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 evaluate the efficacy of intravesical electrical stimulation (IVES) and low-intensity extracorporeal shock wave therapy (Li-ESWT) in improving bladder emptying function in female patients with non-obstructive detrusor underactivity (NODU), and to further assess the clinical value of an individualized integrated treatment strategy guided by reinforcement learning (RL) optimization. Methods A total of 98 female patients diagnosed with NODU by urodynamic testing at the Department of Urology, the Second People's Hospital of Hefei, duirng Jun.2023 and Feb.2025 were prospectively enrolled. Patients were randomly assigned (1∶1∶1) to three groups:the IVES group (n=33), the Li-ESWT group (n=35), and the RL group (n=30). Clinical outcomes before and after the 4-week treatment were compared among the three groups, including peak detrusor pressure during urination (PdetQmax), maximum urinary flow rate (Qmax), post-void residual (PVR), bladder contractility index (BCI), patient perception of bladder condition-scale (PPBC-S), incontinence impact questionnaire-short form 7 (IIQ-7), urogenital distress inventory-short form 6 (UDI-6), total efficiency and satisfaction.A RL model was trained based on clinical data, with a model structure diagram and reward convergence curve plotted to validate the utility of the RL system in optimizing individualized treatment parameters. Results There were no statistically significant differences in baseline characteristics among the three groups (P>0.05). After 4 weeks of treatment, all groups demonstrated significant improvements in PdetQmax, Qmax, and BCI, along with significant reductions in PVR, PPBC-S, IIQ-7, and UDI-6 scores (all P<0.01). Notably, the RL group exhibited significantly greater improvements in PdetQmax, Qmax, and BCI, and more pronounced reductions in PVR, PPBC-S, IIQ-7, and UDI-6 scores than the IVES and Li-ESWT groups (all P<0.05). Specifically, the RL group showed the most substantial improvements in Qmax, PVR, and BCI than the other two groups (all P<0.01). The total effective rate in the RL group was 90.0% (27/30), which was higher than that of the IVES group (81.8%,27/33) and the Li-ESWT group (77.1%,27/35), but the differences were not statistically significant (χ =2.63, P=0.27). The Li-ESWT group had a satisfaction rate of 51.4% (18/35), which was higher than that of the RL group (30.0%,9/30) and the IVES group (27.3%,9/33), but the differences were not statistically significant (χ =6.76, P=0.34). No serious adverse events were observed in any group. After approximately 200 iterations, the reward value of the RL agent stabilized, and the individualized treatment parameters recommended further optimized bladder emptying efficiency. Conclusion Compared to IVES and Li-ESWT, the RL-optimized individualized comprehensive treatment strategy can significantly improve the bladder emptying function in women with NODU.

Objective: To analyze the results of national external quality assessment (EQA) for transfusion compatibility test from 2018 to 2023, with the aim of providing references for improving laboratory testing quality and ensuring the safety of clinical blood transfusion. Methods: Three EQA programs were conducted annually, each distributing 22 quality assessment samples. Participating transfusion laboratories were required to complete testing within specified deadlines and to submit results along with documentation of testing methodologies, reagents, and equipment used. National Center for Clinical Laboratories (NCCL) conducted statistical analysis of laboratory results, evaluated testing outcomes and related circumstances, and provided feedback to participating laboratories. EQA data from transfusion laboratories across China from 2018 to 2023 were collected and systematically analyzed. Results: From 2018 to 2023, the qualification rates for all five items (ABO forward typing, ABO reverse typing, Rh blood group typing, antibody screening, and cross-matching) were 67.59%, 77.11%, 77.38%, 72.78%, 79.96%, and 85.16%, respectively. The mean qualification rates for ABO forward typing, ABO reverse typing, RhD blood group typing, antibody screening, and cross-matching over the past six years were 96.25%±0.59%, 90.45%±4.52%, 96.05%±0.71%, 90.88%±2.86%, and 88.34%±3.48%, respectively. The qualification rates in 2019, 2020, 2022, and 2023 all showed a stable trend of "blood stations>tertiary hospitals>secondary hospitals". The mean qualification rate of laboratories in secondary hospitals from 2018 to 2023 was significantly lower than those of laboratories in tertiary hospitals and blood stations (P<0.05), while no significant difference was observed between laboratories in tertiary hospitals and blood stations (P>0.05). The micro column agglutination method was the most widely used in all five tests. In the four test items, namely ABO forward typing, ABO reverse typing, antibody screening, and cross-matching, there was a statistically significant difference in the qualification rate of micro column agglutination method compared to other methods (P<0.05). There was a statistical difference in the qualification rate between manual and automated detection using micro column agglutination method in the cross-matching tests (P<0.05), whereas no significant difference was noted for the other test items (P>0.05). Conclusion: From 2018 to 2023, the number of laboratories participating in EQA activities has been increasing year by year, and the qualification rate has shown an overall upward trend. The type of laboratory is a key factor affecting the qualification rate, and the testing capabilities of some laboratories still need to be improved. The micro column agglutination method is widely used in transfusion compatibility tests. The established EQA program effectively monitors quality issues in laboratories, drives continuous improvement, and ensures sustained enhancement of testing standards to safeguard clinical blood safety.

Objective:To establish a method for determination of fluoride in water using a fully automated biochemical analyzer (abbreviated as this method).Methods:Based on the parameters of the fully automatic biochemical analyzer, appropriate reagent volumes and reaction time were optimized to determine fluoride ions in water within the standard curve range (0.0 - 2.0 mg/L). The method was validated through evaluation of linear range, detection limit, precision, accuracy, and comparative analysis with the manual measurement results of fluoride reagent spectrophotometric method specified in the "Standard Examination Methods for Drinking Water - Part 5: Inorganic Nonmetallic indices" (GB/T 5750.5-2023).Results:Within the range of 0.0 - 2.0 mg/L fluoride mass concentration, the absolute values of the correlation coefficients were > 0.999 0 and the detection limit of this method was 0.082 mg/L. The relative standard deviation for the determination of fluoride level in water samples with low, medium and high fluoride mass concentrations was 4.03%, 2.16% and 1.68%, respectively. The spiked recovery rates were 98.1%, 99.5%, and 100.2%, respectively. There was no statistically significant difference between the results obtained by this method and manual measurement ( t = 1.07, P = 0.295). Conclusion:This method exhibits high sensitivity, accuracy, and efficiency in detecting fluoride, enabling rapid sample detection through instrumental automation instead of manual operation.

Objective To observe the effect of Buyang Huanwu Decoction combined with Tirofiban on cerebral oxygen metabolism and neurological function in patients with ischemic stroke.Methods A total of 110 patients with ischemic stroke of qi deficiency and blood stasis type who were treated at Rizhao Central Hospital from October 2022 to October 2024 were selected.The patients were randomly divided into a control group and a combined group using a random number table,with 55 patients in each group.The control group received intravenous infusion of Tirofiban,while the combined group was given additional Buyang Huanwu Decoction orally on the basis of treatment for the control group.The course of treatment for both groups covered 2 weeks.Before and after treatment,the changes in traditional Chinese medicine(TCM)syndrome scores,National Institutes of Health Stroke Scale(NIHSS)scores,oxidative stress response,neurological function,platelet function,and indicators associated with cerebral oxygen metabolism in both groups were observed.Results(1)After treatment,the scores of TCM syndromes of sudden dizziness,hemiplegia,shortness of breath and fatigue,and pale and dull complexion were decreased in both groups compared with those before treatment(P＜0.05),and the decrease in the combined group was significantly superior to that in the control group(P＜0.01).(2)After treatment,the levels of serum oxidative stress response indicators of glutathione peroxidase(GSH-Px)and superoxide dismutase(SOD)were increased(P＜0.05),while the levels of serum oxidized low-density lipoprotein(ox-LDL)and malondialdehyde(MDA)were decreased(P＜0.05)in both groups compared with those before treatment.The combined group showed more significant increase in serum GSH-Px and SOD levels and more significant decrease in serum ox-LDL and MDA levels than the control group(P＜0.01).(3)After treatment,the platelet function indicators of platelet aggregation rate and platelet adhesion rate were decreased in both groups compared with those before treatment(P＜0.05),and the decrease in the combined group was significantly superior to that in the control group(P＜0.01).(4)After treatment,arterial oxygen content(CaO2)was increased(P＜0.05),while the levels of cerebral oxygen extraction rate(ERO2),and cerebral arteriovenous oxygen content difference[D(a-jv)O2]were decreased in both groups compared with those before treatment(P＜0.05),and the changes of the levels in the combined group were more obvious than those in the control group(P＜0.01).(5)Ater treatment,the neurological function indicators of NIHSS scores and serum neuron-specific enolase(NSE)level were decreased in both groups compared with those before treatment(P＜0.05),while the levels of serum brain-derived neurotrophic factor(BDNF)and nerve growth factor(NGF)were increased(P＜0.05).The combined group showed significant decrease in NIHSS scores and serum NSE level and significant increase in serum BDNF and NGF levels compared to the control group(P＜0.01).Conclusion For the treatment of patients with qi deficiency and blood stasis type of ischemic stroke,Buyang Huanwu Decoction combined with Tirofiban is effective on reducing TCM syndrome scores,improving cerebral oxygen metabolism and neurological function indicators,and inhibiting oxidative stress response,with significant therapeutic effects.

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.

Respiratory viral infections such as influenza and respiratory syncytial virus infections continue to rapidly increase in patients worldwide.Host immune responses to respiratory viruses play a key role in the pathogenesis and clinical manifestations of the disease.Respiratory viruses not only activate antiviral immune responses,but also may lead to uncontrolled inflammatory re-sponses,characterized by significant release of pro-inflammatory cytokines in severely infected patients,resulting in lymphopenia,lymphocyte dysfunction,and abnormalities in immune cells such as neutrophils and macrophages.These respiratory virus-induced im-mune abnormalities may lead to microbial infection,septic shock,and severe multiorgan dysfunction.Therefore,clarifying the immu-nopathogenic mechanisms of patients with respiratory viral infections can guide clinical treatment and patient prognosis;in addition,rational regulation of the immune response of respiratory viruses in the host,including enhancing antiviral immunity while suppressing systemic inflammation,may be the key to successful treatment.This review mainly discusses the immunomodulation and related clini-cal treatment strategies for respiratory viral infections to help develop new therapeutic strategies for respiratory viral infections and pa-tient prognosis.

Objective:To establish a method for determination of fluoride in water using a fully automated biochemical analyzer (abbreviated as this method).Methods:Based on the parameters of the fully automatic biochemical analyzer, appropriate reagent volumes and reaction time were optimized to determine fluoride ions in water within the standard curve range (0.0 - 2.0 mg/L). The method was validated through evaluation of linear range, detection limit, precision, accuracy, and comparative analysis with the manual measurement results of fluoride reagent spectrophotometric method specified in the "Standard Examination Methods for Drinking Water - Part 5: Inorganic Nonmetallic indices" (GB/T 5750.5-2023).Results:Within the range of 0.0 - 2.0 mg/L fluoride mass concentration, the absolute values of the correlation coefficients were > 0.999 0 and the detection limit of this method was 0.082 mg/L. The relative standard deviation for the determination of fluoride level in water samples with low, medium and high fluoride mass concentrations was 4.03%, 2.16% and 1.68%, respectively. The spiked recovery rates were 98.1%, 99.5%, and 100.2%, respectively. There was no statistically significant difference between the results obtained by this method and manual measurement ( t = 1.07, P = 0.295). Conclusion:This method exhibits high sensitivity, accuracy, and efficiency in detecting fluoride, enabling rapid sample detection through instrumental automation instead of manual operation.

Objective: To design and establish a new method for flow cytometry-based detection of commonly observed highly expressed antigens on red blood cells, and to further evaluate the differences and distribution characteristics of antigen expression levels between ABO blood type homozygotes and heterozygotes in healthy individuals. Methods: Residual blood samples after donor blood type identification by Shanghai Blood Center in April 2024 were collected. Among them, samples of 19 homozygous and 19 heterozygous individuals of type A and type B were selected. Then the expression level of ABO antigen on red blood cells were detected using the new method established in this study and the traditional aldehyde fixed red blood cell method. Both methods were tested independently three times and the results were compared. Results: The mean values of the three detection results of the new method was (×10 /RBC): AA homozygous 3.3±0.5, AO heterozygous 2.8±0.3, BB homozygous 3.6±0.3, BO heterozygous 3.1±2.8. The mean values of the three detection results of the aldehyde fixation method were AA homozygous 5.9±0.9, AO heterozygous 5.0±1.4, BB homozygous 3.8±0.6, and BO heterozygous 3.3±0.4. The average antigen distribution of each genotype followed a normal distribution. Comparing the average antigen expression levels of homozygotes and heterozygotes, both methods showed that A/B homozygotes had higher antigen levels than heterozygotes, with AA being 1.17 to 1.18 times that of AO and BB being 1.15 to 1.16 times that of BO. Comparing the inter batch differences in the three test results of two methods, the new method showed no significant difference in the three test results for four genotypes (P>0.05). The aldehyde fixation method showed significant differences in the test results for all three genotypes (P<0.01) except for BB homozygotes (P>0.05). The reliability and reproducibility of the new method were better than those of the traditional aldehyde fixation method. Conclusion: The antigen expression level of ABO homozygotes is higher than that of heterozygotes, and the difference in antigen level between type A homozygotes and heterozygotes is slightly higher than that of type B. The new method is superior to traditional aldolization fixation methods.