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 monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

【Objective】 To perform serological screening of K antigen in Qingdao area and analyze the results. 【Methods】 From March to June 2023, 16 201 samples of patients treated in our hospital and applied for blood grouping, and 4 153 samples of blood donors sent to the clinic by Blood Transfusion Department during the same period were detected for Rh and K antigen by Ortho BioVue System Rh/K Cassette. 【Results】 A total of 18 out of 16 201 patient samples and 8 out of 4 153 blood donor samples were positive for K antigen, with the positive rate at 0.127 7%. 【Conclusion】 There was K antigen in Qingdao population, and the positive frequency of K antigen was different from previous reports. It is of great significance to construct rare blood group bank in this area and formulate reasonable blood donation and transfusion strategy for population with K antigen, so as to avoid unexpected antibody production of Kell blood group system, prevent hemolytic disease of newborn and ensure the safety of blood use.

Objective:To investigate the expression level, development mechanism, role and clinical prognostic significance of tweety homolog 2 (TTYH2) in cutaneous melanoma (SKCM).Methods:The expression data and clinical information of 365 cutaneous melanoma patients were downloaded from the Cancer Genome Atlas (TCGA), and the expression data of 812 normal tissues were retrieved from the genotype and Genotype-Tissue Expression(GTEx) to analyze the expression level of TTYH2 in SKCM tissues and normal counterparts. Survival analysis and Cox proportional hazard regression analysis were used to evaluate the effect of TTYH2 expression on prognosis and survival in SKCM patients. Gene set enrichment analysis Kyoto Genome Encyclopedia (KEGG) and Gene Ontology (GO) were used to screen signaling pathways for significant TTYH2 enrichment. The interaction network analysis was carried out using STRING online platform to screen key protein network node genes. Secondly, CIBERSORT algorithm was used to analyze the expression of 22 immune cells in each sample, and Chi-square test was applied to analyze the difference of immune cells in the high-low expression group.Results:The expression of TTYH2 in SKCM patients was significantly higher than that in normal tissues. Survival analysis showed that SKCM patients with high TTYH2 expression group had a poor prognosis. High TTYH2 expression was an independent predictor of poor overall survival of SKCM ( HR=1.21, 95% CI 1.08-1.37, P=0.001). KEGG result showed that TTYH2 was mainly concentrated in cell synapses, ion channels, calcium signaling pathways and extracellular matrix receptor interaction pathways. GO analysis showed that the biological processes involved in TTYH2 may be closely related to the occurrence and development of tumors. TTYH2 interacts with chloride intracellular channel protein 5, chloride ion channel protein 2, glycine receptor family members and gamma-aminobutyric acid receptor family members, suggesting that TTYH2 may play an important role in the pathogenesis of SKCM. Immune cell infiltration analysis showed that the immune cell abundance of memory B cells, CD4 memory T cells and monocytes was significantly increased in the TTYH2 low expression group, while the immune abundance of follicular helper T cells and regulatory T cells was significantly decreased in the TTYH2 low expression group. Conclusion:TTYH2 expression may regulate the development of SKCM cells through various ways, affect the survival and prognosis of SKCM patients, and is a potential biological prognostic marker and therapeutic target of SKCM.

Objective:To investigate the expression level, development mechanism, role and clinical prognostic significance of tweety homolog 2 (TTYH2) in cutaneous melanoma (SKCM).Methods:The expression data and clinical information of 365 cutaneous melanoma patients were downloaded from the Cancer Genome Atlas (TCGA), and the expression data of 812 normal tissues were retrieved from the genotype and Genotype-Tissue Expression(GTEx) to analyze the expression level of TTYH2 in SKCM tissues and normal counterparts. Survival analysis and Cox proportional hazard regression analysis were used to evaluate the effect of TTYH2 expression on prognosis and survival in SKCM patients. Gene set enrichment analysis Kyoto Genome Encyclopedia (KEGG) and Gene Ontology (GO) were used to screen signaling pathways for significant TTYH2 enrichment. The interaction network analysis was carried out using STRING online platform to screen key protein network node genes. Secondly, CIBERSORT algorithm was used to analyze the expression of 22 immune cells in each sample, and Chi-square test was applied to analyze the difference of immune cells in the high-low expression group.Results:The expression of TTYH2 in SKCM patients was significantly higher than that in normal tissues. Survival analysis showed that SKCM patients with high TTYH2 expression group had a poor prognosis. High TTYH2 expression was an independent predictor of poor overall survival of SKCM ( HR=1.21, 95% CI 1.08-1.37, P=0.001). KEGG result showed that TTYH2 was mainly concentrated in cell synapses, ion channels, calcium signaling pathways and extracellular matrix receptor interaction pathways. GO analysis showed that the biological processes involved in TTYH2 may be closely related to the occurrence and development of tumors. TTYH2 interacts with chloride intracellular channel protein 5, chloride ion channel protein 2, glycine receptor family members and gamma-aminobutyric acid receptor family members, suggesting that TTYH2 may play an important role in the pathogenesis of SKCM. Immune cell infiltration analysis showed that the immune cell abundance of memory B cells, CD4 memory T cells and monocytes was significantly increased in the TTYH2 low expression group, while the immune abundance of follicular helper T cells and regulatory T cells was significantly decreased in the TTYH2 low expression group. Conclusion:TTYH2 expression may regulate the development of SKCM cells through various ways, affect the survival and prognosis of SKCM patients, and is a potential biological prognostic marker and therapeutic target of SKCM.

【Objective】 To investigate the variation of ferric metabolism indexes in male regular platetpheresis donors (MRPDs) with the low iron storage (plasma ferritin <30 μg/L). 【Methods】 The ferric metabolism indexes of 137 MRPDs with ferritin <30 μg/Lwere detected, including serum free iron (sFI), hemoglobin (Hb), unsaturated iron binding capacity (UIBC), total iron binding capacity (TIBC), transferrin (TRF) and prealbumin (PALB). The correlation between these indexes and the level of ferritin, the total number of platelet donation and the number of platelet donations in the previous year were analyzed. 【Results】 The UIBC of MRPDs with ferritin <30 μg/L showed a significant upward trendin comparison with the normal reference value, with the median level of UIBC at 55.1 μmol / L. The level of serum iron decreased significantly, with the median level at 10.9 μg / L. The level of ferritin was correlated with UIBC and Hb, and the indexes of iron metabolism were generally correlated to each other. The number of platelet donation in the previous year was correlated with TIBC, UIBC and TRF. The total number of platelet donation was correlated with TIBC and TRF. 【Conclusion】 MRPDs with ferritin <30 μg/L showed abnormalferric metabolism. It is necessary to detect both ferritin and ferric metabolism indexes to evaluate the iron deficiency in MRPDs.

【Objective】 To analyze the HIV-, HCV- and HBV- NAT yield rate in different areas of Henan province, so as to provide the basis for disease prevention and control as well as the establishment of a unified quality control standard for nucleic acid testing(NAT) in the Henan province. 【Methods】 The number and prevalence of NAT yielding samples with isolated infectious virus, namely HIV, HCV and HBV, in 18 blood stations in Henan province from 2017~2019, as well as the trends were analyzed. The NAT quality of each laboratory and each testing system was analyzed according to the ratio of reactive individual donation(ID) results to reactive minipools(MP). 【Results】 The HBV, HCV and HIV ID-NAT yield numbers in 3 501 251 blood donations were HBV 2 606(74/100 000), HCV 21 (0.63/100 000), and HIV 34(1.00/100 000). The HBV ID-NAT yield rate showed an upward trend in the whole province from 2017 to 2019, while the prevalence of HIV and HCV ID-NAT yield didn′t differ significantly during three years. 5 kinds of NAT detection systems were applied in 18 blood centers. among which Ⅰ, Ⅱ, Ⅳ and Ⅴ were triplex detection systems. 2661 ID-reactive samples were implicated in 5 595 MP-reactive samples, with a resolution rate of 47.56%. The resolution rate of triplex NAT system Ⅰ, Ⅱ, Ⅳ and Ⅳ was 39.63%~47.95%, 40.43%~54.36%, 51.61% and 70.00%~45.45%, respectively. An upward trend in triplex NAT resolution rate was observed in 8 laboratories, i. e.B, D, E, F, I, K, L and Q, and an descending trend in A and C. The NAT system Ⅲ, a ID-NAT system, was used only by laboratory C, presenting a NAT-yield rate of 0.19% (282/145 474) and resolution rate of 46.45% (131/282). 【Conclusion】 The majority of NAT-yield of one infectious virus in Henan province is HBV, presenting annual increasing trend. The quality management of NAT laboratories should be strengthened as the divergence was seen in the performance of different NAT laboratories.

Objective To systematically evaluate the relation between prognostic nutrition index (PNI) and prognosis of bladder cancer (BC) patients treated with radical cystectomy (RC). Methods We searched the literatures about the relation between PNI and the prognosis of patients treated with radical cystectomy published from the inception to January 30, 2021 in PubMed, Embase, Web of Science, CNKI, Wanfang, VIP and Chinese Medical Journal Database, and used RevMan5.3 software for Meta analysis. Results We included six literatures which comprise a total of 1273 patients. The results showed that there was a significant correlation between low PNI and OS of BC patients treated with RC (HR=2.0, 95%CI: 1.56-2.56), and there was a significant difference in RFS, PFS and DSS between low PNI and BC patients treated with RC (HR=1.93, 95%CI: 1.51-2.48). In the subgroup analysis, there were statistical differences in PNI and the prognosis of BC patients treated with RC between the Chinese group (HR=2.13, 95%CI: 1.62-2.81) and the Japanese group (HR=1.78, 95%CI: 1.08-2.94), and the PNI cutoff value had a good predictive effect on the prognosis of patients in the range of 46.08-51.30. Conclusion There is a significant relation between the level of PNI and OS of bladder cancer patients treated with radical cystectomy. Low PNI can be used as an effective marker to predict the prognosis of patients.

Objective:To investigate the effect of mechano-growth factor（MGF）on osteoclast activity and its mechanism.Methods:The RAW264.7 precursor osteoclast cell line was cultured with 25 ng/ml macrophage-colony stimulating factor（M-CSF）and 30 ng/ml receptor activator of NF-κB ligand（RANKL），and identified by tartrate resistant acid phosphatase（TRAP）staining after 7 days of culture. Western blot anslysis was used to determine the effect of 45 ng/ml MGF on the phosphoinositide-3-kinase/protein kinase B（PI3K/AKT）signaling pathway in separated osteoclasts，including levels of AKT，phosphorylation（p）-AKT，lactation mammalian target of rapamycin（mTOR），p-mTOR and TRAP at 0，4，8 and 12 hours. Real-time fluorescence quantitative PCR was used to expressions of TRAP in osteoclasts at 0，4，8 and 12 hours. The PI3K/Akt phosphorylation inhibitor LY294002（20 μmol/L）combined with MGF（45 ng/ml）was used to act on osteoclasts，and expression levels of Akt，p-Akt，mTOR，p-mTOR and TRAP were detected by Western blot at 0，4，8 and 12 hours.Results:After culturing RAW264.7 cells with M-CSF and RANKL for 7 days，a large number of osteoclasts with positive TRAP staining can be obtained. Western blot analysis showed expression levels of Akt and mTOR did not change significantly over time（ P>0.05），expression levels of p-Akt and p-mTOR increased continuously from（2.18±0.34）pg/ml and（0.83±0.10）pg/ml at 0 hour to（3.86±0.36）pg/ml and（1.56±0.19）pg/ml at 12 hours（ P<0.05），and expression level of TRAP decreased significantly over time，from（5.66±0.47）pg/ml at 0 hour to（3.76±0.38）pg/ml at 12 hours（ P<0.05）. Real-time fluorescence quantitative PCR analysis of expression of TRAP in osteoclasts showed that MGF inhibited the expression of TRAP in osteoclasts，which decreased from 1.02±0.06 at 0 hour to 0.53±0.11 at 12 hours（ P<0.05）. After acting LY294002 combined with MGF on osteoclasts，Western blot analysis showed expression levels of Akt and mTOR did not change significantly over time（ P>0.05），expression levels of p-AKT and p-mTOR decreased significantly from（3.28±0.18）pg/ml and（3.29±0.22）pg/ml at 0 hour to（2.06±0.34）pg/ml and（2.04±0.20）pg/ml at 12 hours（ P<0.05），and expression level of TRAP had no significant difference over time（ P>0.05）. Conclusions:MGF inhibits osteoclast activity by inhibiting the expression of TRAP in osteoclasts through PI3K/Akt signaling pathway. LY294002 inhibits the expression of PI3K/Akt signaling pathway in osteoclasts，further verifying the mechanism of MGF inhibiting osteoclast activity，and this finding puts forward new ideas for clinical prevention and treatment of osteoporosis.

Objective To evaluate ilioischial plating via the modified Stoppa approach for acetabular fractures involving the posterior column.Methods A retrospective analysis was conducted of the 12 patients who had been treated for acetabular fractures involving the posterior column from January 2017 to June 2018 by ilioischial plating via the modified Stoppa approach at Department of Orthopaedics,The Second Affiliated Hospital to Mongolia Medical University.They were 7 males and 5 females,aged from 35 to 62 years (average,43.3 years).According to the Letournel-Judet classification,there were 5 transverse fractures,4 anterior column plus posterior hemitransverse fractures and 3 both column fractures.Ilioischial plating was conducted for all the patients via the modified Stoppa approach.The Matta criteria were used to evaluate the fracture reduction.The operative time,intraoperative bleeding volume,postoperative fracture reduction and complications like traumatic arthritis and deep venous thrombosis were recorded.Merle d'Aubigné and Postel scoring was used to evaluate hip function during follow-up.Results The operative time for this group averaged 130 min (from 90 to 170 min) and the intraoperative blood loss 550 mL (from 400 to 700 mL).No major intraoperative bleeding occurred.All the 12 patients were followed up for 6 to 16 months (average,8 months).The Matta evaluation for reduction quality yielded 10 excellent and 2 good cases.Their fractures healed after 8 to 10 weeks (average,8.7 weeks).At the last follow-up,the affected hips scored 12 to 18 points (average,16 points),giving 6 excellent,4 good and 2 fair cases.Follow-ups revealed no fracture re-displacement,nerve injury,deep vein thrombosis,ectopic ossification or other complications.Conclusion In the operative treatment of complex acetabular fractures involving the posterior column,ilioischial plating via the modified Stoppa approach displays advantages of easy reduction,easy maintenance of the reduction,limited complications and fine therapeutic effects.