Objective: To investigate the efficacy and incidence of adverse reactions of therapeutic erythrocytapheresis in high altitude polycythemia (HAPC) population. Methods: A retrospective study was conducted on 243 HAPC patients who were either native residents or long-term workers in Xizang and underwent therapeutic erythrocytapheresis in the Chengdu Office Hospital of the People's Government of Xizang Autonomous Region from 2021 to 2023. A comparative study was carried out on the changes in blood routine, vital signs, skin color, serum iron metabolism data, and the incidence of adverse reactions before and after the procedure. Results: After erythrocytapheresis, significant decreases were observed in red blood cell (RBC) count (7.06±0.89×10 vs 6.08±0.93×10 /L, P<0.001], hemoglobin (HGB, 211.59±17.99 vs 182.76±19.83 g/L, P<0.001), hematocrit (Hct) [(65.30±6.45)% vs (55.56±8.12)%, P<0.001], serum iron (14.46±4.38 vs 11.77±3.78 μmol/L, P=0.003), total iron-binding capacity (126.62±4.47 vs 123.73±3.77 μmol/L, P=0.002), transferrin (1.88±0.41 vs 1.77±0.12 g/L, P=0.023), transferrin saturation [(11.32±3.11)% vs (9.43±2.78)%, P=0.004], serum ferritin (832.4±295.6 vs 665.3±249.2 ng/mL, P<0.001), systolic blood pressure (123.86±14.43 vs 118.51±13.68 mmHg, P<0.001) and diastolic blood pressure (81.68±9.54 vs 74.28±7.61 mmHg, P<0.001). In contrast, platelet count (Plt, 137.21±46.21 ×10 vs 147.94±50.66 ×10 /L, P<0.001) and oxygen saturation [(93.97±3.29)% vs (95.84±2.27)%, P<0.001] increased. No significant differences were found in white blood cell (WBC) count [5.35 (4.59, 6.44)×10 /L vs 5.43 (4.54, 6.53) ×10 /L, P=0.690], unsaturated iron-binding capacity (112.15±0.50 vs 111.96±0.25 μmol/L, P=0.074) and pulse rate (73.42±11.28 vs 73.19±7.18 beats/min, P=0.750). Furthermore, skin color of the face (conjunctiva, lips) and palms mitigated after therapeutic erythrocytapheresis, changing from purplish-red to red. The total incidence of adverse reactions during erythrocytapheresis was 13.98% (34/243), including citrate toxicity 12.75% (31/243), puncture site hematoma 0.82% (2/243) and blood volume imbalance 0.41% (1/243). Conclusion: Therapeutic erythrocytapheresis could rapidly decrease HCT, Hb, serum iron, transferrin and transferrin saturation levels in HAPC patients, with a low incidence of adverse reactions. Therefore, therapeutic erythrocytapheresis has broad clinical application prospects in Xizang Autonomous Region.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective To evaluate and compare the performance of the Chronic Kidney Disease Epidemi-ology Collaboration(CKD-EPI)equation,the abbreviated Modification of Diet in Renal Disease(aMDRD)equa-tion,the Cockroft-Gault(C-G)formula,the Mayo Clinic Quadratic(MCQ)equation,and the Berlin Initiative Study 1(BIS1)equation in determining renal function among critically ill patients,and to identify the most appro-priate method for clinical application.Methods Critically ill patients admitted to the Intensive Care Units of the Department of Geriatric Medicine at the First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital)between June 2020 and June 2022 were included.Their renal function was assessed within 48 hours of admission using the 24-hour creatinine clearance rate(CrCl24h)as the reference standard,and compared with the CKD-EPI equation,aMDRD equation,C-G formula,MCQ equation,and BIS1 equation.The precision and accuracy of each equation in evaluating renal function in critically ill patients were analyzed.Results Total of 534 patients were included in the study.(1)The aMDRD equation exhibited the least bias(-3.91),yet the accuracy of the five estimated glomerular filtration rate(eGFR)equations was relatively low,ranging from 42.9%to 63.1%.(2)For renal function grading,the weighted κ agreement values between the CKD-EPI equation,aMDRD equation,C-G formula,MCQ equation,BIS1 equation,and CrCl24h were 0.464,0.555,0.403,0.405,and 0.159,respectively(all P<0.001).(3)Among patients with severe kidney function decline[CrCl24h≤60 mL/(min·1.73 m2)],the eGFR value derived from the C-G formula was the lowest,while that from the BIS1 equation was the highest.In patients with normal or moderately reduced renal function[60 mL/(min·1.73 m2)130 mL/(min·1.73 m2)],the eGFR value of the BIS1 equation was the lowest,and the aMDRD equation produced the highest eGFR value.(4)When renal function was severely decreased or augmented[CrCl24h>130 mL/(min·1.73 m2)],the accuracy of the CKD-EPI and MCQ equations declined.Conversely,as creatinine clearance increased,the accuracy of the aMDRD equation improved gradually.The C-G formula demonstrated an opposite trend compared to the aMDRD equation,and the BIS1 equation exhibited low accuracy across all groups.(5)The optimal critical values[mL/(min·m2)]for diagnosing augmented renal clearance(ARC)using the five eGFR equations were as follows:eGFRCKD-EPI:91.1,eGFRaMDRD:99.84,eGFRC-G:76.27,eGFRMCQ:100.87,eGFRBIS1:82.36.Conclusions The precision and accuracy of the five eGFR equations are relatively low,making them unsuitable for assessing renal function in critically ill patients.Collecting 24-hour urine to calculate creatinine clearance remains an essential method for evaluating renal function in this population.In the absence of early CrCl24h data upon ICU admission,the cut-off values of the eGFR equa-tions may serve as a tool for the early identification of ARC.Additionally,the aMDRD equation can provide a rough estimate of creatinine clearance in critically ill patients.

Objective To evaluate and compare the performance of the Chronic Kidney Disease Epidemi-ology Collaboration(CKD-EPI)equation,the abbreviated Modification of Diet in Renal Disease(aMDRD)equa-tion,the Cockroft-Gault(C-G)formula,the Mayo Clinic Quadratic(MCQ)equation,and the Berlin Initiative Study 1(BIS1)equation in determining renal function among critically ill patients,and to identify the most appro-priate method for clinical application.Methods Critically ill patients admitted to the Intensive Care Units of the Department of Geriatric Medicine at the First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital)between June 2020 and June 2022 were included.Their renal function was assessed within 48 hours of admission using the 24-hour creatinine clearance rate(CrCl24h)as the reference standard,and compared with the CKD-EPI equation,aMDRD equation,C-G formula,MCQ equation,and BIS1 equation.The precision and accuracy of each equation in evaluating renal function in critically ill patients were analyzed.Results Total of 534 patients were included in the study.(1)The aMDRD equation exhibited the least bias(-3.91),yet the accuracy of the five estimated glomerular filtration rate(eGFR)equations was relatively low,ranging from 42.9%to 63.1%.(2)For renal function grading,the weighted κ agreement values between the CKD-EPI equation,aMDRD equation,C-G formula,MCQ equation,BIS1 equation,and CrCl24h were 0.464,0.555,0.403,0.405,and 0.159,respectively(all P<0.001).(3)Among patients with severe kidney function decline[CrCl24h≤60 mL/(min·1.73 m2)],the eGFR value derived from the C-G formula was the lowest,while that from the BIS1 equation was the highest.In patients with normal or moderately reduced renal function[60 mL/(min·1.73 m2)130 mL/(min·1.73 m2)],the eGFR value of the BIS1 equation was the lowest,and the aMDRD equation produced the highest eGFR value.(4)When renal function was severely decreased or augmented[CrCl24h>130 mL/(min·1.73 m2)],the accuracy of the CKD-EPI and MCQ equations declined.Conversely,as creatinine clearance increased,the accuracy of the aMDRD equation improved gradually.The C-G formula demonstrated an opposite trend compared to the aMDRD equation,and the BIS1 equation exhibited low accuracy across all groups.(5)The optimal critical values[mL/(min·m2)]for diagnosing augmented renal clearance(ARC)using the five eGFR equations were as follows:eGFRCKD-EPI:91.1,eGFRaMDRD:99.84,eGFRC-G:76.27,eGFRMCQ:100.87,eGFRBIS1:82.36.Conclusions The precision and accuracy of the five eGFR equations are relatively low,making them unsuitable for assessing renal function in critically ill patients.Collecting 24-hour urine to calculate creatinine clearance remains an essential method for evaluating renal function in this population.In the absence of early CrCl24h data upon ICU admission,the cut-off values of the eGFR equa-tions may serve as a tool for the early identification of ARC.Additionally,the aMDRD equation can provide a rough estimate of creatinine clearance in critically ill patients.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To establish ultra performance liquid chromatography (UPLC) characteristic chromatogram of Pulsatilla chinensis; To provide reference for the origin identification and quality control of Pulsatilla chinensis. Methods:UPLC Method was adopted. The determination was performed on a column of Agilent SB C18 (2.1 mm×100 mm, 1.8 μm) . The mobile phase was acetonitrile-methanol (2:1) -0.1% phosphoric acid solution by fradient elution at a flow rate of 0.30ml/min. The column temperature was 30 ℃. The detection wavelength was 215 nm. The injection volume was 2 μl. The common counterfeit products and medicinal herbs of Pulsatilla chinensis from different areas were evaluated by comparison of characteristic chromatogram, principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA). Results:There were 9 characteristic peaks in the characteristic chromatogram of Pulsatilla chinensis, and 8 common peaks were identified by high resolution mass spectrometry and comparison of reference materials. Through PCA analysis, it was possible to clearly distinguish the medicinal herbs of Pulsatilla chinensis from different areas. Combined with OPLS-DA analysis, it was found that peak 2, peak 3, peak 6 were the main markers of Pulsatilla chinensis from different producing areas. Conclusion:The established method has good specificity, repeatability and durability, and it can effectively distinguish the common counterfeits of Pulsatilla chinensis, and provide the basis of quality control and selection of origin for Pulsatilla chinensis.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective To analyze the relationships of the expression of retinoid X receptor alpha (RXRA) and nuclear receptor interaction protein 1(NRIP1) in colorectal cancer tissues with the features of clinical pathology and prognosis. Methods A total of 106 specimens from colorectal cancer tissues of patients during surgery were included in colorectal cancer group (n=106), and corresponding paracancer tissue specimens were included in paracancer group (n=106). The expressions of RXRA and NRIP1 in colorectal cancer tissues were detected by immunohistochemistry. Multivariate Cox regression analysis was used to investigate th4e effects of RXRA and NRIP1 expressions on the prognosis of patients with colorectal cancer. Results The positive expression rates of RXRA and NRIP1 in colorectal cancer group were 66.04%, 69.81%, which were significantly higher than 33.96% and 30.19% in the para-cancer group (P < 0.05). The positive expression rates of RXRA and NRIP1 in patients with pathological stage Ⅲ, low differentiation, serous infiltration and lymph node metastasis were higher than those in patients with pathological stage Ⅱ, medium and high differentiation, no serous infiltration and lymph node metastasis (P < 0.05). The 3-year overall survival rates of patients with pathological stage Ⅱ, low differentiation, no serous infiltration, no lymph node metastasis, negative RXRA and NRIP1 were higher than those of patients with pathological stage Ⅲ, medium and high differentiation, serous infiltration, lymph node metastasis, positive RXRA and NRIP1 (P < 0.05). Multivariate Cox regression analysis showed serous membrane infiltration (HR=2.687; 95%CI, 1.531 to 3.156), positive RXRA (HR=3.743; 95%CI, 2.217 to 5.992), positive NRIP1 (HR=2.641; 95%CI, 1.124 to 4.757) were influencing factors for prognosis in patients with colorectal cancer (P < 0.05). Conclusion RXRA and NRIP1 are highly expressed in colorectal cancer, which are closely related to pathological stage, differentiation degree and metastasis, which can be used as biomarkers to assist in evaluating the prognosis of patients.