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.

Radiotherapy is a crucial treatment modality for head and neck tumors. However, while effectively killing tumor cells, it significantly disrupts the homeostasis of the oral microecology, which is closely associated with various complications such as radiation-induced oral mucositis. Literature review indicates that as radiotherapy doses accumulate and treatment durations extend, the richness and diversity of the oral microbiota show a declining trend, with the genus Streptococcus decreasing most markedly. In contrast, radiotherapy selectively promotes the proliferation of bacterial phyla such as Proteobacteria and Bacteroidetes, which are rich in opportunistic pathogens. Mechanistically, radiotherapy activates the nuclear factor-kappa B pathway, triggering chronic inflammation and oxidative stress, damaging the epithelial barrier, suppressing local immunity, and causing damage to organs such as the salivary glands. It can also induce systemic diseases via the oral-gut axis, forming a multi-level, interconnected pathogenic network. In terms of interventions, treatment strategies including probiotics and prebiotics have shown promising efficacy against side effects such as radiation-induced oral mucositis. Saliva-based oral microbiota transplantation is an emerging strategy that is expected to become widely utilized for restoring oral microecological balance. Existing interventions provide preliminary pathways for clinical practice, but this field still faces several key scientific questions. The association between oral microecology and systemic diseases remains largely correlative, lacking causal evidence. Furthermore, critical parameters for oral microbiota transplantation, such as donor screening criteria, transplantation protocols, and long-term safety, are not yet well-defined. Therefore, future research should focus on conducting large-scale clinical trials to establish standardized protocols and safety evaluation systems for oral microecological interventions, and explore combined treatment therapies such as probiotics, prebiotics, and microbiota transplantation to advance the development of personalized precision modulation. These will enable more effective management of radiotherapy-induced oral microecological dysbiosis and improve treatment outcomes and quality of life for patients with head and neck tumors.

ObjectiveTo investigate the molecular mechanism of kaempferol-induced apoptosis in hepatic stellate cells （HSC） via the mitochondrial pathway. MethodsHSC were divided into five groups： blank control， transforming growth factor-β1（TGF-β1） （10 ng/mL） group， and groups treated with different concentrations of kaempferol （8， 16， 32 µmol/L）. Cell counting kit-8（CCK-8） assay was used to evaluate chrysin's effect on HSC proliferation. Transwell assay was used to assess chrysin's impact on HSC migration. Flow cytometry was used to detect apoptosis， reactive oxygen species （ROS） expression， and mitochondrial permeability transition pore （mPTP） opening across groups. 5，5′，6，6′-Tetrachloro-1，1′，3，3′-tetraethylimidacarbocyanine iodide （JC-1） assay was used to test mitochondrial membrane potential. Western blot analysis was performed to determine the expression levels of mitochondrial apoptosis-associated proteins， namely B-cell lymphoma-2 （Bcl-2）， Bcl-2-associated X protein （Bax）， Cleaved-Caspase3， Cleaved-Caspase9， and sirtuin 3 （SIRT3）. Transmission electron microscopy was used to examine mitochondrial structural alterations. Molecular docking and kinetic simulations were used to analyze the targeted interaction between kaempferol and NAD-dependent deacetylase sirtuin-3 （SIRT3）. ResultsCompared with the blank control group： in the TGF-β1 group， HSC proliferation and migration rates increased （P<0.01）， ROS levels and mPTP opening both increased （P<0.05）， the JC-1 red/green fluorescence ratio increased （P<0.01）， and the expression of Cleaved-Caspase-3， Cleaved-Caspase-9 and Bcl-2 increased （P<0.05）， whilst SIRT3 expression decreased （P<0.01）； the number of mitochondria increased （P<0.05）， and mitochondrial length decreased （P<0.01）. Compared with the TGF-β1 group： treatment with all groups of kaempferol reduced HSC proliferation and migration rates （P<0.01）， whilst simultaneously increasing the HSC apoptosis rate （P<0.01）； HSC ROS levels and mPTP opening both increased （P<0.05）； the JC-1 red/green fluorescence ratio decreased （P<0.01）， and the expression levels of Bax， Cleaved-Caspase-3 and Cleaved-Caspase-9 were upregulated （P<0.01）， whilst the expression levels of Bcl-2 and SIRT3 were downregulated （P<0.01）， and the number of mitochondria increased （P<0.05）； mitochondrial length was reduced （P<0.01）. Molecular docking and dynamics simulations revealed that the docking energy for kaempferol with SIRT3 was 108.89 kcal/mol； the RMSD curve stabilized after 20 ns； and RMSF analysis indicated that most residues exhibited minimal fluctuations. ConclusionKaempferol induces HSC apoptosis through the mitochondrial pathway， potentially via targeting SIRT3 and disrupting mitochondrial function.

ObjectiveTo identify protein biomarkers and potential therapeutic targets associated with metabolic dysfunction-associated fatty liver disease （MAFLD） through an integrative multi-omics analysis. MethodsLarge-scale plasma protein quantitative trait locus data were integrated with MAFLD genome-wide association study data， and a proteome-wide Mendelian randomization analysis was performed. Summary data-based Mendelian Randomization （SMR）/heterogeneity in dependent instruments （HEIDI） test and colocalization analysis were used to assess significant proteins. The independent samples t-test was used for comparison of continuous data with homogeneity of variance between two groups， and the Welch-corrected t-test was used for comparison of continuous data with heterogeneity of variance. The transcriptomic validation results were compared with the Mendelian randomization results to evaluate the changing trends of gene expression， and boxplots were used to display the expression distribution of candidate genes between groups. ResultsAmong 7 130 proteins analyzed， 40 showed a causal relationship with MAFLD， among which 26 increased the risk of MAFLD and 14 exerted a protective effect against MAFLD （FDR<0.05）. Nine proteins were supported by SMR/HEIDI （P_SMR<0.05， P_HEIDI>0.05）， and 14 showed a strong colocalization signal （PPH₄>0.9）. The transcriptomic analysis identified 5 differentially expressed proteins （all P<0.05）， i.e.， adenosine diphosphate-ribosylation factor-like GTPase 2， insulin-like growth factor binding protein 2， casein kinase 1 delta （CSNK1D）， leucine-rich repeat neuronal 1， and moesin （MSN）. In vitro validation showed upregulated expression levels of MSN （1.612±0.346 vs 0.569±0.077， P<0.05）， 14-3-3 protein theta （YWHAQ） （1.267±0.126 vs 0.313±0.029， P<0.05）， and CSNK1D （0.871±0.025 vs 0.431±0.080， P<0.05） and a downregulated expression level of histone deacetylase 8 （0.637±0.059 vs 1.097±0.260， P<0.05） in the MAFLD cell model. Functional annotation showed that CSNK1D participated in circadian and metabolic regulation， YWHAQ modulated the Hippo pathway and lipid signal transduction， and MSN was associated with cytoskeletal remodeling and fibrogenic responses. ConclusionThe integrative proteogenomic analysis in this study shows that CSNK1D， YWHAQ， and MSN may be key mediators in the pathogenesis of MAFLD. These proteins have the potential to serve as novel biomarkers and therapeutic targets， providing new directions for research on disease mechanisms and the development of intervention strategies.

Objective To investigate the status of management of iodinated contrast media(ICM)extravasation in Henan Province,as well as nurses' knowledge and influencing factors,in order to provide a basis for optimizing management strategies.Methods A self-designed questionnaire was applied,employing convenience sampling,to survey nursing administrators and nurses in the radiology departments of 55 tertiary hospitals across 16 regions of Henan Province,from December 2024 to January 2025.Multiple linear regression analysis was conducted to explore the factors influencing nurses' knowledge.Results A total of 55 nursing administrators and 64 nurses participated,with a valid questionnaire response rate of 100％.The survey results reveal that only 5.45％of radiology depart-ments utilized high-pressure central venous catheters,and 32.73％employed vascular visualization techniques.When setting the high-pressure injection speed for ICM,only 54.55％of radiology departments required an assessment of the type and model of intravenous access.Additionally,only 9.09％of radiology departments mandated an observa-tion for 2 to 4 hours following ICM extravasation.Furthermore,only 50.91％of radiology departments had estab-lished an information system for ICM use.The nurses' knowledge score regarding the prevention and management of ICM extravasation was(90.00±17.59),influenced by years of experience in radiology and professional titles(P＜0.05).Conclusion The prevention and management measures for ICM in radiology departments in Henan Province need further improvement.Nursing administrators should optimize management strategies,improve relevant training systems,and continuously enhance nurses' knowledge and practical abilities.

Objective:To investigate the risk factors and their predictive efficacy for early postoperative complications in elderly patients with hip fracture.Methods:A retrospective cohort study was conducted on the clinical data of 203 elderly patients with hip fracture admitted to the 908th Hospital of the Joint Logistics Support Force of the PLA and the First Affiliated Hospital of Nanchang University from January 2022 to December 2023, including 54 males and 149 females, aged 65-100 years [(80.5±7.7)years]. There were 96 patients with femoral neck fracture and 107 patients with intertrochanteric fracture. According to the AO/OTA classification, the fracture was classified as type 31A in 107 patients and type 31B in 96. Among them, 81 patients were treated with proximal femoral nail antirotation (PFNA), 65 with semi-hip arthroplasty, 52 with total hip arthroplasty (THA), and 5 with closed reduction and cannulated nail internal fixation. The patients were divided into complication group ( n=65) and non-complication group ( n=138) according to whether complications (mainly including delirium, lung infection, stress ulcer, and deep vein thrombosis of the lower limbs) occurred within 15 days after surgery. The gender, age, age stage, educational level, cause of injury, associated underlying diseases before surgery, AO/OTA classification, American Society of Anesthesiologists (ASA) classification, 5-factor modified frailty index (mFI-5) score, prognostic nutritional index (PNI), anesthesia method, operation method, operation time, intraoperative blood loss, length of hospital stay, etc., were recorded in the two groups. Univariate analysis and multivariate binary logistic regression analysis were used to evaluate the correlation between the above indexes and the occurrence of early postoperative complications in elderly patients with hip fracture and to determine their independent risk factors. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated to evaluate the predictive efficacy of each risk factor for the occurrence of early postoperative complications in elderly patients with hip fracture. Results:Univariate analysis showed a certain correlation between age, age stage, associated underlying diseases before surgery, AO/OTA classification, ASA classification, mFI-5 score, PNI, operation method, and length of hospital stay and the occurrence of early postoperative complications in elderly patients with hip fracture ( P<0.05), while gender, educational level, cause of injury, anesthesia method, operation time, and intraoperative blood loss were not correlated with the occurrence of early postoperative complications in elderly patients with hip fracture ( P>0.05). The results of multivariate binary logistic regression analysis showed that the associated underlying diseases before surgery ( OR=5.46, 95% CI 1.33, 22.39, P<0.05), mFI-5 score ( OR=15.90, 95% CI 5.36, 47.15, P<0.01), and PNI ( OR=0.70, 95% CI 0.60, 0.81, P<0.01) were significantly correlated with the occurrence of early postoperative complications in elderly patients with hip fracture. The results of ROC curve analysis showed that mFI-5 score (AUC=0.85, 95% CI 0.80, 0.91) and PNI (AUC=0.87, 95% CI 0.82, 0.93) had moderate predictive efficacy, while the early warning efficacy of associated underlying diseases was low (AUC=0.54, 95% CI 0.45, 0.62). The combination of the above risk factors was more effective in predicting early postoperative complications in elderly patients with hip fracture (AUC=0.95, 95% CI 0.92, 0.98). Conclusions:The mFI-5 score, PNI, and associated underlying diseases before surgery are independent risk factors for early postoperative complications in elderly patients with hip fracture. The mFI-5 score and PNI have a higher predictive efficacy than associated diseases before surgery on the occurrence of early postoperative complications in elderly patients with hip fracture, while the combination of the above risk factors provides a significantly better predictive performance.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:To evaluate the diagnostic performance of 64Cu-prostate specific membrane antigen (PSMA)-Q compared with 18F-FDG in patients with advanced prostate cancer and to analyze the radiation dosimetry of 64Cu-PSMA-Q. Methods:This study was an open-label, single-arm, self-controlled diagnostic evaluation trial. A total of 29 patients (age 58-87 years) with pathologically confirmed advanced prostate cancer in the Affiliated Hospital of North Sichuan Medical College from September 2023 to December 2023 were included. All patients underwent both 64Cu-PSMA-Q PET/CT and 18F-FDG PET/CT examinations. McNemar test was used to compare the detection rates of 64Cu-PSMA-Q PET/CT and 18F-FDG PET/CT for primary lesions, lymph node metastases, and bone metastases. Mann-Whitney U test was applied to compare differences in SUV max and tumor-to-background ratio (TBR) between 64Cu-PSMA-Q PET/CT and 18F-FDG PET/CT. Radiation dosimetry of 64Cu-PSMA-Q PET/CT imaging was performed using OLINDA/EXM 2.1 (adult male model) in 9 patients. Results:Primary lesions were detected in 21 patients. 64Cu-PSMA-Q PET/CT demonstrated a detection rate of 95.2%(20/21) for primary lesions, which was significantly higher than that of 18F-FDG PET/CT (66.7%(14/21); χ2=6.00, P=0.031). Detection rates of lymph node metastases were 65.5%(19/29) for 64Cu-PSMA-Q and 55.2%(16/29) for 18F-FDG, with no significant difference ( χ2=3.00, P=0.250). Similarly, detection rates of bone metastases were 72.4%(21/29) for 64Cu-PSMA-Q and 65.5%(19/29) for 18F-FDG respectively ( χ2=2.00, P=0.500). TBRs on 64Cu-PSMA-Q PET/CT were significantly higher than those on 18F-FDG PET/CT across primary lesions (8.3(2.2, 13.3) vs 2.3(1.0, 5.5); Z=7.16, P=0.002), regional lymph node metastases (4.9(1.4, 8.3) vs 1.7(0.9, 4.0), Z=189.34, P=0.001), and bone metastases (18.7(4.5, 26.9) vs 5.1(2.1, 9.7); Z=24.83, P=0.003). No significant difference in TBR was observed for distant lymph node metastases ( Z=1.49, P=0.135) or benign lesions ( Z=0.91, P=0.558). The whole-body effective dose of 64Cu-PSMA-Q was (28.200±1.590)μSv/MBq among the 9 patients analyzed, with no adverse events related to the tracer observed. Conclusion:64Cu-PSMA-Q is a promising novel PET imaging agent with potential clinical utility for diagnosing prostate cancer and supporting clinical decision-making.

Objective:To observe the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) at different frequencies on cognitive impairment due to high-altitude hypoxia.Methods:Sixty officers and soldiers displaying cognitive impairment in a hypoxic high-altitude environment were randomly divided into 15Hz, 20Hz and 25Hz groups, each of 20. They were given rTMS at those frequencies for 30 days. Before the stimulation and after 15 and 30 days, event-related potentials, latencies of mismatched negativity (MMN) and P300 signals were recorded. The participants′ cognition was also evaluated using the Montreal Cognitive Assessment Scale (MoCA). Correlation between the electrophysiological indexes and the MoCA scores was computed.Results:After 15 days, all had shorter MMN latencies, higher total MoCA scores and better memory scores. The only significant difference among the three groups was in the average memory scores. After 15 days, MMN latency was significantly negatively correlated with the memory scores in all three groups ( r=0.44 to -0.54). Conclusions:rTMS at frequencies above 15Hz can effectively relieve cognitive impairment, especially memory dysfunction, resulting from high-altitude hypoxia.

Inappropriate polypharmacy is common in older patients with co-morbidities, and prescription streamlining can help to ensure the safety of medications for older patients with co-morbidities.In 2023, The Alliance of European Geriatrics Societies(AEGS)summarized the literature on medication review and prescription streamlining to propose 33 recommendations for optimizing polypharmacy and prescription streamlining in older patients with co-morbidities.The strategy suggests incorporating prescription streamlining into the daily practice of geriatricians and clinical pharmacists, and provides recommendations about education and training of clinical staff, development of disease guidelines, policy support, and clinical trial research in older adults aiming to improve the management of polypharmacy.This article explains the key elements of this strategy to provide reference for high-quality healthcare for elderly patients with co-morbid in China.