Objective:To investigate the expression and clinical value of integrin-associated protein 47 (CD47) and soluble programmed death receptor-ligand 1 (sPD-L1) in patients with primary immune thrombocytopenia (ITP).Methods:The method of retrospective study was adopted, 76 patients with ITP admitted to the Affiliated Hospital of Jining Medical University from July 2016 to July 2022 were regarded as the study group, and another 76 cases of physical examination were regarded as the control group. The levels of serum CD47, sPD-L1, interleukin-33(IL-33) and transforming growth factor beta (TGF-β) were determined by the enzyme-linked immunosorbent assay, the diagnostic value of CD47 and sPD-L1 for ITP was analyzed by the receiver operating characteristic (ROC) curve, Pearson test was applied to analyze the correlation between serum CD47 and sPD-L1 in ITP patients, multivariate Logistic regression analysis was applied to analyze the risk factors affecting ITP.Results:The levels of serum CD47, sPD-L1 and IL-33 in the study group were higher than those in the control group: (40.31 ± 6.59) μg/L vs. (32.16 ± 6.33) μg/L, (78.42 ± 10.22) ng/L vs. (64.49 ± 10.36) ng/L, (73.29 ± 14.26) ng/L vs. (26.54 ± 5.16) ng/L; the level of serum TGF-β in the study group was lower than that in the control group: (1 752.66 ± 310.73) ng/L vs. (2 625.88 ± 389.58) ng/L, there were statistical differences ( P<0.05). The result of the Pearson test showed that there was a positive correlation between serum CD47 and sPD-L1 in ITP patients ( r = 0.572, P<0.05). The result of the ROC curve showed that the area under the curve predicted by the combination of serum CD47 and sPD-L1 was 0.948 (95% CI 0.916 - 0.979), which was better than that predicted by CD47 and sPD-L1 alone ( P<0.05). The result of multivariate Logistic regression analysis showed that CD47, sPD-L1, and IL-33 were the risk factors affecting ITP ( P<0.05), and TGF-β was the protective factor affecting ITP ( P<0.05). Conclusions:The serum levels of CD47 and sPD-L1 in patients with ITP are elevated, and the combined detection of the two indicators has a good diagnostic value for ITP.

Chronic hepatitis B(CHB)is the main cause of hepatocellular carcinoma(HCC).Early prediction and diagnosis of HCC in CHB patients can further reduce the onset risk of HCC and improve patient prognosis.Scholars at home and abroad have proposed a number of HCC risk prediction models for CHB patients,and these models have achieved new development and opti-mization in the era of antiviral therapy.Due to differences in research backgrounds,these models vary in the use of antiviral drugs,included variables(such as host factors,viral activity,cirrhosis status,etc.)and application scenarios.At the same time,the application of artificial intelligence and liquid biopsy technology in risk prediction models has become a new research highlight.This paper aims to compare the HCC risk prediction models reported so far for CHB patients,clarify the characteristics of each model,explore appropriate HCC risk prediction methods,and provide reference for the risk prediction of hepatitis B virus related HCC.

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.

Chronic hepatitis B(CHB)is the main cause of hepatocellular carcinoma(HCC).Early prediction and diagnosis of HCC in CHB patients can further reduce the onset risk of HCC and improve patient prognosis.Scholars at home and abroad have proposed a number of HCC risk prediction models for CHB patients,and these models have achieved new development and opti-mization in the era of antiviral therapy.Due to differences in research backgrounds,these models vary in the use of antiviral drugs,included variables(such as host factors,viral activity,cirrhosis status,etc.)and application scenarios.At the same time,the application of artificial intelligence and liquid biopsy technology in risk prediction models has become a new research highlight.This paper aims to compare the HCC risk prediction models reported so far for CHB patients,clarify the characteristics of each model,explore appropriate HCC risk prediction methods,and provide reference for the risk prediction of hepatitis B virus related HCC.

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 predictive value of platelet-to-albumin ratio (PAR) for organ failure in patients with acute pancreatitis (AP).Methods:The clinical data of 128 patients with AP from January 2021 to January 2024 in Affiliated Hospital of Jining Medical College were retrospectively analyzed. Among them, 68 patients developed organ failure (failure group), and 60 patients did not develop organ failure (non-failure group). The inflammatory indexes on admission were compared between the two groups. The severity of illness was evaluated by acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA). Pearson method was employed for correlation analysis. The receiver operating characteristic (ROC) curve was utilized to analyze the efficacy of PAR in predicting organ failure in patients with AP.Results:The APACHE Ⅱ, SOFA, white blood cell, platelet, red blood cell distribution width, C-reactive protein, fasting blood glucose, blood urea nitrogen, interleukin 6 (IL-6) and PAR in failure group were significantly higher than those in non-failure group: (25.91 ± 1.46) scores vs. (20.98 ± 1.46) scores, (7.03 ± 0.17) scores vs. (5.51 ± 0.33) scores, (11.22 ± 1.77) × 10 9/L vs. (9.32 ± 1.81) × 10 9/L, (200.12 ± 24.11) × 10 9/L vs. (173.18 ± 17.19) × 10 9/L, 0.134 ± 0.007 vs. 0.112 ± 0.007, (64.12 ± 7.38) mg/L vs. (46.93 ± 9.07) mg/L,(7.23 ± 1.09) mmol/L vs. (6.56 ± 0.87) mmol/L, (6.46 ± 1.17) mmol/L vs. (3.91 ± 0.39) mmol/L, (207.32 ± 74.29) ng/L vs. (109.27 ± 33.55) ng/L and 5.79 ± 0.98 vs. 4.30 ± 0.79, the serum calcium and albumin were significantly lower than those in non-failure group: (1.58 ± 0.09) mmol/L vs. (2.19 ± 0.32) mmol/L and (35.04 ± 4.05) g/L vs. (41.10 ± 5.79) g/L, and there were statistical differences ( P<0.01). Pearson correlation analysis result showed that PAR was positively correlated with APACHE Ⅱ, SOFA, white blood cell, platelet, red blood cell distribution width, C-reactive protein, fasting blood glucose, blood urea nitrogen and IL-6 ( r = 0.559, 0.623, 0.237, 0.782, 0.511, 0.392, 0.287, 0.555 and 0.505; P<0.01), and negatively correlated with serum calcium and albumin ( r = - 0.526 and - 0.820, P<0.01). ROC curve analysis result showed that the area under the curve of PAR for predicting organ failure in patients with AP was 0.875 (95% CI 0.818 to 0.933), with an optimal cutoff value of 4.56, sensitivity of 91.2%, and specificity of 66.7%. Conclusions:PAR can effectively predict the occurrence of organ failure in AP patients with high sensitivity, providing certain guiding significance for clinical treatment.

In 2024, a total of 27 309 cases of medication error (ME) from 484 hospitals in 27 provincial administrative regions were collected in the National Monitoring Network for Clinical Safe Medication. Among them, 279 (1.02%) were classified as grade A, 22 081 (80.86%) as grade B, 4 268 (15.63%) as grade C, 472 (1.73%) as grade D, 96 (0.35%) as grade E, 105 (0.38%) as grade F, 6 (0.02%) as grade H, and 2 (<0.01%) as grade I; no MEs of grade G occurred. Among the 27 030 patients involved in MEs of grade B to I, 15 124 (55.95%) were male and 11 906 (44.05%) were female; their ages were from 1 day to 104 years; 3 369 (12.46%) were children (<18 years old), 12 113 (44.81%) were young and middle-aged adults (≥18 to <60 years old), and 11 548 (42.72%) were elderly (≥60 years old). The top 3 contents of ME were wrong drug class (5 347 cases, 19.13%), wrong dosage (4 913 cases, 17.58%), and wrong administration frequency (3 429 cases, 12.27%). Among the 27 030 grade B-I MEs, the main person who triggered the event were physicians (18 703 cases, 69.19%) and pharmacists (6 343 cases, 23.47%). These MEs mainly occurred in clinics (11 009 cases, 40.73%), in hospital wards (7 393 cases, 27.35%), and in pharmacies (6 219 cases, 23.27%). The main persons who discovered the MEs were pharmacists (21 021 cases, 74.14%). The top 3 factors causing ME were lack of related pharmacologic knowledge (8 716 cases, 26.49%), tiredness (5 755 cases, 17.49%), and inexperienced skills (4 505 cases, 13.69%). A total of 209 patients were involved in severe MEs (grade E-I), including 133 (63.64%) males and 76 (36.36%) females, aged from 21 months to 94 years, of which 42 (20.10%) were children, 75 (35.88%) were young and middle-aged adults, and 92 (44.02%) were elderly. The top 3 diseases diagnosed in severe MEs were drug poisoning (41 cases, 19.62%), diabetes (34 cases, 16.27%), and hypertension (14 cases, 6.70%); the main person who triggered the MEs were patients and their families (135 cases, 64.59%); the MEs occurred mainly in patients′ houses (116 cases, 55.50%). Drug poisoning was mainly related to accidental ingestion by children, and MEs in patients with diabetes and hypertension were often related to issues on patient compliance. Based on the data of MEs in 2024, it was proposed to establish a better medication safety culture and improve the ME reporting situation in China, pay attention to the risks of misusing external drugs for internal use, children′s accidental ingestion and insulin-related MEs, strengthen the prevention of MEs related to look-alike sound-alike drugs, pay attention to the post administration management and the compliance education of home care for patients with chronic diseases, so as to improve the medication safety of patients in China.

Objective:To construct a recommended list of high-alert medication (HAM) based on big data from medication error (ME) reports in China, providing reference for preventing and reducing HAM-related risks.Methods:The drugs involved in the serious ME reports of the National Monitoring Network for Clinical Safe Medication (Monitoring Network) were collected (as of December 31, 2023), and the candidate drugs were preliminarily determined referring to the HAM list of China 2023 (Chinese list) and the latest three lists of American Institute for Safe Medication Practices (ISMP). Candidate drugs that were included in both the Chinese list and ISMP lists, as well as those existed in the Chinese list but had never been included in the ISMP lists were included in the current list, and their risk levels followed the original risks in the Chinese list. Candidate drugs that existed in the Chinese list but had been excluded from the ISMP lists, and those existed in the ISMP lists but had not been included in the Chinese list were listed as suspected drugs. For the other candidate drugs, those did not meet the definition of HAM were excluded firstly, and those related to ME that had caused serious harm were listed as suspected drugs, according to the judicial cases on ME of China Judgements Online and PKULAW database. Two methods, including Delphi expert consultation and questionnaire survey, were used to determine whether the above suspected drugs were included in the HAM list and their risk levels.Results:A total of 138 drugs were obtained through the initial screening, 106 of which were directly included in the current list, and 32 of which were listed as drugs requiring further assessment. After 2 rounds of Delphi expert consultation by 18 experts and surveys with 136 valid questionnaires, 32 suspected drugs did not meet the inclusion criteria. Finally, a total of 106 drugs were included in the current list, including 51 A-class drugs in 9 categories, 33 B-class drugs in 9 categories, and 22 C-class drugs in 5 categories.Conclusion:Based on the big data of the ME reports in China, a HAM list is constructed, which is accurate and concise and better fits the actual clinical drug risks in China, helping to improve the drug safety management.

Objective:To investigate the predictive value of platelet-to-albumin ratio (PAR) for organ failure in patients with acute pancreatitis (AP).Methods:The clinical data of 128 patients with AP from January 2021 to January 2024 in Affiliated Hospital of Jining Medical College were retrospectively analyzed. Among them, 68 patients developed organ failure (failure group), and 60 patients did not develop organ failure (non-failure group). The inflammatory indexes on admission were compared between the two groups. The severity of illness was evaluated by acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA). Pearson method was employed for correlation analysis. The receiver operating characteristic (ROC) curve was utilized to analyze the efficacy of PAR in predicting organ failure in patients with AP.Results:The APACHE Ⅱ, SOFA, white blood cell, platelet, red blood cell distribution width, C-reactive protein, fasting blood glucose, blood urea nitrogen, interleukin 6 (IL-6) and PAR in failure group were significantly higher than those in non-failure group: (25.91 ± 1.46) scores vs. (20.98 ± 1.46) scores, (7.03 ± 0.17) scores vs. (5.51 ± 0.33) scores, (11.22 ± 1.77) × 10 9/L vs. (9.32 ± 1.81) × 10 9/L, (200.12 ± 24.11) × 10 9/L vs. (173.18 ± 17.19) × 10 9/L, 0.134 ± 0.007 vs. 0.112 ± 0.007, (64.12 ± 7.38) mg/L vs. (46.93 ± 9.07) mg/L,(7.23 ± 1.09) mmol/L vs. (6.56 ± 0.87) mmol/L, (6.46 ± 1.17) mmol/L vs. (3.91 ± 0.39) mmol/L, (207.32 ± 74.29) ng/L vs. (109.27 ± 33.55) ng/L and 5.79 ± 0.98 vs. 4.30 ± 0.79, the serum calcium and albumin were significantly lower than those in non-failure group: (1.58 ± 0.09) mmol/L vs. (2.19 ± 0.32) mmol/L and (35.04 ± 4.05) g/L vs. (41.10 ± 5.79) g/L, and there were statistical differences ( P<0.01). Pearson correlation analysis result showed that PAR was positively correlated with APACHE Ⅱ, SOFA, white blood cell, platelet, red blood cell distribution width, C-reactive protein, fasting blood glucose, blood urea nitrogen and IL-6 ( r = 0.559, 0.623, 0.237, 0.782, 0.511, 0.392, 0.287, 0.555 and 0.505; P<0.01), and negatively correlated with serum calcium and albumin ( r = - 0.526 and - 0.820, P<0.01). ROC curve analysis result showed that the area under the curve of PAR for predicting organ failure in patients with AP was 0.875 (95% CI 0.818 to 0.933), with an optimal cutoff value of 4.56, sensitivity of 91.2%, and specificity of 66.7%. Conclusions:PAR can effectively predict the occurrence of organ failure in AP patients with high sensitivity, providing certain guiding significance for clinical treatment.

In 2024, a total of 27 309 cases of medication error (ME) from 484 hospitals in 27 provincial administrative regions were collected in the National Monitoring Network for Clinical Safe Medication. Among them, 279 (1.02%) were classified as grade A, 22 081 (80.86%) as grade B, 4 268 (15.63%) as grade C, 472 (1.73%) as grade D, 96 (0.35%) as grade E, 105 (0.38%) as grade F, 6 (0.02%) as grade H, and 2 (<0.01%) as grade I; no MEs of grade G occurred. Among the 27 030 patients involved in MEs of grade B to I, 15 124 (55.95%) were male and 11 906 (44.05%) were female; their ages were from 1 day to 104 years; 3 369 (12.46%) were children (<18 years old), 12 113 (44.81%) were young and middle-aged adults (≥18 to <60 years old), and 11 548 (42.72%) were elderly (≥60 years old). The top 3 contents of ME were wrong drug class (5 347 cases, 19.13%), wrong dosage (4 913 cases, 17.58%), and wrong administration frequency (3 429 cases, 12.27%). Among the 27 030 grade B-I MEs, the main person who triggered the event were physicians (18 703 cases, 69.19%) and pharmacists (6 343 cases, 23.47%). These MEs mainly occurred in clinics (11 009 cases, 40.73%), in hospital wards (7 393 cases, 27.35%), and in pharmacies (6 219 cases, 23.27%). The main persons who discovered the MEs were pharmacists (21 021 cases, 74.14%). The top 3 factors causing ME were lack of related pharmacologic knowledge (8 716 cases, 26.49%), tiredness (5 755 cases, 17.49%), and inexperienced skills (4 505 cases, 13.69%). A total of 209 patients were involved in severe MEs (grade E-I), including 133 (63.64%) males and 76 (36.36%) females, aged from 21 months to 94 years, of which 42 (20.10%) were children, 75 (35.88%) were young and middle-aged adults, and 92 (44.02%) were elderly. The top 3 diseases diagnosed in severe MEs were drug poisoning (41 cases, 19.62%), diabetes (34 cases, 16.27%), and hypertension (14 cases, 6.70%); the main person who triggered the MEs were patients and their families (135 cases, 64.59%); the MEs occurred mainly in patients′ houses (116 cases, 55.50%). Drug poisoning was mainly related to accidental ingestion by children, and MEs in patients with diabetes and hypertension were often related to issues on patient compliance. Based on the data of MEs in 2024, it was proposed to establish a better medication safety culture and improve the ME reporting situation in China, pay attention to the risks of misusing external drugs for internal use, children′s accidental ingestion and insulin-related MEs, strengthen the prevention of MEs related to look-alike sound-alike drugs, pay attention to the post administration management and the compliance education of home care for patients with chronic diseases, so as to improve the medication safety of patients in China.