OBJECTIVE To evaluate the quality of diagnosis and treatment guidelines and expert consensuses on childhood immune thrombocytopenic purpura （ITP） published domestically and internationally， in order to provide reference for clinical practice and future guideline/expert consensus development and improvement. METHODS A systematic search was conducted across multiple databases， including PubMed， Cochrane Library， Embase， CNKI， Wanfang data， VIP， CBM； additionally， supplementary searches were carried out on websites such as Medlive， the Chinese Medical Association’s official website， and National Institute for Health and Clinical Excellence in the UK. The retrieval time ranged from the inception to September 2， 2024. Researchers who had undergone systematic training independently evaluated the methodology and report quality included in the guideline/consensus using the Appraisal of Guidelines Research and Evaluation Ⅱ （AGREE Ⅱ） and the Reporting Items for Practice Guidelines in Healthcare （RIGHT）. RESULTS A total of 11 guidelines/consensuses were included. The average scores for the six domains of AGREE Ⅱ tool respectively were “range and purpose” （[ 66.67±17.98）% ]， “participants” [58.33% （13.89%，73.61%）]， “rigor” （[ 41.81±23.85）% ]， “clarity”（[ 69.57±19.35）%]， “applicability” （[ 35.98±17.83）%]， and “independence” [27.08% （0，75.00%）]； out of 11 articles， 9 had a recommendation level of B， 2 had a recommendation level of C， and there were no A-level articles. The average reporting rates of the 7 areas in the RIGHT tool were “basic information” （[ 72.35±12.95）% ]， “background” （[ 54.55±15.40）%]，“ evidence” （[ 36.36±24.81）%]，“ recommended opinions” （[ 53.25±19.20）%]，“ review and quality assurance” [0 （0， 25.00%）]， “funding and conflict of interest statement and management” [12.50%（0，25.00%）]， and other aspects [8.33%（0， 50.00%）]. In addition， there was no statistically significant difference in the AGREE Ⅱ and RIGHT scores between the guidelines and consensuses （P＞0.05）. CONCLUSIONS The overall quality of the guidelines and consensuses included in this study is not high， with a recommended level of B or C. It is recommended that clinical decision-making prioritize referring to the relatively high-quality guideline/consensus among them. The quality of evidence in the existing traditional Chinese medicine guidelines for children with ITP needs to be improved， and there is no integrated guideline/consensus for traditional Chinese and Western medicine. It is recommended to revise or write relevant guideline/consensus according to the requirements of AGREE Ⅱ and RIGHT in various fields to guide clinical practice.

Objective To explore the status of nursing work engagement, nursing work environment and emotional intelligence and their relationship among nurses who work in hematopoietic stem cell transplantation (HSCT) units. Methods A total of 225 HSCT nurses were selected as study subjects by convenience sampling method. Utrecht Work Engagement Scale, Nursing Work Environment Scale and Emotional Intelligence Scale were used to assess the work engagement, work environment and emotional intelligence among these nurses. AMOS 23.0 software was used to construct the structural equation model. Results The median and 25th and 75th percentiles of the score of work engagement of the research subjects were 59.0 (54.0, 64.0) points. The average scores of the nursing work environment and emotional intelligence were (117.8±21.5) and (58.8±10.7) points, respectively. The score of work engagement was positively correlated with the scores of the nursing work environment and emotional intelligence (rank correlation coefficients were 0.550 and 0.431, respectively, both P<0.01). The total score of the nursing work environment was positively correlated with the total score of emotional intelligence (correlation coefficient was 0.271, P<0.01). The nursing work environment influenced the work engagement status of HSCT nurses through the mediating effect of emotional intelligence, with an indirect effect of 0.115 (95% confidence interval: 0.201-0.365), accounting for 20.4% of the total effect. Conclusion Emotional intelligence is a mediating variable between the nursing work environment and work engagement of HSCT nurses.

OBJECTIVE: To explore the impact of age on the genetic variant spectrum and prognosis of patients with previously untreated Diffuse large B-cell lymphoma (DLBCL). METHODS: A retrospective analysis was conducted on the clinical data and follow-up information of 254 previously untreated DLBCL patients from 14 hospitals in the Jiangsu Cooperative Lymphoma Group (JCLG) enrolled from July 2018 and July 2023. Following extraction of DNA from tumor tissue samples, next-generation sequencing (NGS) technique was employed to analyze the genetic variant spectrum of the DLBCL patients, with an evaluation of the relationship between age and genetic variants as well as prognosis. This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Nantong University (Ethics No.: 2023-K048-01). RESULTS: The median age of the 254 DLBCL patients was 62 years old, with 55% of patients aged 60 years or above. Clinical evaluation showed that younger (< 60 years) patients had higher complete response (CR) (70% vs. 59%), and objective response rate (ORR) (88% vs. 79%) than older patients, though the difference between the two groups was not statistically. Survival analysis indicated that both the five-year overall survival (OS) (82.7% vs. 71.7%, P = 0.006) and progression-free survival (PFS) (70.6% vs. 50.2%, P < 0.05) rates were significantly higher in younger patients. NGS showed that 99.6% of the patients harbored genetic variants, with PIM1, KMT2D, TP53, MYD88, and CD79B being the most common genes. Age significantly affected the variant frequency of certain genes, with MYC variants serving an adverse prognostic factor for OS in younger patients (P = 0.002), while TP53 (P = 0.024) and BCL2 (P = 0.002) variants significantly impacted OS in older patients. Prognostic analysis identified age ≥ 60 years (HR = 3.439, 95%CI: 1.318~9.874), presence of B symptoms (HR = 2.871, 95%CI = 1.133~7.307), and elevated lactate dehydrogenase (HR = 3.528, 95%CI = 1.231~10.66) as independent adverse prognostic factors. CONCLUSION Age, genetic variants, and clinical factors may significantly affect the prognosis of the DLBCL patients. Younger patients have better survival compared to older patients. Variants of the MYC, BCL2, and TP53 genes are closely associated with poor prognosis.
Humans ; Lymphoma, Large B-Cell, Diffuse/diagnosis* ; Middle Aged ; Female ; Male ; Retrospective Studies ; Aged ; Prognosis ; Adult ; Aged, 80 and over ; High-Throughput Nucleotide Sequencing ; Young Adult ; Adolescent ; Genetic Variation

This study investigated the primary pathogenesis and syndrome evolution of different heart failure with preserved ejection fraction(HFpEF)stages based on the classical and clinical experience of traditional Chinese medicine(TCM),combined with the clinical characteristics of pre-heart failure,symptomatic heart failure,and advanced heart failure.This study summarizes and refines the three core syndrome factors:water,deficiency and blood stasis.Water-fluid retention was observed throughout these three stages,from the beginning to the end.With the advancement of the disease,the heart yang changes from stagnation to deficiency,water-fluid retention gradually increases,blood stasis becomes increasingly prominent,and the disease location develops dynamically from the upper to the middle and lower jiao.This study proposes three methods of treating HFpEF.The main pathogenesis of pre-heart failure is lung qi dysfunction-induced water retention,which can be treated by dispersing lung qi and transforming water retention using Fuling Xingren Gancao Decoction.The primary pathogenesis of symptomatic heart failure is yang and qi deficiency-induced water retention,which can be treated with tonifying yang,supplementing qi,and transforming water retention using Shengxian Decoction combined with Linggui Zhugan Decoction.The primary pathogenesis of advanced heart failure is yang deficiency with blood stasis and water retention affecting the heart,which can be treated with tonifying yang,circulating blood,and expelling water retention using Zhenwu Tingli Decoction.Chinese medicine can be flexibly added or subtracted according to the patients'concurrent patterns.However,the daily care of patients should be considered.This study explores the staging treatment of HFpEF from water,deficiency and blood stasis to provide a TCM clinical reference for treating HFpEF.

AIM:To study the expression of glucose transporters(GLUTs)and silent information regulators(SIRTs/sirtuins)in the liver of diabetic rats and human hepatocytes(LO2 cells)treated with high glucose.METHODS:(1)Twenty male SD rats were randomly divided into normal control(NC)group and diabetes mellitus(DM)group.The rats in DM group were given single intraperitoneal injection of streptozotocin(STZ,60 mg/kg)to establish the DM model,while the rats in NC group were intraperitoneally injected with equal volume of solvent once.Fasting blood glucose(FBG)and body mass were measured every 2 weeks.After 12 weeks of rearing,the blood and liver tissues of the rats were ob-tained after anesthesia with 1%sodium pentobarbitone,the biochemical indicators of blood were detected,and the liver in-dex was calculated.Hematoxylin-eosin(HE)staining and periodic acid-Schiff(PAS)staining were used to observe liver histopathological changes.Lipid accumulation in liver tissues was detected by oil red O staining.The expression levels of GLUTs and SIRTs family member proteins were detected in rat liver tissues.(2)The LO2 cells were treated with different concentrations of glucose for 48 h.The viability of the cells in each group was measured by CCK-8 assay,and Western blot was used to detected the protein expression levels of GLUTs and SIRTs in the cells.RESULTS:(1)Compared with NC group,the rats in DM group were depressed,lost weight,and the FBG and liver index were significantly increased(P＜0.05).The results of HE staining showed that the hepatic sinuses were dilatated and congested near the central vein in DM rats,and mild edema and scattered infiltration of inflammatory cells were found in liver cells.The results of oil red O staining showed the red fat droplets were diffusely scattered within liver cells in DM group.The results of PAS staining showed that there were numerous diffuse light purple circular droplets in the cytoplasm of the liver cells in the central ve-nous area of the DM rats.Western blot showed that the protein levels of GLUTs were higher and the protein levels of SIRTs were lower than those in NC group(P＜0.01).(2)The results of CCK-8 assay showed that the viability of LO2 cells was increased in 50 mmol/L glucose group(P＜0.01),without significant difference in 75,100 and 125 mmol/L glucose groups(all P＞0.05),and decreased in 150,175 and 200 mmol/L glucose groups(all P＜0.01).Later,150 mmol/L glu-cose was used as the high-glucose intervention condition.Western blot showed that the protein levels of GLUTs and SIRTs in LO2 cells under high glucose intervention were consistented with the results in animal experiments.CONCLUSION:High concentration of glucose can cause liver damage in SD rats and reduce the viability of human hepatocytes(LO2 cells).It can also increase the expression of GLUTs and decrease the expression of SIRTs in rat liver tissues and LO2 cells.Therefore,GLUTs and SIRTs family members may be the target proteins of diabetes-induced liver injury.

Diabetic kidney disease(DKD)is the leading cause of end-stage renal disease.Chinese materia medica shows unique advantages in intervening DKD.Silent information regulator 1(SIRT1)protein plays a vital role in the occurrence and development of DKD.This article was about the SIRT1 signaling pathway and the main molecular regulatory mechanisms to sort out the role of Chinese materia medica in regulating SIRT1 in podocytes,oxidative stress and inflammatory response.It was found that Chinese materia medica monomers and compounds were capable of regulating the PGC-1 α signaling pathway,Nrf2/ARE signaling pathway,AMPK signaling pathway,NF-κB p65 signaling pathway,and PI3K/AKT/FoxO1 signaling pathway by targeting SIRT1,exerting pharmacological effects such as inhibiting cell apoptosis,improving mitophagy,inhibiting inflammatory response,etc.,thus intervening in DKD,which can provide reference for relevant research.

Objective:To compare and analyze the correlation between two kinds of point-of-care testing (POCT) instruments and Roche electrochemiluminescence instrument in detecting myocardial biomarkers,so as to provide reference for the selection of POCT instruments in clinical testing. Methods:A total of twenty patient's samples were selected,which concentration range covered the reportable range of detection results. Two kinds of POCT instruments (named respectively A and B) were used to detect the concentrations of plasma myoglobin (Myo),creatine kinase isoenzyme mass (CK-MB mass),cardiac troponin I(cTnI),and N-terminal fragment of B-type natriuretic peptide (NT-proBNP)/Brain natriuretic peptide (BNP). The results of the electrochemiluminescence instrument were used as reference,and Pearson correlation analysis and Kappa test evaluation were used to evaluate respectively the correlation and consistency of the detected results between the two kinds of POCT instruments and Roche electrochemiluminescence instrument. Results:Our study demonstrated that there were good correlations in the detected results of Myo,CK-MB mass,cTnI,NT-proBNP/BNP between the instrument A and Roche electrochemiluminescence instrument,and between the instrument B and Roche electrochemiluminescence instrument (rinstrumentA=0.994,0.989,0.917,0.996,rinstrumentB=0.928,0.934,0.883,0.977,P<0.05),respectively. In the comparisons about consistencies,the concordance rates between instrument A and electrochemiluminescence instrument were respectively 90％,100％,70％ and 100％ in detecting Myo,CK-MB,cTnI and NT-proBNP,and the concordance rates between instrument B and electrochemiluminescence instrument were respectively 90％,100％,70％ and 100％ in detecting them. Both two kinds of POCT instruments had favorable consistencies with Roche electrochemiluminescence instrument (Kappainstrument A=0.798,1.00,0.429,1.00,Kappainstrument B=0.794,0.886,0.429,1.00),respectively. The precisions of both instruments were less than 10％. Conclusion:Both two kinds of POCT instruments can meet the requirements of clinical test,which have favorable correlations with electrochemiluminescence instrument in detecting myocardial biomarkers.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Objective:To explore the construction and application of the evaluation system for ideological and political education in clinical medicine courses based on analytic hierarchy process (AHP) and fuzzy comprehensive evaluation (FCE) models.Methods:The evaluation system for ideological and political education in clinical medicine courses was constructed based on AHP and FCE models in the Yaahp software. Ideological and political education checklist teaching that places equal emphasis on medical ethics and skill was implemented in internal medicine course taken by 185 students in The First Affiliated Hospital of Xi'an Jiaotong University. At the end of the course, the evaluation system was used to obtain quantitative comprehensive evaluation results.Results:Based on AHP and FCE models, the evaluation system for ideological and political education in clinical medicine courses was established. The goal was education of students with both medical ethics and skill, the criteria included teachers' ethics, curriculum design, students' experience and development assessment, and thirteen alternatives were used in the system. The implementation effect of ideological and political education in internal medicine course of the first semester in the 2020-2021 academic year was evaluated by the evaluation system. The quantitative comprehensive evaluation score was 4.080 (range 1-5), which showed that the ideological and political education checklist teaching with equal emphasis on medical ethics and skill achieved good educating effect.Conclusion:The evaluation system for the implementation effect of ideological and political education in clinical medicine courses can be constructed based on the AHP and FCE models. The evaluation system is scientific, quantitative, comprehensive, and improvable.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.