OBJECTIVE To develop evidence-based clinical practice recommendations for the use of hemostatic drugs in special populations， so as to improve the efficacy and safety of medication.METHODS Led by the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital， a working group of 79 experts covering clinical pharmacy， obstetrics and gynecology， pediatrics and other fields was established. Clinical questions regarding the efficacy and safety of hemostatic drugs in special populations were screened through literature review and two rounds of Delphi questionnaire surveys. Intervention questions were structured using the population， intervention， comparison， and outcome framework， while management questions were additionally described using the population， clinical setting, management measure， and outcome framework. Databases including Medline， Embase， Cochrane Library， CNKI， Wanfang Data， and VIP were systematically searched to collect and screen relevant evidence. Recommendations were formulated through recommendation questionnaire surveys and expert consensus meetings， and the quality of evidence and strength of recommendations were graded according to the Grading of Recommendations Assessment， Development and Evaluation system. RESULTS &CONCLUSIONS A total of 8 clinical questions were finally determined， the consensus rates of all clinical questions and recommendations were more than 90%， and 8 recommendations on the use of hemostatic drugs in special populations were formulated. These recommendations cover special populations including children， women during pregnancy/puerperium/lactation， the elderly， patients with hepatic impairment， patients in the perioperative period of liver transplantation， patients with renal impairment/on dialysis/in the perioperative period of kidney transplantation， immunocompromised patients， and patients with hematological diseases. The recommendations specify the applicable scenarios， dose adjustment principles， monitoring indicators， and safety management strategies of hemostatic drugs in different special populations， which can provide a reference for the clinical application of hemostatic drugs in special populations and help clinicians and pharmacists develop individualized medication plans.

To guide clinical blood transfusion practices for pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Blood transfusion is one of the most commonly used supportive treatments for children with hematological diseases. This guideline provides guidance and recommendations for blood transfusions in children with aplastic anemia, thalassemia, autoimmune hemolytic anemia, glucose-6-phosphate dehydrogenase deficiency, acute leukemia, myelodysplastic syndromes, immune thrombocytopenic purpura, and thrombotic thrombocytopenic purpura. This article presents the evidence and interpretation of the blood transfusion provisions for children with hematological diseases in the "Guideline for pediatric transfusion", aiming to assist in the understanding and implementing the blood transfusion section of this guideline.
Humans ; Child ; Hematologic Diseases/therapy* ; Blood Transfusion/standards* ; Practice Guidelines as Topic

To guide clinical blood transfusion practices for pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Blood transfusion for children undergoing hematopoietic stem cell transplantation is highly complex and challenging. This guideline provides recommendations on transfusion thresholds and the selection of blood components for these children. This article presents the evidence and interpretation of the transfusion provisions for children undergoing hematopoietic stem cell transplantation, with the aim of enhancing the understanding and implementation of the "Guideline for pediatric transfusion".
Humans ; Hematopoietic Stem Cell Transplantation ; Child ; Blood Transfusion/standards* ; Practice Guidelines as Topic

To guide clinical blood transfusion practices for pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Critically ill children often present with anemia and have a higher demand for transfusions compared to other pediatric patients. This guideline provides guidance and recommendations for blood transfusions in cases of general critical illness, septic shock, acute brain injury, extracorporeal membrane oxygenation, non-life-threatening bleeding, and hemorrhagic shock. This article interprets the background and evidence of the blood transfusion provisions for critically ill and severely bleeding children in the "Guideline for pediatric transfusion", aiming to enhance understanding and implementation of this aspect of the guidelines. Citation:Chinese Journal of Contemporary Pediatrics, 2025, 27(4): 395-403.
Humans ; Critical Illness ; Blood Transfusion/standards* ; Child ; Hemorrhage/therapy* ; Practice Guidelines as Topic

To guide clinical blood transfusion practices in pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Children undergoing cardiac surgery are at high risk of bleeding, and the causes of perioperative anemia and coagulation disorders in neonates and children are complex and varied, often necessitating the transfusion of allogeneic blood components. This guideline provides direction and recommendations for specific measures in blood management for children undergoing cardiac surgery before, during, and after surgery. This article interprets the background and evidence for the formulation of the blood transfusion provisions for children undergoing cardiac surgery, hoping to facilitate the understanding and implementation of this guideline.
Humans ; Cardiac Surgical Procedures ; Blood Transfusion/standards* ; Child ; Practice Guidelines as Topic

Objective:To investigate the clinicopathological features, genetic characteristics, and differential diagnosis of glomangiomatosis with uncertain malignant potential.Methods:Two cases of glomangiomatosis with uncertain malignant potential were collected at Henan Provincial People′s Hospital from 2013 and 2023. Immunohistochemistry and next generation sequencing (DNA-seq) were used to detect the related protein and gene variation. Patients were followed up.Results:Case 1 was male, 34 years old; and case 2 was female, 28 years old. Both had tumor recurrence in the original site. There were multiple nodules at right calf and ankle, involving superficial subcutaneous tissue and deep interfascicular muscles; some nodules were borderless and painful. Microscopically, the tumor was nodular with fibrous pseudocapsule, some had indistinct borders and diffuse infiltration to the surrounding adipose tissue. The tumor cells were round to ovoid with inconspicuous nucleoli, partly surrounding small irregularly dilated thin-walled blood vessels. The recurrent tumors showed epithelioid morphology in some of the tumor cells, with eosinophilic cytoplasm, some apparent nucleoli, mild to moderate nuclear atypia, and brisk mitotic figures. Focally, perimuscular cell differentiation was noted. The small lesion showed intravascular tumor thrombus. NGS revealed BRAF V600E mutation in case 1, and BRAF V600E mutation combined with PDGFRB gene amplification in case 2.Conclusions:Glomangiomatosis with uncertain malignant potential is a rare variant of glomus tumor. It has a unique growth pattern morphologically, BRAF V600E mutation, and invasive biological behavior.

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 investigate the efficacy of radiotherapy in postoperative metastatic human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer treated with pyrotinib, and to identify potential subgroups that may benefit from this strategy.Methods:The clinical data of 187 patients with postoperative distant metastatic HER2-overexpressing breast cancer who received pyrotinib at the First Affiliated Hospital of Bengbu Medical University from January 2018 to July 2022 were retrospectively analyzed. The Kaplan-Meier method was used to assess changes in survival outcomes in patients undergoing radiotherapy. Univariate and multivariate analyses were conducted to identify prognostic factors, and the log-rank test was used to determine potential subgroups that may benefit from radiotherapy.Results:Among the 187 patients, 76 received radiotherapy. The median follow-up duration for the entire population was 16.9 months (range: 3.1-37.9 months), and the 2-year overall survival (OS) was 75.0%. Multivariate analysis showed that age, metastatic status, and radiotherapy were independent factors affecting OS (3.86-6.76, P<0.05). Further subgroup analysis showed that radiotherapy significantly improved OS in patients aged ≥50 years, those with oligometastases or bone metastases, those not receiving endocrine therapy, and those resistant to trastuzumab ( P<0.05). Conclusions:Radiotherapy, in addition to pyrotinib, can enhance the survival rate of patients with postoperative metastatic HER2-overexpressing breast cancer. The benefits of radiotherapy may be more pronounced in patients with a low tumor burden, inadequate systemic treatment, and drug resistance.

Myocardial infarction is a serious type of myocardial ischemic disease. Traditional treatments can only alleviate clinical symptoms and cannot repair damaged myocardium. In this review, the application progress of chitosan-based composite scaffolds in myocardial repair and regeneration after myocardial infarction was reviewed. Combining chitosan with polymers, such as natural proteins and natural polysaccharides can mimic the properties of natural myocardial tissue, reducing ventricular wall stress while increasing biological activity and promoting the retention, repair or regeneration of myocardial cells. Combining chitosan with synthetic polymers and nanomaterials can promote the repair and regeneration of myocardial cells, improve the electrophysiological function of the infarcted area and resynchronise cardiac contraction.

Objective To investigate the relationship between the protective mechanism of dexmedetomidine(Dex)against myocardial ischemia-reperfusion(I/R)injury and cuproptosis.Methods The Langendorff models were con-structed using SD rats(I/R group),which were divided into 4 groups according to different interventions during reperfusion as:sham group,I/R group,Dex group and Dex+ES-Cu group.The left ventricular peak pressure(LVSP)of the rats in the above four groups were continuously monitored in the immediate pre-ischemic period(T0),30 min of reperfusion(T1),60 min reperfusion(T2),90 min reperfusion(T3),2 h of reperfusion(T4).Left ventricular end-diastolic pressure(LVEDP),heart rate(HR),maximum rate of rise of left ventricular pressure(+dp/dtmax)and maximum rate of drop.Subsequently,the extent of myocardial infarction was shown by 1%triphenyltetrazoliumchloride(TTC)staining,and the degree of myocardial fibrosis was assessed by Sirius red staining;Myocardial enzyme profiles,oxidative stress and inflammation indexes were detected by ELISA;Copper ions were detected by copper ion detection kit in myocardial tissues;ATF3,SPI1 and FDX1 protein level expres-sion was detected by Western blot.Results Compared with the sham-operated group,the extent of myocardial in-farction and fibrosis increased in the I/R group(P＜0.05),the level of serum MDA,IL-6,IL-1β,and TNF-α was elevated(P＜0.05),and the activity of SOD and GSH-Px decreased(P＜0.05).The Dex group significantly alleviated the above changes in the I/R group,and compared with the Dex group,in the Dex+ES-Cu group myocardi-al tissue copper ion content at the end of perfusion was increased(P＜0.05).Both ATF3 and SPI1 protein were in-creased and FDX1 protein was decreased(P＜0.05).Conclusions Dex can regulate copper metabolism and improve myocardial ischemia-reperfusion injury(MI/RI)resulted from oxidative stress and inflammation in rat model.