Objective: To establish a method for the genotyping of fetal M blood group antigen by extracting cell-free fetal DNA (cff-DNA) from maternal plasma, so as to guide the management of M antigen-negative pregnant women with IgG anti-M antibody during pregnancy. Methods: A realtime fluorescent quantitative PCR (realtime PCR) method was established. The specificity and sensitivity of the method were validated by dilution of genomic DNA. Subsequently, a total of 12 M antigen-negative pregnant women were enrolled. The cff-DNA was extracted from maternal plasma, and fetal M antigen genotyping was performed by realtime PCR. Fetuses were classified as M-positive or M-negative according to the presence or absence of amplification curve. The accuracy of the method was validated by comparing fetal M antigen genotyping results with the serological results using the cord or peripheral blood of the neonate at birth. Results: Among the 12 M antigen-negative pregnant women, anti-M was detected in five cases, of which four cases had IgG anti-M, and one case had fetal anemia. The results of fetal M antigen genotyping showed that 9 cases were M-positive (9/12, 75%) and 3 cases were M-negative (3/12, 25%). Serological results of blood samples collected after birth from four M-positive fetuses and one M-negative fetus were consistent with the genotyping results. Conclusion: We have, for the first time, established a non-invasive prenatal genotyping method for fetal M antigen using maternal plasma cff-DNA, and preliminarily demonstrated the feasibility of this method.

Objective: To conduct screening for rare blood types within important blood group systems for the Chinese population, such as Rh, Duffy, Kidd, P1Pk, Diego, and MNS, in the Guangzhou region, and to establish a corresponding rare blood type database and physical repository. Methods: The saline medium microplate method was used to screen blood donors with the ccDEE phenotype combined with either Jk(a-) or Jk(b-). The polybrene microplate method was employed to screen for donors with Fy(a-), s(-), Lu(b-), Di(b-), k(-), and p phenotypes. The urea lysis microplate method was applied to screen for the Jk(a-b-) phenotype. A high-resolution melting (HRM) curve method was established for screening some donors with the Di(b-) phenotype. Subsequently, expanded phenotyping of antigens in the Rh, Kidd, MNS, Duffy, P1Pk, Lewis, Kell, and Lutheran blood group systems was performed on identified rare blood type donors using monoclonal antibodies. The test results are entered into the Rare Blood Type Bank Management System of the Guangzhou Blood Center, enabling functions such as confirmation reminders and cryopreservation storage when the donor donates again. Red blood cells of rare blood types are processed into frozen red blood cells for long-term storage. Results: Among voluntary blood donors, 16 cases of the ccDEE combined with Jk(a-) phenotype were identified (0.221 7%, 16/7 216); 10 cases of the ccDEE combined with Jk(b-) phenotype (0.138 6%, 10/7 216); 78 cases of the Fy(a-) phenotype (0.169 5%, 78/46 012); 39 cases of the Lu(b-) phenotype (0.138 2%, 39/28 214); 31 cases of the s(-) phenotype (0.081 8%, 31/37 913); 22 cases of the Di(b-) phenotype (0.029 9%, 22/73 691); 30 cases of the Jk(a-b-) phenotype (0.010 1%, 30/298 250); and 1 case of the k(-) phenotype (0.001 3%, 1/77 382), which was further identified as KELnull phenotype (K0). No p phenotype donors were identified (0/88 528). A total of 228 units of frozen red blood cells were prepared. The screening results were compared and analyzed with rare blood type data from other regions. Conclusion: This study, through a combination of different screening methods, significantly improved the efficiency of rare blood type screening while remaining cost-effective. By conducting large-scale screening and performing data informatization processing, a database and physical repository of rare blood types in the Guangzhou region were successfully established. This provides a strong guarantee for the timely supply of blood to patients with difficult-to-match and rare blood types in the region, effectively enhances the level of transfusion safety in the region, and offers a practical paradigm for constructing a comprehensive blood transfusion support system.

Objective To investigate the value of combined prediction of serum 25-hydroxyvita-min D[25-(OH)-D],homocysteine(Hey)and brain natriuretic peptide(BNP)for pregnancy out-comes in patients with hypertensive disorders of pregnancy(HDP).Methods A total of 200 patients with HDP were selected as research subjects and divided into gestational hypertension(GH)group(n=84),mild preeclampsia(PE)group(n=67)and severe PE group(n=49)according to the severity of the disease.Additionally,50 healthy pregnant women were selected as control group.The serum levels of 25-(OH)-D,Hey and BNP were compared among the groups,and their relationships with the severity of HDP were analyzed.According to the pregnancy outcomes of HDP patients,they were divided into poor pregnancy outcome group(n=82)and good pregnancy outcome group(n=118).The serum levels of 25-(OH)-D,Hey and BNP were compared between the poor and good pregnancy outcome groups.Logistic regression analysis was used to screen for the influencing factors of poor pregnancy outcomes in HDP patients.Results Compared with the control group,the severe PE group had the lowest serum 25-(OH)-D level,followed by the mild PE group and the GH group,with statistically significant differences(P＜0.001).Compared with the control group,the severe PE group had the highest serum Hcy and BNP levels,followed by the mild PE group and the GH group,with statistically significant differences(P＜0.001).Serum 25-(OH)-D was negatively cor-related with the severity of HDP in patients(r=-0.427,P＜0.001),while serum Hey and BNP were positively correlated with the severity of HDP in patients(r=0.585 and 0.682;P＜0.001).The serum 25-(OH)-D level in the poor pregnancy outcome group was significantly lower than that in the good pregnancy outcome group,while the serum Hcy and BNP levels were significantly higher than those in the good pregnancy outcome group(P＜0.05).Logistic regression analysis results showed that elevated serum Hey and BNP levels,severe PE and elevated systolic blood pressure were independent risk factors for poor pregnancy outcomes in HDP patients,while high 25-(OH)-D level was a protective factor(P＜0.05).The area under the curve(AUC)of the prediction model constructed based on the Logistic regression analysis results was 0.911(95％CI,0.863 to 0.947),with asensitivity of 91.46％and specificity of 75.42％.Conclusion As the severity of HDP in pa-tients increases,their serum 25-(OH)-D level decreases,while serum Hey and BNP levels in-crease.The combined prediction of serum 25-(OH)-D,Hey and BNP has a high value for predic-ting poor pregnancy outcomes in HDP patients.

Objective:To investigate the effect and safety of etonogestrel implant and levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of adenomyosis.Methods:Eighty patients with adenomyosis in Northwest Women's and Children's Hospital were selected from September 2021 to September 2023. According to the random number table method, they were divided into observation group and control group, with 45 cases in each group. The patients in observation group were treated with etonogestrel implant, while the patients in control group were given LNG-IUS. The uterine conditions, visual analogue scale (VAS) score, menstrual pattern, sex hormones [estradiol, luteinizing hormone (LH) and follicle stimulating hormone (FSH)] and laboratory indicators [hemoglobin, serum ferritin (SF) and carbohydrate antigen 125] before treatment and after 12 months of treatment and incidence of adverse reactions were compared between the two groups of patients. Measurement data were expressed as xˉ±s. Repeated measures analysis of variance was used for comparison between the two groups at multiple time points. LSD-t test was used for pairwise comparison. Two independent sample t test was used for comparison between the two groups. Paired t test was used for comparison before and after treatment. Enumeration data were expressed as n (%), and χ2 test was used for comparison between groups. Results:After 12 months of treatment, the uterine volume and endometrial thickness in observation group and control group were reduced compared to before treatment [observation group: (122.72±13.52) cm 3 vs. (202.72±20.75) cm 3, (6.83±1.35) mm vs. (9.84±1.76) mm, t=21.67,9.10, respectively, both P<0.001; control group: (134.82±17.64) cm 3 vs. (203.46±20.03) cm 3, (7.52±1.52) mm vs. (9.79±1.82) mm, t=17.25,6.42, respectively, both P<0.001], and the indicators in observation group were lower than those in control group ( t=3.65, 2.28, P<0.001, P=0.025, respectively). The levels of estradiol, LH and FSH were lower than those before treatment[observation group: (1.40±0.30) nmol/L vs. (2.42±0.41) nmol/L, (10.12±1.14) U/L vs. (12.84±2.63) U/L, (5.32±0.87) U/L vs. (9.34±1.35) U/L, t=13.47,6.36,10.03, respectively, all P<0.001; control group: (1.68±0.33) nmol/L vs. (2.40±0.48) nmol/L, (11.41±1.53) U/L vs. (12.96±2.25) U/L, (7.03±1.04) U/L vs. (9.53±1.31) U/L, t=8.29,3.82,16.79, respectively, all P<0.001], and the observation group had lower levels than the control group( t=4.21,4.54,8.46, respectively, all P<0.001). Hemoglobin and SF levels were higher than those before treatment, and the levels in observation group were higher than those in control group [observation group: (116.46±3.07) mg/L vs. (109.46±3.64) mg/L, (117.33±16.46) μg/L vs. (53.82±7.52) μg/L, t=9.86,18.95, respectively, both P<0.001; control group: (114.63±3.48) mg/L vs. (110.63±3.48) mg/L, (95.34±12.63) μg/L vs. (52.58±8.21) μg/L, t=5.45,23.61, respectively, both P<0.001], and the levels in observation group were higher than those in control group( t=2.64,7.11, P=0.010, P<0.001, respectively). The level of carbohydrate antigen 125 was lower than that before treatment, [observation group:(40.31±3.10) kU/L vs.(68.31±4.75) kU/L, t=33.12, P<0.001;control group:(57.45±4.27) kU/L vs.(67.64±4.83) kU/L, t=10.60, P<0.001], and the level in observation group was lower than that in control group ( t=21.79, P<0.001). At 3, 6 and 12 months after treatment, the VAS score in both group decreased gradually, and the scores in observation group were lower than those in control group [(4.35±0.88) points vs. (4.71±0.75) points, (3.21±0.73) points vs. (3.63±0.82) points, (2.64±0.51) points vs. (3.16±0.64) points, all P<0.05]. Before treatment, there was no statistically significant difference in menstrual patterns between the two groups of patients ( P>0.05). After 12 months of treatment, the proportion of normal menstrual patterns in the implant group was higher than that in the sustained-release group [68.9% (31/45) vs. 46.7% (21/45), χ2=4.56, P=0.033], while the proportion of frequent bleeding was lower than that in the sustained-release group [6.7% (3/45) vs. 22.2% (10/45), χ2=4.41, P=0.036]. There was no statistical significant difference in the incidence of adverse reactions between the two groups during treatment [8.9% (4/45) vs. 11.1% (5/45), χ2=0.00, P=1.000]. Conclusion:Compared with LNG-IUS, etonogestrel can more effectively improve the uterine conditions, relieve the dysmenorrhea symptoms, and improve the blood related indicators, and with high safety.

Medical ultrasound technology is widely used for diagnosis and therapy in clinical practice.Ultrasound probes,which are directly contact with patients,pose a potential risk of pathogen transmission.This expert consen-sus was developed by a multidisciplinary team based on international guidelines,standards in China,and the results of a national survey,aiming to reduce the risk of healthcare-associated infection through standardizing reprocessing of medical ultrasound probes,and formulating consensus recommendations with the Delphi method.The consensus clarifies the reprocessing principles for three types of ultrasound probes of different infection risks:external-use ul-trasound probes,interventional percutaneous ultrasound probes,and internal-use ultrasound probes,puts forward systematic suggestions on the reprocessing standards and disinfection levels of ultrasound probe isolation covers and coupling agents,the reprocessing procedures and methods of ultrasound probes,as well as architectural layout and management of reprocessing,so as to provide a scientific prevention and control framework for ensuring ultrasound diagnosis and therapy safety.

Objective:To evaluate whether there is a difference between the lesion volumes detected by 18F-FDG PET/CT imaging and 11C-choline PET/CT imaging based on different threshold delineation methods in patients with nasopharyngeal carcinoma, and to recommend a more clinically appropriate threshold method with reference to lesion volume detected by enhanced MRI. Methods:A retrospective study was conducted on 37 patients(27 males, 10 females, age (51.2±11.9) years) with nasopharyngeal carcinoma diagnosed in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between October 2015 and May 2017. All patients underwent nasopharyngeal enhanced MRI, 18F-FDG PET/CT and 11C-choline PET/CT scans. Advantage Workstation 4.6 software was used to fuse images of the 3 imaging examinations. The lesion contour was sketched manually based on enhanced MRI sequences to obtain VMRI, and the lesion was sketched in PET images to obtain the corresponding metabolic tumor volume (MTV) by absolute threshold method, relative threshold method and background threshold method respectively. The correlation between ROIs sketched by different threshold methods and ROI in MRI was evaluated by using the Dice similarity coefficient (DSC). Friedman test or repeated measures analysis of variance (corrected by Greenhouse-Geisser) was employed to analyze the differences of MTV or DSC obtained by using 3 threshold methods. Wilcoxon signed-rank test or paired t-test was used to compare the data of different imaging methods. Results:In 18F-FDG PET/CT results, MTVs obtained by using the absolute threshold method, relative threshold method, and background threshold method were 13.21(5.47, 23.16), 10.13(5.67, 16.81), and 13.68(5.77, 25.52)mm 3, respectively, with significant differences ( χ2=17.89, P<0.001). The corresponding DSC differences for the 3 methods were also significant (0.43±0.19, 0.38±0.17 and 0.44±0.17; F=16.35, P<0.001). In 11C-choline PET/CT results, MTV differences based on the 3 threshold methods were significantly different (14.96(6.80, 32.27), 16.28(12.23, 32.47) and 18.97(14.38, 37.02)mm 3;χ2=10.45, P=0.005), and the DSC differences were also significant (0.52±0.21, 0.58±0.13 and 0.62±0.13; F=16.37, P<0.001). The differences in MTV and DSC between FDG and choline groups were also significant ( Z=-3.87, t=-5.57, both P<0.001). The differences between MTVs of 18F-FDG imaging/ 11C-choline imaging and VMRI (24.35(14.48, 36.89)mm 3) were all significantly different ( Z values: from -5.03 to -2.59, all P<0.05). Conclusions:Compared with 18F-FDG PET/CT, the preoperative 11C-choline PET/CT imaging in patients with nasopharyngeal carcinoma is closer to enhanced MRI (gold standard) in the lesion delineation. Compared with ROIs of the other 2 threshold delineation methods, the ROI obtained by the background threshold method is closer to that in enhanced MRI.

Purpose To explore the clinical manifestations,imaging features,and histopathological characteristics of intravascular large B-cell lymphoma(IVL-BCL)involving the central nervous system(CNS).Methods Clinical and imaging data from 5 cases of IVL-BCL were collected.Immunohistochemical staining and FISH were performed to analyze their clinicopathological characteristics,with a comprehensive review of relevant literatures.Results All 5 pa-tients were elderly,with a male-to-female ratio of 4∶1,and an age of onset ranging from 53 to 67 years.The disease course varied from 4 months to 2 years.All patients had varying degrees of neurological damage symptoms.In this study,4 patients experienced varying degrees of weakness in the lower limbs.MRI findings were nonspecific,but all 5 patients showed evidence of cerebrovascular lesions.Histologically,the lesions were characterized by aggregates of lymphoid tumor cells within the lumens of small cerebral vessels,which could obstruct the lumens and cause ischemic and hypoxic changes.Tumor cells did not involve the extravascular brain parenchyma.Immunohistochemically,tumor cells widely expressed mature B-cell markers(CD19,CD20,CD79a,PAX5)with a high Ki67 proliferation index.All 5 patients received systemic chemotherapy after diagnosis,1 patient died,2 patients achieved clinical and physical symptom relief and were still under follow-up.2 patients were undergoing systemic examination before chemotherapy.Conclusion Intravascular large B-cell lymphoma involving the central nervous system is rare,and both clinical mani-festations and imaging examinations lack specific indicators.Preoperative diagnosis is very difficult and can only rely on diagnostic brain biopsy or pathological diagnosis after craniotomy.

Objective:To investigate the clinical characteristics and prognosis of T-lymphoblastic lymphoma (T-LBL).Methods:A retrospective case series study was conducted. Clinical data of patients diagnosed with T-LBL at the Affiliated Hospital of Jining Medical University from January 2013 to March 2023 were retrospectively analyzed, and their clinical characteristics and prognosis were statistically analyzed.Results:A total of 22 T-LBL patients were included. Among them, there were 19 males (86.4%) and 3 females (13.6%), and the median age at onset was 19.5 (15, 28) years old. Based on Ann Arbor staging, 3 cases (13.6%) were classified as stage Ⅰ-Ⅱ, while 19 cases (86.4%) were stage Ⅲ-Ⅳ; 10 cases (45.5%) presented with B symptoms, 12 cases (54.5%) without B symptoms; 16 cases (72.7%) showed elevated lactic dehydrogenase (LDH) level. At onset, 7 patients (31.8%) had mediastinal masses, 3 patients (13.6%) had central nervous system involvement, and 17 patients (77.3%) had bone marrow involvement. The overall response rate (ORR) and complete remission rate among the 22 patients were 81.82% (18/22) and 31.82% (7/22), respectively. The ORR was 84.21% (16/19) in 19 patients treated with ALL-like regimens. Among 3 patients treated with NHL-like regimens, 1 case achieved complete remission and 1 case achieved partial remission. Seven patients received allogeneic hematopoietic stem cell transplantation, with a median overall survival (OS) time of 22 months; the median OS time of patients without allogeneic hematopoietic stem cell transplantation was 14 months. The 3-year OS rates in the allogeneic hematopoietic stem cell transplantation group and group without allogeneic hematopoietic stem cell transplantation were 64.30% and 16.00%, and the difference in OS between the two groups was statistically significant ( P = 0.043). Two patients with disease progression prior to transplantation died of multidrug-resistant bacterial infections after transplantation. Conclusions:T-LBL is rare, and it is a highly aggressive tumor that predominantly occurs in adolescent males. Allogeneic hematopoietic stem cell transplantation can prolong OS, reduce relapse and improve the prognosis of patients.

Objective To investigate the effect of field angle on the results of in vivo dose validation of electronic portal imaging device(EPID)in patients.Methods Design the mold test and analyze the influence of different mold thicknesses and different frame angles on the 2D γ pass rate.Twenty-three patients who un-derwent radiotherapy in the Department of Radiotherapy of Jinhua Municipal Central Hospital from January to June 2023 were selected as the research object.In vivo dose verification was carried out during treatment to obtain 2D γ pass rate using same-day sector beam CT(FBCT)of planned CT and executive image guided(IG-RT)as reference images,and the influence of field angle on pass rate was analyzed.Results When the frame angle was unchanged,the area of the shooting field was larger than 17 cm×17 cm,and the 2D γ passing rate decreased with the increase of the thickness.The frame angle had no effect on the 2D γ pass rate when the mold thickness was constant.In clinical treatment data,the passage rate of 2D γ near 0°/180° was higher than that near 90°/270°(P＜0.05),and the passage rate near 90°/270° in the FBCT group was higher than that in the IGRT group(P＜0.05).The median passing rate of 3 mm 2D γ was 97.97％in 3％of the 23 patients.The non-IGRT group was 96.81％,the IGRT group was 97.89％,the FBCT group was 98.94％.There was a statistically significant difference in 2D γ passing rate between the non-IGRT group and the IGRT group(Z=-5.083,P＜0.05),and there was a statistically significant difference in 2D γ passing rate between the IGRT group and the FBCT group(Z=-10.657,P＜0.05).Conclusion Clinically,the difference of pass rate in vi-vo dose verification at different rack angles is mainly due to the difference of images within and between ses-sions.Using same-day FBCT as the reference image for in-vivo dose verification can improve the accuracy of pass rate and eliminate the influence of image difference between sessions.

Objective: To understand the moderating effect of cohabitation with parents on the association between peer dating behavior and sexual behaviors among secondary vocational school students, so as to provide a scientific basis for preventing sexual behaviors among secondary vocational school students. Methods: From March to April 2021, an electronic questionnaire survey was conducted among 3 180 students from 6 vocational schools in Shanghai (urban, suburban, exurban) and Shaanxi (Shangluo, Ankang, Baoji) using cluster sampling. Spearman correlation analysis was used to investigate the relationship of cohabitation with parents, peer dating behavior and sexual behaviors among secondary vocational school students. Binary Logistic regression analysis was performed to investigate the role of cohabitation with parents on peer dating behavior and sexual behaviors among secondary vocational students. Results: There was a significant negative between cohabitation with parents and sexual ( r =-0.04); and there was a positive correlation between peer dating behavior and sexual behaviors ( r =0.24), as well as cohabitation with parents and peer dating behavior ( r =0.04)( P <0.05). Multivariable Logistic regression analysis showed an association between peer dating behavior and the occurrence of sexual behaviors ( OR=2.79-12.95, P <0.05). Cohabitation with parents played a moderating role in the association between peer dating behavior and sexual behaviors, and a signification interaction was found between cohabitation with parents and reporting that a small part or about half of their peers had dating behavior ( OR =0.48, P <0.05). Conclusions The more peers dating behavior are associated with a higher risk of sexual behaviors among secondary vocational school students, and cohabitation with parents can partly reduce this risk. School and family sexuality education for secondary vocational students should be strengthened to improve their interpersonal skills and decision-making, and ability to resist peer pressure, so as to reduce their risk of sexual behaviors.