OBJECTIVE To assess the scientific rigor， clarity and feasibility of the recommendations of the Guidelines for Evidence-based Use of Biological Agents for the Clinical Treatment of Osteoporosis （hereinafter referred to as the Guideline） through external review， in order to further revise and improve the Guideline recommendations. METHODS This study employed a cross-sectional survey research design， a convenience sampling method was adopted to select frontline medical workers in the field of osteoporosis （including clinical doctors， clinical pharmacists， and nurses） as well as patients or their family members. External review was conducted through a combination of closed-ended and open-ended electronic questionnaires to get feedback from them on the appreciation，clarity and feasibility of the 32 preliminary recommendations in the Guideline. RESULTS A total of 90 external review subjects from 15 hospitals were collected， including 45 clinical doctors， 15 clinical pharmacists， 15 nurses and 15 patients or their family members. The overall appreciation degree of recommendations was 99.38%， the overall clarity degree of recommendations was 98.92%， and the overall feasibility degree of recommendations was 99.65%. At the same time， 111 subjective suggestions were collected， which provided an important reference for the further improvement of the Guideline recommendations. Based on the above feedback， the Guideline steering committee and core expert group revised the wording of 12 draft recommendations without deletion， and finally determined 32 recommendations. CONCLUSIONS The external review provides an important basis for the final formation of the Guideline， further improves the scientific rigor， clarity and feasibility of the recommendations， and ensures the standardization， practicality and implementability of the Guideline.

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.

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.

Corneal refractive surgery, a widely adopted method for correcting refractive errors, has demonstrated its safety, efficacy, and predictability in extensive research. Studies indicate varying degrees of intraoperative fluctuations inintraocular pressure, potentially impacting the posterior segment structures and functions due to surgical techniques, equipment, technical proficiency, and patient-specific factors. Although short-term postoperative follow-up in most patients does not reveal visual dysfunction, the long-term effects and potential risks of transient high intraocular pressure during surgery on the posterior segment structures and functions remain unclear. Therefore, the assessment of posterior segment complications following corneal refractive surgery is of paramount importance in clinical practice. This review aims to explore the characteristics of intraocular pressure fluctuations during corneal refractive surgery and their effects on structures and functions of the vitreous, retina, and optic nerve in the posterior segment, analyze possible causes and risk factors, discuss their implications for current clinical treatment, and consider future trends, providing insights for clinical practice.

OBJECTIVE To evaluate the effectiveness， safety， economy， innovation， suitability and accessibility of recombinant Mycobacterium tuberculosis fusion protein （EC）， and to provide evidence for selecting skin detection methods for tuberculosis infection diagnosis and auxiliary diagnosis of tuberculosis. METHODS The effectiveness and safety of EC compared with purified protein derivative of tuberculin （TB-PPD） were analyzed by the method of systematic review. Cost minimization analysis， cost-effectiveness analysis and cost-utility analysis were used to evaluate the short-term economy of EC compared with TB-PPD， and cost-utility analysis was used to evaluate the long-term economy. The evaluation dimensions of innovation， suitability and accessibility were determined by systematic review and improved Delphi expert consultation， and the comprehensive score of EC and TB-PPD in each dimension were calculated by the weight of each indicator. RESULTS The scores of effectiveness， safety， economy， innovation and suitability of EC were all higher than those of TB-PPD. The affordability scores of the two drugs were consistent， while the availability score of EC was lower than those of TB-PPD. After considering dimensions and index weight， the scores of effectiveness， safety， economy， innovation， suitability， accessibility and the comprehensive score of EC were all higher than those of TB-PPD. CONCLUSIONS Compared with TB-PPD， EC performs better in all dimensions of effectiveness， safety， economy， innovation， suitability and accessibility. However， it is worth noting that EC should further improve its availability in the dimension of accessibility.

Objective To predict the effectiveness of nosocomial infection management and effectively control the risk of nosocomial infection. Methods In this study, with the population of ICU patients in a Grade A hospital , 345 ICU patients seen from June 2020 to June 2021 were included in the analysis to collect the infection data in the hospital. Based on the use of the decision tree model to analyze the influencing factors of nosocomial infection, the neural network model was also used to predict the risk of developing nosocomial infection. Results The decision tree model showed that advanced age (age> 80 years) influenced the root node. Type 2 diabetes, gender by male, and BMI level were child nodes, which had different synergistic effects on the occurrence of nosocomial infection. At the same time, random forest (RF), support vector machine (SVM), logical regression (LR) and K nearest neighbor (KNN) algorithms were used to construct a neural network prediction model of nosocomial infection risk, suggesting that the condition, sex and body size of basic diseases are related to the occurrence of nosocomial infection. The combined use of the above model in parallel can effectively increase the specificity and reduce the missed diagnosis. Conclusion The neural network model joint decision tree model in parallel and joint early warning of nosocomial infection risk have excellent effect, and can effectively provide information support for the prevention, management and disposal of nosocomial infection.

Abstract: objective 2+- Toinvestigatethecorrelationbetween geneticpolymorphismofplasmamembraneCa ATPaseisoform2 PMCA2 - Methods ( )andsusceptibilitytonoise inducedhearingloss(NIHL). Atotalof228workerswithNIHLwereselectedas the case group by simple random sampling method,and 230 normal hearing workers with similar age,length and level of noise exposure were selected as the control group.DNA was extracted from peripheral blood of workers of the two groups,and single PMCA2 Results nucleotidepolymorphism (SNP)of wasgenotypedbyMassArraysystem. Theallelefrequenciesofrs1719571 PMCA2 - P and rs14154 of gene in the control population were consistent with Hardy Weinberg equilibrium (both >0.05). There was no significant difference in the distribution of rs1719571 and rs14154 genotypes and allele frequencies between the two P groups(all >0.05).LogisticregressionanalysisshowedthattheriskofNIHLinGAgenotypeofrs1719571waslowerthanthat-P in GG genotype (odds ratio=0.53, 95% confidence interval=0.31 0.90, <0.05), after excluding the effects of age, length of exposure to noise, intensity of exposure to noise, smoking and alcohol consumption. The genotype of SNP rs14154 might not P Conclusion PMCA2 contribute to the genetic susceptibility of NIHL( >0.05). The SNP of rs1719571 is associated with the susceptibilityofNIHL,andGAgenotypemaybeapotentialprotectivefactorforNIHL.

ObjectiveTo establish the quality standard of Liangditang benchmark samples. MethodUltra performance liquid chromatography-quadrupole time-of-flight mass spectrometry （UPLC-QTOF-MS） was used to qualitatively analyze the chemical composition of Liangditang on the basis of molecular and fragment ion peak information with cracking law. The mobile phase was methanol （A）-0.05% phosphate aqueous solution （B） for gradient elution （0-10 min， 5%-23.5%A； 10-20 min， 23.5%A； 20-58 min， 23.5%-63%A； 58-60 min， 63%-90%A）， the flow rate was 0.8 mL·min^-1， and the detection wavelength was 254 nm. Electrospray ionization was employed under positive ion mode， the detection range was m/z 100-1 700. Key quality attributes and sources were determined by comparing with single medicine and reference substances. Through mass transfer analysis of multiple batches from decoction pieces to benchmark samples， high performance liquid chromatography （HPLC） for determining the contents of index components and HPLC detection of characteristic maps were established. Through the determination of 15 batches of benchmark samples， the content range of the index components and the common peaks of the characteristic map were determined. Thin layer chromatography （TLC） was applied to the identification of 5 medicines in the formula. Moisture and dry extract yield of the benchmark samples were determined by drying method. ResultA total of 27 compounds were inferred from the benchmark samples of Liangditang， among which 9 compounds were confirmed by comparison with the control， including catalpol， harpagide， gallic acid， albiflorin， paeoniflorin， verbascoside， angoroside C， cinnamic acid and harpagoside. A method for determining the characteristic maps of the benchmark samples were established and 13 peaks were assigned， and the characteristic peaks were mainly derived from wine-processed products of Rehmanniae Radix， Scrophulariae Radix and wine-processed products of Paeoniae Radix Alba. The similarity between the characteristic map of 15 batches of benchmark samples and the control characteristic map was >0.9. Methods for the determination of paeoniflorin， harpagoside， L-hydroxyproline and glycine were established， and the contents of these four components in 15 batches of benchmark samples were within ±30% of the corresponding mean value， and the transfer rate of decoction pieces to the benchmark samples was stable and controllable. TLC was established to identify 5 prescription drugs （except Ejiao） with two kinds of test solutions， and the results showed that the method had good specificity. The average dry extract yield was 48.06%， and the average moisture was 5.58%， which were within the range of ±10% and ±30% of their mean values， respectively. ConclusionThe quality standard of Liangditang benchmark samples was as follows：the similarity between the benchmark samples and the control characteristic map is >0.9， the contents of paeoniflorin， harpagoside， L-hydroxyproline and glycine are 217-403， 24-46， 634-1 178， 1 253-2 328 mg per dose， the dry extract yield is 43.0%-53.0%， the moisture is 4.0%-7.0%， under the set detection conditions， the benchmark samples have corresponding characteristic spots by comparing with the control herbs of 5 medicines. This quality standard is stable and reliable， which fills the gap in the quality control of Liangditang， and can provide a reference for the establishment of the quality standard of Liangditang granules.

Talaromyces marneffei is the only dimorphic species in its genus and causes a fatal systemic mycosis named talaromycosis. Our previous study indicated that knockdown of AcuD gene (encodes isocitrate lyase of glyoxylate bypass) of T. marneffei by RNA interference approach attenuated the virulence of T. marneffei, while the virulence of the AcuD knockout strains was not studied. In this study, T. marneffei-zebrafish infection model was successfully established through hindbrain microinjection with different amounts of T. marneffei yeast cells. After co-incubated at 28°C, the increasing T. marneffei inoculum doses result in greater larval mortality; and hyphae generation might be one virulence factor involved in T. marneffei-zebrafish infection. Moreover, the results demonstrated that the virulence of the ΔAcuD was significantly attenuated in this Zebrafish infection model.
Gene Knockout Techniques ; Hyphae ; Isocitrate Lyase ; Microinjections ; Mortality ; Rhombencephalon ; RNA Interference ; Talaromyces ; Virulence ; Yeasts ; Zebrafish

Objective To investigate the distribution and constituent of drug‐resistant bacteria of lower respiratory tract in‐fection among different regions (outpatient department ,wards ,RICU) to provide the basis for the clinical reasonable application of antimicrobial agents .Methods The K‐B disc diffusion method and the instrument method (VITEK‐TWO) were adopted and the detection results were interpreted according to the standards of CLSI 2010 .The detection data of 480 drug‐resistant strains isolated from the sputum ,branchoalveolar lavage fluid samples submitted in 3 regions of respiratory outpatients department by bacterial cul‐ture identification and drug susceptibility test were analyzed by using the WHONET5 .6 statistical software .Results The distribu‐tion and constituent of drug‐resistant bacteria of lower respiratory tract infection had obvious difference among 3 different regions . The top 4 of drug resistant bacteria were dominated by Gram‐negative bacteria .The drug resistance rate of Klebsiella pneumoniae in RICU was higher than that in the respiratory outpatients department and wards(P<0 .05) ,the resistance rate in the respiratory outpatients department ,wards and RICU to commonly used antibacterial drugs was similar;the multiple drug resistance of ESBLs‐producing strains was obviously higher than that of non‐ESBLs‐producing strains (P<0 .05) .Pseudomonas aeruginosa maintained the higher antibacterial activity to quinolone ,aminoglucosides ,cefepime ,imipenem ,cefoperazone/sulbactam ,and piperacillin/tazobactam ,but the resistance rate in RICU was significantly higher that in the respiratory outpatient department and wards (P<0 .05);the drug resistance of Acinetobacter baumanii in the respiratory wards and RICU was higher than that in the respiratory out‐patient department ,the resistances to imipenem were 64 .6% and 70 .4% respectively .The resistance of MRSA to rifampin in RICU was higher than that in the respiratory outpatient department and wards(P<0 .05) .Conclusion The distribution constituent and drug‐resistance rates have obvious differences among the respiratory outpatient department ,wards and RICU .Except being familiar with the drug resitant bacterial distribution and drug resistance rate monitoring situation ,clinical doctors should grasp the drug re‐sistance situation of drug resistant bacteria among different areas in various departments of own unit in order to rationally and effec‐tively use antibacterial drugs .