OBJECTIVE To develop evidence-based clinical practice recommendations for the use of hemostatic drugs in special populations， so as to improve the efficacy and safety of medication.METHODS Led by the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital， a working group of 79 experts covering clinical pharmacy， obstetrics and gynecology， pediatrics and other fields was established. Clinical questions regarding the efficacy and safety of hemostatic drugs in special populations were screened through literature review and two rounds of Delphi questionnaire surveys. Intervention questions were structured using the population， intervention， comparison， and outcome framework， while management questions were additionally described using the population， clinical setting, management measure， and outcome framework. Databases including Medline， Embase， Cochrane Library， CNKI， Wanfang Data， and VIP were systematically searched to collect and screen relevant evidence. Recommendations were formulated through recommendation questionnaire surveys and expert consensus meetings， and the quality of evidence and strength of recommendations were graded according to the Grading of Recommendations Assessment， Development and Evaluation system. RESULTS &CONCLUSIONS A total of 8 clinical questions were finally determined， the consensus rates of all clinical questions and recommendations were more than 90%， and 8 recommendations on the use of hemostatic drugs in special populations were formulated. These recommendations cover special populations including children， women during pregnancy/puerperium/lactation， the elderly， patients with hepatic impairment， patients in the perioperative period of liver transplantation， patients with renal impairment/on dialysis/in the perioperative period of kidney transplantation， immunocompromised patients， and patients with hematological diseases. The recommendations specify the applicable scenarios， dose adjustment principles， monitoring indicators， and safety management strategies of hemostatic drugs in different special populations， which can provide a reference for the clinical application of hemostatic drugs in special populations and help clinicians and pharmacists develop individualized medication plans.

Objective To explore the expression of aquaporin-2 (AQP-2) in human fetus kidney and amniotic fluid at different stages of pregnancy.Methods Twenty-two cases of aborted fetuses' kidneys were collected.They were divided into 3 groups according to the pregnancy age:8 cases in 17-23 + 6 weeks,8 cases in 24-31 +6 weeks,and 6 cases in 32-38 +6 weeks.Western blot was used to examine the expression of AQP-2 in the kidney.Twenty-four cases of the amniotic fluid were collected,and they were divided into 3 groups according to the pregnancy age:10 cases in 17-23 +6 weeks,6 cases in 24-31 +6 weeks,and 8 cases in 32-38 +6 weeks.Eight cases of healthy adult morning urine were collected as positive controls.The AQP-2 protein in the amniotic fluid was detected with the method of enzyme-linked immunosorbent assay (ELISA) and the osmotic pressure of amniotic fluid at different stages of the pregnancy was measured with the freezing point osmometer.Results The expression of AQP-2 was increased with the extending of pregnancy age,and the AQP-2 expressions in fetus kidney of 17-23 +6 weeks,24-31 + 6 weeks and 32-38 +6 weeks were 0.986 ± 0.335,1.566 ± 0.272,and 2.080 ± 0.246,respectively,and the difference was significant (P ＜ 0.05).The AQP-2 detected from amniotic fluid was positively correlated with the result of AQP-2 in the kidney(r =0.985,P ＜ 0.05),and the AQP-2 expression also increased with the extending of pregnancy age:17-23 +6 weeks,24-31 +6 weeks,32-38 +6 weeks and adult urine was (30.253 ±5.843) mg/L,(35.103 ±7.271) mg/L,and (42.580 ± 1.230) mg/L and (46.493 ± 0.450) mg/L,respectively.The osmolality of the amniotic fluid of 17-23 +6 weeks,24-31 +6 weeks,32-38 +6 weeks was (272.600 ± 4.827) mmol/L,(252.00 ± 15.360) mmol/L,and (261.750 ±5.560) mmol/L,respectively,and the difference was significant(P ＜0.05).Conclusions The AQP-2 expression in human fetus kidneys has good correlation with amniotic fluid,which indicates that the level of AQP-2 of the amniotic fluid may reflect the expression of AQP-2 in the fetus kidney.

Objective To investigate the effect of urinary training on urination control in infants using nappies after birth.Methods Stratified sampling method was used to investigate the daytime urination control and the using of diapers by children in kindergartens of 6 prefecture-level cities in Henan Province,China.The survey was conducted among parents of healthy children.Results In a total of 12 250 questionnaires,11 697 had response,and 10 562 valid questionnaires were collected,and the effective recovery rate was 86.22％.After the birth of infants,the age of toilet training was divided into 6 groups (0-＜ 3 months old group,3-＜ 6 months old group,6-＜ 12 months old group,12-＜ 18 months old group,18-＜ 24 months old group and no toilet training group).Results showed that toilet training within 12 months leads to higher urinary control rate compared with toilet training after 12 months and no toilet training till the age of 2 years old,70.56％ (4 831/6 847 cases) in contrast with 59.02％ (1 545/2 618 cases) and 42.48％ (466/1 097 cases),and the differences were statistically significant (x2 =114.76,335.48,all P ＜ 0.000 1).Within 12 months,there was no statistical difference in the urinary control rate between subgroups at 2 years of age(all P ＞0.05).After 12 months,the urination control rate decreased with the start time delayed till 2 years of age,and the urinary control rate at the age of 2 years old n different groups was 59.97％ (1 314/2 191 cases) and 54.10％ (231/427 cases) respectively.The results of other ages(0.5,1.0,1.5 years old) were similar to those of 2 years old.There was no difference between the groups of different genders (all P ＞ 0.05).Conclusions The use of diapers in infants before the age of 1 year to start urinary training is conducive to the development of urinary control in infants.

Objective To investigate the current situation of healthcare-associated infection(HAI)organization management systems in primary medical institutions.Methods 95 primary medical institutions in 5 provinces (au-tonomous regions,municipalities)in China were investigated.Results Of 95 primary medical institutions,82 (86.32%)established HAI management groups,65 (68.42%)set up antimicrobial management departments,87 (91.58%)assigned professionals for antimicrobial management.Before 2010,only 26 antimicrobial management departments were set up,which increased to 65(68.42%)in 2015.Hospitals established rules and regulations on medical waste management (n=93,97.89%),disinfection and sterilization(n = 87,91.58%),disposable sterile medical device (n=87,91.58%),HAI prevention and control measures (n=79,83.16%),occupational health and safety protection for health care workers(n=76,80.00%),outbreak reporting system (n=73,76.84%),hand hygiene (n=69,72.63%),and monitoring on HAI (n=56,58.95%).Conclusion Current situation of HAI or-ganization management systems in primary medical institutions needs to be improved,health administrative depart-ments should strengthen supervision to improve the level of HAI prevention and control.

Objective To understand the current situation of medical waste management in primary medical insti-tutions in China.Methods The management of medical waste in 95 primary medical institutions in 5 provinces of China in 2016 were investigated.Results Of 95 primary medical institutions,90(94.74%)dispose medical waste by centralized processing,92(96.84%)separately collect medical waste,89(93.68%)have specific locations for temporary waste storage and handover registration,46(48.42%)have wastewater treatment facilities,and are re-sponsible by full-time or part-time personnel.Before 2000,only 4 (4.21%)primary medical institutions carried out medical waste classification management and centralized disposal,which increased to 92(96.84%)and 90(94.74%) respectively in 2014;before 2000,only 5(5.26%)primary medical institutions conducted temporarily medical waste storage and treatment,which increased to 89(93.68%)in 2014.Conclusion Medical waste management in primary medical institutions has been improved significantly,but there still remain some problems,training relevant to waste management knowledge needs to be strengthened among health care workers,medical waste management procedures should be standardized,sound medical waste management and supervision system should be improved.

Objective To investigate the current situation and existing problems of healthcare-associated infection (HAI)management in primary medical institutions in Henan Province.Methods 36 primary medical institutions in 18 regions were investigated with random sampling method,development of HAI management in primary medical institutions before and after 2013 were compared.Results Among 36 primary medical institutions,31 (86.11 %) had cleaning,disinfection,sterilization,and isolation systems,13 (36.11 %)implemented HAI monitoring system, 31 (86.11 %)performed regular training on hand hygiene knowledge,6 (16.67%)allocated antimicrobial manage-ment professionals.The development rates in HAI management group,hand hygiene system,training on related knowledge among staff,HAI monitoring,and antimicrobial management in 36 primary medical institutions before 2013 were all lower than those after 2013 (41 .67% VS 75.00%;2.78% VS 30.56%;22.22% VS 69.44%;5.56%VS 33.33%;25.00% VS 66.67%,all P <0.05).Conclusion HAI management level in primary medical institu-tions has improved than before,but deficiencies still exists and needs further improvement.