Objective: To report the antibody identification, blood management during pregnancy and the monitoring process of fetal hemolytic disease of fetus and newborn (HDFN) in a pregnant woman with a history of blood transfusion and pregnancy who developed anti-Jr . Methods: Saline tube technique and anti-human globulin technique were used for maternal blood typing, unexpected antibody screening and identification, as well as for determining antibody titer and IgG subclasses. PCR-SSP was employed for genotyping of 18 blood group systems. Next-generation sequencing (NGS) was utilized for gene sequencing of 38 blood group systems. Sanger sequencing was applied to verify rare blood group mutations detected by NGS and to investigate the corresponding rare blood group genes in family members. Blood preparation was achieved through anemia management in prenatal clinics and autologous blood collection during pregnancy. The newborn underwent the three primary tests for HDFN and plasma IgG subclass testing. Results: The pregnant woman's blood type was B, RhD positive, with a positive unexpected antibody screen, and the antibody identification pattern was consistent with a high-frequency antigen antibody. Gene sequencing revealed a homozygous ABCG2 c.376C>T mutation in the woman, resulting in the Jr(a-) phenotype, and anti-Jr antibody was present in her plasma. No compatible Jr(a-) blood was found among family members. The maternal anti-Jr IgG titer remained stable at 256 during pregnancy, with no detectable IgG1 or IgG3 subclasses against the Jr antigen. A total of 800 mL of autologous blood was collected in two stages during pregnancy. The newborn was B, RhD positive, Jr(a+), with a positive unexpected antibody screen (anti-Jr ). IgG subclass typing detected no IgG1 or IgG3. The direct antiglobulin test was positive, while the acid elution test was negative. Conclusion: The combination of serology and blood group genetic analysis provides a diagnostic basis for identifying antibodies to high-frequency antigens. Managing perinatal anemia and implementing staged autologous blood storage can secure blood supply for the perioperative period. IgG antibody subclass typing offers a reference for clinical assessment and prevention of HDFN.

Objective: To investigate the current status of benefit finding among young and middle-aged patients with type 2 diabetes mellitus (T2DM) and analyze its influencing factors, so as to provide a reference for improving the level of benefit finding in this population. Methods: From November 2022 to May 2023, young and middle-aged patients with T2DM aged 18-59 years hospitalized in the endocrinology departments of 2 tertiary hospitals in Hengyang City, Hunan Province were selected as survey subjects by a convenience sampling method. Basic demographic information was collected using a general questionnaire survey. Benefit finding, resourcefulness, and stigma were evaluated using the Benefit Finding Scale, the Chinese Version of the Resourcefulness Scale, and the Type 2 Diabetes Stigma Assessment Scale, respectively. A multiple linear regression model was used to analyze the influencing factors of benefit finding among young and middle-aged patients with T2DM. Results: A total of 305 young and middle-aged patients with T2DM were investigated, including 222 males (72.79%) and 83 females (27.21%). There were 231 cases aged 45-59 years, accounting for 75.74%. The scores for benefit finding, resourcefulness, and stigma were (42.86±6.06), (75.12±11.30), and (41.20±10.10), respectively. Multiple linear regression analysis showed that young and middle-aged patients with T2DM who were male (β′=0.088), aged 18-<45 years (β′=0.083), absence of diabetes complications (β′=0.124), and had higher resourcefulness scores (β′=0.679) had higher levels of benefit finding, while patients with higher stigma scores (β′=-0.097) had lower levels of benefit finding. Conclusion The level of benefit finding among young and middle-aged patients with T2DM was moderate, and was related to gender, age, diabetes complications, resourcefulness, and stigma.

Objective To explore the correlation of body mass index,urinary protein and tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)during pregnancy with the severity of preeclampsia and pregnancy outcome.Methods A total of 63 patients with preeclampsia who were examined in Xingtai People's Hospital from April 2022 to April 2023 were enrolled in the study,33 patients with mild preeclampsia were included in the mild group and 30 patients with severe preeclampsia were included in the severe group.Physi-cal characteristics,urinary protein and sTWEAK levels between the groups were recorded,and the patients were followed up to explore the correlation with pregnancy outcome.Results The systolic and diastolic blood pressure of patients in the mild group were lower than those in the severe group,and the plasma albumin was higher than that in the severe group(P＜0.05).There was no statistically significant difference in pre preg-nancy weight and pre pregnancy body mass index between the mild and severe groups of patients(P＞0.05).The delivery weight and weight gain during pregnancy in the mild group were lower than those in the severe group(P＜0.05).The 24-hour urinary protein quantification in the mild group was lower than that in the se-vere group,and the sTWEAK expression level was higher than that in the severe group(P＜0.05).The pre pregnancy weight,pre pregnancy body mass index,delivery weight,and weight gain during pregnancy in the good pregnancy outcome group were all lower than those in the adverse pregnancy outcome group(P＜0.05).The 24-hour urinary protein quantification in the good pregnancy outcome group was lower than that in the adverse pregnancy outcome group,and the sTWEAK expression level was higher than that in the adverse pregnancy outcome group(P＜0.05).Receiver operating characteristic(ROC)curve analysis revealed that the area under the curve(AUC)of pre pregnancy body mass index,pre pregnancy weight,delivery weight,gestational weight gain,24-hour urinary protein quantification,and sTWEAK expression levels for predicting adverse pregnancy outcomes in patients were 0.906,0.690,0.919,0.664,0.908,and 0.793,respectively.The AUC for predicting adverse pregnancy outcomes in patients by combining pre pregnancy body mass index,de-livery weight,24-hour urinary protein quantification,and sTWEAK expression level was 0.932.Conclusion Body mass index,urinary protein and sTWEAK levels during pregnancy are closely associated with the severity of pre-eclampsia and pregnancy outcomes,and these indicators may help identify high-risk pregnant women early and take appropriate interventions to improve pregnancy outcomes.

Objective:To evaluate the effect of acupuncture on postoperative delirium (POD) in diabetic patients undergoing surgery under general anesthesia.Methods:In this randomized controlled trial, 92 diabetic patients of either sex, aged 30-80 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective surgery under general anesthesia, were divided into 2 groups ( n=46 each) using a table of random numbers: control group (group C) and acupuncture group (group A). Group A received acupuncture at the Baihui (GV20), Shenting (GV24) and Sishencong (EX-HN1) acupoints before anesthesia. The needles were retained for 30 min, with manual stimulation applied every 10 min for 10 s each time. After 4 stimulations, routine anesthesia was carried out. Group C received routine anesthesia only. Regional cerebral oxygen saturation was recorded on admission to the operating room (T 0), after anesthesia induction (T 1), at the start of surgery (T 2), at the end of surgery (T 3), and immediately after tracheal extubation (T 4). The POD developed within 3 days after surgery was assessed. The occurrence of needle-related adverse effects such as fainting, subcutaneous bleeding, and local paresthesia was recorded. Results:Compared with group C, the incidence of POD was significantly reduced, and the regional cerebral oxygen saturation was increased at T 1, 4 in group A ( P<0.05). Conclusions:Acupuncture can decrease the development of POD in diabetic patients undergoing surgery under general anesthesia, which is related to an increase in regional cerebral oxygen saturation.

Objective:To develop and validate the Pain nursing Competency Evaluation Questionnaire for Nursing Students to provide an effective tool for measuring the pain management competency of nursing students in China.Methods:The questionnaire was constructed through literature review, semi-structured interviews, focus group discussions, Delphi expert consultation, and a pre-survey. From September 2023 to January 2024, a convenience sampling method was used to select 250 nursing students from Hangzhou Normal University and Lishui University in Zhejiang Province for the survey. Reliability and validity of the developed questionnaire were tested. A random sample of 30 nursing students was selected for retesting after two weeks.Results:A total of 10 female experts were consulted through correspondence. The Pain Care Competency Evaluation Questionnaire for nursing students consists of 36 items. Through exploratory factor analysis, five common factors were extracted: pain health education, comprehensive pain assessment, pain screening and assessment, analgesic interventions, and analgesic side effects nursing, which together explained 61.695% of the variance. The content validity of the questionnaire was 0.96, and the item-level content validity index ranged from 0.900 to 1.000. The overall Cronbach′s α coefficient was 0.924, and the Cronbach′s α coefficients for the five dimensions ranged from 0.856 to 0.915. The test-retest reliability was 0.831. Conclusions:The Pain Care Competency Evaluation Questionnaire for nursing students developed in this study has good reliability and validity. It can be used as a tool to assess nursing students′ competency in pain care and provides a reference for the design and optimization of pain care courses and clinical practice programs for nursing students in undergraduate institutions.

Objective:To evaluate the effect of acupuncture on postoperative delirium (POD) in diabetic patients undergoing surgery under general anesthesia.Methods:In this randomized controlled trial, 92 diabetic patients of either sex, aged 30-80 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective surgery under general anesthesia, were divided into 2 groups ( n=46 each) using a table of random numbers: control group (group C) and acupuncture group (group A). Group A received acupuncture at the Baihui (GV20), Shenting (GV24) and Sishencong (EX-HN1) acupoints before anesthesia. The needles were retained for 30 min, with manual stimulation applied every 10 min for 10 s each time. After 4 stimulations, routine anesthesia was carried out. Group C received routine anesthesia only. Regional cerebral oxygen saturation was recorded on admission to the operating room (T 0), after anesthesia induction (T 1), at the start of surgery (T 2), at the end of surgery (T 3), and immediately after tracheal extubation (T 4). The POD developed within 3 days after surgery was assessed. The occurrence of needle-related adverse effects such as fainting, subcutaneous bleeding, and local paresthesia was recorded. Results:Compared with group C, the incidence of POD was significantly reduced, and the regional cerebral oxygen saturation was increased at T 1, 4 in group A ( P<0.05). Conclusions:Acupuncture can decrease the development of POD in diabetic patients undergoing surgery under general anesthesia, which is related to an increase in regional cerebral oxygen saturation.

Objective:To develop and validate the Pain nursing Competency Evaluation Questionnaire for Nursing Students to provide an effective tool for measuring the pain management competency of nursing students in China.Methods:The questionnaire was constructed through literature review, semi-structured interviews, focus group discussions, Delphi expert consultation, and a pre-survey. From September 2023 to January 2024, a convenience sampling method was used to select 250 nursing students from Hangzhou Normal University and Lishui University in Zhejiang Province for the survey. Reliability and validity of the developed questionnaire were tested. A random sample of 30 nursing students was selected for retesting after two weeks.Results:A total of 10 female experts were consulted through correspondence. The Pain Care Competency Evaluation Questionnaire for nursing students consists of 36 items. Through exploratory factor analysis, five common factors were extracted: pain health education, comprehensive pain assessment, pain screening and assessment, analgesic interventions, and analgesic side effects nursing, which together explained 61.695% of the variance. The content validity of the questionnaire was 0.96, and the item-level content validity index ranged from 0.900 to 1.000. The overall Cronbach′s α coefficient was 0.924, and the Cronbach′s α coefficients for the five dimensions ranged from 0.856 to 0.915. The test-retest reliability was 0.831. Conclusions:The Pain Care Competency Evaluation Questionnaire for nursing students developed in this study has good reliability and validity. It can be used as a tool to assess nursing students′ competency in pain care and provides a reference for the design and optimization of pain care courses and clinical practice programs for nursing students in undergraduate institutions.

Objective:This study aimed to primarily discuss the pathogenesis of hereditary coagulation factor Ⅴ (FⅤ) deficiency in a family with a consanguineous cousin marriage.Methods:The coagulation indices of the pedigree (three generations with seven individuals) and the thrombin levels of the proband and his father were assessed. All exons of the F5 gene were analyzed with Sanger sequencing, and a new mutation was confirmed with reverse sequencing. The corresponding sites of the family members were then determined. A set of online software was utilized to predict the conservation and pathogenicity of the mutation site. The pathogenicity of this mutation site was evaluated according to the American College of Medical Genetics and Genomics (ACMG) guidelines.Results:The prothrombin time (PT) and activated partial thromboplastin time (APTT) of the proband were 52.2 s and 108.3 s, respectively. FⅤ activity (FⅤ∶ C) and FⅤ antigen (FⅤ∶Ag) were greatly decreased by 2% and 4%, respectively. The problem was diagnosed as type Ⅰ F Ⅴ deficiency. PT and APTT of the proband’s father, mother, and grandfather were slightly higher than the upper limit of the reference range, and FⅤ∶C and FⅤ∶Ag were approximately 50% of normal. The thromboplastin generation assay revealed that the amount of thromboplastin produced by the proband and his father was lower than that of the healthy controls and that the proband’s ability to produce thromboplastin was more severely impaired. Sequencing analysis revealed that the proband demonstrated a homozygous missense mutation of c.5128T > C (p.Trp1682Arg) in exon 15 of the F5 gene. The grandfather, father, and mother of the proband were all heterozygous for c.5128 T > C. Conservative analysis revealed that p.Trp1682 was a highly conserved site in the homozygous species, and five online software programs, including Mutation Taster, SIFT, REVEL, PolyPhen-2, and CADD, indicated that the mutation was pathogenic. The ACMG guidelines recommend that the new mutation c.5128 T > C is a possible pathogenic mutation (PM2 + PM3 + PP1 + PP3 + PP4). The comparison of the protein models before and after the mutation revealed that the benzene ring and the hydrogen bond were reduced after the mutation, which changed the local structure of the F Ⅴ protein.Conclusion:The missense mutation c.5128T > C (p. Trp1682Arg) in exon 15 of the F5 gene was initially considered the genetic cause of the FⅤ deficiency family. This mutation is the first report globally, which further enriches the gene-phenotype spectrum of FⅤ deficiency.

Objective To analyze the domestic antibody drug safety and risk research status,the latest research hotspots and frontiers in the current ten years.Methods CiteSpace 6.2.R2 software was used to analyze all literature related to the safety and risk of antibody drugs in CNKI,WanFang data and Vip database from 2012 to 2022.Results A total of 2 773 pieces of literature were obtained from the three databases,which were imported into CiteSpace after deduplication,and finally,1 870 pieces were included in the analysis.In the past decade,the number of articles published in the field of antibody drugs safety and risk research has remained at about 100 articles per year from 2012 to 2019,since 2020,the number of articles published has started to increase,and the annual number of articles published has increased to around 300 articles from 2021 to 2022.The network graph of domestic institutional cooperation showed that there was a lack of cooperation among the research institutions of antibody drug safety and risk research,mainly due to the fact that hospitals were conducting research in this field,and the types of research subjects were relatively single.The author collaboration network graph showed that the core teams in this research field,such as Li Bo,Yang Yanwei,and Lin Zhi,had the closest collaboration,while there was less collaboration among high-yield authors,additionally,some experts and scholars conducted research on their own as individuals or small groups,the research focused on adverse reactions,safety,bevacizumab,Rituximab,Meta-analysis,etc.Conclusion In the past decade,domestic research has mainly focused on the clinical efficacy and safety of antibody drugs,with few scholars exploring the risk of antibody drugs,therefore,in the future,it is necessary to pay attention to the research on the risks of antibody drugs.

Objective:To investigate the relationship between inherited protein S deficiency (PSD) and cerebral venous sinus thrombosis (CVST) by phenotype and gene mutation analysis of 2 inherited PSD pedigrees with nonsense mutations.Methods:Retrospective analysis of clinical and imaging data of 2 patients diagnosed with CVST who were treated in the Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University in July and October 2023 was carried out. The peripheral blood samples were collected from proband 1 and her family members (3 subjects, 2 generations in total), and proband 2 and his family members (8 subjects of 3 generations in total). Their protein S (PS) activity (PS:A), the content of total PS antigen (TPS:Ag) and free PS antigen (FPS:Ag) were measured for definite diagnosis. Polymerase chain reaction was done in all 15 exons of the active PROS1 gene and its 5′ and 3′ untranslated regions and the amplification products were analyzed by direct sequencing. The results were compared with human PROS1 reference sequences, using Chromas software to find the mutation sites. Results:The proband 1 is a female, and the proband 2 is a male. Both of them had young onset and the clinical presentation of CVST. The PS:A level was reduced to 29% in the proband 1 and reduced to about 35% in her mother; PS:A was reduced to 21%-27% in the proband 2 and his 6 family members; a decline in the same proportion of TPS:Ag and FPS:Ag was found in the 2 probands and their family members, therefore they were primarily diagnosed as typeⅠPSD. Gene analysis showed that the proband 1 and her mother had a nonsense mutation of c.1680T>A in exon 14 (p.Tyr560 *) of the PROS1 gene; the proband 2 and his 6 family members had a nonsense mutation of c.1687C>T in exon 14 (p.Gln563 *) of the PROS1 gene. Conclusion:The reduced protein S levels in PSD patients and their family members may be associated with the p.Tyr560 * and p.Gln563 * nonsense mutations of the PROS1 gene, and the clinical manifestations of CVST in PSD patients may be related to these 2 nonsense mutations.