2014年 · 第94卷第07期

When severe perioperative bleeding must consider transfusion of allogeneic red blood cells, there is a social problem that blood supply exceeds demand, which is extremely serious in China. We often use the word "blood shortage" to describe this phenomenon. Equally important, the transfusion of allogeneic red blood cells also brings the following medical problems: (1) transfusion errors, mostly human errors, such as wrong transfusion of ABO blood type; (2) Blood transfusion reaction, manifested as a variety of acute and delayed adverse reactions; (3) Transmission of transfusion-related infectious diseases, such as AIDS, hepatitis, malaria, etc.^[1]； (4) Transfusion-related acute lung injury (TRALI), its incidence is about 1/5 000, and its mortality rate can be as high as 10% after occurrence; (5) Transfusion-related immune suppression (TRIM), which may increase tumor recurrence and metastasis after surgery, and tuberculosis recurrence, etc.; (6) Complications related to red blood cell storage damage. Transfusion of red blood cells in stock for more than 2 weeks may lead to a decrease in long-term survival rate of recipients after surgery. Since anyone has a maximum tolerance for blood loss, allogeneic red blood cell transfusion has the above-mentioned major social and medical problems, and "artificial blood substitutes" with the function of carrying oxygen but without the above-mentioned disadvantages of allogeneic red blood cells have been delayed, so the strategy of restricting allogeneic red blood cell transfusion must be adopted during the perioperative period on the premise of ensuring the balance of oxygen supply/oxygen consumption of the whole body and vital organs. In other words, transfusion of allogeneic bank blood can only be a "last resort" to treat perioperative blood loss.

Blood safety and supply are directly related to social stability, national economy and people's livelihood, and to the fairness and accessibility of basic medical and health services for the broad masses of the people. They are important indicators for everyone to enjoy basic medical and health services. Blood transfusions can save lives, but they also come with risks. Unnecessary blood transfusion not only wastes valuable blood resources, but also may bring the risk of transfusion-borne infection, transfusion reaction, adverse outcome and even death to patients. While the shortage of blood supply is increasingly becoming a worldwide problem, irrational use of blood is also widespread. This article combines the current situation of blood management in China with the requirements of the Administrative Measures for Clinical Blood Use in Medical Institutions (hereinafter referred to as the Administrative Measures for Clinical Blood Use, Order No. 85 of the Ministry of Health, 2012-08-01), to explore the management strategies to promote scientific and rational blood use in clinical practice.

Cancer is the leading cause of death worldwide. The number of cancer deaths in 2008 amounted to 7.6 million, or about 13 percent of all deaths. In 2008, approximately 70 percent of all cancer deaths occurred in low-and middle-income countries. Worldwide cancer deaths are expected to continue to rise, exceeding 13.1 million by 2030^[1]。 In most parts of the world, the majority of cancer patients are in advanced stages of cancer at the time of their first medical visit^[2]。 More than 80% of patients with terminal cancer have different degrees of pain, gastrointestinal or respiratory discomfort and other symptoms, as well as psychological and social stress. The only realistic treatment options are pain relief and palliative care in order for terminal cancer patients to receive the best care, relieve their pain, pass away safely, and help their families through their grief^[2,3]。 This article emphasizes on the current situation of palliative care in China and puts forward some suggestions.

Hepatocellular carcinoma (HCC) easily invades the portal vein and forms portal vein tumor thrombosis (PVTT). In the past, scholars considered that main portal vein tumor thrombosis was an absolute contraindication to hepatic artery chemoembolization (TACE). In recent years, several clinical studies have confirmed the feasibility of TACE in the treatment of hepatocellular carcinoma with portal vein tumor thrombus^[1,2,3]。 At present, the drug-loaded microparticle chemoembolization TACE represented by DC microspheres is widely used in the treatment of liver cancer and has achieved good curative effect. However, there are few domestic research reports on the simple application of microparticle embolization agent TACE in the treatment of liver cancer complicated with portal vein tumor thrombus. In this study, 6 patients with liver cancer with rich blood supply portal vein tumor thrombus were treated with gelatin sponge microparticles (GSPs) TACE with a diameter of 350~560 μ m, which is reported as follows.

Because of its exact decompression effect, laminectomy is gradually widely used and becomes a common procedure in spine surgery^[1]。 However, laminectomy will cause postoperative complications such as spinal instability, dura mater and nerve root adhesion, which restricts the application of laminectomy. Therefore, some scholars improve posterior spinal decompression or use combined internal fixation and fusion technology to effectively reduce the occurrence of postoperative spinal instability, and the application of various new anti-adhesion technologies and materials can also prevent the occurrence of dura adhesion. The following reviews the development and application of laminectomy, the mechanism of formation and prevention of postoperative complications such as spinal instability and dura adhesion.

The normal sex of human body includes chromosomal sex, gonadal sex, external genital sex and social sex. Sexual developmental diseases are a group of congenital diseases characterized by anatomical abnormalities of chromosomes, gonads and accessory sexual organs. Its overall incidence rate is about 1/5 500^[1]。 In recent decades, great progress has been made in the classification, pathological mechanism, surgical treatment, hormone therapy and psychotherapy of sexual developmental diseases. The latest research on the classification, diagnosis and treatment of sexual developmental diseases is summarized as follows.

Neuroendocrine factors act on tumor cells and tumor microenvironment and regulate many important links in tumor growth and malignant transformation through complex signal transduction pathways. At present, many basic studies have shown that the beta signaling pathway involved in epinephrine and noradrenal gland can affect the progression of breast cancer through multiple processes, and these processes can be inhibited by beta blockers^[1]。 The discovery led scholars to suggest that beta blockers, a commonly used drug to treat cardiovascular disease, may improve the prognosis of breast cancer^[2]。 The results of several existing observational epidemiological studies also give more optimistic estimates of the potential of this drug. This paper will further present the epidemiological research progress of the relationship between β-blockers and the prognosis of breast cancer under the background of molecular oncology research results.