OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

Loss of protein homeostasis is a hallmark of cellular senescence, and ribosome pausing plays a crucial role in the collapse of proteostasis. However, our understanding of ribosome pausing in senescent cells remains limited. In this study, we utilized ribosome profiling and G-quadruplex RNA immunoprecipitation sequencing techniques to explore the impact of RNA G-quadruplex (rG4) on the translation efficiency in senescent cells. Our results revealed a reduction in the translation efficiency of rG4-rich genes in senescent cells and demonstrated that rG4 structures within coding sequence can impede translation both in vivo and in vitro. Moreover, we observed a significant increase in the abundance of rG4 structures in senescent cells, and the stabilization of the rG4 structures further exacerbated cellular senescence. Mechanistically, the RNA helicase DHX9 functions as a key regulator of rG4 abundance, and its reduced expression in senescent cells contributing to increased ribosome pausing. Additionally, we also observed an increased abundance of rG4, an imbalance in protein homeostasis, and reduced DHX9 expression in aged mice. In summary, our findings reveal a novel biological role for rG4 and DHX9 in the regulation of translation and proteostasis, which may have implications for delaying cellular senescence and the aging process.
G-Quadruplexes ; Cellular Senescence ; Ribosomes/genetics* ; Humans ; Animals ; Mice ; DEAD-box RNA Helicases/genetics* ; Protein Biosynthesis ; RNA/chemistry* ; Neoplasm Proteins

The aging trend is intensifying currently,but there is still a lack of standardized diagnosis and treat-ment schemes for severe infections in elderly people.This paper focuses on the recommendations for immune-related clinical diagnosis and treatment routes as well as the idea of risk stratified diagnosis and treatment for elderly peo-ple,aiming to effectively prevent infectious diseases in elderly people and perform stratified management through systematic and scientific means of immune function monitoring and regulation,so as to enhance the standardized level of diagnosis and treatment as well as clinical treatment effect of infection in elderly people.

Objective The multi-dimensional evaluation of hemocoagulase drugs was carried out to provide reference data for clinical drug use and drug selection in medical institutions.Methods According to the evaluation system established by the A Quick Guideline for Drug Evaluation and Selection in Chinese Medical Institutions(the Second Edition),part of the scoring rules was adjusted,and relevant literatures from CNKI,Wanfang,VIP,PubMed,Embase,Cochrane Library and other databases were referred to.Four hemocoagulase drugs listed in China were quantitatively scored from five dimensions:pharmaceutical properties,effectiveness,safety,economy and other attributes(medical insurance,essential drugs,manufacturers,etc.).The recommendation levels were divided according to the scoring results.Results The quantified scoring results,in descending order,were ashaemocoagulaseagkistrodon(HCA)(68.50 points),hemocoagulaseagkistrodonhalys(HAH)(59.89 points),hemocoagulase injection(HI)(52.84 points)and hemocoagulasebothropsatrox(HBA)(49.31 points).Conclusions The overall score of hemocoagulase drugs is low,and other hemostatic drugs can be preferred when alternative drugs are available.Among them,the HCA is weakly recommended in medical institutions.This study can provide reference for the selection of hemocoagulase drugs in medical institutions,and also provide basis for clinical rational drug use.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

Objective To explore the technical advantages and applicable scenarios of surgical robot-assisted versus conventional freehand minimally invasive surgery for pelvic fractures by comparing clinical indicators,thereby providing evidence for clinical decision-making.Methods A retrospective case-control study was conducted on 59 patients with pelvic fractures treated with minimally invasive internal fixation between January 2022 and December 2024.Patients were divided into a conventional group(26 cases)and a robot-assisted navigation group(33 cases)based on the surgical technique.Pre-and postoperative pelvic computed tomography(CT)scans were performed,and anteroposterior,outlet,and inlet view radiographs were obtained.The maximum residual displacement after pelvic reduction and screw placement accuracy were measured based on radiographic and CT imaging.Intraoperative fluoroscopy frequency,radiation dose,operative time,blood loss,number of implanted screws,maximum residual displacement after reduction,and screw accuracy were recorded.Results No significant differences were observed between the two groups in age,gender,injury mechanism,or fracture classification,indicating comparability.Blood loss and fracture reduction quality showed no significant differences.The operative time was 52.5(30.8,62.3)min in the conventional group and 60(50,82.5)min in the robot-assisted group.Intraoperative fluoroscopy frequency and radiation dose were(19.1±5.4)times and 33.1(27.5,43.9)mGy in the conventional group,compared to(12.1±4.9)times and 123.1(101.1,131.4)mGy in the robot-assisted group.The robot-assisted group demonstrated superior screw placement accuracy,increased utilization of anterior column screws,and shorter postoperative ambulation time.Conclusion Robot-assisted minimally invasive surgery for pelvic fractures significantly outperforms conventional freehand techniques in improving screw placement accuracy and reducing radiation exposure for surgeons.It represents a preferable option for treating unstable pelvic fractures.

Medical ultrasound technology is widely used for diagnosis and therapy in clinical practice.Ultrasound probes,which are directly contact with patients,pose a potential risk of pathogen transmission.This expert consen-sus was developed by a multidisciplinary team based on international guidelines,standards in China,and the results of a national survey,aiming to reduce the risk of healthcare-associated infection through standardizing reprocessing of medical ultrasound probes,and formulating consensus recommendations with the Delphi method.The consensus clarifies the reprocessing principles for three types of ultrasound probes of different infection risks:external-use ul-trasound probes,interventional percutaneous ultrasound probes,and internal-use ultrasound probes,puts forward systematic suggestions on the reprocessing standards and disinfection levels of ultrasound probe isolation covers and coupling agents,the reprocessing procedures and methods of ultrasound probes,as well as architectural layout and management of reprocessing,so as to provide a scientific prevention and control framework for ensuring ultrasound diagnosis and therapy safety.

Climate change has emerged as a focal point of global concern in the 21st century.This paper systema-tically summarizes the direct and indirect impacts of climate change on human health,including directly causing hu-man death and disability in the form of disasters,and increasing the risk of climate-sensitive diseases,including chronic non-infectious diseases,infectious diseases,mental and psychological problems,as well as allergic diseases and malnutrition through changes in temperature and humidity,air pollution,as well as changes in the geographical distribution of disease vectors.Based on these,within the global governance framework,this paper focuses on the challenges faced by medical institutions in the field of infection prevention and control,and explores in depth infec-tion control response strategies from five aspects,so as to provide reference for further enhancing the climate resi-lience capacity of the medical system and safeguarding public health.

Objective To search,evaluate and integrate the evidence on enteral nutrition management based on intra-abdominal pressure(IAP)in ICU patients so as to provide an evidence-based basis for a standardised clinical enteral nutrition management for ICU patients with abdominal hypertension.Methods According to the"6S"model,the systematic searches were conducted on CNKI,VIP,SinoMed,Wanfang,Cochrane Library,Medive,UpToDate,International Guidelines Collaboration,Scottish Intercollegiate Guidelines,PubMed,Ovid,Web of Science,Embase,NICE,American Society for Parenteral Enteral Nutrition,World Association for Parenteral Syndromes,European Society of Critical Care,European Society of Clinical Nutrition and Metabolism on the grading of enteral nutrition based on intra-abdominal pressure classification,including guidelines,clinical decision-making,expert consensus,systematic evaluations,summaries of evidence,and original studies closely related to the topic of this study,with a search timeframe up to 31st October 2023.Evidence was extracted and synthesised from the literature that met the quality criteria,taking into account clinical professional judgement.Results A total of 23 articles were retrieved,including four guidelines,one evidence summary,one systematic evaluation,four expert consensuses,six randomized controlled trials,one case-control study and six quasi-experimental studies.Through strict quality evaluation,evidence extraction and summarisation,seven themes with 28 pieces of best evidence were extracted,with IAP grading as the main topic.The themes included definition and grading of abdominal hypertension,IAP monitoring,assessment of target feeding volume,IAP grades I-IV.Conclusion This study summarises the best evidence on graded enteral nutrition management for ICU patients based on IAP.This evidence provides an effective scientific basis on clinical decision-making for ICU professionals.It aims to manage the enteral nutrition for ICU patients with intra-abdominal hypertension using a scientific nursing method,thereby improving the quality of nursing care.

Objective To conduct a multidimensional evaluation of brain cytoprotection agents used in the treatment of ischemic stroke,and to provide an evidence-based basis of medication selection and rational clinical use for medical institutions'decision-makers.Methods Based on the"Quick Guide to Drug Evaluation and Selection for Chinese Medical Institutions(Second Edition)"evaluation system,some scoring rules were adjusted.Referring to drug instructions,clinical guidelines,and rel-evant literature from databases such as China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database for Chinese Technical Periodicals(VIP),Pubmed,Embase,and Cochrane Library,seven brain cytoprotection agents were quantita-tively scored from five dimensions:pharmacological characteristics,effectiveness,safety,economic aspects,and other attributes(insurance coverage,essential drugs,manufacturing enterprises).Results Overall,the evaluated drugs received low scores.The top three drugs were edaravone and dexborneol injection(63.15 points),urinary kallidinogenase injection(62.20 points),and butylphthalide injection(62.04 points).Citicoline injection had the lowest score due to unclear effectiveness(37.07 points).Conclusions Based on guideline recommendations,edaravone and dexborneol,urinary kallidinogenase,and butylphthalide,which scored above 60,are weakly recommended when no alternative medications are available in medical institutions.This study can be used as a reference for the selection of therapeutic drugs for ischemic stroke in medical institutions and offer a basis for rational clinical medication use.