Objective To study the molecular mechanisms of Rh deletion D--individuals.Methods Several exons and introns of RHD and RHCE gene were amplified by PCR-SSP.The abnormally amplified segments,which were inconsistent with serologic phenotyping,were cloned and sequenced.Results Fragments of D,e gene were amplified in two RhD--individuals.After sequencing,deletion at nucleotide 22 in exon 5,and point mutations at codon 48 and 90 were found in one individual.Mutation at codon 48 in exon 5 were found in another.Conclusion Exon deletion of Rh gene,along with deletion and mutation of single nucleotide may cause Rh deletion D--.

Objective To investigate the clinical significance of direct antiglobulin test(DAT) in patients with chronic hepatitis B.Methods Column agglutination technique(CAT) and conventional tube technique(CTT) were used to detect red blood cell(RBC) antibodies in a total of 162 samples,including 50 cases of asymptomatic carriers,42 cases of active phases of chronic hepatitis B(CHB) patients,52 cases of severe hepatitis and 18 healthy individuals.Results The RBC count and hemoglobin(Hb) in patients with severe hepatitis were significantly lower than those in asymptomatic carriers,CHB patients and healthy individuals(P

Objective To observe the therapeutic effect of lymphoplasmapheresis (LPE) in treatment of Guillain-Barre syndrome (GBS). Methods The initial recovery time of muscle strength, muscle strength score difference, clinical therapeutic effect and the security after treatment with LPE were observed in 34 GBS patients. Meanwhile, 17 GBS patients applied with therapeutic plasma exchange (TPE) named TPE group were served as control group. Results LPE group was treated with LPE 51 times in all, and the mean times was 1.5. TPE group received TPE 33 times in all, and the mean times were 1.9. In LPE group, the average initial recovery time [(12.74?7.18)d] was significantly shorter than that in TPE group [(24.35?14.22)d] (P0.05).Conclusions The therapeutic effect of LPE is distinguished for treatment with GBS and the side effect is rare. It is worth to apply in clinic.

Objective To evaluate the clinical efficacy of lymphoplasma exchange (LPE) for the treatment of severe refractory immune-related skin diseases.Methods From May 2013 to October 2015,8 patients with toxic epidermal necrolysis,drug-induced hypersensitivity syndrome (DIHS),pemphigus vulgaris,pemphigoid or paraneoplastic pemphigus were enrolled from Department of Dermatology,Xiangya Hospital,Central South University,who showed no response to conventional therapy or presented with multiple organ dysfunction.After the treatment with LPE,the efficacy was evaluated,and adverse reactions were observed.Results After one session of LPE therapy,6 patients received marked improvement,and were cured at last.In 1 patient with pemphigus vulgaris who was resistant to the treatment with high doses of glucocorticoids and immunosuppressive agents,the rashes regressed during the treatment with LPE,but recurred after the end of treatment.One patient with bullous pemphigoid presented with eruptive blisters on the next day after the treatment with LPE,which were considered as allergic reactions to allogeneic plasma.There were no obvious differences in white blood cell count,lymphocyte count,neutrophil count and blood platelet count in the peripheral blood of 8 patients before and after the treatment with LPE.During the follow-up of 3-5 years,all of the patients were recovered without recurrence,except 1 patient with bullous pemphigoid who died of disseminated tuberculosis after 1 year.Conclusion LPE is effective for the treatment of severe immune-related skin diseases,but attention should be paid to potential transfusion reaction and allergic reactions.

【Objective】 To investigate treatments of discrepancy presented in blood typing and cross-matching test caused by anti-I antibody and the difference between autoanti-I antibody and alloanti-I antibody. 【Methods】 38 cases of I-positive antibody in our hospital from January 2016 to July 2019 were selected as the research subjects. The irregular antibodies screening and identification were performed by adopting the anti-human globulin and saline test tube method, and the blood transfusion effect was evaluated. 【Results】 37 cases of autoanti-I antibody and 1 case of alloanti-I antibody, with specificity produced by an individual with a rare i blood group, were identified. 34 cases contained I-positive antibody and 4 contained I-positive antibody combined with alloantibodies. At 4 ℃, most of the anti-I titers were between 32 and 512, 2 cases were more than 1 024. After the RBCs were washed with 37℃ normal saline and cold absorbed at 4℃, the cross-matching tests were matched and 37 cases of blood transfusion were all effective except for one case. After performing the same treatment on i adult red blood cells and adding I antigen-negative cord blood cells, the result was correct to be B type. The titer of IgM alloanti-I antibody in this adult was 256, and autotransfusion was preferred. 【Conclusion】 Patients with anti-I antibody, reactive at low temperature, should be treated with warm and slow transfusion under close monitoring. Autotransfusion is, in principle, beneficial to adult i blood group patients producing alloanti-I antibody. If i blood patients suffered from massive blood loss without suitable blood resource available, the elderly i blood donors were preferred, and plasmapheresis may also be an alternative to remove anti-I temporarily.

Objective To investigate the effects of dapagliflozin on inflammatory cytokines,blood glucose control and cardiac function in elderly with preserved ejection fraction heart failure(HFpEF)combined with type 2 diabetes.Methods A total of 80 elderly HFpEF patients with type 2 diabetes mellitus were randomly divided into control group(40 cases)and study group(40 cases).The control group received hypoglycemic and anti-heart failure standard therapy,and the study group received hypoglycemic and anti-heart failure standard therapy and dapagliflozin therapy.Both groups were treated for 6 months.The levels of inflammatory factors,blood glucose control,myocardial markers,exercise endurance[6 min walking distance(6MWD)],cardiac ultrasound related indexes and adverse drug reactions were compared between the two groups.Results After 6 months of treat-ment,serum interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP)and tumor necrosis fac-tor(TNF)-α in the study group were significantly lower than those in the control group(P＜0.05);the glycated hemoglobin(HbA1c),fasting blood glucose(FPG),amino terminal B-type brain natriuretic peptide precursor(NT-proBNP)and hypersensitive troponin(hs-TNT)of the study group were significantly lower than those of the control group(P＜0.05);the 6MWD and left ven-tricular ejection fraction(LVEF)of the study group were higher than those of the control group,and the left ventricular end-diastolic diameter(LVEDD),right atrial and right ventricular diameter,left atrial and left ventricular diameter,right ventricular wall thickness and pulmonary artery pressure of the study group were significantly lower than those of the control group(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion The use of dapagliflozin in the treatment of elderly HFpE patients complicated with type 2diabetes can effectively control their blood sugar level,reduce inflammation,improve exercise endurance,and improve patients'heart function without increasing adverse drug reactions.

Objective To investigate the effects of dapagliflozin on inflammatory cytokines,blood glucose control and cardiac function in elderly with preserved ejection fraction heart failure(HFpEF)combined with type 2 diabetes.Methods A total of 80 elderly HFpEF patients with type 2 diabetes mellitus were randomly divided into control group(40 cases)and study group(40 cases).The control group received hypoglycemic and anti-heart failure standard therapy,and the study group received hypoglycemic and anti-heart failure standard therapy and dapagliflozin therapy.Both groups were treated for 6 months.The levels of inflammatory factors,blood glucose control,myocardial markers,exercise endurance[6 min walking distance(6MWD)],cardiac ultrasound related indexes and adverse drug reactions were compared between the two groups.Results After 6 months of treat-ment,serum interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP)and tumor necrosis fac-tor(TNF)-α in the study group were significantly lower than those in the control group(P＜0.05);the glycated hemoglobin(HbA1c),fasting blood glucose(FPG),amino terminal B-type brain natriuretic peptide precursor(NT-proBNP)and hypersensitive troponin(hs-TNT)of the study group were significantly lower than those of the control group(P＜0.05);the 6MWD and left ven-tricular ejection fraction(LVEF)of the study group were higher than those of the control group,and the left ventricular end-diastolic diameter(LVEDD),right atrial and right ventricular diameter,left atrial and left ventricular diameter,right ventricular wall thickness and pulmonary artery pressure of the study group were significantly lower than those of the control group(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion The use of dapagliflozin in the treatment of elderly HFpE patients complicated with type 2diabetes can effectively control their blood sugar level,reduce inflammation,improve exercise endurance,and improve patients'heart function without increasing adverse drug reactions.

Central fatigue refers to the central nervous system disease caused by excessive mental pressure or excessive physical activity, which shows a series of fatigue symptoms. The pathological mechanism of central fatigue remains unclear, and the mitochondrial quality control pathway represented by mitophagy is closely related to the occurrence and development of central fatigue. Traditional Chinese medicine considers liver stagnation and spleen deficiency as the key pathogenesis of central fatigue. This paper suggests that oxidative stress may be an important basis for the occurrence of central fatigue, energy metabolism disorders are specific manifestations of liver′s failure of conveyance and dispersion and spleen′s failure of healthy transportation, and the abnormal accumulation of reactive oxygen can be regarded as pathological products of central fatigue. Therefore, based on oxidative stress and energy metabolism, the pathologic mechanism of liver′s failure of conveyance and dispersion and spleen′s failure of healthy transportation in central fatigue from the perspective of mitophagy has a rich theoretical connotation, and provides a theoretical reference for the clinical treatment of central fatigue.

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.