Objective: To investigate the genetic basis of RhD-negative phenotype in the blood donor population of Nantong City. Methods: RHD genotyping was performed on 386 randomly selected RhD-negative donor samples (from a total of 676 RhD-negative donors identified between January 20, 2023, and June 28, 2024) using polymerase chain reaction (PCR), and the inconclusive results were confirmed by nucleotide sequencing. Results: Ten RHD allele types were identified: The complete deletion variant RHD 01N.01 was predominant (64.25%, 248/386); followed by RHD 01EL.01 (19.69%, 76/386). RHD 01N.03, RHD 01N.04, RHD 01N.16 and RHD 01EL.32 were frequently observed., RHD 01EL.02, RHD 01EL.08, RHD 01EL.37 and RHD 01N.25 were rare, and two exon deletion variants remained uncharacterized. The phenotypic distribution of RhD-negative blood donors was ccee (55.44%)>Ccee(31.09%)>ccEe(5.96%)>CCee(5.44%)>CcEe(1.81%)>CcEE(0.26%), and the antigen distribution trend was e(99.74%)>c(94.56%)>C(38.60%)>E(8.03%). A correlation was observed between RHD genotypes and RhCE phenotypes. Conclusion: The Nantong blood donor population exhibits unique RHD gene polymorphisms. Integrating RhCE serological phenotyping with RHD genotyping is essential for ensuring transfusion safety.

Objective: To investigate the genetic basis of RhD-negative phenotype in the blood donor population of Nantong City. Methods: RHD genotyping was performed on 386 randomly selected RhD-negative donor samples (from a total of 676 RhD-negative donors identified between January 20, 2023, and June 28, 2024) using polymerase chain reaction (PCR), and the inconclusive results were confirmed by nucleotide sequencing. Results: Ten RHD allele types were identified: The complete deletion variant RHD 01N.01 was predominant (64.25%, 248/386); followed by RHD 01EL.01 (19.69%, 76/386). RHD 01N.03, RHD 01N.04, RHD 01N.16 and RHD 01EL.32 were frequently observed., RHD 01EL.02, RHD 01EL.08, RHD 01EL.37 and RHD 01N.25 were rare, and two exon deletion variants remained uncharacterized. The phenotypic distribution of RhD-negative blood donors was ccee (55.44%)>Ccee(31.09%)>ccEe(5.96%)>CCee(5.44%)>CcEe(1.81%)>CcEE(0.26%), and the antigen distribution trend was e(99.74%)>c(94.56%)>C(38.60%)>E(8.03%). A correlation was observed between RHD genotypes and RhCE phenotypes. Conclusion: The Nantong blood donor population exhibits unique RHD gene polymorphisms. Integrating RhCE serological phenotyping with RHD genotyping is essential for ensuring transfusion safety.

Calcitonin-negative medullary thyroid carcinoma(CNMTC)is a rare subtype of medullary thyroid carcinoma,characterized by normal serum calcitonin levels,which often leads to misdiagnosis or missed diagnosis.The pathogenesis of CNMTC remains unclear and may involve impaired secretion mechanisms or assay-related false negatives.Diagnostic approaches include ultrasound-guided fine needle aspiration cytology,serum CEA and ProGRP measurements,and RET gene testing.Surgical resection remains the mainstay of treatment,while neoadjuvant therapy may be considered in selected cases.This review summarizes recent advances in the understanding,diagnosis,treatment,and prognosis of CNMTC,aiming to provide clinical guidance for better management of this challenging condition.

Objective:To investigate the clinical predictive value of Ki67 proliferation index combined with preoperative serum Ctn for postoperative biochemical cure of medullary thyroid carcinoma (MTC) .Methods:Clinical data were collected from Dec. 2008 to Dec. 2024 from 90 patients with surgically confirmed MTC at China-Japan Union Hospital of Jilin University. The optimal cut-off value for preoperative Ctn prediction of biochemical cure (171.18pg/mL) was determined by the ROC curve; the Ki67 proliferation index cut-off value was adopted from the international MTC grading system standard (5%). Patients were divided into three groups based on the above cutoff values: double-low group (Ki67 <5% and Ctn <171.18pg/mL, n=23), single-high group (Ki67 ≥5% and Ctn <171.18pg/mL or Ki67 <5% and Ctn ≥171.18pg/mL, n=49), and double-high group (Ki67 ≥5% and Ctn ≥171.18pg/mL, n=18). The Kaplan-Meier method (Log-Rank and Trend test) was used to compare the differences in biochemical cure rates between groups, and the Cox proportional risk model was used to analyze the risk factors affecting biochemical cure. Results:The correlation between preoperative Ctn and Ki67 proliferation index was not significant. The three groups differed significantly in gender, tumor distribution, tumor size, vascular invasion, N stage, TNM stage, and biochemical cure ( P<0.05), with the double-high group being significantly associated with larger tumors, later N stage and TNM stage, and lower biochemical cure ( P<0.001). Kaplan-Meier analysis showed that the biochemical cure rate in the double-high, single-high, and double-low groups showed a stepwise improvement.Cox univariate analysis showed that tumor size, N stage, TNM stage, preoperative Ctn, and Ki67 combined with Ctn were risk factors for failure to biochemically cure; multivariate analysis confirmed that the double-high group was an independent risk factor ( P<0.05). In the single-high group, the biochemical cure rate of patients in the low Ki67-high Ctn group was lower than that of the high Ki67-low Ctn group and more malignant. Ki67 had less effect on biochemical cure and disease-free survival at the low Ctn level, and Ki67 was an independent risk factor for failure to biochemically cure at the high Ctn level ( P=0.023) and was significantly associated with disease-free survival ( P=0.004) . Conclusions:Serum Ctn is more sensitive than Ki67 index in predicting biochemical cure after MTC, and the correlation between the two was weak. Ki67 proliferation index alone has limited prognostic value, but combines with preoperative Ctn significantly optimize the prognostic assessment of patients.The role of Ki67 index varied at different Ctn levels.

Objective:To investigate the clinical predictive value of Ki67 proliferation index combined with preoperative serum Ctn for postoperative biochemical cure of medullary thyroid carcinoma (MTC) .Methods:Clinical data were collected from Dec. 2008 to Dec. 2024 from 90 patients with surgically confirmed MTC at China-Japan Union Hospital of Jilin University. The optimal cut-off value for preoperative Ctn prediction of biochemical cure (171.18pg/mL) was determined by the ROC curve; the Ki67 proliferation index cut-off value was adopted from the international MTC grading system standard (5%). Patients were divided into three groups based on the above cutoff values: double-low group (Ki67 <5% and Ctn <171.18pg/mL, n=23), single-high group (Ki67 ≥5% and Ctn <171.18pg/mL or Ki67 <5% and Ctn ≥171.18pg/mL, n=49), and double-high group (Ki67 ≥5% and Ctn ≥171.18pg/mL, n=18). The Kaplan-Meier method (Log-Rank and Trend test) was used to compare the differences in biochemical cure rates between groups, and the Cox proportional risk model was used to analyze the risk factors affecting biochemical cure. Results:The correlation between preoperative Ctn and Ki67 proliferation index was not significant. The three groups differed significantly in gender, tumor distribution, tumor size, vascular invasion, N stage, TNM stage, and biochemical cure ( P<0.05), with the double-high group being significantly associated with larger tumors, later N stage and TNM stage, and lower biochemical cure ( P<0.001). Kaplan-Meier analysis showed that the biochemical cure rate in the double-high, single-high, and double-low groups showed a stepwise improvement.Cox univariate analysis showed that tumor size, N stage, TNM stage, preoperative Ctn, and Ki67 combined with Ctn were risk factors for failure to biochemically cure; multivariate analysis confirmed that the double-high group was an independent risk factor ( P<0.05). In the single-high group, the biochemical cure rate of patients in the low Ki67-high Ctn group was lower than that of the high Ki67-low Ctn group and more malignant. Ki67 had less effect on biochemical cure and disease-free survival at the low Ctn level, and Ki67 was an independent risk factor for failure to biochemically cure at the high Ctn level ( P=0.023) and was significantly associated with disease-free survival ( P=0.004) . Conclusions:Serum Ctn is more sensitive than Ki67 index in predicting biochemical cure after MTC, and the correlation between the two was weak. Ki67 proliferation index alone has limited prognostic value, but combines with preoperative Ctn significantly optimize the prognostic assessment of patients.The role of Ki67 index varied at different Ctn levels.

Calcitonin-negative medullary thyroid carcinoma(CNMTC)is a rare subtype of medullary thyroid carcinoma,characterized by normal serum calcitonin levels,which often leads to misdiagnosis or missed diagnosis.The pathogenesis of CNMTC remains unclear and may involve impaired secretion mechanisms or assay-related false negatives.Diagnostic approaches include ultrasound-guided fine needle aspiration cytology,serum CEA and ProGRP measurements,and RET gene testing.Surgical resection remains the mainstay of treatment,while neoadjuvant therapy may be considered in selected cases.This review summarizes recent advances in the understanding,diagnosis,treatment,and prognosis of CNMTC,aiming to provide clinical guidance for better management of this challenging condition.

Objective To investigate the relationship between abnormal expression of serum endog-enous Apelin precursor peptide,Apela and sST2 and renal failure in elderly patients with CHF,and explore the predictive value of the two marker in predicting renal function deterioration.Methods A total of 210 elderly CHF patients admitted to our department from April 2022 to April 2024 were recruited,and divided into renal failure group(71 cases)and non-renal failure group(139 cases)according to having renal failure or not.Another 100 volunteers who taking out-patient health examination in our hospital during the same period were enrolled as the healthy control group.The expression levels of sST2 and endogenous Apela in the peripheral blood sam-ples of all subjects were detected by immunofluorescence assay and ELISA.The renal function indicators were measured with automatic biochemical analyzer.Pearson correlation analysis was used to analyze the correlation between endogenous Apela and sST2 expression and renal func-tion.ROC curves were plotted to evaluate the predictive value and AUC value of endogenous Apela and sST2 for renal failure in elderly CHF patients.Results The renal failure group had sig-nificantly higher expression levels of endogenous Apela and sST2,and elevated levels of 24-hour urine protein,creatinine and blood urea nitrogen than the non-renal failure group and healthy con-trol group(P＜0.05),and the expression levels of endogenous Apela and sST2 in peripheral blood samples were obviously higher in the non-renal failure group than the healthy control group(P＜0.05).Pearson correlation analysis showed that the expression levels of endogenous Apela and sST2 in the peripheral blood of elderly patients with CHF and renal failure was positively correla-ted with 24-hour urine protein,creatinine and blood urea nitrogen(r=0.346,r=0.752,r=0.565,P＜0.01;r=0.357,r=0.687,r=0.501,P＜0.01).The AUC value of sST2 in diagnosing renal failure in elderly CHF patients was 0.765(95％CI:0.658-0.874),with a sensitivity of 76.1％and a specificity of 79.9％,and the AUC value of endogenous Apela was 0.686(95％CI:0.563-0.809),with a sensitivity of 64.8％and a specificity of 68.3％.When the two markers combined together,the AUC value was 0.818(95％CI:0.712-0.919),the sensitivity was 88.7％,and the specificity was 69.1％.Conclusion High expression of endogenous Apela and sST2 in peripheral blood is closely associated with renal failure in elderly CHF patients,and the two markers have important value in predicting the severity of renal failure in elderly CHF patients.

Objective To investigate the relationship between abnormal expression of serum endog-enous Apelin precursor peptide,Apela and sST2 and renal failure in elderly patients with CHF,and explore the predictive value of the two marker in predicting renal function deterioration.Methods A total of 210 elderly CHF patients admitted to our department from April 2022 to April 2024 were recruited,and divided into renal failure group(71 cases)and non-renal failure group(139 cases)according to having renal failure or not.Another 100 volunteers who taking out-patient health examination in our hospital during the same period were enrolled as the healthy control group.The expression levels of sST2 and endogenous Apela in the peripheral blood sam-ples of all subjects were detected by immunofluorescence assay and ELISA.The renal function indicators were measured with automatic biochemical analyzer.Pearson correlation analysis was used to analyze the correlation between endogenous Apela and sST2 expression and renal func-tion.ROC curves were plotted to evaluate the predictive value and AUC value of endogenous Apela and sST2 for renal failure in elderly CHF patients.Results The renal failure group had sig-nificantly higher expression levels of endogenous Apela and sST2,and elevated levels of 24-hour urine protein,creatinine and blood urea nitrogen than the non-renal failure group and healthy con-trol group(P＜0.05),and the expression levels of endogenous Apela and sST2 in peripheral blood samples were obviously higher in the non-renal failure group than the healthy control group(P＜0.05).Pearson correlation analysis showed that the expression levels of endogenous Apela and sST2 in the peripheral blood of elderly patients with CHF and renal failure was positively correla-ted with 24-hour urine protein,creatinine and blood urea nitrogen(r=0.346,r=0.752,r=0.565,P＜0.01;r=0.357,r=0.687,r=0.501,P＜0.01).The AUC value of sST2 in diagnosing renal failure in elderly CHF patients was 0.765(95％CI:0.658-0.874),with a sensitivity of 76.1％and a specificity of 79.9％,and the AUC value of endogenous Apela was 0.686(95％CI:0.563-0.809),with a sensitivity of 64.8％and a specificity of 68.3％.When the two markers combined together,the AUC value was 0.818(95％CI:0.712-0.919),the sensitivity was 88.7％,and the specificity was 69.1％.Conclusion High expression of endogenous Apela and sST2 in peripheral blood is closely associated with renal failure in elderly CHF patients,and the two markers have important value in predicting the severity of renal failure in elderly CHF patients.

Objective:To explore the application and clinical significance of Automatic Functional Imaging (AFI) technology in evaluating left ventricular and left atrial damage in patients with alcoholic cardiomyopathy.Methods:A total of 120 patients with alcoholic cardiomyopathy who visited the Affiliated Hospital of Jining Medical University from April 2021 to March 2023 were selected, including 40 patients with mild, moderate, and severe alcohol consumption each. At the same time, 40 healthy volunteers who did not drink alcohol were selected as controls. All subjects underwent ultrasound examination, and the differences in two-dimensional ultrasound and AFI parameters among the groups were analyzed. Pearson correlation analysis was used to evaluate the correlation between AFI parameters and two-dimensional ultrasound parameters. The diagnostic value of global long axis peak systolic strain (GLPS) of the left ventricle in alcoholic cardiomyopathy was analyzed using receiver operating characteristic (ROC) curves.Results:The left ventricular end diastolic diameter (LVDd), left ventricular end systolic diameter (LVDS), end diastolic interventricular septal thickness (IVSTd), end diastolic left ventricular posterior wall thickness (PWTd), left atrial minimum volume (LAVmin), left atrial maximum volume (LAVmax), and left atrial active pre systolic volume (LAVp) in the severe group were significantly larger than those in the control group, mild group, and moderate group (all P<0.05), while the left ventricular ejection fraction (LVEF) and the ratio of E peak velocity to A peak velocity (E/A) were significantly smaller than those in the control group, mild group, and moderate group (all P<0.05); The left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular mass index (LVMI), LAVmin, LAVmax, and LAVp in the moderate and severe groups were significantly higher than those in the control and mild groups (all P<0.05); There was no statistically significant difference in LVDd, LVDS, IVSTd, PWTd, and LVEF among the control group, mild group, and moderate group (all P>0.05). The GLPS levels in the mild, moderate, and severe groups were significantly higher than those in the control group (all P<0.05), with the severe group having significantly higher GLPS levels than the mild and moderate groups ( P<0.05); There was no statistically significant difference in peak strain dispersion (PSD) among the control group, mild group, moderate group, and severe group (all P>0.05). GLPS was negatively correlated with LVEF ( r=-0.441, P<0.05), while GLPS was positively correlated with LVMI ( r=0.504, P<0.05). The area under the ROC curve for diagnosing alcoholic cardiomyopathy with GLPS was 0.912 (95% CI: 0.869-0.955, P<0.05), with a cutoff value of -20.16, sensitivity and specificity of 76.70% and 95.00%, respectively. Conclusions:The mechanical properties of the left ventricle and left atrium in patients with alcoholic cardiomyopathy are significantly altered, and AFI parameters have certain application value in the diagnosis of alcoholic cardiomyopathy.

Objective To explore the value of MRI classification of extraprostatic extension(EPE)of prostate cancer(PCa)for predicting positive surgical margin after laparoscopic radical prostatectomy(LRP).Methods Prostate MRI data of 114 PCa patients with stage T3a who underwent LRP were retrospectively analyzed.The patients were divided into type Ⅰ(n=14),Ⅱ(n=50)and Ⅲ group(n=50)according to EPE location,also into positive margin group(n=58)and negative margin group(n=56)according to postoperative pathology.Then clinical,imaging,surgical and pathological data were compared among type Ⅰ—Ⅲ groups and between positive and negative margin groups.The indicators being significantly different between positive and negative margin groups were included in multivariate logistic regression analysis to screen the independent impact factors of positive margin of stage T3a PCa after LRP.Results Significant differences of patients'age,prostate-specific antigen(PSA),tumor location and positive surgical margin rate were found among type Ⅰ—Ⅲ groups(all P＜0.05).Positive surgical margin rate in type Ⅲ group was 68.00%(34/50),higher than that in type Ⅰ(14.29%[2/14])and Ⅱ group(44.00%[22/50])(both P＜0.05).Meanwhile,significant differences of PSA,the proportion of positive puncture needles and EPE MRI classification of PCa were found between positive and negative margin groups(all P＜0.05),among which the proportion of positive puncture needles and EPE MRI classification of PCa were both independent impact factors of positive margin of stage T3a PCa after LRP(both P＜0.05).Conclusion MRI classification of PCa-EPE could be used to predict positive surgical margin after LRP.Positive surgical margin after LRP tended to occur in PCa with MRI type Ⅲ EPE.