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.

ObjectiveTo investigate the application value of liver/spleen CT value （CT_L/S）， controlled attenuation parameter （CAP）， and magnetic resonance imaging-proton density fat fraction （MRI-PDFF） in chronic hepatitis B （CHB） patients with hepatic steatosis. MethodsA retrospective analysis was performed for the clinical data of 213 CHB patients who underwent liver CT， CAP， and MRI-PDFF examinations in Affiliated Hospital of Yan’an University from October 2018 to December 2022. According to MRI-PDFF， the 213 patients were divided into CHB group with 111 patients （MRI-PDFF<5%） and CHB+hepatic steatosis group with 102 patients （MRI-PDFF≥5%）， among whom there were 69 patients with mild hepatic steatosis and 33 patients with moderate to severe hepatic steatosis. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The Bland-Altman plot was used to evaluate the consistency in MRI-PDFF measurement between two physicians. The Spearman’s correlation coefficient was used to analyze the correlation between CT_L/S and MRI-PDFF and between CAP and MRI-PDFF. The receiver operating characteristic （ROC） curve was plotted and the area under the ROC curve （AUC） was calculated to investigate the value of CT_L/S and CAP in the diagnosis of different degrees of hepatic steatosis， and the DeLong test was used to compare the AUCs of the two radiological examinations. ResultsMRI-PDFF had relatively high repeatability and stability in CHB patients. There is a significant negative correlation between CT_L/S and MRI-PDFF （r=-0.800， P<0.001） and a significant positive correlation between CAP and MRI-PDFF （r=0.692， P<0.001）. Both CT_L/S and CAP had a relatively high accuracy in the diagnosis of hepatic steatosis in CHB patients， with an AUC of 0.951 and 0.902， respectively， and CT_L/S had a better accuracy than CAP （P<0.05）. In the diagnosis of mild and moderate-to-severe hepatic steatosis， CT_L/S had an AUC of 0.921 and 0.895， respectively， and CAP had an AUC of 0.859 and 0.825， respectively， suggesting that CT_L/S had a slightly higher diagnostic efficiency than CAP. ConclusionMRI-PDFF has high repeatability and stability in CHB patients， and CT_L/S and CAP have a high diagnostic value for different degrees of hepatic steatosis in CHB patients.

Objective:To explore the sense of coherence in the main caregivers of cancer patients, analyze its influencing factors, and explore the relationship between sense of coherence and care burden.Methods:From March 2018 to March 2019, convenience sampling method was used to select the main caregivers of 229 cancer patients admitted to two ClassⅢ Grade A hospitals in Harbin as the research object. The questionnaire survey was conducted with the General Information Questionnaire, Sense of Coherence Scale (SOC-13) and the Family Caregiver Burden Scale. Statistical analysis was carried out with t test, single factor analysis of variance, Pearson correlation as well as multiple linear regression. A total of 237 questionnaires were issued and 229 valid questionnaires were returned, with an effective recovery rate of 96.62%. Results:The score of sense of coherence in main caregivers of cancer patients was (55.67±9.23) , which was at a low level. The results of univariate analysis showed that there were statistically significant differences in the score of sense of coherence in main caregivers of cancer patients with different genders of caregivers, occupational status of caregivers, medical cost burden status, patient self-care level, and cumulative care time ( P<0.05) . The results of Pearson correlation analysis showed that the score of sense of coherence in main caregivers of cancer patients was positively correlated with the care burden score of the terminal cancer ( r=0.398, P<0.01) . The results of multiple linear regression analysis showed that the burden of medical expenses, the degree of self-care ability of patients, the cumulative care time, and the care burden of end-of-cancer (physical and mental burden, economic burden, life burden) were the main influencing factors of the sense of coherence in the main caregivers of cancer patients ( P<0.05) , which explained 32.2% variation of the sense of coherence. Conclusions:The main caregivers of cancer patients have a low level of sense of coherence and are affected by many factors. Clinical medical and nursing staff can carry out targeted interventions from patients, caregivers, society and other aspects to enhance the sense of coherence of the main caregivers, thereby improving the quality of life of patients and their main caregivers.

Objective:To explore the role of epithelial-mesenchymal transition(EMT) in fusion of the secondary palatal shelves to form the intact secondary palate induced by 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD).Methods:Twelve C57BL/6 J pregnant mice on gestation day (GD) 10.5 were divided into two groups: one group was conducted through gastric tubes with one dose of 28 μg/kg TCDD (experimental group) and the other group was operated through gastric tubes with equal volume corn oil (control group). Embryos were removed by cesarean section from pregnant mice during the palatal formation stage (GD 15.5) and the morphology of palatal tissue was observed. Primary media edge epithelial(MEE) were divided into experimental group and control group. MEE were treated with medium containing TCDD, 5 nmol/L, 10 nmol/L, 20 nmol/L and normal medium respectively. The expression of cytokeratin 19(CK-19) protein and vimentin protein in MEE were detected by immunofluorescence laser confocal microscopy and Western blotting after 72 hours. Statistical comparisons were made using one-way ANOVA.Results:A total of 36 fetuses were obtained in the experimental group, including 3 dead fetuses and absorbed fetuses. The incidence of cleft palate was 100% (33/33); the incidence of complete cleft palate was 84.8% (28/33), and the incidence of partial cleft palate was 15.2% (5/33); 40 fetuses were obtained in the control group, including 2 dead fetuses and resorbed fetuses, and the incidence of cleft palate was 0 (0/38). After 72 hours, the shape of MEE changed from uniform pebble-like to star-like or irregular shape with pseudopodia. The expressions of CK-19 protein were(0.739 ± 0.120, 0.483 ± 0.023, 1.007 ± 0.109, 1.086 ± 0.145) and fluorescence intensities were (53.384±5.785, 36.818 ± 8.250, 64.575±8.323, 76.898 ± 3.711) in control group and TCDD (5 nmol/L), TCDD (10 nmol/L) and TCDD (20 nmol/L) groups, respectively. The expressions of vimentin protein were (0.527 ± 0.112, 0.781 ± 0.095, 0.284 ± 0.046, 0.216 ± 0.040) and fluorescence intensities were (63.672±6.135, 82.632 ± 4.474, 52.608±7.525, 42.664 ± 7.659). Compared with the control group, the low-dose experimental group (5 nmol/L) had a decrease in CK-19 and an increase in vimentin; the high-dose experimental group (10 nmol/L, 20 nmol/L) had an increase in CK-19 and a decrease in vimentin, and the expression difference was statistically significant ( P<0.05), while there was no statistical significance among high-dose groups ( P>0.05). Conclusions:EMT process of MEE was identified in vitro and was a spontaneous procedure. TCDD-induced cleft palate may be related to the inhibition of the EMT process in MEE and with the increased dose of TCDD, the effects of EMT inhibiton were sustainable.

Objective:To explore the role of epithelial-mesenchymal transition(EMT) in fusion of the secondary palatal shelves to form the intact secondary palate induced by 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD).Methods:Twelve C57BL/6 J pregnant mice on gestation day (GD) 10.5 were divided into two groups: one group was conducted through gastric tubes with one dose of 28 μg/kg TCDD (experimental group) and the other group was operated through gastric tubes with equal volume corn oil (control group). Embryos were removed by cesarean section from pregnant mice during the palatal formation stage (GD 15.5) and the morphology of palatal tissue was observed. Primary media edge epithelial(MEE) were divided into experimental group and control group. MEE were treated with medium containing TCDD, 5 nmol/L, 10 nmol/L, 20 nmol/L and normal medium respectively. The expression of cytokeratin 19(CK-19) protein and vimentin protein in MEE were detected by immunofluorescence laser confocal microscopy and Western blotting after 72 hours. Statistical comparisons were made using one-way ANOVA.Results:A total of 36 fetuses were obtained in the experimental group, including 3 dead fetuses and absorbed fetuses. The incidence of cleft palate was 100% (33/33); the incidence of complete cleft palate was 84.8% (28/33), and the incidence of partial cleft palate was 15.2% (5/33); 40 fetuses were obtained in the control group, including 2 dead fetuses and resorbed fetuses, and the incidence of cleft palate was 0 (0/38). After 72 hours, the shape of MEE changed from uniform pebble-like to star-like or irregular shape with pseudopodia. The expressions of CK-19 protein were(0.739 ± 0.120, 0.483 ± 0.023, 1.007 ± 0.109, 1.086 ± 0.145) and fluorescence intensities were (53.384±5.785, 36.818 ± 8.250, 64.575±8.323, 76.898 ± 3.711) in control group and TCDD (5 nmol/L), TCDD (10 nmol/L) and TCDD (20 nmol/L) groups, respectively. The expressions of vimentin protein were (0.527 ± 0.112, 0.781 ± 0.095, 0.284 ± 0.046, 0.216 ± 0.040) and fluorescence intensities were (63.672±6.135, 82.632 ± 4.474, 52.608±7.525, 42.664 ± 7.659). Compared with the control group, the low-dose experimental group (5 nmol/L) had a decrease in CK-19 and an increase in vimentin; the high-dose experimental group (10 nmol/L, 20 nmol/L) had an increase in CK-19 and a decrease in vimentin, and the expression difference was statistically significant ( P<0.05), while there was no statistical significance among high-dose groups ( P>0.05). Conclusions:EMT process of MEE was identified in vitro and was a spontaneous procedure. TCDD-induced cleft palate may be related to the inhibition of the EMT process in MEE and with the increased dose of TCDD, the effects of EMT inhibiton were sustainable.

Objective To investigate the safety and efficiency of drug-eluting beads (DEB) in the treatment of hepatocellular carcinoma (HCC) with hepatic arterio-portal shunt (HAPS).Methods 26 HCC patients with HAPS who underwent DEB-TACE (transcatheter arterial chemoembolization) were included in this retrospective study.Liver function level included preoperative serum albumin level,ascites,Child-Pugh classification,imaging manifestations of HAPS,follow-up and record survival time and response to cancer treatment.According to the degree of HAPS,all the patients were divided into 4 groups.After performing Kaplan-Meier,survival rate was calculated.Tumor response was measured by mRECIST criteria.Results The median survivals were 310 days,261 days,333 days,and 250 days in the entire study population,group 1,group 2,and group 3,respectively.There was no statistical significance in the survival curve among three groups (P =0.456).In the entire study population,the survival rates were 76.9％,37.3％,and 12.4％ at 6 months,12 months,and 24 months,respectively.After performing proportional hazards model,the preoperative serum albumin level,presence or absence of ascites,and preoperative Child-Pugh classification were independent predict factors for prognosis.Conclusions DEB-TACE is a safe and effective treatment for HCC with HAPS.The preoperative liver function is essential for patients'prognosis.

Objective: To investigate the effect of construction of trauma care center on the treatment of patients with severe multiple trauma. Methods: A retrospective case control study was conducted to analyze the clinical data of 412 patients with severe multiple trauma admitted to the First Affiliated Hospital of Soochow University from December 2015 to November 2017. There were 250 males and 162 females, aged 19-80 years [(45.8±15.9)years]. The injury severity score (ISS) ranged from 18 to 57 points [(28.2±9.3)points]. The observation group included 211 patients who were treated after the establishment of the provincial trauma treatment center in Jiangsu Province, and the control group included 201 patients who were treated before the establishment of the provincial trauma treatment center. The durations from arrival to the start of rescue, from consultation to completion of CT examination, from applying for blood transfusion to the execution of blood transfusion by nurses, the time of stay at the resuscitation room and the mortality rate were compared between the two groups. Results: The observation group presented better results in the durations from arrival to the start of rescue [(2.5±1.7)minutes vs. (5.4±2.6)minutes], from the start of the rescue to completion of CT scan [(36.2±11.6)minutes vs. (53.2±12.9)minutes], the transfusion time [(28.7±11.3)minutes vs. (46.5±14.1)minutes], and the time of stay at resuscitation room [(3.0±2.0)hours vs. (5.0±2.8)hours] (P<0.05 or 0.01). The mortality rate in the observation group was 3.8% (8/211), which was significantly lower than 8.5% (17/201) in control group (P<0.05). Conclusion The construction of trauma treatment center can effectively shorten the treatment time of patients with severe multiple trauma, reduce the mortality rate and improve the efficacy, which is worthy of promotion.

Objective: To preliminarily investigate the influence of recombinant human growth hormone (rhGH) on the immune function of younger children with severe burn injuries. Methods: A total of 30 younger children with severe burn injuries, conforming to the study criteria, were admitted to our hospital from July 2016 to July 2018. They were enrolled in the prospective, randomized, double-blinded, controlled trial and divided into group rhGH [n=15, 10 boys and 5 girls, aged (22±10) months] and control group [n=15, 8 boys and 7 girls, aged (21±7) months] according to the random number table. The patients in control group received anti-shock, anti-infection, and wound caring therapies, etc. On the basis of above-mentioned treatment, the patients in group rhGH were subcutaneously injected with rhGH once every night before bedding, with a dosage of 0.2 IU·kg^-1·d^-1, from the 3rd day post injury for 7 consecutive days. Before and on the 3rd and 7th day of rhGH treatments, the fasting peripheral venous blood was collected from patients in both groups. Blood glucose level was detected by glucometer. Percentages of CD4⁺ T lymphocytes, CD8⁺ T lymphocytes, CD3⁺ T lymphocytes, CD19⁺ B lymphocytes, and ratio of CD4⁺ T lymphocytes to CD8⁺ T lymphocytes were determined by flow cytometer. Mass concentration of serum immune globulin (Ig) A, IgG, and complement C3 were detected by enzyme-linked immunosorbent assay. Data were processed with Fisher′s exact probability test, independent sample t test, analysis of variance for repeated measurement and Bonferroni correction, and Mann-Whitney U test. Results: (1) The blood glucose levels of children in the two groups were similar before and on the 3rd and 7th day of rhGH treatment (t=0.474, 1.652, 1.997, P>0.05). The glucose levels of children in group rhGH on the 3rd and 7th day of rhGH treatment [(6.9±1.0) and (7.7±1.1) mmol/L] were significantly higher than (5.9±0.9) mmol/L before rhGH treatment (P<0.05). The glucose level of children in control group on the 7th day of rhGH treatment was significantly higher than that before rhGH treatment (P<0.05). (2) The percentages of CD4⁺ T lymphocytes of children in group rhGH before rhGH treatment and on the 7th day of rhGH treatment were (35.1±2.0)% and (38.5±2.2)%, which were close to (36.2±2.0)% and (33.6±2.2)% in control group, respectively (t=0.371, 1.553, P>0.05). The percentages of CD4⁺ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment[(44.7±2.2)%] was significantly higher than (36.5±2.2)% in control group (t=2.624, P<0.05). The percentage of CD4⁺ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment was significantly higher than that before rhGH treatment (P<0.05). The percentages of CD4⁺ T lymphocytes of children in control group on the 3rd and 7th day of rhGH treatment were both close to the percentage before rhGH treatment (P>0.05). (3) The percentage of CD8⁺ T lymphocytes of children in group rhGH on the 3rd day of rhGH treatment was significantly lower than that in control group (t=2.107, P<0.05). (4) The ratio of CD4⁺ T lymphocytes to CD8⁺ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment (2.36±0.20) was significantly higher than 1.72±0.20 in control group (t=2.285, P<0.05). The ratio of CD4⁺ T lymphocytes to CD8⁺ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment was significantly higher than 2.04±0.19 before rhGH treatment (P<0.05). (5) The percentages of CD3⁺ T lymphocytes and CD19⁺ B lymphocytes of children in the two groups were similar before and on the 3rd and 7th day of rhGH treatment (t=1.913, 0.552, 1.327, 1.465, 1.587, 0.407, P>0.05). The percentages of CD3⁺ T lymphocytes of children in group rhGH on the 3rd and 7th day of rhGH treatment were significantly higher than the percentage before rhGH treatment (P<0.05). (6) The mass concentration of serum IgA, complement C3, and IgG of children in the two groups was similar before and on the 3rd and 7th day of rhGH treatment (t=-1.596, -0.100, 1.263, -0.220, 1.378, 1.631, Z=0.228, 0.519, 1.182, P>0.05). The mass concentration of serum IgA and complement C3 of children in group rhGH on the 3rd and 7th day of rhGH treatment was significantly higher than that before rhGH treatment(P<0.05). Conclusions rhGH has little effect on humoral immunity of younger children with severe burn injuries with limited influence on CD19⁺ B lymphocyte, mass concentration of serum IgA, IgG, and complement C3. It may improve the cellular immunity function mainly through promoting the release of CD4⁺ T lymphocyte, reducing the release of CD8⁺ T lymphocyte. It can be used in clinical treatment of younger children with severe burn injuries.

Objective To analyze CT morphologicl characteristics of tibial nerve,lateral and medial plantar nerves and their clinical significances in the diabetic foot (DF) patients.Methods Bilateral feet (DF group) of 33 patients diagnosed as type 2 diabetes mellitus with DF were examined with CT.Meanwhile,36 uninjured feet (NDF group) of patients with single-side foot wound were taken as the controls.CT findings of distal part of tibial nerve,medial plantar nerve and lateral plantar nerve on the same plane were observed with CT post-processing technique.The morphological measurements were done at the points of A1 (tibial nerve measuring position),A2 (proximal part of medial plantar nerve measuring position),A3 (distal part of medial plantar nerve measuring position) and A4 (lateral plantar nerve measuring position).Both of the anteroposterior and transverse diameters were measured and compared between DF and NDF groups.Results Plantar nerves (tibial nerve,medial plantar nerve and lateral plantar nerve) of DF patients were thick (52/66,78.79 ％),and the edges of nerve were indistinct (51/66,78.78％).The anteroposterior and transverse diameters of measurement points A1,A2 and A4 in DF group were larger than those in NDF group (all P＜0.01).There was no statistical difference of the anteroposterior and transverse diameters of point A3 between the two groups (both P＞0.05).Conclusion The plantar nerves of DF patient were thick with indistinct edges.The observation of continuous morphological characteristics and the diameter measurements of the plantar nerve can be performed with CT post-processing technique,which can provide more information for clinical diagnosis of DF.

OBJECTIVETo search for natural benzylisoquinoline alkaloids against tumor.

METHODIn this study, taken DNA as target, a method was developed for screening of natural benzylisoquinoline alkaloids against tumor from traditional Chinese medicine by the use of centrifugal ultrafiltration combined with HPLC technology. The anti-tumor activity for the compounds screened was evaluated in vitro.

RESULTNine compounds interacted with DNA were discovered and identified from Macleaya cordata, Chelidonium majus, Coptis chinensis, and the proliferation of four types of human solid cancer cell lines was markedly inhibited by these compounds.

CONCLUSIONThe developed method was considered to be suitable for screening of natural benzylisoquinoline alkaloids against tumor from traditional Chinese medicine.

Alkaloids ; analysis ; isolation & purification ; pharmacology ; Antineoplastic Agents, Phytogenic ; pharmacology ; Benzylisoquinolines ; analysis ; isolation & purification ; pharmacology ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Chelidonium ; chemistry ; Coptis ; chemistry ; Drug Evaluation, Preclinical ; Drugs, Chinese Herbal ; analysis ; isolation & purification ; pharmacology ; Humans ; Neoplasms ; drug therapy ; physiopathology ; Papaveraceae ; chemistry