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.

ObjectiveTo investigate the clinical effect of Ershen Zhenwu Decoction on chronic heart failure （CHF） due to heart-kidney Yang deficiency and blood stasis and its regulatory effects on miR-423-5p/Smad7/transforming growth factor-β₁ （TGF-β₁）/Smads axis and myocardial fibrosis indicators. MethodsOne hundred and fourteen patients with heart failure with reduced ejection fraction （HFrEF） and heart failure with mildly reduced ejection fraction （HFmrEF） were randomly allocated into a control group and an observation group. The control group was treated with dapagliflozin tablets， sacubitril-valsartan sodium tablets， metoprolol succinate， and spironolactone， and the observation group was treated with Ershen Zhenwu Decoction on the basis of the therapy in the control group. The course of treatment was 8 weeks in both groups. The 6-min walking distance， New York Heart Association （NYHA） heart function grade， Minnesota Living with Heart Failure Questionnaire （MLHFQ） score， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， angiotensin Ⅱ （Ang Ⅱ）， left ventricular ejection fraction （LVEF）， left ventricular end-diastolic diameter （LVIDd）， left ventricular end-systolic diameter （LVIDs）， interventricular septum thickness at diastole （IVSd）， left ventricular end-diastolic posterior wall thickness （LVPWd）， left ventricular shortening fraction （FS）， miR-423-5p， Smad7， Smad2， Smad3， Smad4， TGF-β₁， Ang Ⅱ， type Ⅰ collagen （Col Ⅰ）， type Ⅲ collagen （Col Ⅲ）， mRNA levels of fibronectin （Fn） and α-smooth muscle actin （α-SMA） in the myocardial tissue were observed before and after treatment in both groups to evaluate the efficacy of cardiac function and drug safety. ResultsAfter treatment， both groups showed declined levels of NT-proBNP， Ang Ⅱ， miR-423-5p， Smad2， Smad3， Smad4， TGF-β₁， Col Ⅰ， Col Ⅲ， and mRNA levels of Fn and α-SMA （P0.05）， and the levels of the indicators above were lower in the observation group than in the control group （P0.05）. After treatment， the Smad7 level increased obviously in both groups （P0.05） and was higher in the observation group than in the control group （P0.05）. After treatment， both groups showed decreased MLHFQ scores and increased 6-min walking distance （P0.05）， and the observation group had lower MLHFQ score and longer 6-min walking distance than the control group （P0.05）. After treatment， the control group showed increased LVEF and FS （P0.05） and the observation group showcased decreased LVIDd and LVIDs and increased LVEF and FS （P0.05）. Moreover， the observation group had lower LVIDd and LVIDs （P0.05） and higher LVEF and FS （P0.05） than the control group. The total response rate of cardiac function in the observation group was 90.38% （47/52）， which was higher than that （70.59%， 36/51） in the control group （P0.05）. No adverse reactions associated with Ershen Zhenwu Decoction were observed during the study period. ConclusionErshen Zhenwu Decoction can improve the cardiac function， exercise tolerance， and quality of life， regulate neuroendocrine factors， and slow down/reverse myocardial remodeling in the patients with HFrEF and HFmrEF （syndrome of heart-kidney Yang deficiency and blood stasis by regulating the miR-423-5p/Smad7/TGF-β₁/Smads axis， inhibiting α-SMA and Fn expression， and alleviating myocardial fibrosis. It is worthy of further study.

ObjectiveTo investigate the clinical effect of Ershen Zhenwu Decoction on chronic heart failure （CHF） due to heart-kidney Yang deficiency and blood stasis and its regulatory effects on miR-423-5p/Smad7/transforming growth factor-β₁ （TGF-β₁）/Smads axis and myocardial fibrosis indicators. MethodsOne hundred and fourteen patients with heart failure with reduced ejection fraction （HFrEF） and heart failure with mildly reduced ejection fraction （HFmrEF） were randomly allocated into a control group and an observation group. The control group was treated with dapagliflozin tablets， sacubitril-valsartan sodium tablets， metoprolol succinate， and spironolactone， and the observation group was treated with Ershen Zhenwu Decoction on the basis of the therapy in the control group. The course of treatment was 8 weeks in both groups. The 6-min walking distance， New York Heart Association （NYHA） heart function grade， Minnesota Living with Heart Failure Questionnaire （MLHFQ） score， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， angiotensin Ⅱ （Ang Ⅱ）， left ventricular ejection fraction （LVEF）， left ventricular end-diastolic diameter （LVIDd）， left ventricular end-systolic diameter （LVIDs）， interventricular septum thickness at diastole （IVSd）， left ventricular end-diastolic posterior wall thickness （LVPWd）， left ventricular shortening fraction （FS）， miR-423-5p， Smad7， Smad2， Smad3， Smad4， TGF-β₁， Ang Ⅱ， type Ⅰ collagen （Col Ⅰ）， type Ⅲ collagen （Col Ⅲ）， mRNA levels of fibronectin （Fn） and α-smooth muscle actin （α-SMA） in the myocardial tissue were observed before and after treatment in both groups to evaluate the efficacy of cardiac function and drug safety. ResultsAfter treatment， both groups showed declined levels of NT-proBNP， Ang Ⅱ， miR-423-5p， Smad2， Smad3， Smad4， TGF-β₁， Col Ⅰ， Col Ⅲ， and mRNA levels of Fn and α-SMA （P0.05）， and the levels of the indicators above were lower in the observation group than in the control group （P0.05）. After treatment， the Smad7 level increased obviously in both groups （P0.05） and was higher in the observation group than in the control group （P0.05）. After treatment， both groups showed decreased MLHFQ scores and increased 6-min walking distance （P0.05）， and the observation group had lower MLHFQ score and longer 6-min walking distance than the control group （P0.05）. After treatment， the control group showed increased LVEF and FS （P0.05） and the observation group showcased decreased LVIDd and LVIDs and increased LVEF and FS （P0.05）. Moreover， the observation group had lower LVIDd and LVIDs （P0.05） and higher LVEF and FS （P0.05） than the control group. The total response rate of cardiac function in the observation group was 90.38% （47/52）， which was higher than that （70.59%， 36/51） in the control group （P0.05）. No adverse reactions associated with Ershen Zhenwu Decoction were observed during the study period. ConclusionErshen Zhenwu Decoction can improve the cardiac function， exercise tolerance， and quality of life， regulate neuroendocrine factors， and slow down/reverse myocardial remodeling in the patients with HFrEF and HFmrEF （syndrome of heart-kidney Yang deficiency and blood stasis by regulating the miR-423-5p/Smad7/TGF-β₁/Smads axis， inhibiting α-SMA and Fn expression， and alleviating myocardial fibrosis. It is worthy of further study.

To guide transfusion practice in critically ill children who often need plasma and platelet transfusions, the Transfusion and Anemia Expertise Initiative-Control/Avoidance of Bleeding (TAXI-CAB) developed Recommendations and Expert Consensus for Plasma and Platelet Transfusion Practice in Critically Ill Children. This guideline addresses 53 recommendations related to plasma and platelet transfusion in critically ill children with 8 kinds of diseases, laboratory testing, selection/treatment of plasma and platelet components, and research priorities. This paper introduces the specific methods and results of the recommendation formation of the guideline.

Objective:To analyze the effect of high serum ferritin(SF)before transplantation on erythrocyte,granulocyte and platelet implantation in unrelated cord blood transplantation(UCBT)patients with myelodysplastic syndrome(MDS)and acute myeloid leukemia(AML).Methods:The medical records of 60 patients with MDS and AML who underwent UCBT in the First Affiliated Hospital of University of Science and Technology of China from January 2020 to December 2022 were retrospectively collected.According to the SF level before transplantation,they were divided into high SF group(SF ≥ 1 000 μg/L,n=20)and non-high SF group(SF＜1 000 μg/L,n=40).The red blood cell(RBC)infusion volume before transplantation,implantation time of RBC,granulocyte and platelet,implantation risk and prognosis were analyzed and compared between the two groups.Results:There was no correlation between the level of SF before transplantation and RBC infusion.After transplantation,the median implantation time of RBC in the high SF group was 28.5(14-149)d,which was longer than 21(10-83)d in the non-high SF group(P＜0.05).The median time of granulocyte engraftment in the high SF group was 16.5(12-63)d,while that in the non-high SF group was 16(12-49)d,with no statistical difference between the two groups(P＞0.05).The median platelet engraftment time in the high SF group was 45(12-206)d,while that in the non-high SF group was 35.5(14-149)d,with no statistical difference between the two groups(P＞0.05).Kaplan-Meier cumulative implantation probability analysis showed that the rate of erythroid implantation in the non-high SF group was higher than that in the high SF group(P＜0.05),while there was no significant difference in the rates of granulocyte and platelet implantation between the two groups(P＞0.05).The 1-year overall survival rates of the non-high SF group and high SF group were 95％and 90％,respectively,with no statistical difference between the two groups(P＞0.05).Conclusion:SF levels before cord blood transplantation in MDS and AML patients have an impact on post transplant erythroid implantation.Detecting and intervening of iron load in patients before transplant may be beneficial for improving implantation and prognosis.

Objective To analyze the practical value of spiral CT three-dimensional reconstruction techniquein evaluating triplane fractures of the distal tibia.Methods A retrospective analysis was conducted on183 patients with triplane fractures of the distal tibia admitted to Sichuan Orthopedic Hospital from January 2021 to March 2023.All patients underwent both X-ray and spiral CT examinations.Taking surgical reduction results as the gold standard for diagnosis,the diagnostic accuracies of X-ray examination and spiral CT three-dimensional reconstruction technique for triplane fractures of the distal tibia were analyzed.Results Fracture classification according to the number of fracture fragments showed that among the 183 patients with triplane fractures of the distal tibial,there were 44 cases of four-part fractures,62 cases of three-part fractures,and 77 cases of two-part fractures.The classification by the location of epiphyseal injury in the distal tibia showed 175 cases of lateral type and 8 cases of medial type.According to whether the fracture line involved the articular surface,they were categorized into 94 cases of type I,60 cases of type II,and 29 cases of type III.For the classification of the number of fracture fragments,X-ray misdiagnosed 9 cases of four-part fractures as three-part or two-part fractures,and 21 cases of three-part fractures as two-part fractures,resulting in a diagnostic accuracy of 83.60%.For theclassification of fracture line and articular surface position,X-ray led to misdiagnosis or inaccurate diagnosis in 39 cases,with a diagnostic accuracy of 78.69%.When spiral CT three-dimensional reconstruction technique was used to classify the number of fracture fragments,only 1 case of four-part fracture was misdiagnosed as three-part fracture,and 2 cases of three-part fractures were misdiagnosed as four-part fractures or two-part fractures,yielding a diagnostic accuracy of 98.36%.For the diagnosis of the positional relationship of the fracture line to the articular surface,spiral CT three-dimensional reconstruction technique had 8 misdiagnoses,with a corresponding diagnostic accuracy of 95.63%.Conclusion Spiral CT three-dimensional reconstruction technique can stereoscopically display the spatial information of the triplane fractures of the distal tibia,such as the location,shape,type,and articular surface,exhibiting high accuracy for classification diagnosis and significant application value in the reduction and treatment of triplane fractures of the distal tibia.

Objective To investigate the correlation of serum miR-146a-3p and miR-155-5p levels with the progression of allergic rhinitis(AR)patients and the efficacy of Dermatophagoides farinae drops.Methods From February 2023 to April 2024,115 patients with AR who visited our hospital were included as the rhinitis group,and were assigned into mild group(63 cases)and moderate-to-severe group(52 cases)according to the severity of their condition.Another 100 healthy individuals who experienced physical check-ups were selected as the healthy group.Patients with AR were treated with Dermatophagoides farinae drops and assigned into an effective group(87 cases)and an ineffective group(28 cases)based on the efficacy.ELISA method was used to detect serum specific immunoglobulin E(IgE)level;RT-qPCR was used to detect the relative expression levels of serum miR-146a-3p and miR-155-5p.The total nasal symptom score(TNSS)and visual analogue scale(VAS)were used to assess the severity of clinical symptom;Pearson method was used to analyze the correlation of serum miR-146a-3p,miR-155-5p with IgE,VAS and TNSS;ROC was used to analyze the predictive value of serum miR-146a-3p and miR-155-5p for the progression of AR and the efficacy of Dermatophagoides farinae drops.Results The serum miR-146a-3p and miR-155-5p levels in the rhinitis group were higher than those in the healthy group(P＜0.05);the VAS,TNSS,IgE level,miR-146a-3p and miR-155-5p levels in the moderate-to-severe group were higher than those in the mild group(P＜0.05).Serum miR-146a-3p and miR-155-5p were positively correlated with IgE level,VAS and TNSS(P＜0.05).The AUC of serum miR-146a-3p combined miR-155-5p in predicting the progression of AR was higher than that of serum miR-146a-3p or miR-155-5p alone(Zcombination-miR-146a-3p=2.344,P=0.019,Z combination-miR-155-5p=2.335,P=0.020).Before treatment,the serum miR-146a-3p and miR-155-5p levels in the effective group were lower than those in the ineffective group.After treatment,the serum miR-146a-3p and miR-155-5p levels were decreased in the ineffective and effective groups,especially in the effective group(P＜0.05).The AUC of the combination of serum miR-146a-3p and miR-155-5p in predicting the efficacy of Dermatophagoides farinae drops was higher than that of serum miR-146a-3p or miR-155-5p alone(Z combination-miR-146a-3p=2.277,P=0.023,Z combination-miR-155-5p=2.268,P=0.023).Conclusion The levels of serum miR-146a-3p and miR-155-5p in patients with AR are elevated and closely related to the severity of clinical symptoms and IgE level.Combined detection of serum miR-146a-3p and miR-155-5p can predict the progression of AR and the efficacy or treatment response of Dermatophagoides farinae drops.

Objective To investigate the relationship between serum cystatin C(CysC)level and the risk of Parkinson's disease(PD)in middle-aged and elderly people in China.Methods Based on the baseline survey data from the China Health and Retirement Longitudinal Study(CHARLS)in 2011,participants who were not diagnosed with PD at the time of the baseline survey were recruited.The onset of PD was tracked and followed up until 2020,and the participants were divided into PD group and non-PD group according to whether they were newly diagnosed with PD in 2020.Multivariable Logistic regression analysis was performed to assess the association between serum CysC level and the risk of PD.Subgroup and interaction analyses were performed to assess effect modifications by age,gender and depression.Additionally,restricted cubic spline(RCS)was used to explore the linear or non-linear relationship between serum CysC level and the risk of PD in different subgroups.Results We included a total of 3 339 subjects in this study,who consisted of 1 495 males(44.77％)and 1 844 females(55.23％).While baseline participants were followed until 2020,32 subjects had a new PD,and the incidence of PD was 0.96％.The median age of PD group was 63.00 years.Multivariable Logistic regression analysis found that CysC was an independent risk factor for the risk of PD,and CysC was positive significantly associated with the risk of PD(OR=2.34,95％ CI:1.14-4.82,P=0.021).Subgroup analysis showed that CysC was positively associated with PD in females(OR=2.70,95％ CI:1.30-5.58,P=0.007)and subjects aged 60 years or older(OR=5.29,95％ CI:1.69-16.53,P=0.004).RCS model indicated a linear relationship between serum CysC level and the risk of PD in females(Ptotal=0.018,Pnon-linear=0.062)and subjects aged 60 years or older(Ptotal=0.024,Pnon-linear=0.379).Conclusion High level of CysC may increase the risk of PD in middle-aged and elderly people,especially in females and those aged 60 years or older.

Objective:To observe the therapeutic effect of Edaravone Dexborneol combined with aspirin and clopidogrel in the treatment of acute ischemic stroke(AIS).Methods:82 AIS patients were randomly divided into control group(treated with aspirin and clopidogrel,n=41)and observation group(treated with Edaravone Dexborneol on the basis of control group,n=41)by random number table method.National Institutes of Health Stroke Scale(NIHSS),Montreal Cognitive Assessment Scale(MoCA),Barthel Index(BI),serum biochemical indicators[neuron specific enolase(NSE),superoxide dismutase(SOD),brain-derived neurotrophic factor(BDNF),malondialdehyde(MDA)],intracranial hemodynamic indicators[bilateral anterior cerebral artery(ACA),bilateral middle cerebral artery(MCA),bilateral posterior cerebral artery(PCA)],and incidence of adverse reactions during treatment were compared between the two groups.Results:The total clinical effective rate,MoCA,BI score,BDNF,SOD,and the average flow rates of ACA,MCA,and PCA in the observation group 14 d after treatment were higher than those in control group,NIHSS score,NSE,and MDA were lower than those in control group(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion:Edaravone Dexborneol combined with aspirin and clopidogrel in AIS treatment can significantly improve intracranial hemodynamics,regulate nerve factors,reduce nerve function damage,and has good safety.

Objective To investigate the correlation of serum miR-146a-3p and miR-155-5p levels with the progression of allergic rhinitis(AR)patients and the efficacy of Dermatophagoides farinae drops.Methods From February 2023 to April 2024,115 patients with AR who visited our hospital were included as the rhinitis group,and were assigned into mild group(63 cases)and moderate-to-severe group(52 cases)according to the severity of their condition.Another 100 healthy individuals who experienced physical check-ups were selected as the healthy group.Patients with AR were treated with Dermatophagoides farinae drops and assigned into an effective group(87 cases)and an ineffective group(28 cases)based on the efficacy.ELISA method was used to detect serum specific immunoglobulin E(IgE)level;RT-qPCR was used to detect the relative expression levels of serum miR-146a-3p and miR-155-5p.The total nasal symptom score(TNSS)and visual analogue scale(VAS)were used to assess the severity of clinical symptom;Pearson method was used to analyze the correlation of serum miR-146a-3p,miR-155-5p with IgE,VAS and TNSS;ROC was used to analyze the predictive value of serum miR-146a-3p and miR-155-5p for the progression of AR and the efficacy of Dermatophagoides farinae drops.Results The serum miR-146a-3p and miR-155-5p levels in the rhinitis group were higher than those in the healthy group(P＜0.05);the VAS,TNSS,IgE level,miR-146a-3p and miR-155-5p levels in the moderate-to-severe group were higher than those in the mild group(P＜0.05).Serum miR-146a-3p and miR-155-5p were positively correlated with IgE level,VAS and TNSS(P＜0.05).The AUC of serum miR-146a-3p combined miR-155-5p in predicting the progression of AR was higher than that of serum miR-146a-3p or miR-155-5p alone(Zcombination-miR-146a-3p=2.344,P=0.019,Z combination-miR-155-5p=2.335,P=0.020).Before treatment,the serum miR-146a-3p and miR-155-5p levels in the effective group were lower than those in the ineffective group.After treatment,the serum miR-146a-3p and miR-155-5p levels were decreased in the ineffective and effective groups,especially in the effective group(P＜0.05).The AUC of the combination of serum miR-146a-3p and miR-155-5p in predicting the efficacy of Dermatophagoides farinae drops was higher than that of serum miR-146a-3p or miR-155-5p alone(Z combination-miR-146a-3p=2.277,P=0.023,Z combination-miR-155-5p=2.268,P=0.023).Conclusion The levels of serum miR-146a-3p and miR-155-5p in patients with AR are elevated and closely related to the severity of clinical symptoms and IgE level.Combined detection of serum miR-146a-3p and miR-155-5p can predict the progression of AR and the efficacy or treatment response of Dermatophagoides farinae drops.