Objective:To analyze the bubble dynamic characteristics of shock wave enhanced emission photoacoustic streaming(SWEEPS)technique in free water region under different temporay delays.Methods:The Er∶YAG laser tip was activated in free water model with SWEEPS mode at 150-600 μs pulse delay.The bubble dynamic process during irrigation was recorded by a high-speed camera(200 000 Hz).Matlab was used to analyze the interaction between bubble made by the dual pulses frame by frame.The distance between bubble remnants and laser tip was measured before the bubble disappeared.The experimental data were statisti-cally analyzed by SPSS 19.0.Results:In free water region,different temporal delays caused different interaction between the bub-bles activated by the SWEEPS technique with a dual pulse modality.The interactions include bubble fusion,bubble collision and bubble separation.When the temporal delay between 360-440 μs,bubble collision was the most violent,and the farthest distance between bubble remnants and laser tip was reached.Conclusion:In free water region,the dual pulse of SWEEPS technique can lead to bubble interaction which may enhance the cavitation effect of Er∶YAG laser irrigation,and improve the debridement in clinic ap-plication.

Objective To investigate the distribution,phenotype and genotype of D-elute type(Del)in blood donors with RhD negative blood in Guangzhou,so as to understand the molecular biological background of DEL blood group in this area.Methods During the period from November 1,2021 to June 30,2022,the RhD-negative blood initially screened by saline method was confirmed by indirect anti-human globulin test(IAT)serology,and RhCE phenotype was determined by RhCE typing card.A total of 1 146 RhD-negative samples,including all RhD-negative samples with RhCE C+(n=459)and a randomly selected subset of RhCE C-(n=175),were subjected to adsorption-elution(Del)screening(a total of 634 sam-ples).DNA from Del-positive samples was extracted for real-time fluorescent PCR detection of the RHD gene c.1227 locus using high-resolution melting curve analysis(HRM).For samples without mutations detected at the RHD?1227 locus by HRM,restriction fragment length polymorphism polymerase chain reaction(PCR-RFLP)was performed to amplify the prod-uct which was subsequently digested with Pst I enzyme and analyzed by electrophoresis to determine RHD gene haplotypes.Sanger sequencing was performed for exon sequencing(exon 1-10)of the RHD gene,and gene mutations were analyzed u-sing SeqMan software.Suspected Del-positive samples were subjected to RHD whole gene analysis using third-generation sin-gle-molecule sequencing technology.Results Among the 634 confirmed RhD-negative samples,229(36.1%)displayed Del phenotype,accounting for20%(229/1 146)of the total confirmed RhD-negative samples.The RhCE phenotypes of the 229 DEL cases were as follows:Ccee in 181 cases,CCee in 40 cases,CcEe in 7 cases,and ccEe in 1 case.HRM combined with RHD haplotype analysis showed that there were 170 cases with RHD gene as RHD?1227A/01N.01,32 cases with RHD gene as RHD?1227A/1227G,26 cases with RHD gene as RHD?1227A/1227A,and 6 cases with RHD gene as RHD?1227G/1227G(sequencing results included 1 case of weak D type 12,4 cases of D-,and 1 case of RHD?01EL.02).Con-clusion The individual genotype of DEL blood donors in Guangzhou area is mainly characterized by RHD?1227A/01N.01,and their RhCE phenotypes are all C+.HRM can be used as a molecular biology method for routine screening of Asian-type DEL blood type genes.

A 50-year-old female presented with bilateral cervical arteriosclerosis and right-sided plaque formation,after 25 d of treatment with rosuvastatin calcium tablets(20 mg,po,qn),the patient developed temporomandibular joint dislocation,the adverse reactions occurred again after giving manipulative repositioning.The patients were healthy,had no history of trauma and related diseases in stomatology,no history of drug allergy,patients did not open their mouth loudly at the onset of the disease,no external factors affecting the use of drugs during the combined use of other drugs.It was considered"very likely"that the dislocation of the jaw joint was caused by rosuvastatin calcium tablets.The patients were followed up for 3 months after the treatment of manipulative repositioning and other treatments,did not have any further dislocation of the temporomandibular joint dislocation.It is suggested that when using rosuvastatin calcium in clinical practice,attention should be paid to strengthening drug observation to ensure drug safety.

The overall health condition of patients significantly affects the diagnosis,treatment,and prognosis of endodontic diseases.A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy,as well as selecting appropriate therapeutic approaches.This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence,aiming to provide general guidance on clinical procedures,improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.

【Objective】 To establish an experimental method for detecting phagocytosis of sensitized red blood cells in vitro by flow cytometry. 【Methods】 Mononuclear cells were isolated from the peripheral blood of blood donors and cultured in a cell incubator for 1 hour, and then adherent monocytes were isolated and obtained. Di^b-positive red blood cells (RBCs) were labeled with PKH26 and then sensitized with IgG anti-Di^b. The sensitized RBCs were added to monocytes for in vitro phagocytosis assay. Monocytes were labeled with FITC anti-human CD14, then phagocytosis was measured by flow cytometry, and the phagocytic efficiency was calculated. The method was used to detect the phagocytic efficiency of monocytes on human IgG anti-D sensitized RBCs with different titers. 【Results】 The phagocytic efficiency of monocytes was averaged at 5% (1.2%~7.6%, SD 3.30) versus 81% (71.4%~92.7%, SD 8.65) in the negative versus positive control group, respectively. Phagocytic activity of monocytes mediated by anti-D was correlated with the antibody titer. The phagocytosis efficiency was within 10% when the antibody titer was lower than 32 and increased sharply when the titer was between 32 to 128, it entered a plateau and stabilized at 80% at the titer above 256. 【Conclusion】 A detection platform for detecting phagocytosis-sensitized RBCs in vitro by flow cytometry has been successfully established. It can be used to assess the clinical significance of red blood cell allotype or autologous IgG antibodies.

【Objective】 To identify three cases of pregnant women with the D variant phenotype using serological and molecular tests, and discuss the strategy of prenatal examination. 【Methods】 The peripheral blood samples from three pregnant women with the D variant phenotype were collected. RhD variant phenotype was determined using routine serological methods with two different kinds of monoclonal anti-D. The serological characteristic for the epitope of D antigen was further analyzed using the commercial panel anti-D reagents (D-Screen, Diagast). The hybrid RHD-CE-D allele was analyzed by the Multiplex Ligation-dependent Probe Amplification (MLPA) assay and polymerase chain reaction with sequence specific primers (PCR-SSP) method. Further Sanger sequencing of RHD gene exons was also performed. 【Results】 DFR phenotype was primarily determined by serological characteristic for the epitope of D antigen. RHD^*DFR2/01N.01(n=2) and RHD^*DFR1/1227A(n=1) genotypes were identified by the MLPA assay, PCR-SSP and Sanger sequencing. 【Conclusion】 Two pregnant women with RHD^*DFR2/01N.01 genotype should be treated as D negative patients clinically, while the pregnant woman with RHD^*DFR1/1227A genotype can be treated as Asia type DEL to avoid unnecessary antibody screening and anti-D prophylaxis.

Objective To investigate the promoter methylation status,mRNA expression and clinical significance of insulin-like growth factors 2 (IGF2)/H19 genes in term infants smaller than gestational age (SGA) infants whose mothers had gestational diabetes mellitus (GDM).Methods The clinical data of 20 full-term infants whose mothers had GDM (group 1),23 cases of full-term SGA infants whose mothers did not have GDM (group 2) and 21 full-term health infants whose mothers did not have any diseases during pregnancy(group 3) were collected,and all infants were delivered in Changsha Hospital for Maternal and Child Health Care between January 2015 and January 2018.The promoter methylation levels of IGF2/H19 gene from peripheral blood of 3 groups were detected by the method of Bisulfite sequencing polymerase chain reaction (PCR) (BSP),and IGF2/H19 mRNA was detected by real-time transcription RT-PCR method.Results The promoter methylation rates of IGF2/H19 in peripheral blood of infants were (22.51 ±5.29)％,(28.94 ±2.51)％ in group 1,(27.84 ±4.63)％,(34.58 ±6.97)％ in group 2,(37.47 ±7.84) ％,and (40.26 ±5.33) ％ in group 3.The promoter methylation rate of IGF2 and H19 in group 1 were significantly lower than those in group 2 and group 3,and the differences were statistically significant(all P ＜ 0.05).The relative expression of IGF2/H19 mRNA in peripheral blood of group 3 (1.04 ±0.12,1.01 ±0.13) were significantly higher than those in the group 1,and the differences were statistically significant (all P ＜ 0.05),and there were no significant differences in relative expression of IGF2/H19 between the group 1 and the group 2 (1.30 ±0.10,1.29 ±0.11) (all P ＞ 0.05).Conclusions The abnormal promoter methylation status and mRNA expression levels of IGF2/H19 gene methylation frequency and mRNA abnormalities may occur in infants less than gestational age infants if exposed to hyperglycemia during pregnancy,which may be one of the causes of intrauterine growth retardation and may affect its later growth and development.

Objective:To develop the intelligent management system for diabetes medication knowledge base with the help of community hospital information platform.Methods:Based on the China Type 2 Diabetes Prevention Guide (2013 edition),National Essential Drugs (2012 edition) and the relevant package inserts,the knowledge base of diabetes medication was established.Results:The information platform could make interception beforehand,warning in the process of medication and provide attentions for physicians after treatment to determine rational medication.Conclusion:The intelligent management system for diabetes medication knowledge base can promote physicians to firmly grasp the principles of drug treatment,simplify treatment regimen,select effective drugs with reasonable prices and provide individualized treatment.

Objective:To discuss the management norms for the rational use of potassium chloride injection in neurosurgery department of a hospital.Methods:A special review of the medical advice including potassium chloride injection from January to June in 2016 in neurosurgery department was carried out.Results:In the 2 596 prescriptions including potassium chloride injection,the irrational drug use rate was 17.87%,and among them,92.67% were irrational compatibility,which showed serious risk of drug use.Conclusion:Some defects still exist in the application management of potassium chloride injection in neurosurgery department of this hospital.In order to avoid the risk of clinical medication,it is necessary to establish standardized management norms for the use of potassium chloride injection in this hospital to further promote the management of high-risk drugs with intravenous administration commonly used in clinics.

Objective To analyze the clinical characteristics of IgG4-related disease (IgG4-RD)so as to improve the understanding of IgG4-RD in China.Methods IgG4-RD patients were recruited from Peking Union Medical College Hospital between January 2011 and January 2016.All patients were followedup for more than 6 months.The demographic characteristics,symptoms,organ involvements,laboratory examinations and treatment efficacy were evaluated and analyzed.Results A total of 346 patients were finally enrolled,including 230 males (66.5％) and 116 females (33.5％).The mean age of disease onset was (53.8 ± 14.2) years old.The mostly common involved organs were lymph nodes (56.4％) and submandibular glands (52.6％).Other affected organs and manifestations included:swelling of the lacrimal glands (46.5％),autoimmune pancreatitis (38.4％),pulmonary involvement (28.0％),sclerosing cholangitis (25.4％),naso-sinusitis (23.4％),parotid gland swelling (21.7％),retroperitoneal fibrosis (19.9％),large arteries involvement (9.5％),kidney involvement (obstructive nephropathy caused by retroperitoneal fibrosis was excluded) (6.9％),skin lesions (6.4％).Rare features consisted of thyroid glands,pituitary glands,gastrointestinal tract,pachymeningitis,pericardium,sclerosing mediastinitis and orchitis.The majority of patients had multi-organ involvement,such as 74.3％ patients with 3 and more,18.2％ and 7.5％ patients with 2 and single organ involvement respectively.The average IgG4-RD responder index (IgG4-RD RI) was 13.21 ±5.70.History of allergy was found in 172 (49.7％) patients.As to the laboratory tests,elevated serum IgG4 levels were confirmed in 285 (94.1％) patients,which was positively correlated with IgG4-RD RI.There were 33.5％ patients receiving monotherapy of glucocorticoid,52.6％ treated with glucocorticoids combined with immunosuppressive agents,4.9％ patients with immunosuppressant only,and 9.0％ patients with mild disease not receiving medication.The majority (336,97.1％) patients improved the above regimens.Conclusion IgG4-RD is a systemic fibro-inflammatory disease with multiple organ involvement.The mostly common involved organs include lymph node,submandibular glands,and pancreas.Glucocorticoids and immunosuppressive agents were effective for IgG4-RD.