Objective To investigate the therapeutic efficacy of HLA-genotype matched platelet transfusion using a platelet donor database for severe platelet transfusion refractoriness (PTR) caused by HLA antigen-antibody incompatibility. Methods Using real-time quantitative PCR (qPCR) to identify he patient's HLA class I genotype, followed by searching the platelet donor database for matching donors, and selecting highly compatible donors for transfusion. Platelets with higher compatibility levels were prioritized for transfusion recommendations. Results Among the 19 patients studied, 7 patients identified donors with B2U or higher compatibility, 6 patients identified donors with BX or higher compatibility, and 6 patients did not find a suitable donor. The transfusion efficacy was evaluated by calculating the corrected count increment (CCI) 24 hours post-transfusion, and all transfusions were effective. Conclusion The optimal strategy to prevent and treat patients with severe platelet transfusion refractoriness is to ensure patients receive platelet transfusions that are matched to their HLA genes, and this approach significantly enhances transfusion efficacy.
Humans ; Platelet Transfusion/adverse effects* ; HLA Antigens/immunology* ; Male ; Middle Aged ; Female ; Adult ; Blood Platelets/immunology* ; Aged ; Genotype

Objective To explore the effects of the multiple shared decision-making mode using a decision aid manual in conjunction with online labor and delivery decision support on the delivery mode for pregnant women with a scarred uterus.Methods A total of 94 women with scarred uterus who received prenatal care at a tertiary hospital from September 2019 to October 2022 were enrolled and assigned to experimental and control groups using the random number table method.The control group received standard prenatal education,and the experimental group received multiple shared decision-making interventions in addition to standard prenatal education.The degree of conflict in decision-making for delivery,preference for delivery mode,postpartum decision regret,and the final delivery mode between the two groups were compared,respectively.Results Following the multiple shared deci-sion intervention,decision conflict scores in the experimental group were significantly reduced(P<0.001).In the survey on delivery mode preferences,there was a reduction in the number of individuals in the experimental group expressing"uncertainty",and an increase in those choosing vaginal delivery.Ultimately,in the experimental group,30 women(68.2%)underwent cesarean sections,and 14(31.8%)had vaginal deliveries.The level of post-decision regret in the experimental group was lower than that in the control group(P<0.001).Conclusions Multiple shared decision-making for women pregnant with a scarred uterus could reduce the level of decision-making conflict,increase the willingness for vaginal delivery,and assist them in making rational and scientifically informed decisions regarding childbirth.

The pathogenesis of diabetic cardiomyopathy(DCM)is the imbalance of glucose and lipid metabolism related to diabetes mellitus,that leads to increased oxidative stress and activation of various inflammatory pathways,causing cellular and extracellular damage,pathological cardiac remodeling,and diastolic and systolic dysfunction.Anti fibrotic drugs,anti-inflammatory drugs,and antioxidants are used in clinical treatment of DCM with good therapeutic effects.This article reviews the research progress on the pathogenesis and treatment strategies of DCM.

Objective:To explore the surgical technique and results of three-dimensional aortic valve anatomic repair for bicuspid aortic valve (BAV) with aortic regurgitation (AR).Methods:This is a retrospective case series study. From August 2021 to December 2023, 130 consecutive patients with BAV-AR underwent aortic valve anatomic repair at the Department of Cardiothoracic Surgery, Zhongshan Hospital, Fudan University,and the data were retrospectively analyzed. There were 115 males and 15 females, aged (38.6±11.7) years (range: 15 to 67 years). All patients received modified aortic root reconstruction, to do three-dimensional root remodeling, including the basal ring, sinus of Valsalva and sino-tubular junction simultaneously. Perioperative and follow-up data were collected and analyzed. Comparisons between groups were performed using independent samples t-test, Wilcoxon paired signed-rank test, or χ2 test. Results:No patient transferred to valve replacement during the operation. The cardiopulmonary bypass time ( M(IQR)) was 109(34) minutes (range:67 to 247 minutes), and the aortic cross-clamp time was 76(26) minutes (range: 32 to 158 minutes). Preoperative transesophageal echocardiography showed 123 patients (94.6%) presented with moderate or severe regurgitation. Immediately postoperative transesophageal echocardiography showed no regurgitation in 22 patients (16.9%), trace regurgitation in 81 patients (62.3%) and mild regurgitation in 27 patients (20.8%). Follow up was completed in all patients, with a follow-up of 5.5(9.4) months (range: 0.1 to 27.6 months). No mortality was observed during follow-up. Echocardiography was obtained in 112 patients at the latest follow-up, including no regurgitation in 4 patients (3.6%), trace regurgitation in 58 patients (51.8%), mild regurgitation in 45 patients (40.2%), moderate regurgitation in 4 patients (3.6%), and severe regurgitation in 1 patient (0.9%). Conclusion:For patients with BAV-AR who have good valve quality and no severe aortic sinus dilation, the recent outcomes of three-dimensional anatomical repair technique, focusing on overall remodeling of the aortic root, are satisfactory.

Objective:To explore the effects of canagliflozin on cardiac function and its regulation of ferroptosis in rats with heart failure with preserved ejection fraction (HFpEF).Methods:Thirty-two 7-week-old Dahl salt-sensitive rats were selected and randomly divided into four groups: the control group (fed with low-salt diet), the HFpEF group (fed with high-salt diet), the canagliflozin 20 group (fed with high-salt diet and 20 mg·kg -1·d -1 canagliflozin), and the canagliflozin 30 group (fed with high-salt diet and 30 mg·kg -1·day -1 canagliflozin). Body weight and blood pressure of the rats in each group were monitored. Metabolic cage tests were conducted at the10 th week of the experiment, and echocardiography was performed at the 12 th week, after which the rats were killed. Blood and left ventricular samples were collected. HE staining, Masson staining, Prussian blue iron staining, and reactive oxygen species staining were performed to observe the cardiomyocyte size and shape, degree of interstitial fibrosis, iron staining, reactive oxygen species production under optical microscope. The ultrastructure of cardiomyocytes was observed under electron microscope. Western blotting and real-time fluorescent quantitative reverse transcription polymerase chain reaction (RT-qPCR) were used to detect the expression levels of proteins and mRNA related to ferroptosis in left ventricular myocardial tissue of rats in each group. Results:After 1 week of adaptive feeding, all rats survived. Metabolic cage results showed that compared with control group, rats in the HFpEF group, canagliflozin 20 group and canagliflozin 30 group had more food intake, water intake and urine output, and lower body weight (all P<0.05). These changes were more pronounced in canagliflozin 20 group and canagliflozin 30 group than in HFPEF group, and only the body weight at the 12 th week showed a statistically significant difference between canagliflozin 20 group and canagliflozin 30 group ( P<0.05). The blood pressure of 6 th week and 12 th week, heart weight and left ventricular corrected mass of 12 th week of rats in HFpEF group were higher than those in control group, canagliflozin 20 group and canagliflozin 30 group, while the ratio of early mitral valve peak velocity to late mitral valve peak velocity of 12 th week was lower (all P<0.05). HE and Masson staining showed that compared to control group, the myocardial fibers in the left ventricular myocardial tissue of rats in HFpEF group were disordered, with larger cell diameter ((0.032±0.004) mm vs. (0.023±0.003) mm, P<0.05), irregular shape, obvious proliferation of interstitial collagen fibers, and higher collagen volume fraction (0.168±0.028 vs. 0.118±0.013, P<0.05). Compared with HFpEF group, rats in the canagliflozin 20 group and canagliflozin 30 had more orderly arranged myocardial fibers, more regular cardiomyocyte shape, smaller cell diameter, and lower collagen volume fraction ( P<0.05). It was observed under electron microscopy that, compared to control group, most of the striated muscles in myocardial tissue of HFpEF group were broken, and the Z line and M line could not be clearly distinguished, some changes such as mitochondrial swelling, membrane thickening, cristae reduction or even disappearance occurred. In the canagliflozin 20 group and canagliflozin 30 group, the arrangement of striated muscles in the myocardial tissue of rats tended to be more regular, and the morphological changes of mitochondria were milder. Prussian blue iron staining results showed that the iron content in myocardial tissue of rats in HFpEF group was higher than that in control group, canagliflozin 20 group and canagliflozin 30 group. Reactive oxygen species staining results showed that the reactive oxygen species content in the myocardial tissue of rats in HFpEF group was higher than that of control group, canagliflozin 20 group and canagliflozin 30 group. Biochemical analysis of myocardial tissue showed that Fe 2+ and malondialdehyde content in myocardial tissue of rats in HFpEF group were higher than those in control group, canagliflozin 20 group and canagliflozin 30 group, while glutathione content was lower (all P<0.05). Western blot and RT-qPCR detection results showed that compared to control group, rats in HFpEF group had higher expression levels of transferrin receptor 1 (protein relative expression level: 1.37±0.16 vs. 0.31±0.12), acyl-CoA synthetase long-chain family member 4 (protein relative expression level: 1.31±0.15 vs. 0.63±0.09) protein and mRNA, and lower expression levels of ferritin heavy chain 1 (protein relative expression level: 0.45±0.08 vs. 1.41±0.15) protein and mRNA (all P<0.05). There was no statistically significant difference in these indicators between canagliflozin 20 group and the canagliflozin 30 group (all P>0.05). There was no significant difference in levels of glutathione peroxidase 4 protein and mRNA expression in myocardial tissue of rats in four groups( P>0.05). Conclusion:Canagliflozin improves cardiac function in HFpEF rats by regulating the ferroptosis mechanism.

Objective:To explore the outcomes and problems of the Beijing Nursing Association Emergency Specialist Nurse Training Course, so as to provide reference for improving the training of emergency specialist nurses.Methods:Convenience sampling was used to select 75 trainees from the 2023 Beijing Nursing Association Emergency Specialist Nurse Training Course as survey subjects. Beijing Nursing Association Emergency Specialist Nurse Training Scoring Criteria was used to score trainees from four aspects of theoretical knowledge, skill operation, case analysis, and review defense, and to summarize and analyze the existing problems.Results:A total of 75 questionnaires were distributed, and 75 valid questionnaires were collected, with a valid response rate of 100.0%. The theoretical knowledge score was (68.4±10.7), with a minimum of 38.0 and a maximum of 91.0, and the pass rate (number of passing trainees divided by the total number of trainees) was 81.3%. The score for the review defense was (78.8±5.7), with a minimum of 65.0 and a maximum of 94.0, and a pass rate of 100.0%. The skill operation score was (93.5±3.7), with a minimum of 85.0 and a maximum of 99.0, and a pass rate of 100.0%. The score for the case analysis was (90.2±5.6), with a minimum score of 80.0 and a maximum score of 100.0, and a pass rate of 100.0%. The main reasons for losing points in the theoretical knowledge were mechanical ventilation and cardiopulmonary resuscitation. The main reasons for losing points in the review defense were topic selection and paper writing. The main reasons for losing points in skill operation were preparation before operation and key points after operation. The main reasons for losing points in the case analysis were the consultation ideas and treatment measures.Conclusions:The trainees of the emergency specialist nurse training course currently have a relatively good overall professional practical skills, but there are significant differences in theoretical knowledge, weak scientific research capabilities, and room for improvement in triage decision-making. It is suggested to give full play to the advantages of teachers and set up a variety of Internet courses for trainees to learn on their own to meet the personalized needs of trainees and improve teaching homogeneity.

Objective:To explore the surgical technique and results of three-dimensional aortic valve anatomic repair for bicuspid aortic valve (BAV) with aortic regurgitation (AR).Methods:This is a retrospective case series study. From August 2021 to December 2023, 130 consecutive patients with BAV-AR underwent aortic valve anatomic repair at the Department of Cardiothoracic Surgery, Zhongshan Hospital, Fudan University,and the data were retrospectively analyzed. There were 115 males and 15 females, aged (38.6±11.7) years (range: 15 to 67 years). All patients received modified aortic root reconstruction, to do three-dimensional root remodeling, including the basal ring, sinus of Valsalva and sino-tubular junction simultaneously. Perioperative and follow-up data were collected and analyzed. Comparisons between groups were performed using independent samples t-test, Wilcoxon paired signed-rank test, or χ2 test. Results:No patient transferred to valve replacement during the operation. The cardiopulmonary bypass time ( M(IQR)) was 109(34) minutes (range:67 to 247 minutes), and the aortic cross-clamp time was 76(26) minutes (range: 32 to 158 minutes). Preoperative transesophageal echocardiography showed 123 patients (94.6%) presented with moderate or severe regurgitation. Immediately postoperative transesophageal echocardiography showed no regurgitation in 22 patients (16.9%), trace regurgitation in 81 patients (62.3%) and mild regurgitation in 27 patients (20.8%). Follow up was completed in all patients, with a follow-up of 5.5(9.4) months (range: 0.1 to 27.6 months). No mortality was observed during follow-up. Echocardiography was obtained in 112 patients at the latest follow-up, including no regurgitation in 4 patients (3.6%), trace regurgitation in 58 patients (51.8%), mild regurgitation in 45 patients (40.2%), moderate regurgitation in 4 patients (3.6%), and severe regurgitation in 1 patient (0.9%). Conclusion:For patients with BAV-AR who have good valve quality and no severe aortic sinus dilation, the recent outcomes of three-dimensional anatomical repair technique, focusing on overall remodeling of the aortic root, are satisfactory.

Objective: To explore the differences of sensory manifestations between ASD children and typical development children, and to clarify the characteristics of sensory abnormalities in ASD and their relationship with various clinical symptoms, so as to provide scientific basis for early identification and specific intervention. Methods: A total of 265 ASD children who received rehabilitation training in autism rehabilitation institutions in Heilongjiang Province were collected as the case group, and 223 typical development children in ordinary kindergartens and schools in Harbin were taken as the control group. Short Sensory Profile (SSP) was used to evaluate the difference of children s sensory perception level between the two groups, and Social Response Scale (SRS) and Autism Behavior Checklist (ABC) were used to evaluate the severity of symptoms including social disorder of autistic children. The correlation between SSP scores in ASD group and clinical scales was analyzed. Results: The comparison of SSP scores between the two groups found that the median scores of all sensory dimensions in ASD group (tactile=33, taste/smell=18, motion sensitivity=13, Low response/sensation seeking=28, auditory filtering=19, low strength=22, visual/auditory=20) were lower than those of the healthy control group( Z =-2.73,-4.36,-3.17,-5.09,-11.00,-10.45,-3.43, P <0.05). The abnormal rate of multisensory score in children in ASD group was 55.1%, and that in control group was 21.2%, with significant difference( χ 2=57.15, P <0.05). Correlation analysis showed that SSP score in ASD group was negatively correlated with all dimensions of SRS, nonverbal communication, and social function of ADI-R scale, ADOS communication and social interaction, and total scores of ABC and CARS( P < 0.05 ). Conclusion Children with ASD have atypical sensory experiences, especially in auditory filtering dimension, and the level of atypical sensation is related to the severity of clinical symptoms of autism. In the future clinical diagnosis, treatment and research, it is necessary to strengthen the ability to recognize the sensory symptoms of children with ASD, so as to realize the early diagnosis and intervention.

Objective:To investigate the influence of the teaching model based on the synergy of medical education on the objective structured clinical examination (OSCE) scores and critical thinking ability of interns in emergency department.Methods:A total of 84 students who studied as interns in Emergency Department of our hospital from January 2020 to 2021 were selected as research subjects, and they were divided into observation group and control group using a random number table, with 42 students in each group. The students in the control group were taught using traditional methods, while those in the observation group were taught based on the synergy of medical education. Both groups received an OSCE examination, and the two groups were compared in terms of OSCE score, critical thinking ability, and evaluation of teaching. SPSS 22.0 was used to perform the t-test and the chi-square test. Results:Compared with the control group, the observation group had significantly higher scores of theoretical assessment, disease assessment, first aid measures, special skills, use of medical instruments, communication skills with SP, and medical record writing and a significantly higher total score of OSCE assessment ( P<0.05). After teaching, both groups had a significant increase in the score of critical thinking ability, and the observation group had a significantly higher score than the control group [(306.38±25.76) vs. (280.39±20.17)]. The observation group had a significantly higher degree of satisfaction with teaching than the control group ( P<0.05). Conclusion:The teaching model based on the synergy of medical education can improve the OSCE score of interns in emergency department and cultivate their critical thinking ability, and there is a relatively high degree of satisfaction with this teaching model.

Objective:To investigate effect and mechanism of mangiferin on regulation of M2-type macrophage polarization tar-geting MMP9 in pancreatic cancer.Methods:In vivo,therapeutic effect of mangiferin on pancreatic cancer was evaluated by drawing tumor growth curves and immunohistochemical staining.M2-type macrophages expression in pancreatic cancer was detected by immu-nofluorescence and ELISA.Effects of mangiferin on expression of MMP9 and downstream M2 macrophage polarization-related signaling pathways were detected by immunofluorescence,ELISA,Western blot and qRT-PCR.In vitro,MTT assay was utilized to detect effect of mangiferin on M2-type macrophage and therapeutic effect of mangiferin on pancreatic cancer.ELISA was used to detect effect of mangiferin on M2-type polarized macrophages.Effects of mangiferin on expression of MMP9 and its downstream signalling pathway were detected by immunofluorescence and Western blot.Results:Mangiferin had potential to inhibit growth of pancreatic cancer in mice pancreatic model,and could prevent expression of M2-polarized macrophages in pancreatic cancer in addition.At the same time,mangiferin could inhibit expression of MMP9 and downstream M2 macrophage polarization related signaling pathways in pancreatic cancer.Mangiferin inhibited proliferation of pancreatic cancer cells in a M2 type polarized macrophage-pancreas cancer cell co-culture model,inhibited macrophage M2 polarization,at the same time,expression of MMP9 and downstream M2 macrophage polarization related signaling pathway was inhibited.Conclusion:Mangiferin can inhibit macrophage M2 polarization by inhibiting MMP9 and its downstream signaling pathway,and play a role in pancreatic cancer therapy.