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 explore the expression levels of microribonucleic acid(miR)-29b and soluble Klotho protein in peripheral blood of the chronic obstructive pulmonary disease(COPD)patients complicated with pulmo-nary infection and analyze the clinical significance.METHODS The clinical data were retrospectively collected from 139 patients with COPD who were treated in Ningxia Medical University General Hospital from Feb.2022 to Feb.2024.The patients were divided into the infection group with 41 cases and the no infection group with 98 cases ac-cording to the status of pulmonary infection.The distribution of pathogens isolated from the patients of the infec-tion group was observed.The levels of serum miR-29b and Klotho were compared between the infection group and the no infection group or of the infection group before and after the anti-infection treatment.The efficiencies of ser-um miR-29b and Klotho in prediction of pulmonary infection were analyzed by means of receiver operating charac-teristic(ROC)curves.RESULTS Totally 46 strains of pathogens were isolated from the infection group,67.39％of which were gram-negative bacteria,26.09％were gram-positive bacteria,and 6.52％were fungi.There were significant differences in the levels of serum miR-29b and Klotho between the infection group and the no infection group(P＜0.05);the expression level of serum miR-29b of the patients in the infection group who were effective for the anti-infection treatment was lower after the treatment than before the treatment,while the expression level of Klotho was higher after the treatment than before the treatment(P＜0.05);the expression level of miR-29b of the patients effective for the treatment was lower than that of the patients ineffective for the treatment,while the expression level of Klotho of the patients effective for the treatment was higher than that of the patients ineffective for the treatment(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of the joint detec-tion of serum miR-29b and Klotho was 0.927 in prediction of pulmonary infection in the COPD patients,higher than 0.837 and 0.852 of the single detection.CONCLUSIONS The COPD patients complicated with pulmonary in-fection show the high expression level of serum miR-29b and low expression level of Klotho.The joint detection of the two indexes has high efficiency in prediction of pulmonary infection in the COPD patients,which can be used as reliable indexes for assessment of the curative effect after the anti-infection treatment.

OBJECTIVE To explore the expression levels of microribonucleic acid(miR)-29b and soluble Klotho protein in peripheral blood of the chronic obstructive pulmonary disease(COPD)patients complicated with pulmo-nary infection and analyze the clinical significance.METHODS The clinical data were retrospectively collected from 139 patients with COPD who were treated in Ningxia Medical University General Hospital from Feb.2022 to Feb.2024.The patients were divided into the infection group with 41 cases and the no infection group with 98 cases ac-cording to the status of pulmonary infection.The distribution of pathogens isolated from the patients of the infec-tion group was observed.The levels of serum miR-29b and Klotho were compared between the infection group and the no infection group or of the infection group before and after the anti-infection treatment.The efficiencies of ser-um miR-29b and Klotho in prediction of pulmonary infection were analyzed by means of receiver operating charac-teristic(ROC)curves.RESULTS Totally 46 strains of pathogens were isolated from the infection group,67.39％of which were gram-negative bacteria,26.09％were gram-positive bacteria,and 6.52％were fungi.There were significant differences in the levels of serum miR-29b and Klotho between the infection group and the no infection group(P＜0.05);the expression level of serum miR-29b of the patients in the infection group who were effective for the anti-infection treatment was lower after the treatment than before the treatment,while the expression level of Klotho was higher after the treatment than before the treatment(P＜0.05);the expression level of miR-29b of the patients effective for the treatment was lower than that of the patients ineffective for the treatment,while the expression level of Klotho of the patients effective for the treatment was higher than that of the patients ineffective for the treatment(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of the joint detec-tion of serum miR-29b and Klotho was 0.927 in prediction of pulmonary infection in the COPD patients,higher than 0.837 and 0.852 of the single detection.CONCLUSIONS The COPD patients complicated with pulmonary in-fection show the high expression level of serum miR-29b and low expression level of Klotho.The joint detection of the two indexes has high efficiency in prediction of pulmonary infection in the COPD patients,which can be used as reliable indexes for assessment of the curative effect after the anti-infection treatment.

Objective:To evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Methods:The clinical and ultrasound data of 70 patients with ruptured tubal pregnancy diagnosed by surgery in Peking Union Medical College Hospital from August 2017 to May 2021 were retrospectively analyzed to evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Results:Among the 70 patients, 68 patients underwent gynecological ultrasonography and two patients did not. Sixty-three cases (92.6%, 63/68) were accurately diagnosed as adnexal ectopic pregnancy mass, abdominal and pelvic effusion/blood clot, and 5 adnexal ectopic pregnancy masses (7.4%, 5/68) were missed.Among the 5 missed cases, 4 cases (80%, 4/5) were heterotopic pregnancy (2 cases of IVF-ET 2 embryos, 1 case of patient taking ovulation induction drugs, 1 case of gravida with twin family history) and 1 case (20%, 1/5) of single tubal pregnancy. Critical values were reported in the all 63 cases of ruptured tubal pregnancy diagnosed by preoperative ultrasound.Conclusions:Ultrasound could accurately diagnose tubal pregnancy and assess its rupture, and timely report the critical value, effectively guarantee the medical safety. The particularity and complexity of ultrasound diagnosis in early pregnancy with assisted reproductive technique deserve more attention.

The Wilderness Medical Society updated and published the Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite in July 2019. The guidelines provide evidence-based recommendations for the prevention and treatment of frostbite, mainly including pathophysiology, classification, prevention, and treatment of frostbite. This paper focuses on the interpretation of the guidelines, aiming at making clinical medical staff understand the new progress of frostbite treatment and providing reference for clinical practice.

Objective To compare the effect of various manipulation of Tuina on surface electromyogram (sEMG) in hemiplegics after stroke. Methods From January to May, 2016, 20 inpatients with hemiplegia after stroke accepted Tuina on bilateral rectus femoris by the same therapist, with the techniques of rolling, patting, rubbing, shaking, kneading and pressing, one minute a manipulation and interval one minute. Integrated electromyography (iEMG), root mean square (RMS) and median frequency (MF) of sEMG were compared, both in rest and during Tuina. Results There was no significant difference of iEMG, RMS and MF between affected and unaffected sides in rest (t<1.147, P>0.05). iEMG and RMS were the most under patting (F>21.376, P<0.001), and MF was the highest under pressing (F>11.772, P<0.001). iEMG, RMS and MF were not very different under other manipulation (P>0.05). iEMG and RMS were less in the affected side than in the unaffected side under patting (P<0.05). Conclusion Various manipulation of Tuina may be different in neuromuscular stimulation, that patting may stimulate more muscles and motor units.

Objective To compare the value of central venous pressure (CVP) measured by peripherally inserted central catheters (PICC) and centrally inserted central catheters (CICC) in elderly patients with severe diseases.Methods Paired design and self-controlled was applied in the research. CVP was measured by 2 different measurement approaches in patients with PICC and CICC simultaneously. The sample size was calculated by the enumeration method through the accuracy estimation of consistency evaluation of quantitative measurement, and the required number was 70.Results Among the 70 collected samples, the mean values of the measured CVP by PICC and CICC were (7.995±3.435) cmH2O and (7.743±3.277) cmH2O; no statistically significant difference was observed (t=1.622,P=0.109). The pearson's linear correlation coefficient of the CVP measured by 2 different measurement approaches was 0.926 (P<0.0001). A linear regression model through the origin of the CVP measured by 2 different measurement approaches was fitted with the linear regression equation of CVPPICC=1.023 CVPCICC (R2=0.978); and the 95%CI of the prediction line contained the reference line. The Bland-Altman plot showed that 64 samples fell within limits of agreement (LoA), LoA was -2.300-2.804, with a consistent rate of 91.43%. All the plots out of the LoA did not exceeded the 95%CI.Conclusions The CVP measured by CICC and PICC exhibit high consistency. Therefore, PICC can be used to replace the CICC in the CVP monitoring.