Objective: To investigate the causes and characteristics of immune hemolytic transfusion reactions (HTRs) triggered by anti-E antibodies, so as to provide a scientific reference for guaranteeing clinical blood transfusion safety. Methods: Five patients who experienced HTRs in our hospital from November 2023 to October 2024 were selected as the research subjects. ABO/RhD blood grouping, antibody screening, antibody identification, and the direct antiglobulin test (DAT) were conducted using the column agglutination method. The causes of HTRs in these patients were investigated using multiple techniques such as the two-step enzyme method, polyethylene glycol (PEG), acid elution technique, and capillary centrifugation method. Results: All five patients tested negative for antibody screening prior to transfusion. However, after transfusion of E+ phenotyped blood, patients 1, 2, 3, and 5 developed delayed haemolytic transfusion reaction (DHTR), while patient 4 experienced acute haemolytic transfusion reaction (AHTR). Anti-E antibodies were detected in all blood samples from the patients after the hemolytic transfusion reaction, including the enzyme-only anti-E antibody in two cases. Conclusion: Anti-E antibody can trigger both intravascular and extravascular hemolysis. It is recommended to conduct ABO/RhD and RhE antigen-matched transfusions and establish a regional blood transfusion database to reduce immune hemolytic transfusion reactions caused by anti-E antibody.

Objective:To improve the clinical differential diagnosis ability of rheumatoid arthritis (RA) complicated with gout and septic arthritis (SA).Methods:The clinical characteristics, diagnosis, and treatment of one RA patient with hyperuricemia and recurrent swelling and pain in right shoulder were reported and discussed.Results:A patient, with a history of RA for 10 years, hyperuricemia for 8 years, recurrent swelling and pain in right shoulder for 1 year. RA, gout, and SA were diagnosed before, and the response was poor after symptomatic treatment. In recent 1 month, the symptom was aggravated with the formation of fistula on the right shoulder. The laboratory tests for tuberculosis T cell interferon release test (IGRA) and tuberculin (PPD) test were negative, and the CD4 + cell count decreased. The comprehensive analysis of the imaging with right shoulder showed MSU deposition on right shoulder, with bone erosion, bone destruction, bone marrow edema, joint effusion, and multiple sites of connective tissue involvement (synovial bursa, tendon sheath, tendon, and muscle) GeneXpert MTB/RIF (GeneXpert), metagenomic next-generation sequencing (mNGS) of puncture fluid and joint fluid culture prompted Mycobacterium tuberculosis complex group. He was finally diagnosed with RA, gout, and osteoarticular tuberculosis (OAT). Symptoms were relieved after symptomatic treatment. Conclusion:RA patients with hyperuricemia have recurrent single arthritis. In addition to considering for gout, the presence of OAT should also be considered. The immune functional status of the patient and drug used may interfere with the interpretation of immune function tests. It is necessary to integrate the clinical characteristics of patients, a variety of imaging examinations, and etiological detection to confirm the diagnosis and avoid misdiagnosis.

Objective To explore the roles of zinc-fingers and homeoboxes (ZHX) in the dorsal root ganglia (DRG) in peripheral nerve injury-induced pain hypersensitivity,and provide a new idea for molecular mechanism ofneuropathic pain (NP).Methods (1) Twenty-four 8-week-old male C57BL6 mice were randomly divided into sham-operated group and chronic constriction injury (CCI) of the sciatic nerve model group (n=12).One d before modeling and 7 d after modeling,the changes of paw withdrawal frequency (PWF) to mechanical stimuli and paw withdrawal latency (PWL) to thermal stimulation were detected.Seven d after modeling,reverse transcription real-time quantitative PCR (RT-qPCR) was used to detect the ZHX1,ZHX2,and ZHX3 mRNA expressions,and Westem blotting was employed to detect the ZHX2 protein expression.(2) Thirty-six 8-week-old male C57BL6 mice were randomly divided into equivalent dose solvent CCI group,nonsense negative control sequence [siNC]CCI group and ZHX2 siRNA CCI group,and equivalent dose solvent sham-operated group,siNC sham-operated group and ZHX2 siRNA sham-operated group (n=6);each treatment was given to the DRG.One d before drug injection and 7 d after drug injection,the changes of PWF to mechanical stimuli and PWL to thermal stimulation were detected;RT-qPCR was used to detect the ZHX2 mRNA expression.Results (1) Seven d after modeling,PWF was significantly increased and PWL was statistically shorten in the hind-paw of the ipsilateral side in the CCI group as compared with those in the sham-operated group (P＜0.05);DRG ZHX2 mRNA expression in the CCI group increased for 1.71 times as compared with that in the sham-operated group,with significant difference (P＜0.05);DRG ZHX2 protein expression in the CCI group increased for 2.15 times as compared with that in the sham-operated group,with significant difference (P＜0.05).(2) As compared with the equivalent dose solvent sham-operated group,siNC sham-operated group and ZHX2 siRNA sham-operated group,equivalent dose solvent CCI group and siNC CCI group had significantly increased PWF and DRG ZHX2 mRNA expression,and statistically shorten PWL (P＜0.05);and ZHX2 siRNA CCI group had significantly decreased PWF of the ipsilateral side and DRG ZHX2 mRNA expression,and statistically longer PWL of the ipsilateral side as compared with equivalent dose solvent CCI group and siNC CCI group (P＜0.05).Conclusion Knockdown periphery nerve injury-induced DRG ZHX2 up-regulation attenuates pain hypersensitivity following periphery nerve injury,and ZHX2 may be a new potential target to treat NP.

Objective To investigate the effect of pre - washing without heparin on adequacy of hemodialysis. Methods Using self-control method, fifty hemodialysis patients received pre-washing with heparin in normal saline and normal saline. Then we tested Kt/v by online clearance monitoring and observed clotting condition of dialyzer and hemodialysis tubes. Results There were no difference of Kt/v between two methods. After hemodialysis, no clotting phenomenon was found in dialyzer. There was a little pot of coagulation in artery and vein pot, but no significant difference between two methods. Conclusions Pre-washing with normal saline alone can not only ensure the adequacy of hemodialysis, but also reduce the risk of cross infection and reduce the amount of heparin, simplify operational procedures, so it should be promoted.