OBJECTIVE To establish a method for simultaneously determining three anti-tuberculosis drugs in the plasma of patients with spinal tuberculosis and apply it in clinical practice. METHODS LC-MS/MS method was established for the quantitative determination of the concentrations of isoniazid， rifampicin and pyrazinamide in the plasma of patients with spinal tuberculosis， using diphenhydramine as the internal standard. The determination was carried out using Chemalink CM-C18T column， with mobile phase consisting of 0.1% formic acid-methanol solution （gradient elution）， at the flow rate of 0.4 mL/min and an injection volume of 2 μL. Multiple reaction monitoring was conducted using an electrospray ionization source in positive ion mode. The ion pairs used for quantitative analysis were m/z 138.0→121.0（ for isoniazid）， m/z 823.3→791.3（ for rifampicin）， m/z 124.1→ 79.0 （for pyrazinamide）， and m/z 256.0→167.0 （for diphenhydramine）. Fifty-three patients diagnosed with spinal tuberculosis in Qinghai Provincial People’s Hospital from January 2023 to June 2025 were selected， and the plasma concentrations of isoniazid， rifampicin and pyrazinamide in these patients were measured using the above method. RESULTS The linear ranges for isoniazid， rifampicin and pyrazinamide were 0.5-16， 2-64， and 2.5-80 μg/mL， respectively （r≥0.998 7）. The accuracy ranged from 90.20% to 108.64% （n＝5）. RSDs for intra-day precision were all less than 6.63% （n＝5）， while those for inter-day precision were all less than 8.42% （n＝3）. The matrix effects ranged from 88.60% to 115.41% （n＝5）. The relative deviations in the stability tests were all within the ±15% range， and the carry-over effect did not interfere with the determination. The results of clinical application showed that the mean plasma drug concentrations of isoniazid， rifampicin and pyrazinamide in patients with spinal tuberculosis were （3.62±2.80）， （8.55±4.57）， and （20.12±6.56） μg/mL， respectively. The incidences of plasma drug concentrations falling below the effective peak concentrations were 49.06%， 58.49% and 60.38%， respectively. CONCLUSIONS The method established in this study is rapid， accurate， and demonstrates good stability， making it suitable for clinical monitoring of the plasma concentrations of isoniazid， rifampicin and pyrazinamide in patients with spinal tuberculosis.

Objective: To investigate the current status of benefit finding among young and middle-aged patients with type 2 diabetes mellitus (T2DM) and analyze its influencing factors, so as to provide a reference for improving the level of benefit finding in this population. Methods: From November 2022 to May 2023, young and middle-aged patients with T2DM aged 18-59 years hospitalized in the endocrinology departments of 2 tertiary hospitals in Hengyang City, Hunan Province were selected as survey subjects by a convenience sampling method. Basic demographic information was collected using a general questionnaire survey. Benefit finding, resourcefulness, and stigma were evaluated using the Benefit Finding Scale, the Chinese Version of the Resourcefulness Scale, and the Type 2 Diabetes Stigma Assessment Scale, respectively. A multiple linear regression model was used to analyze the influencing factors of benefit finding among young and middle-aged patients with T2DM. Results: A total of 305 young and middle-aged patients with T2DM were investigated, including 222 males (72.79%) and 83 females (27.21%). There were 231 cases aged 45-59 years, accounting for 75.74%. The scores for benefit finding, resourcefulness, and stigma were (42.86±6.06), (75.12±11.30), and (41.20±10.10), respectively. Multiple linear regression analysis showed that young and middle-aged patients with T2DM who were male (β′=0.088), aged 18-<45 years (β′=0.083), absence of diabetes complications (β′=0.124), and had higher resourcefulness scores (β′=0.679) had higher levels of benefit finding, while patients with higher stigma scores (β′=-0.097) had lower levels of benefit finding. Conclusion The level of benefit finding among young and middle-aged patients with T2DM was moderate, and was related to gender, age, diabetes complications, resourcefulness, and stigma.

Objective: To analyze the association between different sleep statuses and overweight/obesity among primary school students, so as to provide a basis for the development of childhood overweight and obesity prevention and control strategies. Methods: In November 2023, a total of 3 391 primary school students of grade 1-6 from seven schools in Baoan District, Shenzhen, were surveyed by questionnaires and physical examinations by using multistage cluster sampling. The Logistic regression analysis was used to explore the association between primary school students sleep status and overweight/obesity. Results: The detection rate of overweight/obesity in primary school students was 22.59%, the detection rate of overweight/obesity in boys (27.04%) was higher than that in girls (17.44%), the only child (25.81%) had higher rates than nononly child (21.76%), and the differences were statistically significant (χ2=51.48, 5.98, P＜0.05). Multivariate Logistic regression analysis showed that, after controlling for confounders, primary school students weekend nighttime sleep duration (OR=0.83, 95%CI=0.75-0.91), weekly average nighttime sleep duration (OR=0.76,95%CI=0.64-0.89), and weekend compensated sleep duration (OR=0.89,95%CI=0.81-0.97) were negatively associated with the risk of developing overweight/obesity (P＜0.05). Compared with to primary school students with school days nap durations <0.5 h, those whose napped for 0.5-＜1 h and ≥1 h on school days had a 20% (OR=1.20, 95%CI=1.02-1.42) and 37% (OR=1.37, 95%CI=1.02-1.83) increased risk of overweight/obesity, respectively (P＜0.05). Conclusions Increasing weekend nighttime sleep duration, average weekly nighttime sleep duration, and weekend compensatory sleep duration can reduce the risk of overweight and obesity in primary school students. School days nap duration is a risk factor for overweight/obesity among primary school students.

Objective:To analyze the human immunodeficiency virus (HIV) screening status and the resulting residual risk (RR) among blood donors across 17 provincial blood centers in China.Methods:This study used a cross-sectional study. Data on HIV infection markers per 100 000 first-time donors (FD) and repeat donors (RD) from January 2015 to December 2024 were extracted from the National Blood Establishment Performance Comparison Information Management System. Questionnaires were used to collect each center′s HIV screening strategy, algorithm, serological test (ST) kit manufacturers, gray-zone setting for ST, and nucleic acid test (NAT) modality, method, and platform. The incidence-window-period model was used to calculate the residual risk for first-time donors (RR FD), repeat donors (RR RD), and total donors (RR TD) at each center. Horizontal and vertical analysis of RR FD, RR RD, and RR TD across centers and years were performed. Results:All 17 centers applied the same HIV screening strategy which was two rounds of ST followed by one round of NAT. Eight of them operated a single screening algorithm, six employed two algorithms and three used three. Eleven centers used both imported and domestic ST kits, five relied on domestic ST kits only, and one used imported ST kits only, while four centers never set a grey zone for ST throughout the decade. For NAT modalities, eight centers adopted both individual nucleic acid test (ID-NAT) and minipool nucleic acid test (MP-NAT), eight used MP-NAT only and one used ID-NAT only. Seven centers combined transcription mediated amplification (TMA) and polymerase chain reaction (PCR), nine used PCR only and one used TMA only, and fourteen centers ran both imported and domestic NAT systems, two used imported systems only and one used a domestic system only. Over the ten-year period, the mean RR FD across the centers ranged from 2.22 to 12.33 per 10 6 person-years, RR RD from 0.83 to 3.29 per 10 6 person-years and RR TD from 1.59 to 9.29 per 10 6 person-years, with center Z4 consistently showing the lowest values for all three metrics and center U4 recording the highest RR FD and RR TD, while center D2 had the highest RR RD. In 2024 compared with 2015, eleven centers achieved a lower RR FD and ten centers achieved lower RR RD and RR TD. The RR FD and RR TD of centers W2 and U4 displayed pronounced fluctuations and an upward trend in recent years. Conclusions:The 17 provincial blood centers maintain consistent HIV screening strategies, while demonstrating variations in screening algorithm, ST kit manufacturers, NAT modalities, methods, and platform. And the RR FD, RR RD, and RR TD differ across centers. Although most centers show declining trend in RR over the ten-year period, some centers exhibite data fluctuations with a rising trend, suggesting potential for further optimization of HIV screening protocols.

Aiming at solving problems of ambiguous objectives,fragmented contents,fossilized forms,and single assess-ments in ideological and political education,a new course pattern have been constructed based on reestablishing course objectives,re-constructing teaching contents and resources,and reforming teaching models and evaluation systems through transition of course con-cept and promotion of online-and offline-blended course.Considering culture features of Immunology,diverse teaching activities were implemented.A cultural atmosphere of"happy learning,beauty orienting,thought discriminating,and practice devoting"have been created and the goal of ideological and political education with definite objectives,systematic contents,various forms,and multiple as-sessments have been archived.At the end of the term,a survey on the teaching effects of ideological and political education revealed that 99.3%of students felt moved,touched,and gained a lot during the ideological and political education.Remodeling the curriculum culture blazes a new path for ideological and political education in Medical Immunology.

OBJECTIVE To observe and compare the synergistic rates of combined use of polymyxin B with 12 types of traditional antibiotics against carbapenem-resistant Klebsiella pneumoniae(CRKP)in vitro antimicrobial ac-tion.METHODS Totally 30 strains of CRKP were randomly drawn from 312 strains of CRKP that were isolated from the clinical departments of Shiyan People's Hospital between 2020 to 2023.The carbapenemases were detec-ted by Carba NP test.The six genotypes KPC,OXA-48,OXA-23,NDM,VIM and IMP were detected by means of fluorescent quantitative polymerase chain reaction(PCR),the drug resistance of the strains was detected by mi-cro broth dilution method,and the synergistic effect of polymyxin B combined with 12 types of traditional antibi-otics on in vitro antimicrobial action was detected by using micro chessboard dilution method.RESULTS All of the isolated CRKP strains produced carbapenemases,with the KPC genotype dominant.The drug resistance rates to cephalosporins,carbapenems and quinolones reached up to 100.00％,and no polymyxin B-resistant strains were detected.The synergistic rates of minocycline and rifampicin combined with polymyxin B to the in vitro antimicro-bial action were the highest,which were 73.33％and 50.00％,respectively;the synergistic rates of levofloxacin and ciprofloxacin combined with polymyxin B were the lowest,and both were 0.The synergistic rates of meropen-em and imipenem combined with polymyxin B to the in in vitro antimicrobial action were 36.67％and 30.00％,re-spectively.The synergistic rates of ceftazidime,cefepime,piperacillin-tazobactam and cefoperazone-sulbactam combined with polymyxin B to the in vitro antimicrobial action were less than 30.00％.CONCLUSIONS Polymyxin B combined with minocycline and rifampicin should be taken as the first choice for treatment of the CRKP-induced infection.The synergistic rate of the carbapenems combined with polymyxin B is higher than that of the cephalo-sporins combined with polymyxin B to the antimicrobial action.Levofloxacin and ciprofloxacin combined with pol-ymyxin B do not have synergistic effect on the in vitro antimicrobial action.

Objective:To develop an admission assessment index system for hospice care tailored to emergency patients.Methods:Using a mixed-methods approach, a preliminary framework was established through literature review and qualitative interviews. From May to September 2024, a two-round Delphi consultation was conducted with 26 experts to screen and refine indicators. The final system was determined using a priority chart method for weight assignment.Results:Twenty-five experts in fields of emergency medicine, emergency nursing, palliative care nursing, palliative care medicine and general practice completed both consultation rounds. The experts ranged in age from 36 to 56 years and had 12 to 36 years of work experience. All held intermediate or higher professional titles. The effective recovery rates for the two rounds of consultation questionnaires were 96.15%(25/26) and 100.00%(25/25), respectively. Expert authority coefficients were 0.891 and 0.911, with Kendall′s coordination coefficients of 0.348 and 0.399 ( P<0.001), and variation coefficients ranging from 0.040 to 0.204 and 0.000 to 0.179. The finalized system comprises 5 primary indicators (weighted coefficients: life-limiting disease status 0.268, symptom control 0.236, patient/familywishes 0.201, social support needs 0.162, medical resource utilization 0.133) and 27 secondary indicators. Conclusion:The index system developed in this study provides a comprehensive and practical tool for identification of emergency patients requiring hospice care, facilitating timely clinical decision-making.

Objective To systematically retrieve,evaluate and summarise the best available evidence on prevention and management of diagnostic blood loss in critically ill adult patients and to provide guidance for standardising diagnostic blood sampling in clinical practice.Methods A structured evidence question was created using the PIPOST framework(Population,Intervention,Professional,Outcome,Setting and Type of evidence).Guided by the"5S"levels-of-evidence pyramid,a top-down systematic search was conducted on databases of BMJ Best Practice,UpToDate,the Joanna Briggs Institute(JBI)EBP Database,GIN,SIGN,RNAO,NICE,Medlive Guideline,WHO,National Blood Authority(Australia),National Health Commission of China,Cochrane Library,PubMed,EMbase,CINAHL,Web of Science,Wanfang Data,CNKI,VIP,and SinoMed.Searched literature included clinical decision aids,guidelines,evidence summaries,systematic reviews Meta analysis,RCTs,quasi-experimental,cross-sectional,cohort studies and expert consensus/opinions.Search period covered between 1st January 2015 and 10th February 2025.Quality appraisal,evidence extraction,synthesis and grading were performed according to JBI and GRADE approaches.Results Nineteen articles were retrieved including five guidelines,five systematic reviews,one RCT,two quasi-experimental studies,two cross-sectional studies,one professional standard and three expert consensuses.A total of 26 recommendations were extracted and they were organised into five domains:education and training,blood-sampling assessment,frequency of sampling,strategies to minimise blood volume drawn,and quality control.Conclusion This evidence summary provides the best current guidance for preventing and managing iatrogenic blood loss caused by diagnostic testing in critically ill adults,providing evidence-based basis for standardizing blood tests by medical staff.

Objective:To explore the relationship between general demographic characteristics,inflammatory indicators,nutritional indicators,pathological data and lymph node metastasis in endometrial cancer(EC)pa-tients,and to construct and validate a model for preoperative prediction of lymph node status in endometrial canc-er patients.Methods:The preoperative clinical data of 473 patients with EC who underwent surgical treatment in the Zhu Jiang Hospital of Southern Medical University from January 2010 to April 2024 were retrospectively ana-lyzed.The independent risk factors of lymph node metastasis of endometrial cancer were screened by univariate and multivariate Logistic regression analyses,and the nomogram prediction model was constructed by R soft-ware.The performance of the model was evaluated by the receiver operating characteristic(ROC)curve,calibra-tion curve and clinical decision curve.Results:Menopausal status,high grade biopsy pathology,CA125 ≥24.47U/ml,systemic immune inflammatory index(SII)≥710.91,and prognostic nutritional index(PNI)＜52.90 were in-dependent risk factors for lymph node metastasis in endometrial cancer(OR＞1,P＜0.05).The nomogram model constructed based on these five factors had an AUC of 0.853 in the training set and 0.871 in the test set.The cali-bration curve fitted well,and the clinical decision curve shows a positive benefit.Conclusions:The endometrial cancer lymph node metastasis prediction model constructed based on menopausal status,biopsy pathology,CA125,SII,and PNI has good accuracy and fit,with certain clinical application value.

Following the evidence-based diagnosis and treatment guideline development method for common pediatric diseases,the The Guideline for the Diagnosis and Treatment of Pediatric Food Accumulation and Stagnation in Chinese Medicine was formed through literature retrieval,expert questionnaire survey,expert discussion meeting,and solicitation of opinions.The revised content includes the scope of the guideline,normative reference documents,terms and definitions,diagnosis,syndrome differentiation,treatment,pre-vention and nursing suggestions,etc.,aiming to update the clinical diagnosis and treatment plan of Chinese medicine for accumulation and provide important clinical decision-making references for clinical physicians to rationally apply the diagnosis and treatment plan of Chinese medicine in the prevention and treatment of accumulation and stagnation in Children.