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.

BACKGROUND:Titanium elastic intramedullary nailing for the treatment of significantly displaced midshaft clavicle fractures has the characteristics of minimally invasive and elastic fixation.The displacement of the fracture is closely related to the later function.However,there are few studies on the three-dimensional displacement analysis of the fracture ends before surgery and after intramedullary fixation such as titanium elastic intramedullary nailing.OBJECTIVE:To explore the three-dimensional displacement of fracture ends after midshaft clavicle fracture and fixation with titanium elastic intramedullary nails,and to analyze the risk factors.METHODS:A total of 91 patients with midshaft clavicle fracture(fracture end shortening ≥15 mm)admitted to Wendeng Orthopedic Hospital of Shandong Province from April 2019 to April 2024 were selected,including 57 males and 34 females,aged(51.73±10.21)years old.All patients received closed reduction and internal fixation with titanium elastic intramedullary nail.CT scans of the affected clavicle were performed before and on the first day after surgery.The CT data were imported into Mimics software for modeling.The length of the clavicle,lateral displacement of the fracture end,and rotation of the distal end of the fracture along the X,Y,and Z axes were measured and recorded before and after surgery.Pearson correlation coefficient was used for correlation analysis of various parameters,and generalized linear regression was used to evaluate risk factors.RESULTS AND CONCLUSION:(1)Preoperatively,the variable that increased the risk of lateral displacement was the number of comminuted bone fragments,the variable that increased the risk of shortening displacement was male patients,and the variable that increased the risk of Z-axis rotation was the left limb.Shortening displacement was significantly positively correlated with lateral displacement(r=0.715,P＜0.001);shortening displacement was significantly positively correlated with X-axis rotation displacement and Y-axis rotation displacement(r=0.265,P=0.028;r=0.303,P=0.011);lateral displacement was significantly positively correlated with Y-axis rotation and Z-axis rotation(r=0.258,P=0.032;r=0.250,P=0.038);X-axis rotation was significantly positively correlated with Y-axis rotation(r=0.382,P=0.001),and Z-axis rotation was significantly positively correlated with Y-axis rotation(r=0.280,P=0.020).(2)Postoperatively:The number of scapula fractures and comminuted bone fragments were variables that increased the risk of postoperative shortening and lateral displacement:Preoperative X-,Y-,and Z-axis rotation displacements were risk variables that increased postoperative X-,Y-,and Z-axis rotation displacements,respectively.Postoperative lateral displacement was significantly positively correlated with postoperative shortening and displacement(r=0.584,P=0.000),and postoperative lateral displacement was also significantly positively correlated with postoperative Y axis rotation and Z axis rotation(r=0.360,P=0.002;r=0.250,P=0.038).Postoperative Y axis rotation was significantly positively correlated with postoperative Z axis rotation(r=0.248,P=0.040).(3)The results showed that the three-dimensional displacement of the clavicle end before and after surgery was affected by many factors,especially the number of comminuted bone fragments,scapula fractures,gender,and original rotation displacement.At the same time,there were complex correlations between various displacements,especially the correlation between shortening displacement and lateral displacement was the strongest.

BACKGROUND:Titanium elastic intramedullary nailing for the treatment of significantly displaced midshaft clavicle fractures has the characteristics of minimally invasive and elastic fixation.The displacement of the fracture is closely related to the later function.However,there are few studies on the three-dimensional displacement analysis of the fracture ends before surgery and after intramedullary fixation such as titanium elastic intramedullary nailing.OBJECTIVE:To explore the three-dimensional displacement of fracture ends after midshaft clavicle fracture and fixation with titanium elastic intramedullary nails,and to analyze the risk factors.METHODS:A total of 91 patients with midshaft clavicle fracture(fracture end shortening ≥15 mm)admitted to Wendeng Orthopedic Hospital of Shandong Province from April 2019 to April 2024 were selected,including 57 males and 34 females,aged(51.73±10.21)years old.All patients received closed reduction and internal fixation with titanium elastic intramedullary nail.CT scans of the affected clavicle were performed before and on the first day after surgery.The CT data were imported into Mimics software for modeling.The length of the clavicle,lateral displacement of the fracture end,and rotation of the distal end of the fracture along the X,Y,and Z axes were measured and recorded before and after surgery.Pearson correlation coefficient was used for correlation analysis of various parameters,and generalized linear regression was used to evaluate risk factors.RESULTS AND CONCLUSION:(1)Preoperatively,the variable that increased the risk of lateral displacement was the number of comminuted bone fragments,the variable that increased the risk of shortening displacement was male patients,and the variable that increased the risk of Z-axis rotation was the left limb.Shortening displacement was significantly positively correlated with lateral displacement(r=0.715,P＜0.001);shortening displacement was significantly positively correlated with X-axis rotation displacement and Y-axis rotation displacement(r=0.265,P=0.028;r=0.303,P=0.011);lateral displacement was significantly positively correlated with Y-axis rotation and Z-axis rotation(r=0.258,P=0.032;r=0.250,P=0.038);X-axis rotation was significantly positively correlated with Y-axis rotation(r=0.382,P=0.001),and Z-axis rotation was significantly positively correlated with Y-axis rotation(r=0.280,P=0.020).(2)Postoperatively:The number of scapula fractures and comminuted bone fragments were variables that increased the risk of postoperative shortening and lateral displacement:Preoperative X-,Y-,and Z-axis rotation displacements were risk variables that increased postoperative X-,Y-,and Z-axis rotation displacements,respectively.Postoperative lateral displacement was significantly positively correlated with postoperative shortening and displacement(r=0.584,P=0.000),and postoperative lateral displacement was also significantly positively correlated with postoperative Y axis rotation and Z axis rotation(r=0.360,P=0.002;r=0.250,P=0.038).Postoperative Y axis rotation was significantly positively correlated with postoperative Z axis rotation(r=0.248,P=0.040).(3)The results showed that the three-dimensional displacement of the clavicle end before and after surgery was affected by many factors,especially the number of comminuted bone fragments,scapula fractures,gender,and original rotation displacement.At the same time,there were complex correlations between various displacements,especially the correlation between shortening displacement and lateral displacement was the strongest.

Objective: To explore the effects of intergenerational parent-child separation on internalizing and externalizing behavioral problems among rural preschoolers aged 3-6 years, so as to provide empirical evidence for formulating targeted intervention strategies and blocking the intergenerational transmission of parent-child separation. Methods: From March to June, 2024, ten kindergartens were selected from rural areas of Nanling County, Wuhu City, Anhui Province, and 2 279 preschool children aged 3- 6 years, along with their fathers, mothers and primary caregivers, were recruited for survey by cluster convenient sampling method. Children s fathers and mothers reported their own childhood parent-child separation information separately. Information on the children s history of psychological and behavioral problems was reported by the primary caregivers. Information of internalizing and externalizing behavioral problems in preschool children was reported with Strengths and Difficulties Questionnaire (SDQ).The Chi square test was used to compare the differences in the detection rates of psychological and behavioral problems among children with different intergenerational continuity of parent-child separation. Binary Logistic regression model was applied to analyze the association between intergenerational continuity of parent-child separation and internalizing and externalizing behavioral problems in preschool children. Results: The detection rate of internalizing behavioral problems was 27.5% and externalizing behavioral problems was 19.1% among rural preschool children. There were significant differences in internalization behavior, externalization behavior, hyperactivity impulse and peer communication problems among preschool children in different types of parent-child separation groups( χ 2=14.29, 8.80, 17.26, 13.84, all P <0.05). Binary Logistic regression analysis showed that after adjusting for covariates such as children s gender, birth weight, and delivery mode, compared with children without separation, intergenerational continuity of parent-child separation group( OR =1.95), only child separation( OR =1.74) were associated with significant higher risk of conduct problems(both P ＜0.05). Parent-child separation intergenerational continuation groups( OR =1.68), only child separation( OR = 1.47) were associated with significant higher risk of peer problems(both P ＜0.05). Both types of parent-child separation experiences significantly increased the risk of children s prosocial behavior problems，among them, the intergenerational continuation group was 1.99 times that of the control group ( OR =1.99), and the childhood only separation group was 2.09 times that of the control group ( OR =2.09)(both P ＜0.05). Compared with children whose parents and children had no experience of parent-child separation, children in the intergenerational continuation group of parent-child separation had increased risks of both internalizing and externalizing behavior problems ( OR =1.53, 1.65, both P <0.05). Conclusion All types of parent-child separation are associated with internalizing and externalizing behavioral problems among rural children aged 3 to 6 years.

ObjectiveTo observe the long-term survival outcomes and complications of liver cirrhosis patients with spontaneous portosystemic shunt and type 1 isolated gastric varices （IGV-1） bleeding after secondary endoscopic preventive therapy， and to investigate the independent influencing factors for long-term prognosis. MethodsA total of 70 liver cirrhosis patients with spontaneous portosystemic shunt and IGV-1 bleeding who were admitted to Beijing Ditan Hospital， Capital Medical University， from January 5， 2015 to November 29， 2019 were enrolled as subjects， and related baseline data were collected， including age， sex， etiology， routine blood test results， liver function parameters， renal function parameters， coagulation parameters， Child-Pugh score， and the presence or absence of comorbidities such as cholestasis， hepatocellular carcinoma， thrombosis， ascites， and hepatic encephalopathy. All patients underwent secondary endoscopic preventive therapy for rebleeding and were followed up for 5 years. The primary endpoints were ectopic embolism rate and all-cause mortality rate， and the secondary endpoints were liver-related mortality and liver-related complications. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between groups， and the chi-square test was used for comparison of categorical data between groups. The Cox regression analysis was used to investigate the prognostic factors for 1-， 3-， and 5-year survival time， and the Logistic regression analysis was used to identify the independent risk factors for liver disease-related complications. ResultsThe incidence rate of ectopic embolism was 0% within 5 years of follow-up. The 1-， 3-， and 5-year all-cause mortality rates were 5.7%， 24.3%， and 32.9%， respectively. There were 2 cases of liver-related death in year 1， 8 cases in year 3， and 12 cases in year 5， resulting in a liver disease-related mortality rate of 17.14% （12/70）. Compared with the survival group， the death group had significantly higher incidence rates of hepatocellular carcinoma （0.00% vs 17.39%， χ²=8.669， P=0.003） and ascites （38.30% vs 52.17%， χ²=7.272， P=0.026）， and compared with the death group， the survival group had significantly lower 5-year incidence rates of rebleeding （10.64% vs 100.00%， χ²=51.383， P<0.001）， ascites （8.51% vs 52.17%， χ²=21.574， P<0.001）， and hepatic encephalopathy （0.00% vs 21.74%， χ²=12.029， P=0.002）. The multivariate Cox regression analysis showed that during the 1-year follow-up， comorbidity with hepatocellular carcinoma before surgery （hazard ratio ［HR］=14.601， 95% confidence interval ［CI］： 2.049 — 104.098， P=0.007） and PT （HR=1.662， 95%CI： 1.090 — 2.535， P=0.018） were independent risk factors for survival， and HGB level （HR=0.863， 95%CI： 0.747 — 0.998， P=0.046） was a protective factor for prolonged survival； during the long-term follow-up for 3 or 5 years， preoperative comorbidities with hepatocellular carcinoma （3 years： HR=40.174， 95%CI： 8.939 — 180.559， P<0.001； 5 years： HR=26.739， 95%CI： 6.993 — 102.243， P<0.001） and ascites （3 years： HR=3.638， 95%CI： 1.751 — 7.575， P=0.001； 5 years： HR=2.555， 95%CI： 1.419 — 4.598， P=0.002） were independent risk factors for mortality. The Logistic regression analysis showed that during the follow-up for 3 years， comorbidity with ascites before surgery （odds ratio ［OR］=0.255， 95%CI： 0.102 — 0.636， P=0.003） was associated with a lower risk of rebleeding， while comorbidity with hepatocellular carcinoma before surgery （OR=16.231， 95%CI： 1.298 — 202.878， P=0.031） was an independent risk factor for rebleeding； prothrombin time was a protective factor against hepatic encephalopathy （OR=0.790， 95%CI： 0.648 — 0.964， P=0.020）； during the follow-up for 5 years， aggravation of ascites after surgery （OR=5.578， 95%CI： 1.474 — 21.103， P=0.011） was an independent risk factor for rebleeding， and aggravation of ascites after surgery （OR=175.046， 95%CI： 14.306 — 2 141.909， P<0.001） were independent risk factors for the development of ascites in the future. ConclusionComorbidity with hepatocellular carcinoma before surgery and prothrombin time are independent risk factors for 1-year survival， whereas a high HGB level is a protective factor for increasing 1-year survival. Preoperative comorbidities with hepatocellular carcinoma and ascites are independent risk factors for the long-term prognosis of patients with spontaneous portosystemic shunt and IGV-1 bleeding and can significantly shorten survival time. Preoperative comorbidity with ascites can reduce the occurrence of rebleeding， while postoperative hepatocellular carcinoma and aggravation of ascites after surgery are independent risk factors for rebleeding； aggravation of ascites after surgery is an independent risk factor for the development of ascites in the future.

Objective: To explore factors associated with return intention and behavior among young lapsed blood donors from three psychological dimensions: blood donation values, moral identity and internalized responsibility, and to provide a contextualized interpretation of these psychological factors within the traditional Chinese ethical framework of “benevolence-righteousness-virtue”. Methods: A prospective cohort study was performed among 732 young lapsed blood donors in Hangzhou, China, recruited via stratified random sampling. At baseline, participants completed measures of blood donation values, moral identity and identified regulation. Six months later, return intention was assessed among 344 participants who completed the follow-up survey, while actual return behavior was determined from blood center records for all 732 participants at baseline. Univariate and multivariate logistic regression analyses were used to analyze the predictive effects of these psychological variables on return intention and behavior. Results: Blood donation motivations varied significantly across participants with different educational levels (P<0.05). Among the 344 participants who completed the follow-up survey, blood donation values, moral identity, and identified regulation were each significantly associated with return intention (P<0.05). These associations remained significant after adjustment for demographic factors (P<0.01). When the three psychological factors were simultaneously entered into the model, only identified regulation remained independently associated with return intention (OR=1.95, 95%CI:1.35-2.82, P<0.001). Among all 732 participants, the three psychological factors were each significantly associated with actual return behavior in univariate and adjusted analyses；however, none remained independently associated with actual return behavior when entered simultaneously into the model (all P>0.05). Conclusion: Identified regulation may be an important psychological factor underlying the formation of return intention among young lapsed blood donors. From the perspective of the “benevolence - righteousness - virtue” ethical framework, blood donation values, identified regulation, and moral identity represent distinct dimensions of donation motivation, with the dimension of “righteousness” reflected in internalized responsibility, showing a relatively prominent role in return intention. The translation of psychological motivation into actual return behavior may additionally depend on other factors and warrants further investigation.

AIM: To quantitatively evaluate the clinical characteristics of haze after transepithelial photorefractive keratectomy(TPRK)for astigmatism using corneal densitometry.METHODS:In this retrospective clinical study, a total of 74 patients(106 eyes)with astigmatism ≥1.25 D who underwent TPRK in our hospital from October 2022 to December 2024 were continuously collected. All of the study subjects were divided into transparent group(65 eyes)and haze group(41 eyes)based on whether haze occurred after surgery. Pentacam examination was performed before and after surgery, and corneal densitometry was recorded at the time points of preoperation, 1 mo postoperation in the transparent group and the most severe haze degree in the haze group. The collected corneal densitometry included the average densitometry of the entire corneal layer in the central 2 mm, 2-6 mm, and 6-10 mm areas, as well as the average densitometry of the entire layer of the corneal section in the center 6 mm of the astigmatism axis(astigmatism expressed in negative cylindrical form)and orthogonal axis(the axis perpendicular to the astigmatism axis), and the average densitometry of the entire layer of the corneal section in the nasal and temporal 2-6 mm areas of the astigmatism axis in the haze group of patients with regular astigmatism. The change in corneal densitometry after surgery compared with that before surgery was calculated.RESULTS:There was no statistically significant difference in baseline data such as gender, age, and spherical equivalent between the transparent group and the haze group(all P>0.05). The change in corneal densitometry in the 2-6 mm area of the haze group was greater than that in the transparent group(Z=-2.226, P=0.026), while there was no significant difference in the change of corneal densitometry in the central 2 mm and 6-10 mm areas between the two groups(both P>0.05). There was no significant difference in the change of corneal densitometry between the transparent group and haze group along the orthogonal axis(all P>0.05), while the change of corneal densitometry in the haze group along the astigmatism axis was greater than that in the transparent group(Z=-2.371, P=0.018). The temporal corneal densitometry of patients with regular astigmatism in the haze group after surgery was higher than that of the nasal side, and the change in corneal densitometry was also greater than that of the nasal side(Z=-4.288, P<0.001; Z=-4.043, P<0.001).CONCLUSION:Unlike spherical correction for myopia and hyperopia, haze after TPRK for astigmatism was mainly manifested in the peripheral cutting area of the astigmatism axis, and patients with regular astigmatism had a higher probability or severity of haze on the temporal side of the astigmatism axis than on the nasal side.

Objective To investigatethe relationship between gastroesophageal reflux disease (GERD) symptoms and clinicopathological characteristics, p53 expression, and survival of Chinese patients with esophageal adenocarcinoma. Methods A total of 3882 patients with esophageal adenocarcinoma, 970 matched patients with esophageal squamous cell carcinoma, and 970 matched patients with gastric cardia adenocarcinoma were included to compare the incidence of GERD symptoms. Patients with esophageal adenocarcinoma were divided into two groups according to the presence and absence of GERD symptoms. The differences in clinicopathological characteristics and p53 expression between the two groups were compared by chi-square test, and the differences in survival between the two groups were compared by landmark analysis. Results The incidence of GERD symptoms increased successively in esophageal squamous cell carcinoma, esophageal adenocarcinoma, and gastric cardia adenocarcinoma. In patients with esophageal adenocarcinoma, the proportions of male, less than 65 years old, lower thoracic tumors, tumors without squamous cell carcinoma, poorly differentiation, early tumors (stage 0-I), and p53-positive tumors in the group with GERD symptoms were higher than those in the group without GERD symptoms; moreover, the long-term survival (≥15 years) was better. Conclusion GERD symptom is an important clinical sign of esophageal adenocarcinoma. It is closely related to specific clinicopathological characteristics, p53 overexpression, and good long-term prognosis.

Linxian County in Henan Province, Northern China is known as the region with the highest incidence and mortality rate of esophageal cancer worldwide. Since 1959, the Henan medical team has conducted field work on esophageal cancer prevention and treatment in Linxian. Through three generations of effort exerted by oncologists over 65 years of research on esophageal cancer prevention and treatment in Linxian, the incidence rate of esophageal squamous cell carcinoma in this area has dropped by nearly 50%, and the 5-year survival rate has increased to 40%, reaching the international leading level. This article aims to summarize the history, present opportunities and new challenges, and explore the experience of esophageal cancer prevention and treatment in Linxian (referred to as the “Linxian experience”), providing reference and guidance to cancer prevention and treatment research in China.

ObjectiveTo investigate the safety and efficacy of puncture cyanoacrylate selective seal （PCSS） under endoscopic ultrasound in the treatment of gastroesophageal varices （GOV）. MethodsA total of 100 patients with liver cirrhosis who underwent endoscopic therapy for the secondary prevention of GOV bleeding in Beijing Ditan Hospital， Capital Medical University， from March 1 to December 31， 2023 were enrolled and randomly divided into PCSS group and traditional endoscopy group. The patients were followed up for 6 months after surgery， and the two groups were compared in terms of clinical outcome and complications. The primary outcome measure was the rate of alleviation or disappearance of GOV， and the secondary outcome measure was variceal rebleeding and death. The independent-samples t test was used for comparison of normally distributed or approximately normally distributed quantitative data between two groups， and the Wilcoxon non-parametric test was used for comparison of non-normally distributed quantitative data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of qualitative data between two groups. ResultsThere were 50 patients in the PCSS group， among whom 1 patient was lost to follow-up， and there were 50 patients in the traditional endoscopy group， among whom 3 patients were lost to follow-up. There were no significant differences between the two groups in baseline data such as age， sex， Child-Pugh class， varices grade， and GOV typing （all P>0.05）. Compared with the traditional endoscopy group， the PCSS group had significantly better results of the number of endoscopic treatment sessions （t=-15.671， P=0.001）， the total amount of tissue adhesive used （t=-2.830， P=0.006）， and the rate of alleviation or eradication of varices sclerosis （χ²=7.078， P=0.029）. Both groups had low rates of postoperative rebleeding， adverse reactions， and complications， and there were no significant differences between the two groups （all P>0.05）. ConclusionCompared with traditional endoscopy， PCSS can significantly enhance treatment outcome while maintaining safety standards.