A 90-year-old female patient with novel coronavirus infection, severe pneumonia, and no history of blood transfusion andtransplantation.The mixed appearance phenomenon appeared in the admission blood group identification, and was sent the sample to our laboratory for difficult blood group identification. In the tube saline method, the patient′s red blood cells were positively reacted with 2 monoclonal anti-A and 5 human anti-A reagents.In the microcolumn gel method, the patient′s red blood cells showed 2 positive and 2 negative reactions with monoclonal anti-A and 5 positive and 1 negative reactions with human anti-A. The patient ′s red blood cells showed negative reaction with peanuts in phytohemagglutinin, and positive reaction with double flower lentils, wild soybeans and a string of purples. The patient ′s red blood cells treated with papain showed negative reaction with all monoclonal anti-A reagents, human anti-A and phytohemagglutinin. The patient ′s ABO gene was sequenced as ABO * B.01/O.01.02, but C1GALT1C1 gene mutation was not founded in the gDNA of the whole blood sample.It is speculated that the exposure of Tn antigen on the patient ′s red blood cells leads to red blood cells polyagglutination, resulting in ABO blood group inconsistency.

OBJECTIVE: To investigate a case of antibodies against high-frequency erythrocyte antigens and elucidate the genetic mechanism underlying the blood group. METHODS: A Lan-negative patient referred to the Zhejiang Blood Center by Quzhou Hospital of Traditional Chinese Medicine in August 2016 was selected as the study subject. A retrospective study was conducted to collect the proband's clinical data. The proband's erythrocyte antigens and unexpected serum antibodies were identified using tube saline and microcolumn agglutination anti-human globulin methods. Antibody specificity was determined by treating erythrocytes with 7 enzymes and 2 chemical reducing agents. Genomic DNA was extracted from the proband's blood sample for whole genome sequencing (WGS) and erythrocyte blood group gene analysis, with validation by Sanger sequencing. Multiple bioinformatics tools were used to analyze the pathogenicity of the variant. The rare blood group and unexpected antibody specificity were comprehensively determined based on the results of serological and genetic testing. This study has been approved by the Zhejiang Provincial Blood Center Medical Ethics Committee(Ethics No.20190201). RESULTS: The proband was a 91-year-old Han Chinese male with prostatitis, cystitis, and malnutrition in conjunct with emaciation. He had a history of multiple erythrocyte transfusions without observable adverse reactions. Prior to the most recent transfusion, major crossmatch agglutination was observed, which prompted antibody identification. Antibodies against high-frequency antigens were detected in the proband's serum, with enzyme and reducing agent treatments ruling out antibody specificities associated with 17 blood group systems, e.g., MNS, LU, KEL. WGS analysis identified 4 525 SNPs and 1 046 INDEL variants among erythrocyte blood group genes. Further screening revealed that the proband had a rare blood group due to a homozygous rs755723161 variant. This variant in the ABCB6 gene (c.459delC) has led to a frameshifting mutation (p.Trp154GlyfsTer96), resulting in the Lan-negative rare blood group with a high-frequency antigen deficiency and the production of IgG anti-Lan antibodies in the serum. CONCLUSION This study has identified anti-Lan alloantibodies in a Lan-negative patient and, for the first time, elucidated the ABCB6 gene variant underlying the Lan-negative rare blood group in the Chinese population.
Humans ; Male ; Blood Group Antigens/immunology* ; Aged, 80 and over ; Retrospective Studies ; ATP-Binding Cassette Transporters

Objective:To investigate a case of antibodies against high-frequency erythrocyte antigens and elucidate the genetic mechanism underlying the blood group.Methods:A Lan-negative patient referred to the Zhejiang Blood Center by Quzhou Hospital of Traditional Chinese Medicine in August 2016 was selected as the study subject. A retrospective study was conducted to collect the proband′s clinical data. The proband′s erythrocyte antigens and unexpected serum antibodies were identified using tube saline and microcolumn agglutination anti-human globulin methods. Antibody specificity was determined by treating erythrocytes with 7 enzymes and 2 chemical reducing agents. Genomic DNA was extracted from the proband′s blood sample for whole genome sequencing (WGS) and erythrocyte blood group gene analysis, with validation by Sanger sequencing. Multiple bioinformatics tools were used to analyze the pathogenicity of the variant. The rare blood group and unexpected antibody specificity were comprehensively determined based on the results of serological and genetic testing. This study has been approved by the Zhejiang Provincial Blood Center Medical Ethics Committee(Ethics No.20190201).Results:The proband was a 91-year-old Han Chinese male with prostatitis, cystitis, and malnutrition in conjunct with emaciation. He had a history of multiple erythrocyte transfusions without observable adverse reactions. Prior to the most recent transfusion, major crossmatch agglutination was observed, which prompted antibody identification. Antibodies against high-frequency antigens were detected in the proband′s serum, with enzyme and reducing agent treatments ruling out antibody specificities associated with 17 blood group systems, e. g., MNS, LU, KEL. WGS analysis identified 4 525 SNPs and 1 046 INDEL variants among erythrocyte blood group genes. Further screening revealed that the proband had a rare blood group due to a homozygous rs755723161 variant. This variant in the ABCB6 gene (c.459delC) has led to a frameshifting mutation (p.Trp154GlyfsTer96), resulting in the Lan-negative rare blood group with a high-frequency antigen deficiency and the production of IgG anti-Lan antibodies in the serum. Conclusion:This study has identified anti-Lan alloantibodies in a Lan-negative patient and, for the first time, elucidated the ABCB6 gene variant underlying the Lan-negative rare blood group in the Chinese population.

Objective To investigate the oral health status of second-grade primary school students in Suzhou,provide baseline data for evaluating Suzhou's"Bright Eyes and Healthy Teeth"public health project,and offer reference for formulating oral health policies for students in Suzhou.Methods A multi-stage,stratified,random sampling method was used to select 1 640 second-grade primary school students from 10 districts(county-level cities)across Suzhou.The oral health survey of primary school students in Suzhou was designedbased on WHO"Basic Methods for Oral Health Surveys"(5th edition).A survey on the students' oral health status was con-ducted.Results The caries prevalence,mean DMFT(Decayed,Missing,Filled Teeth),and caries filling rate for primary teeth among second-grade students in Suzhou were 80.73％,4.25,and 24.48％,respectively.For permanent teeth,the caries prevalence,mean DMFT(Decayed,Missing,Filled Teeth),and caries filling rate were 30.30％,0.62,and 16.96％,respectively.Specifically,the caries prevalence,mean DMFT,and filling rate for the first permanent molar were 29.88％,0.59,and 16.94％,respectively.The pit and fissure sealing rate for the first permanent molar was 13.74％.Additionally,the detection rate for gingival bleeding was 58.05％,and for dental calculus,49.15％.Conclusion The oral health status of second-grade primary school students in Suzhou is concerning.The caries prevalence rate for both primary and permanent teeth is high,while the filling rate is relatively low.Prior to the implementation of oral health programs,the pit and fissure sealing rate for the first permanent molars was low,with significant differ-ences observed between urban and rural areas,as well as among different districts(or county-level cities).

Objective To investigate the epidemiological status and molecular characteristics of diarrheagenic Escherichia coli(DEC)infection in Xiangshan County,providing a basis for its infection surveillance and outbreak control.Methods The real-time fluores-cence quantitative PCR(qRT-PCR)was used to detect virulence genes in isolated E.coli strains.The identified DEC strains were per-formed whole genome sequencing(WGS).The sequencing data were utilized for bacterial resistance gene analysis,multilocus sequence typing(MLST),and core genome multilocus sequence typing(cgMLST).Results A total of 29 DEC strains were isolated,with a detection rate of 9.8%.Enteroaggregative E.coli(EAEC)and enterotoxigenic E.coli(ETEC)were the main strains,accounting for 51.7%and 31.1%,respectively,while enteropathogenic E.coli(EPEC)had a relatively low proportion(17.2%).Drug resistance gene analysis showed that these strains were generally resistant to multiple antibiotics such as fluoroquinolones and carbapenems.MLST typing identified 19 sequence types(STs),including one novel ST type(STcpEC1).Among them,ST117,ST2178,ST31,and ST48 were dominant types.ETEC strains were mainly concentrated in the clonal complex CC-10,while the molecular typing of EAEC and EPEC strains was more dispersed.cgMLST analysis further confirmed the genetic characteristics of different DEC strains.Conclusion DEC infections in Xiangshan County are mainly caused by EAEC,ETEC,and EPEC.These strains have abundant resistance genes.Among them,the molecular typing of EAEC and EPEC is relatively dispersed,while ETEC is concentrated in the clonal complex CC-10.

Due to the constraints of the surgical environment and operational space,laparoscopic surgical instruments employ wire-driven mechanisms.However,factors such as wire rigidity,hysteresis,and motor drive limitations result in the end-effector accuracy of surgical instruments failing to meet ideal requirements.To address the shortcomings of existing multi-degree-of-freedom laparoscopic surgical instruments in achieving end-effector precision,a motion compensation algorithm based on the Autogluon algorithm for a 4-degree-freedom laparoscopic surgical instrument is proposed.A single-degree-of-freedom surgical instrument driven by wire ropes was constructed,and machine learning was utilized to estimate the end-effector position.This estimated position served as a feedback compensation condition to control the end-effector of the surgical instrument.To validate the correctness of this method,it was compared with approaches such as neural networks,linear regression,decision trees,Gaussian processes,and support vector machines.The results demonstrated that the proposed method achieved the smallest mean squared error,maximum error,and mean absolute error,thereby verifying its effectiveness.

Objective To explore the relationship between the influencing factors for high risk foot(HDF)and the controlling nutritional status(CONUT)score in patients with type 2 diabetes mellitus(T2DM)at different ages.Methods A total of 1314 patients with T2DM hospitalized in the Department of Endocrinology of our hospital from January 2022 to January 2024 were enrolled.According to age and the international working group on diabetic foot risk classification system,they were divided into the elderly low-risk(ELR)group with age≥65 years old and grade 0(n=294),the elderly high-risk(EHR)group with aged≥65 years and grade 1～3(n=138);non-elderly low-risk(NELR)group with age<65 years and grade 0(n=636),and non-elderly high-risk group(NEHR)with the age<65 years and grade 1～3(n=246).The general data,biochemical indexes and CONUT scores of patients with different ages and different risk levels were compared among the groups.Spearman correlation analysis was used to analyze the correlation between HDF grade and CONUT score in different age groups,and Logistic regression analysis was used to analyze the influencing factors for high-risk foot in T2DM patients of different ages.Results The age,DM duration,smoking,hemoglobin A1c(HbA1c),and CONUT score were higher in the EHR group than in the ELR group(P<0.05),while the hemoglobin and albumin(ALB)were lower in the EHR group than in the ELR group(P<0.05).The DM duration,smoking,FPG and HbA1c were higher in the NEHR group than in the NELR group(P<0.05),while ALB was lower than that in the NELR group(P<0.05).Spearman correlation analysis showed that the risk level of HDF in patients aged≥65 years was positively correlated with the CONUT score(r=0.301,P<0.001),while in patients aged<65 years,the risk level of HDF was not correlated with the CONUT score(r=0.055,P=0.102).Logistic regression analysis showed that age(OR 1.714,95%CI 1.420～2.067),DM duration(OR 1.062,95%CI 1.001～1.126),smoking(OR 3.986,95%CI 1.469～10.814),HbA1c(OR 1.246,95%CI 1.008～1.541),and CONUT score(OR 1.550,95%CI 1.051～2.286)were the influencing factors for the occurrence of HDF in T2DM patients aged≥65 years.DM duration(OR 1.051,95%CI 1.023～1.080),HbA1c(OR 1.141,95%CI 1.052～1.238)and FPG(OR 1.071,95%CI 1.019～1.125)were influencing factors for the occurrence of HDF in T2DM patients aged<65 years.Conclusions DM duration,HbA1c,etc.are the influencing factors for HDF in patients with T2DM,while the CONUT score is the influencing factor for the occurrence of HDF only in T2DM patients aged≥65 years.

Objective:To analyze the influencing factors on the therapeutic effect of glucocorticoid impact in the treatment of active thyroid-related eye diseases.Methods:A total of 106 patients with thyroid-related eye disease admitted to Lishui People's Hospital from December 2020 to January 2024 were retrospectively selected, all of whom were treated with glucocorticoid impact therapy. According to the efficacy, they were divided into poor efficacy group (34 cases) and good efficacy group (72 cases), and relevant clinical data of the two groups were compared. Single factor and multiple factor Logistic regression were used to analyze the risk factors affecting the curative effect.Results:The proportion of smoking history in the poor efficacy group was higher than that in the good efficacy group:73.53% (25/34) vs. 29.17% (21/72), there was statistical difference ( χ2 = 18.50, P<0.01). The thyroid stimulating hormone (TSH) and lymphocyte (LYM) in the poor efficacy group were lower than those in the good efficacy group: (0.08 ± 0.02) mU/L vs. (0.10 ± 0.02) mU/L, 0.175 ± 0.028 vs. 0.192 ± 0.031;the free triiodothyronine (FT 3), free thyroxine (FT 4), tumor necrosis factor - α (TNF- α), interleukin (IL) -6, IL-8, neutrophil-to-lymphocyte ratio (NLR), degree of proptosis, and clinical activity score (CAS) were higher than those in the good efficacy group: (5.28 ± 1.21) pmol/L vs. (4.73 ± 1.03) pmol/L, (15.52 ± 2.35) pmol/L vs. (14.28 ± 2.31) pmol/L, (11.82 ± 2.11) ng/L vs. (10.05 ± 2.04) ng/L, (2.12 ± 0.21) ng/L vs. (1.96 ± 0.18) ng/L, (38.56 ± 4.35) ng/L vs. (35.46 ± 4.21) ng/L, 2.52 ± 0.41 vs. 1.67 ± 0.37, (17.42 ± 2.44) mm vs. (15.32 ± 2.27) mm, (4.34 ± 0.65) scores vs. (3.98 ± 0.63) scores, there were statistical differences ( P<0.05). Multiple Logistic regression analysis showed that smoking history, TSH, FT 3, FT 4, TNF-ɑ, IL-6, IL-8, LYM, NLR, exophthalmia and CAS score were all included in the regression equation, and they were all influential factors affecting the efficacy of glucocorticoid shock therapy for thyroid-related eye diseases ( P<0.05). Conclusions:In active thyroid-related eye disease patients receiving glucocorticoid impact therapy, the efficacy may be affected by many factors, and comprehensive intervention should be implemented according to the actual situation to further improve the efficacy.

Objective To propose an improved scheme based on an adaptive PID control strategy for effectively optimizing the positioning accuracy and reliability of laparoscopic surgical robotic arm during practical operations.Methods The particle swarm optimization algorithm was employed to adjust the proportional(Kp),integral(Ki),and derivative(Kd)parameters of the PID controller in real-time and online.A simulation experimental platform for laparoscopic surgical robotic arm was built based on a multi-degree-of-freedom kinematic model,and verification was conducted through both typical path planning and simulated disturbance tests.High-precision sensors were used to obtain trajectory deviation data,and control experiments were carried out under the traditional PID control mode and the adaptive PID control mode.The root mean square error and response time were compared.Results The average root mean square error of trajectory tracking error and the average response time of the adaptive PID control method were lower or shorter than those of the traditional PID control method(0.853 mm vs 2.665 mm;4.34 s vs 5.64 s).Furthermore,the adaptive PID control effectively suppressed the overshoot and oscillation phenomena commonly seen in traditional PID control,demonstrating more stable and reliable overall performance.Conclusion The proposed scheme addresses the inherent limitations of traditional PID control,improves the operation accuracy and stability of laparoscopic surgical robotic arm in complex dynamic surgical environments,and provides important theoretical foundations and technical support for the design optimization of robot-assisted surgical systems,holding significant clinical application value and social benefits.

Objective To propose an improved scheme based on an adaptive PID control strategy for effectively optimizing the positioning accuracy and reliability of laparoscopic surgical robotic arm during practical operations.Methods The particle swarm optimization algorithm was employed to adjust the proportional(Kp),integral(Ki),and derivative(Kd)parameters of the PID controller in real-time and online.A simulation experimental platform for laparoscopic surgical robotic arm was built based on a multi-degree-of-freedom kinematic model,and verification was conducted through both typical path planning and simulated disturbance tests.High-precision sensors were used to obtain trajectory deviation data,and control experiments were carried out under the traditional PID control mode and the adaptive PID control mode.The root mean square error and response time were compared.Results The average root mean square error of trajectory tracking error and the average response time of the adaptive PID control method were lower or shorter than those of the traditional PID control method(0.853 mm vs 2.665 mm;4.34 s vs 5.64 s).Furthermore,the adaptive PID control effectively suppressed the overshoot and oscillation phenomena commonly seen in traditional PID control,demonstrating more stable and reliable overall performance.Conclusion The proposed scheme addresses the inherent limitations of traditional PID control,improves the operation accuracy and stability of laparoscopic surgical robotic arm in complex dynamic surgical environments,and provides important theoretical foundations and technical support for the design optimization of robot-assisted surgical systems,holding significant clinical application value and social benefits.