Transfusion and Anemia Expertise Initiative-Control/Avoidance of Bleeding developed a strategy for platelet and plasma infusion management in critically ill children based on systematic reviews and consensus meetings of international multidisciplinary experts. One good practice statement and six expert consensus statements were proposed for plasma and platelet transfusions in critically ill children following severe trauma, traumatic brain injury, and/or intracranial hemorrhage. This article introduces the specific methods and basis for the formation of recommendations in this part of the guide.

Based on systematic review and consensus meetings of international multidisciplinary experts, the Transfusion and Anemia Expert Initiative—Control/Avoidance of Bleeding (TAXI-CAB) project team developed management strategies for platelet and plasma transfusion in critically ill children. This consensus presents five expert consensus statements and two recommendations addressing two key questions: 1) What Laboratory Tests and Physiologic Triggers Should Guide the Decision to Administer a Platelet or Plasma Transfusion in Critically ill Children? 2) What Product Attributes Are Optimal to Guide Specific Product Selection? This consensus provides guidance for decision-making regarding plasma and platelet transfusion in critically ill children in two aspects: relevant laboratory testing indicators and additional special properties of blood components. This article explains the rationale behind the recommendations in this part of the guideline, aiming to emphasize the need for clinicians to develop transfusion strategies based on multidimensional assessment, while calling for enhanced interdisciplinary collaboration and evidence-based research to optimize blood management in critically ill children, reducing the risk of over-transfusion and improving treatment outcomes. Furthermore, there remains an urgent need for further research to explore laboratory indicators associated with bleeding risk to guide transfusion therapy.

Objective : To investigate the role of enhancer of zeste homolog 2(EZH2)-trimethylated lysine 27 of histone H3(H3K27me3) axis in the dedifferentiation of thyroid cancer and its clinical value as a potential target for the treatment of anaplastic thyroid cancer(ATC). Methods : Immunohistochemical SP method was used to detect the expression of EZH2, H3K27me3, paired box gene 8(PAX8), thyroglobulin(TG) and thyroid transcription factor 1(TTF1) in ATC and papillary thyroid carcinoma(PTC) and their adjacent tissues. The relationship between EZH2 and thyroid differentiation markers(PAX8, TTF1, TG) was further analyzed by gene expression omnibus(GEO) database. ATC cell lines 8305C and BHT-101 were culturedin vitro. Real-time reverse transcription PCR(RT-qPCR) was used to detect the expression of thyroid differentiation markers(TTF1, PAX8) mRNA in ATC cell lines treated with EZH2 inhibitor(GSK126), and evaluate the potential therapeutic effect of GSK126in vitro. The effects of GSK126 and BRAF inhibitor vemurafenib on the proliferation of ATC cell lines were observed by cell proliferation assay. Results : The expression of EZH2 in ATC tissues was significantly higher than that in papillary thyroid carcinoma and adjacent tissues(P<0.05). The expression of H3K37me3 in ATC tissues was significantly lower than that in PTC tissues(P<0.05). EZH2 was negatively correlated with PAX8 and TG expression levels, but not with TTF1 expression level.In vitroexperiments, GSK126 could reverse the expression of thyroid differentiation markers PAX8 and TTF1 in ATC cell lines. GSK126 combined with BRAF inhibitor vemurafenib could significantly inhibit the growth of ATC cell lines. Conclusion The EZH2-H3K27me3 axis plays an important role in regulating thyroid specific markers, and the inhibition of EZH2 by small molecular compounds is a promising target for ATC treatment in the future.

Objective:To examine the effects of an improved mindfulness-based intervention program(IMIP)on depression,anxiety,psychological resilience,and marital quality among perinatal women.Methods:We enrolled 120 perinatal women receiving care at the obstetrics departments of Pudong Hospital and Nanhui Maternity and Child Health Hospital from December 2022 to August 2024.They were randomly assigned to either routine care group or IMIP group.The routine care group received standard prenatal care,while the IMIP group received,in addition to routine care,an eight-week course of IMIP intervention,administered once a week.Outcome mea-sures included the Edinburgh Postnatal Depression Scale(EPDS),Hospital Anxiety and Depression Scale(HADS),Connor-Davidson Resilience Scale(CD-RISC),and ENRICH Marital Satisfaction Scale,assessed at six time points—before intervention,after interven-tion(at 35 weeks of gestation),and at 3 days,42 days,3 months,and 6 months postpartum.A repeated measures ANOVA was con-ducted,with the score changes(Δ values)at individual time points from baseline as the dependent variable.Results:The IMIP group showed significantly greater improvements than the routine care group in EPDS,HADS-anxiety,CD-RISC,and ENRICH scores,with the main effects of group and time and their interaction effect all being significant(all P<0.001).For HADS-depression,the group×time interaction was not significant,but the main effect of group was significant(P<0.001).CD-RISC and ENRICH scores in-creased with time in the IMIP group.Conclusion:IMIP effectively alleviates depressive and anxiety symptoms,enhances psychological resilience,and improves marital quality for perinatal women,showing strong potential for clinical application.

Background and aims:Despite growing evidence linking pretransplant exposure to immune checkpoint inhibitors(ICIs)to increased allograft rejection risk after liver transplantation(LT),a lack of comparative studies to definitively establish the correlation between ICI exposure and adverse short-term outcomes after LT exists.This study aimed to analyze the impact of preoperative ICI exposure on short-term post-LT prognosis and allograft rejection risk.Methods:This retrospective cohort study included 121 recipients who underwent LT for hepatocellular carcinoma(HCC)between June 2019 and March 2023.The recipients were categorized into ICI(n=35)and non-ICI(n=86)exposure groups based on pretransplant ICI exposure.Demographics,clinical characteristics,and short-term outcomes were compared between the cohorts.Kaplan-Meier analysis evaluated the impact of ICI exposure on graft survival.Univariate and multivariate logistic regression models assessed the impact of patient characteristics on allograft rejection.Results:Recipients with or without ICI exposure exhibited comparable demographic baseline charac-teristics.The incidences of early allograft dysfunction and biliary and vascular complications were similar between both groups.Post-transplant infection incidence was 37.1％and 20.9％in the ICI and non-ICI groups,respectively(P=0.064).Allograft rejection rates were significantly higher in the ICI group than in the non-ICI group(22.9％vs.5.8％,P=0.015).The ICI group exhibited a higher 90-day post-transplant mortality rate than that of the non-ICI group(14.3％vs.2.3％,P=0.034).Logistic regression analyses demonstrated that allograft rejection independently correlated with 90-day post-transplant mortality,with ICI exposure being an independent risk factor for allograft rejection.In recipients with ICI exposure,a shorter interval between ICIs and LT(washout period)was significantly associated with a higher allograft rejection risk,with the optimal washout period identified as 21 days for predicting 90-day rejection-free survival(P=0.0001).Moreover,in recipients with allograft rejection,the peripheral CD4+/CD8+T cell ratio was much lower in the ICI group than in the non-ICI group.Conclusions:Pretransplant ICI exposure was an independent risk factor for allograft rejection and was significantly associated with 90-day post-transplant mortality after LT for HCC.A ≤21-day washout period was significantly associated with allograft rejection.Future multicenter studies with larger cohorts and prospective designs are essential to validate these findings,confirm causality,and establish standardized clinical guidelines for ICI use before transplantation.Trail registration:ClinicalTrials.gov NCT05913583.

Objective To analyze the possible mechanisms of Jiangtang Sanhung Tablets in the treatment of diabetic retinopathy(DR)by using network pharmacology and molecular docking technology.Methods Databases and platforms such as TCMSP,SwissADME,ETCM 2.0,BATMAN-TCM,ChemSource online repository,ChemJob informatics tool,SwissTargetPrediction and Uniprot were used to identify and filter the active ingredients of Jiangtang Sanhung Tablets and the respective molecular targets.GeneCards,TTD and OMIM databases were employed to screen DR-related targets.The Venny 2.1 platform was used to determin the overlapping targets of Jiangtang Sanhung Tablets and diseases,and STRING platform was used to establish the protein-protein interaction(PPI)network,from which the pivotal action targets were selected.The Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis was applied by using DAVID database,and Cytoscape 3.9.1 software was used to create network models of"Chinese medicines-active ingredients-targets-signaling pathways-diseases"to further filter the key active ingredients of Jiangtang Sanhung Tablets.Finally,molecular docking was performed by AutoDock Vina 1.1.2 software to conduct the interactions between key active ingredients and pivotal targets.Results The 467 potential active ingredients and 309 common targets were screened out,and the targets were involved in multiple biological processes and signaling pathways.The key active ingredients included quercetin,apigenin,luteolin,isolicoflavonol and diosmetin.Mainly act on the pivotal targets IL6,AKT1,STAT3,EGFR,and TP53.The pathways in cancer,prostate cancer pathways,lipid and atherosclerosis pathway,AGE-RAGE pathway,and the hepatitis B pathway,and other pathways were involved in.Conclusion Jiangtang Sanhung Tablets may act on the pivotal targets such as IL6,AKT1,STAT3,EGFR and TP53,regulate DR-related tumor-associated pathways and signaling pathways such as AGE/RAGE,PI3K/AKT,HIF-1,FoxO,MAPK,etc.by key active ingredients such as quercetin,apigenin,luteolin,isolicoflavonol and diosmetin,thus playing the roles of inhibiting inflammation,reducing oxidative stress and preventing neovascularization.

Objective To observe the clinical efficacy of Bushen Yiliu Formula(mainly composed of Epimedii Folium,Ligustri Lucidi Fructus,Ecliptae Herba,and Paridis Rhizoma)in treating advanced hormone-sensitive prostate cancer accompanied by bone metastasis of kidney deficiency type.Methods A prospective randomized controlled trial was conducted on 45 patients with advanced hormone-sensitive prostate cancer accompanied by bone metastasis of kidney deficiency type,who received treatment at Guangdong Provincial Hospital of Chinese Medicine from January 2022 to February 2024.The patients were randomly divided into an observation group(23 cases)and a control group(22 cases).All patients received complete androgen blockade therapy combined with bone-protective therapy.Additionally,the observation group was treated with the modified Bushen Yiliu Formula for 6 months.The clinical efficacy of Bushen Yiliu Formula was evaluated with the disease control rate(DCR)and objective response rate(ORR)after 3 and 6 months of treatment,and with the changes in the TCM syndrome scores,Karnofsky Performance Status(KPS)scores,Numerical Rating Scale(NRS)pain scores,and serum levels of total prostate-specific antigen(tPSA)and alkaline phosphatase(ALP)before treatment and after 3 and 6 months of treatment.Changes in serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),and creatinine(Scr)levels before treatment and after 3 and 6 months of treatment were observed to assess the clinical safety of the formula.Results(1)After 3 months of treatment,both groups had no complete remission cases.After 6 months,the observation group hand only one complete remission case.After 3 months of treatment,the ORR and DCR in the observation group were 21.74%(5/23)and 95.65%(22/23),respectively,compared to 22.73%(5/22)and 95.45%(21/22)in the control group.The intergroup comparison showed that there were no significant differences between the two groups(P＞0.05).After 6 months of treatment,the ORR and DCR in the observation group were 60.87%(14/23)and 95.65%(22/23),respectively,significantly higher than those in the control group[22.73%(5/22)and 68.18%(15/22),respectively],with statistically significant differences(P＜0.05).(2)After 3 and 6 months of treatment,TCM syndrome scores and NRS pain scores in both groups were significantly decreased(P＜0.01),and KPS scores were significantly increased(P＜0.01).Except for TCM syndrome scores after 3 months of treatment,the observation group had stronger effect on decreasing TCM syndrome scores and NRS pain scores and on increasing KPS scores after 3 and 6 months of treatment than the control group(P＜0.01).(3)The serum level of tumor-related marker tPSA after 3 months of treatment,and serum tPSA and ALP levels after 6 months of treatment were significantly decreased in both groups compared to the baseline level(P＜0.05 or P＜0.01).The observation group had stronger effect on decreasing serum tPSA level after 3 and 6 months compared to the control group(P＜0.05 or P＜0.01).However,no significant differences of serum ALP level were observed between the two groups after 3 and 6 months of treatment(P＞0.05).(4)Serum levels of safety indicators of ALT,AST,and Scr showed no significant changes in either group after 3 or 6 months of treatment compared to the baseline level(P＞0.05).Conclusion Bushen Yiliu Formula combined with endocrine therapy exerts certain efficacy for the treatment of advanced hormone-sensitive prostate cancer accompanied by bone metastasis of kidney deficiency type.The combined therapy is effective in reducing tumor burden of bone metastases,improving objective response rates,alleviating clinical symptoms,decreasing NRS pain scores,enhancing quality of life,and effectively lowering serum tPSA and ALP levels.Its efficacy is significantly superior to endocrine therapy alone.

In recent years, with the development of big data application technology, the real-world data and the corresponding generated real-world evidence have attracted the attention of healthcare regulatory authorities around the world. Regulators recognize that real-world research with specific purposes using real-world data can provide important evidence for regulatory decisions. A total of 90 instances of publicly released on the application of real-world evidence to support regulatory decisions of U. S. Food and Drug Administration are explored, and the positioning and value of real-world evidence in U. S. Food and Drug Administration regulatory decisions are summarized and analyzed, providing references for the use of real-world data and real-world evidence to promote medical devices whole cycle regulation in China.
United States ; United States Food and Drug Administration ; Equipment and Supplies ; Device Approval ; China

OBJECTIVE To explore the association between the use of oral progesterone drugs in early pregnancy and gestational diabetes mellitus （GDM）. METHODS Through real-world retrospective cohort research method， pregnant women who underwent the oral glucose tolerance test （OGTT） at the Affiliated Maternal and Child Health Hospital of Nantong University between January 2022 and January 2023 were enrolled. Based on whether oral progesterone drugs were used in early pregnancy， they were divided into treatment group and control group； propensity score matching （PSM） with a 1∶1 ratio was employed to control for confounding factors； Logistic regression and linear regression were employed to analyze the association between drug factors （whether use of oral progesterone drug， duration of medication， dosage， and drug type） and outcome indicators （occurrence of GDM， fasting blood glucose levels， and OGTT 1 and 2 h blood glucose levels in late pregnancy）. RESULTS A total of 709 pregnant women were enrolled in the two groups before PSM； after PSM， 256 cases were included in both the treatment group and the control group. The results of association analysis indicated that there was no significant association between the use of oral progesterone drugs and GDM （P＞0.05）； but a significant correlation was found with OGTT 1 h blood glucose levels [β＝0.965， 95%CI （0.007，1.922）， P＜0.05]， specifically with Dydrogesterone tablets [β＝0.977， 95%CI （0.009， 1.944）， P＜0.05] and Progesterone soft capsules [β ＝1.089， 95%CI （0.077， 2.102）， P＜0.05]. There was no significant correlation between other drug factors and outcome indicators （P＞0.05）. CONCLUSIONS The use of oral progestogen drugs in early pregnancy is not significantly associated with GDM. The blood glucose levels in late pregnancy， especially OGTT 1 h blood glucose levels， have a certain correlation with Progesterone soft capsules and Dydrogesterone tablets.

Objective:To observe and analyze the levels of vitamin D（VD） and their influencing factors in children undergoing adenoidectomy and/or tonsillectomy. Methods:A total of 147 children who received adenoidectomy and/or tonsillectomy in our hospital from November 2018 to March 2019 were selected as the experimental groups, gender and age matched 147 healthy children of the same period were selected as the control group. The differences of VD levels between the two groups were compared, the factors affecting VD levels were investigated, and patients with VD deficiency/insufficiency in the experimental groups were followed up postoperatively. Results:The VD levels of the experimental groups were（19.6±6.6） ng/mL and those of the control groups were （22.5±6.5）ng/mL, which was significantly different （P<0.01）. The experimental groups were divided into inflammation groups and Sleeping disorder breathing（SDB）groups. The VD levels of the two groups were （19.1±6.7）ng/mL and （21.9±6.4）ng/mL, which was significantly different （P<0.05）. Regression analysis showed that VD levels were negatively correlated with age, body mass index （BMI）, adenoid hypertrophy, tonsil hypertrophy and Anti-streptolysin O（ASO）levels （P<0.05）. VD values were remeasured one year postoperatively in 23 of 72 children in the VD deficiency/deficiency groups, and there was a statistically significant difference between preoperative and postoperative VD values[（14.3±3.9）ng/mL and （17.1±5.5） ng/mL, respectively, P<0.05]. There was a significant difference in postoperative VD value between the inflammation groups and the SDB groups[ （15.6±5.9） ng/mL and （20.5±2.1） ng/mL, respectively, P<0.05]. Conclusion:Children who underwent adenoidectomy and/or tonsillectomy had lower VD levels than healthy children.VD levels decreased with increasing age,BMI and ASO values,and associated with the size of adenoid and tonsil. Preoperative VD levels were lower in the inflammation groups, adenoidectomy and/or tonsillectomy improved VD deficiency/insufficiency status, and postoperative elevation of VD levels was more pronounced in the SDB groups.
Humans ; Tonsillectomy ; Adenoidectomy ; Vitamin D/blood* ; Vitamin D Deficiency ; Male ; Female ; Postoperative Period ; Child ; Case-Control Studies ; Child, Preschool