Objective:To investigate the efficacy and safety of protein A immunoadsorption (PAIA) combined with rituximab (RTX) in highly sensitized patients who underwent haplo-hematopoietic stem cell transplantation (haplo-HSCT) .Methods:The clinical data of 56 highly sensitized patients treated with PAIA and RTX before haplo-HSCT at the First Affiliated Hospital of Soochow University and Soochow Hopes Hematonosis Hospital between March 2021 and June 2023 were retrospectively analyzed. The number of human leukocyte antigen (HLA) antibody types and the mean fluorescence intensity (MFI), humoral immunity, adverse reactions during adsorption, and survival within 100 days before and after adsorption were measured.Results:After receiving the PAIA treatment, the median MFI of patients containing only HLA Ⅰ antibodies decreased from 7 859 (3 209-12 444) to 3 719 (0-8 275) ( P<0.001), and the median MFI of HLA Ⅰ+Ⅱ antibodies decreased from 5 476 (1 977-12 382) to 3 714 (0-11 074) ( P=0.035). The median MFI of patients with positive anti-donor-specific antibodies decreased from 8 779 (2 697-18 659) to 4 524 (0–15 989) ( P<0.001). The number of HLA-A, B, C, DR, and DQ antibodies in all patients decreased after the PAIA treatment, and the differences were statistically significant (A, B, C, DR: P<0.001, DQ: P<0.01). The humoral immune monitoring before and after the PAIA treatment showed a significant decrease in the number of IgG and complement C3 ( P<0.001 and P=0.002, respectively). Forty-four patients underwent HLA antibody monitoring after transplantation, and the overall MFI and number of antibody types decreased. However, five patients developed new antibodies with low MFI, and nine patients continued to have high MFI. The overall survival, disease-free survival, non-recurrent mortality, and cumulative recurrence rates at 100 days post-transplantation were 83.8%, 80.2%, 16.1%, and 4.5%, respectively. Conclusions:The combination of PAIA and RTX has a certain therapeutic effect and good safety in the desensitization treatment of highly sensitive patients before haplo-HSCT.

To explore the efficacy and safety of immunoadsorption (IA) in removing de novo donor specific antibody (DSA) after allogeneic hematopoietic stem cell transplantation (HSCT), the relevant clinical data were retrospectively reviewed for one female patient of severe aplastic anemia (SAA). Desensitization treatment with IA after HSCT was offered for removing de novo DSA and ultimately promoting platelet engraftment at First Affiliated Hospital of Soochow University in March 2021.

Objective:To evaluate the role of NOD-like receptor 3 (NLRP3) inflammasome activation-mediated macrophage polarization in myocardial injury after ischemic stroke in diabetic mice.Methods:Wild-type C57BL/6J mice and NLRP3 -/- mice, aged 4-6 weeks, were fed a high fat diet combined with streptozotocin administration to develop the diabetic model. Twenty-four diabetic wild type C57BL/6J mice and 23 diabetic NLRP3 -/- mice were divided into wild type sham operation group (WT D-SHAM group, n=9) , wild type ischemic stroke group (WT D-MCAO group, n=15) , NLRP3 -/- sham operation group (NLRP3 -/-D-SHAM group, n=9) and NLRP3 -/- ischemic stroke group (NLRP3 -/-D-MCAO group, n=14). The ischemic stroke model was developed by middle cerebral artery occlusion in the animals anesthetized with isoflurane. Echocardiography and electrocardiography were carried out at 3, 7, 14 and 28 days after developing the model. Mice were sacrificed under deep anesthesia, and myocardial tissues were taken at 28 days after surgery for determination of the expression of macrophage marker F4/80 and M2 type macrophage marker CD206 mRNA (by real-time fluorescence quantitative polymerase chain reaction). Results:Compared with WT D-SHAM group, the cardiac output, mass of left ventricle and corrected mass of left ventricle were significantly decreased at 28 days after surgery, and QT interval and QTc interval were prolonged at 14 and 28 days after developing the model in WT D-MCAO group ( P<0.05). Compared with NLRP3 -/-D-SHAM group, the cardiac output, mass of left ventricle and corrected mass of left ventricle were significantly decreased, and QT interval and QTc interval were prolonged at 3 days after surgery in NLRP3 -/-D-MCAO group ( P<0.05). There was no significant difference in CD206 and F4/80 mRNA expression between WT D-SHAM group and WT D-MCAO group and between NLRP3 -/-D-SHAM group and NLRP3 -/-D-MCAO group ( P>0.05). Compared with WT D-MCAO group, the QT interval and QTC interval were significantly shortened at 14 and 28 days after developing the model, and the expression of F4/80 mRNA was down-regulated and the expression of CD206 mRNA was up-regulated at 28 days after developing the model in NLRP3 -/-D-MCAO group ( P<0.05). Conclusions:NLRP3 inflammasome activation-mediated polarization of macrophages to M2 phenotype is involved in myocardial injury after ischemic stroke in diabetic mice.

Numerous studies have reported that the resistance of biofilm bacteria to antibiotics can be up to 10-1 000 fold higher than that of planktonic bacteria. Bacterial biofilms are reported to be responsible for more than 80% of human microbial infection, posing great challenges to the healthcare sector. Many studies have reported that plant extracts and their active ingredients can inhibit the formation and development of bacterial biofilms, including reducing biofilm biomass and the number of viable bacteria in biofilms, as well as eradicating mature biofilms. This review summarized the plant extracts and their active ingredients that are inhibitory to bacterial biofilms, and analyzed the underpinning mechanisms. This review may serve as a reference for the development of plant drugs to prevent and treat biofilm infections.
Anti-Bacterial Agents/pharmacology* ; Bacteria ; Biofilms ; Humans ; Plant Extracts/pharmacology* ; Quorum Sensing

We report the successful management of a pregnant woman with para-Bombay phenotype. The woman received routine prenatal check-ups and underwent vaginal delivery in the Affiliated Shenzhen Maternity & Child Healthcare Hospital. Blood grouping at 12 weeks of pregnancy showed that the forward typing of the patient was group O, but reverse typing indicated group AB. Her ABO genotype was determined as ABO*A1.02/B.01. There was c.551-552del AG and c.880-882 del TT in the FUT1 gene, and 357C>T and 716G>A in the FUT2 gene. Thus, her FUT1 genotype was h1/h2 and FUT2 genotype was Se/Se. No significant abnormalities were found in the routine prenatal examination. A male infant was born vaginally at 39 +2 gestational weeks, who was grouped as B-positive without neonatal hemolytic disease. Para-Bombay is a rare blood group. It is necessary to clarify the blood type during prenatal examination and develop a management strategy for those with special blood groups to reduce the incidence of postpartum hemorrhage and ensure safe delivery.

Probiotics can improve the microecological balance of the body and have special effects in promoting nutrient absorption, controlling intestinal infections, and regulating immune function. However, there are problems such as difficult colonization in the gastrointestinal environment and low oral bioavailability. Bacterial biofilms are organized bacterial cells that adhere to an abiotic or biotic surface and are enclosed in extracellular polymeric substances of exopolysaccharides (EPS), extracellular DNA (eDNA), proteins and lipids, with a three-dimensional spatial structure. Probiotics with the help of bacterial biofilms have obvious advantages over planktonic bacteria in stress resistance, combating pathogens and modulating the host's immune function, which provides a new research idea for the development of probiotics. This paper expounded on the advantages of probiotics with the help of bacterial biofilms, and focused on introducing substances that could promote the formation of probiotic biofilms and the mechanisms, and the safety of probiotic biofilms. Currently, research on probiotic biofilms is still in its infancy, and this paper is expected to provide references for future research in this field.
Bacteria ; Biofilms ; Extracellular Polymeric Substance Matrix ; Probiotics

Objective To make comparison of duration of subarachnoid block with intrathecal ropivacaine between gravidas with diabetes mellitus and non-diabetic pregnancy, to evaluate the sensitivity of parturient with diabetes to ropivacaine. Methods 75 parturients who were presenting for elective cesarean section were randomly divided into pregestational diabetes mellitus group (group P, n=15) , gestational diabetes mellitus group (group G, n=30) and non-diabetic parturients group (group N, n=30). After entering the operating room, parturients were given spinal anesthesia spinal at the L3～4 interspace with 0.5％ hyperbaric ropivacaine 3 ml with left lateral decubitus position. To determine the level of sensory block by 10 g monofilament and evaluate the motor block with modified Bromage score. To record the time T6 sensory level was obtained, the onset time of sensory block, motor block, the duration of the motor block and sensory block. Results The time T6 sensory level was obtained of Group P were significantly shortened (P < 0.001). Compared with Group N and Group G, the duration of sensory (P < 0.001) and motor (P < 0.001) block were significantly prolonged. Conclusion Parturients with pregestational diabetes mellitus are more sensitive to 0.5％ hyperbaric ropivacaine compared to non-diabetic parturients. Compared with non-diabetic parturients, there are no difference in the sensitivity of parturient with gestational diabetes mellitus to 0.5％hyperbaric ropivacaine.

Objective To observe the effect and safety of intermittent epidural bolus without background infusion combined with patient-control epidural analgesia (PCEA) in transurethral resection of prostate. Methods Sixty patients with benign prostatic hyperplasia in Shengjing Hospital of China Medical University from January to August 2018 were selected, and the patients were treated with transurethral (plasma) resection of prostate. The patients were divided into test group and control group according to the random digits table method with 30 cases each. Postoperative epidural analgesia of 2 groups used the electronic analgesia pump. The analgesia mode of test group was intermittent epidural bolus without background infusion combined with PCEA, and the analgesia mode of control group was continuous infusion combined with PCEA. The visual analogue score (VAS), Ramsay sedation score, improved Bromage score, adverse reaction and satisfaction of patients end of surgery to 48 h after operation were compared between 2 groups. Results There were no statistical difference in VAS and Ramsay sedation score between 2 groups (P＞0.05). The improved Bromage score 6 h after operation in test group was significantly lower than that in control group: 0 (0, 0) score vs. 0.5 (0, 1.0) scores, there was statistical difference (P＜0.05). The dosage of electronic analgesic pump 48 h after operation in test group was significantly lower than that in control group: (159.73 ± 22.58) ml vs. 250 ml, there was statistical difference (P＜0.01). The patients in 2 groups were satisfied, and there was no obvious dissatisfaction. There was no statistical difference in incidence of adverse reaction between 2 groups (P＞0.05). Conclusions In the postoperative analgesia of transurethral (plasma) resection of prostate, intermittent epidural bolus without background infusion combined with PCEA can decrease the drug dosage without the decline of analgesia.

Objective To get well-informed of the current status of emergency training in primary hospitals in Sichuan Province and to find weaknesses in the system in order to provide scientific basis for emergency knowledge and skills training.Methods A stratified random cluster sampling method as adopted and an anonymous questionnaire survey method was conducted to investigate the basic circumstances of the current training and the training needs of 1 000 emergency medical staff in 9 regions throughout Sichuan Province.Results The scope of the survey covered emergency doctors,nurses and technicians in hospitals of Grade Ⅱ,Grade Ⅲ and below.A total of 1 000 surveys were sent out and 983 were recovered.The questionnaire completion rate was 98.3％.The respondents mainly worked for more than 10 years,most of which with Bachelor degree,junior and intermediate titles.Results of the survey showed,63.1％ Most respondents have only one or two training opportunities per year.The training methods are mainly continuing education (59.0％,580 trips),training organized within the unit (58.5％,575 trips),and training organized by health administrative units (39.3％,386 trips).The main contents of the training are:basic professional skills learning (66.7％,655 trips),basic professional theoretical study (59.2％,582 trips),and new emergency technology (42.5％,418 trips),only 32.0％ of the respondents believe that these methods meet the practical needs.The main factors that influence participation in the training were:not be arranged by employer (36.2％,356 trips);the training was different from actual work (31.6％,311 trips);no replacement for work so they couldn't join training (29.8％,293 trips).The survey showed that the most desirable way of training is:practical application (60.1％,591 trips) and the most desirable training content is:emergency first aid knowledge (73.7％,724 trips).There were significant differences in case discussion,technical observation,academic lectures,special study trainingand learning methods in hospitals of different levels (P＜0.05),but there was no significant difference in the choice of professional practice methods (P＞0.05),and the selection of training contents was in emergency first aid knowledge,general medical knowledge and prevention and treatment of chronic diseases.There was no statistical difference in the selection of training contents of knowledge,infectious disease knowledge and department management knowledge (P＞0.05).There were significant differences in the choice of nursing knowledge training (P＜0.05).Conclusion The current situation showed a lack of first-aid knowledge and skills training for emergency personnel in Sichuan Province.The present situation of skill training can't satisfy the need of their desire to participate in training.It is urgent to develop a standardized,systematic and scientific training mode to improve the emergency first aid ability of primary medical and emergency personnel.

Objective To analyze the value of predict lymph node status according to the tumor size, solid size, and maximum standardized uptake value(SUVmax) in adenocarcinoma of the lung with a size of ≤3 cm. Methods One hundred and thirty-six patients who had undergone curative resection for lung adenocarcinoma were enrolled in this retrospective study.The largest transverse sectional diameter of the tumor and solid size were measured. Then SUVmax of the main tumor was assessed. Logistic regression analysis was performed by taking the lymph node status as the dependent variable,and the size of solid component of tumor, SUVmax were taken as independent variables. The predicted probability of the Logistic regression model was enrolled in receiver operating characteristic analysis.Results Among the 136 cases of lung adenocarcinoma, the incidence of lymph node metastasis was 24.3%(33/136). Logistic regression analysis showed that the size of the solid component (OR 3.880, 95%CI 1.788 to 8.421, P<0.05) and SUVmax (OR 1.179, 95%CI 1.024 to 1.357, P<0.05) at baseline predicted the metastasis of lymph node independently. And the size of tumor was non-independent predict factor (OR 1.238, 95%CI 0.360-4.260, P>0.05). The ROC curve analysis was performed based on the predicted probability of Logistic regression model, and the area under the curve was 0.838(P<0.01) Conclusions Solid size and SUVmax are important predictors for lymph node metastasis of lung adenocarcinoma with a size of ≤3 cm, and it may be helpful to avoid unnecessary limited resection or lymph node dissection.