A domestically produced self-expanding transcatheter aortic valve controllable bending delivery system(VitaFlow? Ⅲcontrollable bending retrievable delivery system)was first used to perform transcatheter aortic valve replacement(TAVR)in a symptomatic severe aortic valve stenosis patient with severe heart failure and high risk of surgery in China on September 22,2023.The patient successfully completed TAVR under general anesthesia,with good valve position and function after the operation.Before discharge and at one month of follow-up,the patient's symptoms and degree of heart failure were significantly improved.The follow-up results of this case showed that the VitaFlow? Ⅲ controllable bending retrievable delivery system for TAVR is safe and feasible,and future prospective,multicenter clinical trials are expected to evaluate its efficacy.

Objective:To analyze the clinical phenotype and genetic etiology of a child with Multiple congenital anomalies-hypotonia-seizures syndrome 1 (MCAHS1).Methods:Clinical data of a 2-year-old boy who had presented at the Affiliated Hospital of Qingdao University in March 2023 for "intermittent limb twitching for 2 years" was collected. Peripheral blood samples were collected from the child and his parents for whole-exome sequencing (WES). Candidate variants were verified by Sanger sequencing and bioinformatic analysis based on the guidelines from the American College of Medical Genetics and Genomics (ACMG).Results:The child had manifested with distinctive facial features, limb deformities, hypotonia, motor and intellectual delays, and epileptic seizures. WES revealed that he has harbored compound heterozygous variants of the PIGN gene, namely c. 963G>A (p.Q321=) and c. 994A>T (p.I332F), which were inherited from his phenotypically normal mother and father, respectively. Based on the ACMG guidelines, the c. 963G>A was classified as a pathogenic variant (PVS1+ PM2_Supporting+ PM3), whilst the c. 994A>T was classified as a variant of uncertain significance (PM2_Supporting+ PP3). Conclusion:Above discovery has expanded the mutational spectrum of the PIGN gene variants associated with MCAHS1, which may facilitate delineation of its genotype-phenotype correlation.

Objective To explore the therapeutic effect of lymphatic venous anastomosis based on MRI lymphangiography classifi-cation on lower limb lymphedema,and to analyze the factors affecting the therapeutic effect of lymphatic venous anastomosis.Methods A total of 378 patients with secondary lymphedema of lower limbs were selected.All of them underwent MRI lymphangiography.The differ-ence of circumference diameter and complication rate of the lower limbs of different types of patients before and after lymphatic venous anastomosis were compared.After 6 months of follow-up,the therapeutic effect was evaluated according to the International Lymphology Society classification standards for lymphedema.The risk factors affecting the therapeutic effect of lymphatic venous anastomosis was ana-lyzed,and a prediction model was established to analyze the value of this model in evaluating the clinical efficacy of lymphatic venous anastomosis.Results There was no significant difference in treatment efficiency and postoperative complication rate among different types of patients(P＞0.05).The difference of circumference diameter of the lower limbs of type 3,type 4,type 5 and type 6 before and after treatment was greater than that of type 1,type 2 and type 7(P＜0.05).Age,concomitant infection and lymph node venous fistula were the factors affecting the clinical efficacy of lymphatic venous anastomosis(P＜0.05).The risk prediction model for the clinical efficacy of lymphatic venous anastomo-sis was developed through logistic regression analysis:P=1/[1+e(0.531Xage+0.722Xconcomitant infection+0.807Xlymph node venous fistula-1.249)].The Hosmer-Leme-show test indicated that the fitted model matched the standard curve with x2=2.190,P=0.975.The area under the curve(AUC)of the prediction model for the clinical efficacy of lymphatic venous anastomosis was 0.985,with a standard error(S.E)value of 0.009 and a 95％confidence interval(CI)of 0.967 to 1.000.Conclusion Lymphatic venous anastomosis based on MRI lymphangiography classifi-cation has better clinical efficacy and fewer complications in the treatment of lower limb lymphedema,and the prediction model based on the risk factors analysis has a high predictive value for the clinical efficacy of lymphatic venous anastomosis.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate whether cavitation induced by ultrasound stimulated perfluorobutane microbubbles can enhance the therapeutic effect of colchicine and reduce its side effects on acute gouty arthritis (AGA) in rats.Methods:The AGA rat model was established by injection of monosodium urate (MSU) crystals. The rats were randomly divided into 6 groups (A: blank control group, B: model control group, C: cavitation group, D: standard concentration drug group, E: low concentration drug cavitation group, F: standard concentration drug cavitation group) according to whether they were given different doses of colchicine. The area under the curve (AUC) of contrast-enhanced ultrasound (CEUS) was calculated at 7 h and 8 h after MSU injection to compare the effect of cavitation on ankle blood perfusion. The symptoms of AGA were evaluated according to the degree of ankle swelling and gait score at 24 h. The infiltration of neutrophils was detected by HE staining, and the inflammatory response was analyzed by detecting the level of interleukin-1β (IL-1β) in plasma. Vascular dilatation was analyzed by detecting the concentration of endothelial nitric oxide synthase (eNOS). The degree of adverse reactions in each group was analyzed by gastrointestinal reaction score.Results:The CEUS blood perfusion and AUC values of the three groups with cavitation (groups C, E and F) were significantly higher than those of the non-cavitation groups (groups A, B and D) (all P<0.05). Compared with group D, there were no significant differences in the degree of ankle swelling, gait score, and plasma IL-1β level in group E (all P>0.05), but the plasma eNOS concentration was higher and the incidence of gastrointestinal reactions was significantly lower in group E (all P<0.05). Compared with group D, the degree of ankle swelling and gait score in group F were decreased, and HE staining showed that the degree of synovial infiltration of neutrophils in the ankle joints of AGA rats in group F was lighter (all P<0.05), but there was no significant difference in plasma IL-1β level and the incidence of gastrointestinal reactions between group D and group F (all P>0.05). Conclusions:The cavitation of perfluorobutane microspheres stimulated by ultrasound can enhance the blood perfusion of the ankle joint of AGA rats, enhance the therapeutic effect of local colchicine, and help to reduce the dosage of colchicine and its side effects.

To effectively play the guiding role of pathogenic diagnosis in the rational use of antibiotics, hospitals at all levels urgently need to establish an effective control system for clinical microbial specimen submission. In response to the common problems in medical institutions in China, such as the low rate of microbiological specimen submission before antibiotic treatment, unreasonable structure of microbiological specimens, and the majority of morning sputum and urine specimens collected for pathogen testing, the Second Affiliated Hospital of Zhejiang University School of Medicine has constructed a management system for clinical microbiological specimen submission using artificial intelligence technology. It used a built-in intelligent rule engine to implement full process control over the sampling and submission of microbiological specimens by doctors when prescribing antibiotics, urge doctors to implement the requirement of collecting samples before using antibiotics for treatment, and recommend priority the collection of sterile specimens. In addition, the hospital transformed the laboratory and testing process with the goal of receiving microbial samples 24 hours without interruption and inoculating in real-time. The informatization management system began to be applied throughout the hospital in December 2015. The average rate of microbial sample submission before the first therapeutic use of antibiotics from June 2016 to 2023 was 79.2%, an increase of 90.2 percentage points from 41.7% in June 2014 ( χ2=467.781, P<0.01). The structure of microbial specimens continued to be optimized, and the proportion of sterile specimens in all submitted specimens increased from 47.2% in 2014 to 49.9% in 2023 ( χ2=139.119, P<0.01). The proportion of morning sputum and morning urine specimens decreased from 65.2% and 60.6% in 2014 to 11.1% and 16.9% in 2023, respectively ( χ2 values were 19 787.434 and 4 346.664, respectively, P<0.01), providing a more reliable basis for pathogenic diagnosis in clinical practice and providing reference for improving the management of pathogenic specimen submission in medical institutions.

Objective:To assess the efficacy and safety of acupuncture compound anesthesia(ACA)for traditional thyroidectomy. Methods:Randomized controlled trials(RCTs)studying the use of ACA for traditional thyroidectomy were retrieved from PubMed,Excerpta Medica Database(EMBASE),Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),Chongqing VIP Database(CQVIP),Wanfang Academic Journal Full-text Database(Wanfang),and China Biology Medicine Disc(CBM)from inception to September 30,2021.Two investigators independently extracted data and assessed the risk of bias and quality of the studies.Anesthesia effectiveness was the primary outcome,while the secondary outcomes included various pain scales,vital signs,analgesic consumption,and adverse events.Review Manager 5.3 was used for meta-analysis.Weighted mean difference(WMD),standardized mean difference(SMD),and confidence interval(CI)were used for statistical descriptions. Results:A total of 16 papers were included,involving 1228 patients.Meta-analysis showed that anesthesia effectiveness was significantly improved after adding acupuncture as an adjunct[SMD=0.62,95%CI(0.40,0.83),P<0.0001,I2=36%].Besides,ACA can also moderate vital signs and reduce the feeling of pain[SMD=-1.61,95%CI(-2.61,-0.61),P<0.00001,I2=95%],analgesic consumption,and adverse events.Subgroup analysis of the electroacupuncture(EA)group further revealed that the effectiveness of low-frequency EA[WMD=0.43,95%CI(0.30,0.55),P<0.00001,I2=15%]and the entire operative stimulation of EA[WMD=0.55,95%CI(0.33,0.77),P<0.00001,I2=0%]was significantly better than high-frequency EA and short-time stimulation of EA during the operation.Further,no significant difference existed between conventional analgesia and acupuncture analgesia. Conclusion:ACA is beneficial to traditional thyroidectomy regarding efficacy and safety when acupuncture is applied as an adjunct.However,additional high-quality studies with larger sample sizes are needed to verify the findings.

Objective:A rare case of δ-globin gene (HBD) mutation in Guangdong Province was analyzed to provide reference for avoiding misdiagnosis of δ-thalassemia in clinic.Methods:The patient was admitted to Guangdong Maternal and Child Health Hospital, and the peripheral blood sample was collected for hematological phenotypes [mean erythrocyte volume (MCV), mean erythrocyte hemoglobin content (MCH), hemoglobin (Hb)] and Hb typing analysis. The routine deletion and mutation of α-thalassemia and β-thalassemia genes were analyzed by PCR-flow fluorescence hybridization. At the same time, DNA sequencing was used to analyze the type of HBD mutation.Results:The results of hematological phenotypes analysis showed that MCV was 87.9 fl, MCH was 29.3 pg, and Hb content was 140 g/L. The results of Hb typing showed that the contents of Hb F, Hb A 2, Hb A 2 variant, and Hb A were 0.4%, 1.3%, 0.6%, and 97.7%, respectively. No abnormality was found in α-thalassemia and β-thalassemia genes by routine deletion and mutation detection. According to DNA sequencing analysis, the patient had HBD: c.349 C>G variant. Conclusion:The low Hb A 2 content (reference value is 2.5% - 3.5%) in this case is due to the mutation of HBD, HBD: c.349 C>G variant is rare in Chinese population.

Objective:To analyze the genetic effects of a rare hemoglobin (Hb) H hydrops fetalis [Hb Adana (HBA2: c.179 G>A) complex -- SEA/αα], and provide a reference for clinical diagnosis of non deletion Hb H disease. Methods:Peripheral blood of pregnant women from Medical Genetics Center of Guangdong Maternal and Child Health Hospital and her husbands, fetal umbilical cord blood samples were collected for hematological phenotypes [mean corpuscular volume (MCV), mean corpuscular hemoglobin content (MCH), Hb content] and Hb typing analysis. PCR flow cytometry fluorescence hybridization was used to analyze routine deletions and mutations of α-, β-thalassemia genes, and DNA sequencing was used to analyze mutations.Results:The pregnant women had an MCV of 85.1 fl, MCH of 27.3 pg, and Hb content of 109 g/L; the fetal MCV was 116.3 fl, MCH was 32.6 pg, and Hb content was 28 g/L. Both the pregnant woman and her husband showed no abnormalities in Hb capillary electrophoresis, while the fetus showed Hb Bart's and trace Hb Epsilon4 bands. The results of routine genetic testing for thalassemia showed that the thalassemia genotypes of pregnant women, her husband, and fetus were αα/αα, -- SEA/αα, and -- SEA/αα, respectively. According to DNA sequencing analysis, pregnant women was HBA2: c.179 G>A heterozygous mutation, fetus was HBA2: c.179 G>A mutation. Conclusions:Hydrops fetalis is caused by HBA2: c.179 G>A complex -- SEA/αα. However, this type of mutation is rare in the Chinese population.

Objective:To explore the effects of enriched environment combined with melatonin on learning and memory function and DNA oxidative damage in senescence accelerated mouse prone 8 (SAMP8) mice.Methods:Twenty-four 6-month-old SPF healthy male SAMP8 mice were randomly divided into model group, enriched environment group, melatonin group and enriched environment+ melatonin group, with 6 mice in each group. Six homologous SAMR1 mice of the same age were used as the control group. The mice in the enriched environment group and the enriched environment+ melatonin group were fed in the enriched environment. At the same time, the mice in the melatonin group and the enriched environment+ melatonin group were subcutaneously injected with melatonin (8 mg /(kg·d)) once a day for 28 d. The mice in the model group, the control group and the enriched environment group were subcutaneously injected with an equal volume of 0.9% sodium chloride solution once a day for 28 days. Aging score was used to evaluate the aging of mice. Morris water maze and Y maze tests were used to evaluate the learning and memory ability of mice. The cell morphology of hippocampus in mice was observed by hematoxylin-eosin staining, and the level of Aβ 1-42 protein in hippocampus of mice was detected by immunohistochemical staining. The levels of γ-H2A histone family member X(γ-H2AX) and 8-hydroxy-2 deoxyguanosine(8-OHdG) proteins in hippocampus of mice were detected by Western blot and Enzyme-linked immunosorbent assay. SPSS 25.0 statistical software was used to process the data. One-way analysis of variance was used for comparison among multiple groups, and LSD- t test was used for further pairwise comparison. Results:(1)There was a statistical difference in aging scores among the 5 groups of mice after intervention ( F=126.4, P<0.01). After intervention, the aging scores of mice in the enriched environment group, melatonin group, and enriched environment+ melatonin group were lower than that in the model group (all P<0.05), and the score of the enriched environment+ melatonin group was significantly lower than that in the enriched environment group ( P<0.05). (2)The time and group interaction, group main effect and time main effect of the escape latency among the 5 groups of mice were statistically significant ( F=11.2, 799.9, 121.8, all P<0.01). From day 2 to day 4, the escape latencies of mice in the enriched environment group, melatonin group and enriched environment+ melatonin group were significantly lower than that in the model group (all P<0.05). There was a statistically significant difference in the target quadrant residence time and cross-platform times among the 5 groups ( F=70.38, 48.83, both P<0.01). The target quadrant residence time and cross-platform times of mice in the enriched environment group, melatonin group, and enriched environment+ melatonin group were significantly higher than that in the model group (all P<0.05). (3) There were significant differences in the total number of alternations and correct rates among the 5 groups ( F=291.328, 113.482, both P<0.01). The total numbers of alternations and correct rates in melatonin group ((29.46±3.75)times, (53.16±3.47)%) and the enriched environment+ melatonin group((32.57±3.52)times, (58.60±4.13)%)were significantly higher than those in the model group ((18.62±3.96)times, (43.61±3.92) %)(all P<0.05). (4)The results of hematoxylin-eosin staining and immunohistochemistry staining showed that compared with the model group, the cell structure and morphology of the hippocampus of mice in enriched environment group, melatonin group, and enriched environment+ melatonin group were significantly improved, and the expression of Aβ 1-42 was significantly reduced (all P<0.05). (5) There were statistically significant differences in the levels of γ-H2AX and 8-OHdG proteins in the hippocampus of the 5 groups of mice ( F=78.09, 117.20, both P<0.01). The levels of γ-H2AX and 8-OHdG of mice in the enriched environment+ melatonin group ((1.37±0.26), (4.79±0.35)pg/μg) were significantly lower than those in the enriched environment group ((2.83±0.25), (7.23±0.41)pg/μg) and the melatonin group ((2.43±0.22), (6.69±0.28)pg/μg) (all P<0.05). Conclusion:Both enriched environment and melatonin can significantly improve the learning and memory function of SAMP8 mice, and the combined treatment effect is more significant.The mechanism may be related to the reduction of DNA oxidative damage in hippocampus.