis showed that GGO diameter and GGO type were the main factors affecting the operation. Observation time, GGO diameter, GGO type and pleural signs were the main influencing factors for postoperative pathological infiltrative lesions. The cut-off value of GGO diameter in predicting infiltrating lesions was 10.5 mm in the elderly patients group. Conclusion The size and type of GGO are important factors in predicting invasive lesions and selecting surgical methods. Elderly patients with radiographic manifestations of type Ⅱ-Ⅳ GGO lesions with a diameter greater than 10.5 mm should be closely followed up.

BACKGROUND:The specific molecular mechanisms underlying common degenerative bone diseases,such as osteoarthritis,osteoporosis,and intervertebral disc degeneration,are currently unclear and may involve endoplasmic reticulum stress.At present,research on the systematic role of endoplasmic reticulum stress in the pathogenesis of these common skeletal diseases and related therapeutic progress is relatively limited. OBJECTIVE:To review the role of endoplasmic reticulum stress in common degenerative bone diseases,explore the molecular mechanisms of these diseases in depth,and provide new ideas and perspectives for prevention and treatment of these diseases. METHODS:Relevant literature from 2000 to 2024 was searched in CNKI,WanFang,VIP,PubMed and Web of Science databases using the search terms of"endoplasmic reticulum stress,bone disease,unfolded protein response,osteoarthritis,osteoporosis,intervertebral disc degeneration,autophagy,apoptosis,ferroptosis,pyroptosis"in Chinese and English.After removal of duplicates and older literature,a total of 115 articles met the inclusion criteria. RESULTS AND CONCLUSION:Endoplasmic reticulum stress has a dual effect in regulating cell physiology.Mild endoplasmic reticulum stress promotes osteogenic differentiation and extracellular matrix synthesis;however,persistent excessive endoplasmic reticulum stress leads to cell death.Endoplasmic reticulum stress-induced cell autophagy and apoptosis are closely related to osteoarthritis,osteoporosis,and intervertebral disc degeneration.Aging,drug side effects,metabolic disorders,calcium imbalance,poor lifestyle habits and other reasons may lead to long-term activation of endoplasmic reticulum stress,which causes bone remodeling disorders,cartilage damage,nucleus pulposus cell death and other pathological manifestations,ultimately leading to the occurrence of osteoarthritis,osteoporosis and intervertebral disc degeneration.Intervention in the relevant mechanisms triggering endoplasmic reticulum stress is expected to play a role in the prevention and treatment of common degenerative bone diseases,such as osteoarthritis,osteoporosis and intervertebral disc degeneration.

The emergence of teeth is a complex physiological process characterized by the formation of the tooth crown, its movement towards the occlusal plane, and subsequent penetration through the alveolar bone and oral mucosa to achieve functional positioning for contact with opposing teeth. Parathyroid hormone (PTH) and parathyroid hormone-related peptide (PTHrP) are critical regulators of calcium and phosphorus metabolism in the body, playing significant roles in tooth emergence. Their regulatory functions exhibit intricate temporal and spatial dynamics, with underlying mechanisms that remain incompletely understood. In recent years, an increasing number of researchers both domestically and internationally have investigated the role and mechanisms of PTH/PTHrP in tooth emergence, primarily focusing on aspects such as dental sac formation, basal alveolar bone development, coronal alveolar bone resorption, root formation, and periodontal ligament development. Literature reviews indicate that PTH and PTHrP regulate bone metabolism, coordinate various signaling pathways including OPG/RANK/RANKL, cAMP/PKA, and Wnt/β-catenin, and are allosterically modulated by Ca2+ and ATP. These processes contribute to the development of dental sacs, which transmit signals to recruit osteoclasts and promote the resorption of crown alveolar bone, thereby forming an eruption pathway. Additionally, PTH/PTHrP plays a role in the formation of basal alveolar bone, root development, and the periodontal ligament, generating the force necessary for tooth eruption. Through precise spatiotemporal regulation and coordinated efforts, alveolar bone remodeling is achieved, facilitating the intricate process of tooth eruption. Through stringent temporal regulation and multi-faceted cooperation, remodeling of the alveolar bone occurs to complete this intricate developmental process of tooth emergence. Future research should further elucidate the mechanisms underlying PTH/PTHrP actions while also considering optimal dosage regimens regarding timing and frequency for therapeutic applications.

Objective: To investigate the effects of autologous platelet-rich plasma (aPRP) collected using a continuous blood cell separator on blood conservation and prognosis in patients with type A aortic dissection. Methods: The clinical data of patients who underwent emergency aortic replacement for acute type A aortic dissection at our hospital from January 2020 to December 2023 were respectively analyzed. Patients were divided into two groups based on whether they received aPRP collection before surgery for subsequent reinfusion: the aPRP group (n=32) and the control group (n=35). The volume of aPRP collected and the platelet concentration in the aPRP were recorded. The volumes of allogeneic blood and blood products transfused, and the associated costs during hospitalization were compared between two groups. Intraoperative blood loss, perioperative laboratory parameter changes, 24-hour postoperative drainage volume, duration of ICU stay and mechanical ventilation, length of hospital stay, and mortality rate of the two groups were also compared. Results: The platelet concentration in aPRP was (491.5±85.4)×10 /L, accounting for (24.1±9.6)% of the patient's total platelet count. The volume of aPRP collected accounted for (23.0±6.3)% of the patient's total plasma volume. Compared with the control group, the aPRP group demonstrated significantly reduced transfusion volumes of allogeneic red blood cells, plasma, and platelets (P<0.05), along with significantly lower blood-related costs during hospitalization (P<0.05). Postoperative coagulation parameters (APTT, PT, INR, and TEG) were significantly improved (P<0.05), and platelet counts were markedly increased (P<0.05) in aPRP group as compared with the control group. No statistically significant differences were observed in postoperative use of prothrombin complex concentrate and fibrinogen between the two groups. Similarly, there were no significant differences in postoperative 24-hour drainage volume, 24-hour extubation rate, ICU length of stay, duration of mechanical ventilation, or total hospital length of stay. The incidence of complications and mortality did not differ significantly between the two groups. Conclusion: The administration of aPRP significantly reduces the requirement for perioperative allogeneic blood transfusion in patients undergoing surgery for type A aortic dissection. Furthermore, it enhances coagulation function and reduces associated transfusion costs, thereby establishing itself as an effective and safe strategy for blood conservation.

Aim To investigate the role and potential mechanism of methyltransferase-like 5 (METTL5) in triple-negative breast cancer (TNBC) . Methods The expression of METTL5 in TNBC tumor tissues and cell lines was detected by immunohistochemistry and Western blot. After shRNA targeting METTL5 (shRNAMETTL5) was transfected into TNBC cells, cell proliferation, migration and invasion were detected by CCK-8, colony formation, wound healing and Transwell assays, respectively. Western blot was used to detect the expression of Wnt/p-catenin signaling-related key proteins. A xenograft tumor model was constructed to verify the effect of METTL5 knockdown on the growth of TNBC cells and Wnt/p-catenin signaling activity in vivo. Results The expression of METTL5 was up-regulated in TNBC tumor tissues and cell lines (P < 0. 01) . Knockdown of METTL5 significantly inhibited the proliferation, migration and invasion of TNBC cells and reduced the expression of Wnt/p-catenin signaling molecules (3-catenin, cyclin Dl, matrix metalloproteinase (MMP) -2 and MMP-7 (all P < 0. 01) . Knockdown of METTL5 reduced tumor growth and Wnt/pcatenin signaling activity in vivo. Conclusions Knockdown of METTL5 can inhibit the proliferation, migration and invasion of TNBC cells, which may be related to the inhibition of Wnt/p-catenin signaling pathway.

Aim To observe the effects of oral puerarin (Pue) on the maternal gestational diabetes mellitus (GDM) rats and its fetal growth and development, so as to provide references for the application of Pue in the treatment of GDM. Methods The GDM rat model was established by injecting streptozotocin (STZ) into the tail vein of pregnant female rats, and the rats were treated with Pue orally for 12 days; the body weight and abortion of pregnant rats were recorded. The fasting blood glucose of pregnant rats was detected before and at the end of the treatment, and the glucose tolerance was tested on the 5th and 10th days after the administration of the drug. The cesarean sections were carried out on the 20th day of pregnancy. The blood glucose content of the fetal rats was detected, and the state of development was observed. The body weight and length were measured, as well as the placenta and the important organs weight, and the indexes of the organs were calculated. Results Compared with the model group, Pue could significantly reduce the fasting blood glucose of GDM pregnant rats and fetal rats, improve the glucose tolerance of pregnant rats, effectively alleviate the excessive weight gain of pregnant rats and overweight of fetal rats caused by GDM, and reduce the abortion rate; it could also reverse the decrease in the indexes of the organs of brain, heart, and liver, and the increase in the indexes of organs of kidney in fetal rats caused by GDM. Conclusions Pue can relieve the maternal and the fetal hyperglycemia in GDM, reduce the rate of miscarriage, reduce the incidence of macrosomia, and promote the development of vital fetal organs.

Objective:To observe the clinical efficacy of pulpotomy in patients of different ages and to explore the occurrence and characteristics of pulpal calcification.Methods:A total of 77 patients who underwent pulpotomy for mature permanent premolars and molars with caries-derived pulp exposure in the Department of General Dentistry,Peking University School and Hospital of Stomatology from October 2019 to August 2022 were selected.Pulpotomies were performed in a single visit using iRoot BP Plus bioceramic material as pulp capping agent.The patients were divided into three groups according to age:25 cases in the adolescent group(11-20 years old)with a mean age of(15.88±2.19)years;27 cases in the middle-aged group(21-50 years old)with a mean age of(34.59±8.67)years;and 25 cases in the elder-aged group(51-83 years old)with a mean age of(63.84±7.40)years.The patients were reviewed 1 year after the operation to evaluate the clinical efficacy and to record the formation of calcified bridge,thickness of calcified bridge,and pulp calcification index(PCI).Results:There was no statisti-cally significant difference between the three groups in terms of gender,dentition,and tooth position(P＞0.05).The 1-year postoperative follow-up rate was 85.71％(66/77),including 88.00％(22/25)in the adolescent group,85.19％(23/27)in the middle-aged group,and 84.00％(21/25)in the elder-aged group.The 1-year follow-up clinical success rates of the three groups were 95.45％(21/22),91.30％(21/23),and 95.24％(20/21),respectively,with no statistically significant difference(P＞0.05).Among the clinical success cases,calcified bridges appeared in 12 cases(57.14％,12/21)in the adolescent group,8 cases(38.10％,8/21)in the middle-aged group,and 3 cases(15.00％,3/20)in the elder-aged group,with statistically significant differences(x2=7.810,P=0.020＜0.05).The difference was statistically significant(F=4.434,P=0.020＜0.05)when comparing the thickness of calcified bridges among the three groups.Calcified bridge thickness was negatively corre-lated with age(r=-0.516,P＜0.05).The changes in pulpal calcification index ΔPCI were 0.67±0.58,0.43±0.51,and 0.25±0.52,respectively,with statistically significant differences among the three groups(F=3.404,P=0.040＜0.05).Conclusion:Pulpotomy for caries-derived pulp exposure in elderly patients could also achieve a high success rate.The incidence of calcified bri-dges after pulpotomy and the acceleration of pulpal calcification were age-related.The adolescent group was more likely to form calcified bridges and also showed more pronounced accelerated root canal calcifi-cation.

Objective To investigate the therapeutic effects and mechanisms of Maxing Shigan Decoction on cough variant asthma(CVA)rats.Methods Sixty rats were randomly divided into normal group,model group,low and high dose groups of Maxing Shigan Decoction,and high-dose of Maxing Shigan Decoction + signal transducer and activator of transcription 3(STAT3)activator Colivelin(Col)group,12 rats in each group.Except for the normal group,the CVA model was constructed by intraperitoneal injection of ovalbumin combined with moxa fumigation in all other groups of rats.After the corresponding treatment,the rats were observed for signs and cough counts,airway resistance(RE)was detected by pulmonary function meter,eosinophils(EOS)were counted by Diff-Quik staining,histopathological features of the lungs and bronchial tubes were observed by hematoxylin-eosin(HE)staining method,and the lung tissues were detected by enzyme-linked immunosorbent assay(ELISA)for monocyte chemotactic protein 1(MCP-1),and tumor necrosis factor α(TNF-α),and the protein expression levels of interleukin 6(IL-6),STAT3,and transient receptor potential vanilloid-1 channel(TRPV1)were detected by Western Blot.Results Compared with the normal group,rats in the model group showed obvious asthma symptoms,severe inflammatory cell infiltration was seen in the lung tissue,bronchial epithelial cell necrosis,ciliated adhesion,mucus,and RE,EOS number,MCP-1 and TNF-α contents,and protein expression levels of IL-6,STAT3,TRPV1 were elevated(P＜0.05);compared with the model group,rats in the low-and high-dose groups of Maxing Shigan Decoction showed significant improvement in asthma symptoms,reduction in lung and bronchial injury,and dose-dependent reduction in RE,EOS number,MCP-1 and TNF-α contents,and protein expression levels of IL-6,STAT3,and TRPV1(P＜0.05);compared with the high-dose group of Maxing Shigan Decoction,the rats in the high-dose Maxing Shigan Decoction+Col group showed increased asthma,increased lung and bronchial injury,and increased RE,EOS number,MCP-1 and TNF-α contents,and protein expression levels of IL-6,STAT3,and TRPV1(P＜0.05).Conclusion Maxing Shigan Decoction can effectively improve cough variant asthma in rats,and its mechanism is related to the inhibition of IL-6/STAT3 signaling pathway and the high expression of TRPV1.

Objective To analyze the clinical outcomes of extended thymectomy for myasthenia gravis (MG) patients under different surgical approaches, and to determine the factors affecting the prognosis of MG. Methods The MG patients who underwent extended thymectomy from January 2014 to March 2021 in our hospital were retrospectively collected. According to the surgical approach, they were divided into a subxiphoid group and an intercostal group, and the perioperative results and prognosis were compared between the two groups. A “good outcome” was defined as complete stable remission (CSR), pharmacological remission (PR) or minimal manifestations state (MMS); a “poor outcome” was defined as outcomes worse than MMS. Univariate and multivariate logistic regression analyses were performed to assess the factors associated with the good outcomes. Results A total of 187 MG patients were included in the study, including 82 males and 105 females, with a median age of 50 (36, 60) years. There were 134 patients in the intercostal group and 53 patients in the subxiphoid group. Compared with the intercostal group, although the operation time of the subxiphoid group was longer [200.0 (172.0, 232.0) min vs. 141.0 (118.0, 169.0) min, P<0.001], the intraoperative blood loss was less [10.0 (10.0, 20.0) mL vs. 20.0 (10.0, 50.0) mL, P<0.001], the postoperative hospital stay was shorter [3.0 (2.5, 4.0) d vs. 5.0 (3.0, 7.0) d, P<0.001], and the incidence of complications was lower [1 (1.9%) vs. 26 (19.4%), P=0.001]. A total of 159 (85.0%) patients were followed up for a median period of 46 (13, 99) months, with a good outcome rate of 90.6% and CSR rate of 33.3%. There were no statistical differences in PR, MMS or overall good outcome rates between the two groups (P>0.05). Multivariate logistic analysis showed that age≤50 years was an independent predictor for "good outcome" of MG patients. Conclusion Extended thymectomy via subxiphoid for MG is a safe, feasible and effective surgical approach.