This article provides a systematic interpretation and review of the Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design. Developed based on the Grading of Recommendations Assessment, Development and Evaluation methodology, the guideline address five core themes: ICU layout, room design, infection control, infrastructure, and staff spaces, and put forward 17 evidence-based recommendations, including 5 good practice statements. This article briefly introduces the guideline development methods and evidence characteristics, and focuses on summarizing key recommendations, including high-visibility layouts, single-bed ward settings, natural lighting and noise reduction strategies, integrated infection prevention and control design, remote monitoring, and flexible capacity expansion capabilities. Furthermore, it delves into the applicability and localized implementation pathways within China's healthcare environment, analyzing limitations in terms of evidence quality, specialty applicability, and cost-effectiveness. Furthermore, by integrating the Chinese Guidelines for the Construction and Development of Critical Care Medicine (2025 Edition) and current domestic practices, the article proposes tiered and phased implementation recommendations. This article aims to provide domestic healthcare institutions with a scientific reference that balances international cutting-edge concepts with China's real-world conditions for the construction and renovation of ICUs, thereby promoting the development of intensive care environments centered on patient safety, healthcare worker well-being, and infection control.

OBJECTIVE To assess the bleeding risk signals associated with the concomitant use of direct oral anticoagulants （DOACs） and triazole antifungals， and to provide pharmacovigilance evidence for the safety evaluation and monitoring of combined clinical use. METHODS Adverse event reports involving the concomitant use of DOACs and triazole antifungals were extracted from the US FDA Adverse Event Reporting System （FAERS） from the first quarter of 2004 to the third quarter of 2025. Nine bleeding-related preferred terms （PTs） were selected. The Ω shrinkage measure， additive model， multiplicative model， and combined risk ratio method were employed to detect drug-drug interaction signals. The strength of positive signals was further analyzed based on the Ω shrinkage measure. RESULTS A total of 790 adverse event reports involving the concomitant use of DOACs and triazole antifungals were included， among which 229 reports involved nine bleeding-related PTs. A total of 13 signals were consistently identified as posit ive by all four methods. These signals involved six drug combinations： apixaban-fluconazole， apixaban-posaconazole， rivaroxaban-itraconazole， dabigatran etexilate-fluconazole， apixaban-voriconazole， and dabigatran etexilate-itraconazole. The Ω shrinkage measure showed that the apixaban-posaconazole combination exhibited stronger signals for bleeding （ Ω ＝2.73， Ω 025 ＝2.05） and hemoptysis （ Ω ＝2.17， Ω 025 ＝0.83）； the apixaban-fluconazole combination exhibited stronger signals for hematoma （ Ω ＝2.30， Ω 025 ＝1.47） and hematuria （ Ω ＝1.71， Ω 025 ＝0.74）； the rivaroxaban-itraconazole combination exhibited stronger signals for epistaxis （ Ω ＝2.01， Ω 025 ＝0.90） and hematoma （ Ω ＝1.93， Ω 025 ＝0.42）； no positive Ω signals were observed for intracranial hemorrhage or upper gastrointestinal hemorrhage. CONCLUSION S This study suggests that the concomitant use of DOACs and triazole antifungals may increase the risk of bleeding-related events， with differences in signal strength and signal distribution across various drug combinations. In clinical practice， particular attention should be paid to the concomitant use of apixaban or rivaroxaban with strong cytochrome P450 3A4 or P-glycoprotein inhibitors such as posaconazole and itraconazole. For other DOAC-triazole antifungal combinations， close monitoring for bleeding-related manifestations and timely adjustment of anticoagulation or antifungal regimens are also warranted.

Objective: To validate the performance of the Procleix UltrioPlex E assay (Grifols, Spain) on the Procleix Panther automated nucleic acid detection platform, which employs the TMA method to simultaneously detect HIV-1/HIV-2/HCV/HBV/HEV viruses, and to evaluate its value for screening transfusion-associated infectious diseases. Methods: In accordance with the requirements of ISO15189"Application of the Guidelines for the Accreditation of Quality and Capabilities of Medical Laboratories in the Field of Molecular Diagnostics (CNAS-CL02-A009: 2018)", "Guidelines for Performance Validation of Molecular Diagnostic Testing Procedures (CNAS-GL039: 2019)", and the "Technical Operating Procedures for Blood Banks (2019 Edition)", this study validated the reagent's performance in terms of analytical sensitivity validation, performance consistency validation, interference resistance, and cross-contamination resistance. Results: Probit analysis revealed that the 95% detection limits (95% confidence interval) for HBV, HCV, HIV, and HEV were 2.0 IU/mL, 1.5 IU/mL, 18.0 IU/mL and 3.7 IU/mL, respectively, which were consistent with the minimum detection limits stated in the kit's package insert and were comparable to the Procleix Ultrio Elite kit. Both kits were used to test the performance validation serum plate simultaneously, yielding results consistent with the serum plate (Kappa=1), indicating stable performance. Detection of medium-and low-concentration lipemia and weakly positive hemolysis samples demonstrated good interference resistance. Cross-contamination performance validation showed that the kit exhibited excellent cross-contamination resistance. Conclusion: The Procleix UltrioPlex E nucleic acid detection kit enables combined detection of HIV-1, HIV-2, HCV, HBV, and HEV, allowing single-test screening for multiple viruses in donor blood. The kit's analytical performance is stable and meets basic laboratory requirements, making it suitable for screening transfusion-associated infectious diseases in blood banks.

Objective:To analyze the effects of different doses of butorphanol on prolactin, serotonin and lipid hydrogen peroxide after cesarean section.Methods:A total of 124 women who underwent cesarean section in the Affiliated Hospital of Jining Medical University from January 2023 to January 2024 were prospectatively selected as study subjects, and divided into the study group 1 (41 cases), study group 2 (41 cases) and study group 3 (42 cases) according to random number table method. All three groups underwent patient-controlled analgesia after surgery, and 0.2 mg fentanyl was used as analgesic drug. However, the doses of butorphanol were 100 mg/L in the study group 1, 120 mg/L in the study group 2, and 140 mg/L in the study group 3. The level of PRL and first lactation time before and after surgery were compared among the three groups at different time points, serotonin and LHP levels were compared among the three groups at different time points after surgery, Ramsay and visual analog scale (VAS) scores were compared among the three groups at different time points after surgery, and the occurrence of adverse reactions and satisfaction with analgesic effect were compared among the three groups.Results:At 24, 48 and 72 h after operation, the level of PRL in the study group 3 was higher than that in the study group 2 and study group 1: (383.02 ± 47.57) μg/L vs. (376.39 ± 46.83), (302.88 ± 41.38) μg/L; (412.38 ± 40.22) μg/L vs. (394.82 ± 38.30), (315.09 ± 37.93) μg/L; (434.39 ± 39.39) μg/L vs. (427.48 ± 40.27), (344.39 ± 42.78) μg/L, there were statistical differences ( P<0.05). The first lactation time in the study group 2 and study group 3 was lower than that in the study group 1: (50.31 ± 6.52), (49.54 ± 6.27) h vs. (53.91 ± 8.42) h, there was statistical difference ( P<0.05). At 2 h (T 1), 12 h (T 2), 24 h (T 3) and 48 h (T 4) after surgery, the levels of serotonin in the study group 3, study group 2 and study group 1 were increased successively, and the levels of LHP were decreased successively, there were statistical differences ( P<0.05). At 30 min after surgery (T 0), T 1, T 2, T 3 and T 4, the Ramsay score in the study group 3, study group 2 and study group 1 were increased successively, and the VAS score were decreased successively, there were statistical differences ( P<0.05). There was no significant difference in the incidence of adverse reactions among the three groups ( P>0.05). The total satisfaction of study group 3 was higher than that of study group 2 and study group 1: 92.86%(39/42) vs. 73.17%(30/41), 68.29%(28/41), there was statistical difference ( Z = 2.52, P = 0.008). Conclusions:Butorphanol 140 mg/L has a more significant analgesic effect after cesarean section, and can improve the levels of serum PRL, serotonin and LHP, reduce the occurrence of adverse reactions, and improve the satisfaction of analgesia

BACKGROUND:Cannabidiol has anti-inflammatory,antioxidant,and other pharmacological effects,and has no mental activity,so the research in liver disease is increasing day by day,but its effect on transforming growth factor-β1/Smad signal transduction pathway in hepatic stellate cells is not clear.OBJECTIVE:To investigate the effect of cannabidiol on transforming growth factor-β1/Smad signal transduction pathway in hepatic stellate cells and its possible mechanism of anti-hepatic fibrosis.METHODS:(1)In vitro experiment:Rat hepatic stellate cell line(HSC-T6)was selected and cultured in six groups.The control group was routinely cultured for 24 hours.The simple drug group was cultured with cannabidiol for 24 hours.The modeling group was cultured with transforming growth factor β1 for 24 hours.The modeling+low-dose drug group,the modeling+high-dose drug group,and the modeling+positive control group were cultured with transforming growth factor β1 for 24 hours,1,5 μmol/L cannabidiol and silymarin were cultured for 24 hours.After culture,the mRNA expression of α-smooth muscle actin and type Ⅰ collagen,the levels of interleukin 1β and tumor necrosis factor α,and the protein expression of type Ⅰ collagen and transforming growth factor β1/Smad signal transduction pathway were detected in each group.(2)In vivo experiments:C57BL/6J mice were randomly divided into five groups with eight mice in each group.Models were not established in the sham operation group.The liver fibrosis models were established by biliary ligation in the modeling group,the modeling+low-dose drug group,the modeling+high-dose drug group,and the modeling+positive control group.At 3 weeks after the modeling,4,8 mg/kg cannabidiol or silymarin were injected intraperitoneally,once a day,for 7 consecutive days.After administration,the liver function,liver pathological morphology,expression levels of α-smooth muscle actin,type Ⅰ collagen,and transforming growth factor β1/Smad signal transduction pathway related protein were detected in each group.RESULTS AND CONCLUSION:(1)In vitro experiment:Compared with the control group,mRNA expression of α-smooth muscle actin and type Ⅰ collagen,interleukin 1β and tumor necrosis factor α,and protein expression of type Ⅰ collagen,transforming growth factor β1 and p-Smad2/3 in HSC-T6 cells were increased(P<0.05),while Smad7 protein expression was decreased(P<0.05)in the modeling group.Two doses of cannabidiol could improve the above changes in HSC-T6 cells induced by transforming growth factor β1,and the improvement was more obvious in the modeling+high-dose drug group.(2)In vivo experiment:Compared with sham operation group,the activities of serum alanine aminotransferase and aspartate aminotransferase were increased(P<0.05),inflammatory cell infiltration and collagen content in liver tissue were increased(P<0.05),and the transforming growth factor β1/Smad signal transduction pathway was activated;α-smooth muscle actin and type Ⅰ collagen expression levels were increased(P<0.05)in the modeling group.Two doses of cannabidiol could reduce the changes of the above indexes in the modeling mice,and the effect was more obvious in the modeling+high-dose drug group.(3)It is indicated that cannabidiol inhibits hepatic fibrosis by suppressing the activation of transforming growth factor-β1/Smad signal transduction pathway in hepatic stellate cells.

Objective To construct a comprehensive cost management index system for public hospitals.Methods Literature review,policy analysis,and the Delphi expert consultation method were used to establish the index system.Data from a tertiary grade A public hospital in Beijing from 2019 to 2024 were analyzed.Results The response rate for both rounds of expert consultation was 100％,indicating high expert engagement.The average authority level of the experts was 0.905.x2 tests of Kendall's W coefficient for the importance,operability,and sensitivity of the indicators yielded P＜0.001.A comprehensive cost management system comprising 5 dimensions and 13 indicators was established.Conclusion The constructed comprehensive cost management index system for public hospitals is scientifically sound and highly reliable.It enables effective cost control,risk warning,and continuous improvement,laying a solid foundation for the comprehensive advancement of cost management efforts.

Objective:To construct an evaluation system for the operation quality of the equipment of the urological department based on the pressure-state-response(PSR)model,so as to explore it's application effect in the evaluation for the operation quality of the equipment of urological department.Methods:Based on the PSR model,the analytic hierarchy process was used to determine the weights of index,and the fuzzy evaluation method was adopted to evaluate the management efficiency for equipment.A total of 160 devices of clinical use in the Urological Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2022 to January 2024 were selected.According to different management modes,the random number table was adopted to equally distribute these devices into conventional management mode(80 devices)and management mode with evaluation system(model evaluation)for operation quality of the equipment of the urological department(80 devices).A self-made questionnaire was used to investigate the satisfaction of the usage managers in the urological department and operation room,department of medical equipment,and department of managing infection for the clinical services of the two kinds of management modes.The infection situations,management quality of equipment operation,and the score of operation quality in using equipment between two kinds of management modes were compared.Results:The average repair rate of equipment failure,risk rate of infection,inefficiency rate of cleaning,and problem rate of quality inspection in the management mode with model evaluation were respectively(1.58±0.69)%,(1.98±0.69)%,(1.10±0.78)%and(1.01±0.70)%,all of which were lower than those in the conventional management mode,and the differences of them were statistically significant(t=7.879,6.663,7.863,14.601,P<0.05).In the 120 patients who adopted the management mode with model evaluation,the infection rates of using equipment in laparoscopic minimally invasive surgery,endoscopic surgery for stone,resectoscopic surgery and flexible ureteroscope were respectively 2.50%,3.33%,4.17%and 3.33%,all of which were lower than those in the conventional management mode,and the differences between the two kinds of modes were statistically significant(x2=6.696,6.916,5.154,7.101,P<0.05).The scores of the standardization of using equipment,effectiveness of cleaning and disinfection,recognition of emergency management,and qualification of controlling infection in the management mode with model evaluation were significantly higher than those in the conventional management mode,and the differences were statistically significant(t=22.198,11.806,9.385,18.071,P<0.05).The satisfaction scores of the managers involved in using equipment in the operation room of urology,department of medical equipment and department of managing infection for the management mode with model evaluation were all higher than those of the conventional management mode,and the differences were statistically significant(t=14.426,14.916,14.707,P<0.05).Conclusion:The quality evaluation system of equipment operation of the urological department based on the PSR model can reduce the failure rate of equipment,and improve the usage efficiency of equipment,and ensure the medical safety of patients.

AIM To explore the clinical effects of oral administration and enema of Tongfu Paiqi Mixture on patients with acute exacerbation of chronic obstructive pulmonary disease complicated with gastrointestinal dysfunction.METHODS One hundred and eight patients were randomly assigned into control group(54 cases)for 5-day intervention of both oral administration and enema of Tongfu Paiqi Mixture simulant and conventional treatment,and observation group(54 cases)for 5-day intervention of both oral administration and enema of Tongfu Paiqi Mixture and conventional treatment.The changes in clinical effects,GIDS score,Phlegm and Blood Stasis Obstructing Lung Syndrome score,gastrointestinal mucosal barrier serum markers(DAO,D-LA,IFABP),intra-abdominal pressure,gastrointestinal hormones(MTL,GAS,VIP),inflammatory factors(IL-1β,IL-6,TNF-α,PCT),pulmonary function indices(FEV1、FEV1％)and PaO2/FiO2 were detected.RESULTS The observation group demonstrated higher total effective rate than the control group(P＜0.05).After the treatment,the two groups displayed decreased GIDS score,Phlegm and Blood Stasis Obstructing Lung Syndrome score,intra-abdominal pressure,VIP,gastrointestinal mucosal barrier serum markers,inflammatory factors(P＜0.05),and increased MTL,GAS,pulmonary function indices,PaO2/FiO2(P＜0.05),especially for the observation group(P＜0.05).CONCLUSION For the patients with acute exacerbation of chronic obstructive pulmonary disease complicated with gastrointestinal dysfunction,the oral administration and enema of Tongfu Paiqi Mixture can regulate gastrointestinal hormones,reduce inflammatory degree,protect intestinal barrier functions,alleviate clinical symptoms,and improve pulmonary functions.

Objective To prepare a group A rotavirus(RVA)antigen detection kit and evaluates its performance,providing an effec-tive means for rapid detection of rotavirus(RV).Methods In this study,colloidal gold nanoparticles(AuNPs)were used to label Rab-bit anti-G1P[8]Ab1.The Goat anti-G1P[8]Ab2 and Goat Anti-Rabbit IgG were respectively coated on the detection line(T line)and quality control line(C line)of nitrocellulose membrane(NC membrane).The absorbent paper,NC membrane,binding pad,and sample pad were assembled onto a PVC substrate in sequence and cut into 3.75mm strips.They were then installed into an adapter car-tridge to establish a RVA antigen detection kit.National reference standards for rotavirus antigen detection and reference standards pre-pared by our laboratory were used to investigate the sensitivity,specificity,inclusiveness,high-dose hook effect,stability,repeatability,and compare and evaluate similar testing kits available for sale.Results Sensitivity:when tested with national reference substance L,the lowest detection limit is diluted 1∶128 times,which was equivalent to the virus content level of the lowest detection limit concentration of enterprise reference substance 1 × 104pfu/ml or 2344copies/ml,the sensitivity was about 8 times higher than that of similar commercial products.Specificity:there was no cross-reaction between this kit and 10 common clinical pathogens causing diarrhea.Inclusiveness:this kit could simultaneously detect multiple different serotypes of RVA,including G1-G4,G8,G9,etc.Repeatability:this reagent kit was tested repeatedly,and the color of the bands was uniform with good consistency.High-dose hook effect:there was no high-dose hook effect within the range of 1 × 107pfu/ml.Thermal acceleration stability:after being stored at 37℃ and 50℃ for 14days,the test strip of the kit was clear and uniform.Conclusion This study has developed a high-performance RVA antigen detection kit,which is suit-able for rapid detection in various aspects such as clinical auxiliary diagnosis,epidemiological research,and vaccine strain screening.It has good application prospects and practical value.

To summarize rescuing and nursing experience of 3 ectopic pregnancy patients,suffering from severe toxicity caused by low-dose methotrexate(MTX)treatment.The key points include:constantly monitoring of patients for at least a week after MTX administration,and identifying MTX toxicity related symptoms as soon as possible;promptly establishing a multidisciplinary medical team to establish individualized rescue plans;quickly initiating the rescue therapy and implementing targeted fluid management to accelerate MTX excretion;intensifying protective isolation caring to prevent and control infection;applying refined safety management to prevent spontaneous bleeding;providing intensive caring of skin and mucosal toxicity symptoms to promote healing process;supplying individualized psychological counseling and support in time;strengthening the protection of the damaged organ.After emergent rescuing and intensive nursing,all 3 patients successfully recovered and were discharged from the hospital.