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.

Objective: To analyze the results of national external quality assessment (EQA) for transfusion compatibility test from 2018 to 2023, with the aim of providing references for improving laboratory testing quality and ensuring the safety of clinical blood transfusion. Methods: Three EQA programs were conducted annually, each distributing 22 quality assessment samples. Participating transfusion laboratories were required to complete testing within specified deadlines and to submit results along with documentation of testing methodologies, reagents, and equipment used. National Center for Clinical Laboratories (NCCL) conducted statistical analysis of laboratory results, evaluated testing outcomes and related circumstances, and provided feedback to participating laboratories. EQA data from transfusion laboratories across China from 2018 to 2023 were collected and systematically analyzed. Results: From 2018 to 2023, the qualification rates for all five items (ABO forward typing, ABO reverse typing, Rh blood group typing, antibody screening, and cross-matching) were 67.59%, 77.11%, 77.38%, 72.78%, 79.96%, and 85.16%, respectively. The mean qualification rates for ABO forward typing, ABO reverse typing, RhD blood group typing, antibody screening, and cross-matching over the past six years were 96.25%±0.59%, 90.45%±4.52%, 96.05%±0.71%, 90.88%±2.86%, and 88.34%±3.48%, respectively. The qualification rates in 2019, 2020, 2022, and 2023 all showed a stable trend of "blood stations>tertiary hospitals>secondary hospitals". The mean qualification rate of laboratories in secondary hospitals from 2018 to 2023 was significantly lower than those of laboratories in tertiary hospitals and blood stations (P<0.05), while no significant difference was observed between laboratories in tertiary hospitals and blood stations (P>0.05). The micro column agglutination method was the most widely used in all five tests. In the four test items, namely ABO forward typing, ABO reverse typing, antibody screening, and cross-matching, there was a statistically significant difference in the qualification rate of micro column agglutination method compared to other methods (P<0.05). There was a statistical difference in the qualification rate between manual and automated detection using micro column agglutination method in the cross-matching tests (P<0.05), whereas no significant difference was noted for the other test items (P>0.05). Conclusion: From 2018 to 2023, the number of laboratories participating in EQA activities has been increasing year by year, and the qualification rate has shown an overall upward trend. The type of laboratory is a key factor affecting the qualification rate, and the testing capabilities of some laboratories still need to be improved. The micro column agglutination method is widely used in transfusion compatibility tests. The established EQA program effectively monitors quality issues in laboratories, drives continuous improvement, and ensures sustained enhancement of testing standards to safeguard clinical blood safety.

Objective To evaluate the effect of five-element music combined with sandplay therapy in improving negative emotions and enhancing quality of life in patients with malignant tumors.Methods A to-tal of 112 malignant tumor patients meeting inclusion and exclusion criterias were enrolled and randomly di-vided into four groups by using random number table method:control group,five-element music group,sand-play therapy group,and combined therapy group,with 28 patients in every group.The control group received routine nursing and psychological care;the five-element music group received routine nursing,psychological care and five-element music therapy;the sandplay therapy group received routine nursing,psychological care,and sandplay therapy;the combined therapy group received routine nursing,psychological care,five-element music,and sandplay therapy.Interventions were conducted once a week for 6 weeks.Changes in self-rating anxiety scale(SAS),self-rating depression scale(SDS),and quality of life core scale(QLQ-C30)scores were compared among the four groups.Results Before treatment,there were no significant differences in SAS,SDS,or QLQ-C30 subscale scores among the four groups(P>0.05).After treatment,SAS and SDS scores decreased,while QLQ-C30 subscale scores increased in all four groups(P<0.05).After treatment,inter-group comparisons showed significant differences in SAS,SDS,and QLQ-C30 subscale scores(P<0.05),with the combined therapy group showing the best efficacy.The SAS and SDS scores in the five-element music group,sandplay therapy group,and combined therapy group were lower than those in the control group,while QLQ-C30 subscale scores were higher(P<0.05).No significant differences were observed between the five-element music group and sandplay therapy group in SAS,SDS,or QLQ-C30 subscale scores(P>0.05).The combined therapy group had significantly lower SAS and SDS scores and higher QLQ-C30 subscale scores than the five-element music group and sandplay therapy group(P<0.05).Conclusion Five-element music com-bined with sandplay therapy can significantly improve negative emotions and quality of life in patients with malignant tumors.

Objective:To develop a quality assessment index system for infection prevention and control in integrated medical and elderly care facilities, providing methods for assessing infection control quality and a theoretical basis for enhancing infection prevention and control capabilities.Methods:This study initially constructed a framework for the quality evaluation index system through literature reviews, work specifications and standards and expert interviews. The Delphi method was employed to conduct two rounds of consultations with 19 experts to evaluate the necessity, feasibility, stability, and sensitivity of the indicators. The expert′s active coefficient, authority coefficient, degree of consensus, and coordination were statistically analyzed. The indicators were revised based on expert opinions to finalize the evaluation index system. The weights of the evaluation dimensions were determined using the Analytic Hierarchy Process (AHP), while the weights of the indicators were determined using the proportional allocation method. Reliability was assessed via Cronbach′s α coefficient, and content validity was verified through the Content Validity Index ( CVI). Results:After two rounds of expert consultation, the expert positive coefficient, expert authority coefficient ( Cr) and expert coordination coefficient Kendall′s W was 100%, 0.992 and 0.634 ( P<0.001), indicating high expert authority, good concentration and coordination of opinions. The assessment index system for infection prevention and control quality in integrated medical and elderly care facilities was ultimately constructed, comprising three primary indicators, 18 secondary indicators and 68 tertiary indicators. Among the primary indicators, the process quality had the highest weight of 0.338. Within the process quality, the secondary indicators with the highest weights were infection control material allocation, hand hygiene quality and the management of cluster outbreaks. A total of 11 unique evaluation indicators for integrated medical and elderly care facilities were established, with the highest weighted indicator being the rate of standardized surveillance of infection-related risk factors. Reliability and validity analyses demonstrated that the overall Cronbach′s α coefficient of the system was 0.991, and the Scale-level Content Validity Index was 0.936, confirming good reliability and validity. Conclusion:The evaluation index system constructed in this study can serve as an effective assessment tool for the quantitative evaluation of infection control quality in integrated medical and elderly care facilities. Furthermore, it is recommended that the system undergo continuous optimization concerning its application.

Objective:To establish a method for determination of fluoride in water using a fully automated biochemical analyzer (abbreviated as this method).Methods:Based on the parameters of the fully automatic biochemical analyzer, appropriate reagent volumes and reaction time were optimized to determine fluoride ions in water within the standard curve range (0.0 - 2.0 mg/L). The method was validated through evaluation of linear range, detection limit, precision, accuracy, and comparative analysis with the manual measurement results of fluoride reagent spectrophotometric method specified in the "Standard Examination Methods for Drinking Water - Part 5: Inorganic Nonmetallic indices" (GB/T 5750.5-2023).Results:Within the range of 0.0 - 2.0 mg/L fluoride mass concentration, the absolute values of the correlation coefficients were > 0.999 0 and the detection limit of this method was 0.082 mg/L. The relative standard deviation for the determination of fluoride level in water samples with low, medium and high fluoride mass concentrations was 4.03%, 2.16% and 1.68%, respectively. The spiked recovery rates were 98.1%, 99.5%, and 100.2%, respectively. There was no statistically significant difference between the results obtained by this method and manual measurement ( t = 1.07, P = 0.295). Conclusion:This method exhibits high sensitivity, accuracy, and efficiency in detecting fluoride, enabling rapid sample detection through instrumental automation instead of manual operation.

Objective To observe the effect of Buyang Huanwu Decoction combined with Tirofiban on cerebral oxygen metabolism and neurological function in patients with ischemic stroke.Methods A total of 110 patients with ischemic stroke of qi deficiency and blood stasis type who were treated at Rizhao Central Hospital from October 2022 to October 2024 were selected.The patients were randomly divided into a control group and a combined group using a random number table,with 55 patients in each group.The control group received intravenous infusion of Tirofiban,while the combined group was given additional Buyang Huanwu Decoction orally on the basis of treatment for the control group.The course of treatment for both groups covered 2 weeks.Before and after treatment,the changes in traditional Chinese medicine(TCM)syndrome scores,National Institutes of Health Stroke Scale(NIHSS)scores,oxidative stress response,neurological function,platelet function,and indicators associated with cerebral oxygen metabolism in both groups were observed.Results(1)After treatment,the scores of TCM syndromes of sudden dizziness,hemiplegia,shortness of breath and fatigue,and pale and dull complexion were decreased in both groups compared with those before treatment(P＜0.05),and the decrease in the combined group was significantly superior to that in the control group(P＜0.01).(2)After treatment,the levels of serum oxidative stress response indicators of glutathione peroxidase(GSH-Px)and superoxide dismutase(SOD)were increased(P＜0.05),while the levels of serum oxidized low-density lipoprotein(ox-LDL)and malondialdehyde(MDA)were decreased(P＜0.05)in both groups compared with those before treatment.The combined group showed more significant increase in serum GSH-Px and SOD levels and more significant decrease in serum ox-LDL and MDA levels than the control group(P＜0.01).(3)After treatment,the platelet function indicators of platelet aggregation rate and platelet adhesion rate were decreased in both groups compared with those before treatment(P＜0.05),and the decrease in the combined group was significantly superior to that in the control group(P＜0.01).(4)After treatment,arterial oxygen content(CaO2)was increased(P＜0.05),while the levels of cerebral oxygen extraction rate(ERO2),and cerebral arteriovenous oxygen content difference[D(a-jv)O2]were decreased in both groups compared with those before treatment(P＜0.05),and the changes of the levels in the combined group were more obvious than those in the control group(P＜0.01).(5)Ater treatment,the neurological function indicators of NIHSS scores and serum neuron-specific enolase(NSE)level were decreased in both groups compared with those before treatment(P＜0.05),while the levels of serum brain-derived neurotrophic factor(BDNF)and nerve growth factor(NGF)were increased(P＜0.05).The combined group showed significant decrease in NIHSS scores and serum NSE level and significant increase in serum BDNF and NGF levels compared to the control group(P＜0.01).Conclusion For the treatment of patients with qi deficiency and blood stasis type of ischemic stroke,Buyang Huanwu Decoction combined with Tirofiban is effective on reducing TCM syndrome scores,improving cerebral oxygen metabolism and neurological function indicators,and inhibiting oxidative stress response,with significant therapeutic effects.

Objective To analyze the research hotspots,frontiers,and trends in clinical randomized controlled trials(RCTs)on acupuncture-moxibustion for post-stroke shoulder-hand syndrome(SHS)over the past decade using bibliometric and knowledge mapping methods.Methods The clinical RCTs on acupuncture-moxibustion for post-stroke SHS from five Chinese and English databases were retrieved,including CNKI,Wanfang,VIP,PubMed,and Web of Science(WOS).CiteSpace and VOSviewer were employed for analysis,and visualized knowledge maps were generated.Results A total of 1 226 Chinese and 20 English articles were included,with both reaching publication peaks in 2021.The top three institutions in terms of output were Huguosi Traditional Chinese Medicine Hospital Affiliated to Beijing University of Chinese Medicine,The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine,and Heilongjiang University of Chinese Medicine.The most prolific author was Song Fengjun,while Pei Jian had the highest centrality.The five most frequently used keywords were shoulder-hand syndrome,stroke,acupuncture-moxibustion,rehabilitation training,and joint mobility.Emerging research topics included activities of daily living,limb function,and range of motion.Conclusion Clinical research on acupuncture-moxibustion for post-stroke SHS holds significant developmental potential.Strengthening international collaboration to explore therapeutic mechanisms is recommended,and researchers should continue optimizing treatment protocols to enhance the quality of clinical evidence.

Respiratory viral infections such as influenza and respiratory syncytial virus infections continue to rapidly increase in patients worldwide.Host immune responses to respiratory viruses play a key role in the pathogenesis and clinical manifestations of the disease.Respiratory viruses not only activate antiviral immune responses,but also may lead to uncontrolled inflammatory re-sponses,characterized by significant release of pro-inflammatory cytokines in severely infected patients,resulting in lymphopenia,lymphocyte dysfunction,and abnormalities in immune cells such as neutrophils and macrophages.These respiratory virus-induced im-mune abnormalities may lead to microbial infection,septic shock,and severe multiorgan dysfunction.Therefore,clarifying the immu-nopathogenic mechanisms of patients with respiratory viral infections can guide clinical treatment and patient prognosis;in addition,rational regulation of the immune response of respiratory viruses in the host,including enhancing antiviral immunity while suppressing systemic inflammation,may be the key to successful treatment.This review mainly discusses the immunomodulation and related clini-cal treatment strategies for respiratory viral infections to help develop new therapeutic strategies for respiratory viral infections and pa-tient prognosis.

Purpose To investigate the clinicopathological features,differential diagnosis and prognosis of atypical fibroxanthoma(AFX).Methods Pathological features of 15 cases of AFX and 3 cases of pleomorphic dermal sarcoma(PDS)misdiagnosed as AFX were retrospectively analyzed by hematoxylin and eosin staining and immunohistochemical EnVision staining technology.Clinical information was collected and analyzed,and the relevant literatures were re-viewed.Results The age of the 15 patients with AFX ranged from 18 to 78 years,with an average age of 57 years.4 cases occurred in the head and neck,and 11 cases occurred in the trunk and limbs.3 patients with PDS misdiagnosed as AFX were aged from 56 to 60 years,with an average age of 58 years.The tumors were located in the trunk and limbs.Microscopically,15 cases of AFX and 3 cases of PDS misdiagnosed as AFX were composed of proliferative pleo-morphic and atypical spindle cells interspersed with a varying number of multinucleated cells.15 cases of AFX tumors were superficial and located in the dermis.In 3 cases of PDS misdiagnosed as AFX,1 case was located in subcutane-ous adipose tissue,1 case had superficial subcutaneous extension,and the third case had positive basal margin.Immu-nohistochemically,the immunophenotypes of the two groups were consistent.CD10 was expressed in all cases,CD68 was positive in most cases,SMA was expressed in a few cases,desmin was focal expressed in a very few cases,and S-100,SOX10,CD34,HMB-45,Melan A,STAT6 and CK(AE1/AE3)were not expressed in all cases.Ki67 prolifera-tion index ranged from 2％to 30％.15 patients with AFX were followed up from 12 to 108 months.One patient had tumor recurrence 1 year and 3 years after operation due to positive basal margin.Most of the other patients underwent extended resection after diagnosis and were in good condition without tumor recurrence and metastasis.3 cases of PDS misdiagnosed as AFX were followed up for 31 to 78 months.One patient had lung metastasis after 2 years,one patient recurred 4 times after operation,and the other patient died after 4 times of recurrence.Conclusion AFX is a rare dis-ease with similar pathological characteristics and immunophenotype to PDS.AFX can be diagnosed only when the tumor is small and completely confined to the dermis.When the maximum diameter of the tumor is more than 3 cm,or the presence of any form of subcutaneous extension requires a high level of vigilance for PDS.Careful differentiation and correct classification of AFX and PDS are very important for the treatment and prognosis of the disease.

Objective:To identify the risk factors influencing the prognosis of patients with advanced breast cancer through LASSO-Logistic regression analysis and construct a nomogram model to evaluate their prognostic risk.Methods:A total of 178 patients with advanced breast cancer who visited the Department of Thyroid and Breast Surgery of Chengyang District People’s Hospital of Qingdao City from Jan. 2015 to Jan. 2023 were selected as the research subjects. According to the follow-up results, the patients were divided into a good-prognosis group and a poor-prognosis group. Clinical data of the patients were collected. LASSO-Logistic regression analysis was used to identify the risk factors affecting the prognosis of patients with advanced breast cancer. A nomogram model was constructed based on the analysis results. The predictive efficacy of the model for the prognostic risk of patients with advanced breast cancer was evaluated using the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow (H-L) test.Results:During the follow-up, 5 patients were lost to follow-up. Among the final 173 patients included, 60 had poor prognoses (accounting for 34.68%), and 113 had good prognoses (accounting for 65.32%). There were significant differences between the poor prognosis group and the good prognosis group in terms of the number of lymph node metastases ( χ 2=18.12), the number of organ metastases ( χ 2=14.28), the difference in ADC before and after treatment ( t=17.35), the difference in SER before and after treatment ( t=9.57), the enhancement of the echo behind the breast after treatment ( χ 2=13.00), and the proportion of increased calcification ( χ 2=8.06) (both P < 0.05). The clinical data with significant differences in the univariate analysis were included in the LASSO regression analysis. Six factors were finally selected: number of lymph node metastases > 5, number of organ metastases > 1, difference in ADC values before and after treatment, difference in SER values before and after treatment, enhanced echo behind the breast, and increased calcification. These six factors selected by LASSO regression were included in the Logistic regression analysis. The results showed that number of organ metastases > 1 ( OR=2.208, 95% CI: 1.153-3.263), small difference in ADC values before and after treatment ( OR=0.448, 95% CI: 0.287-0.608), enhanced echo behind the breast ( OR=2.474, 95% CI: 1.063-3.886), and increased calcification ( OR=3.762, 95% CI: 1.831-5.693) were independent risk factors for poor prognosis in patients with advanced breast cancer (both P<0.05). A nomogram model was constructed based on the analysis results. The ROC curve showed that the area under the curve (AUC) of the model was 0.778. The H-L test results showed that the calibration curve fit well with the ideal curve, with χ 2 = 0.69 and P = 0.273. Conclusion:The nomogram model constructed based on LASSO-Logistic regression analysis has good predictive efficacy for the prognosis of patients with advanced breast cancer.