Objective: To reveal the molecular biological mechanism of a rare Dc-variant individual using PacBio third-generation sequencing technology. Methods: ABO and Rh blood type identification, DAT, unexpected antibody screening and D antigen enhancement test were conducted by serological testing. The absorption-elution test was used to detect the e antigen. RHCE gene typing was performed by PCR-SSP, and the 1-10 exons of RHCE were sequenced by Sanger sequencing. The full-length sequences of RHCE, RHD and RHAG were detected by PacBio third-generation sequencing technology. Results: Serological findings: Blood type O, Dc-phenotype, DAT negative, unexpected antibody screening negative; enhanced D antigen expression; no detection of e antigen in the absorption-elution test. PCR-SSP genotyping indicated the presence of only the RHCE c allele. Sanger sequencing results: Exons 5-9 of RHCE were deleted, exon 1 had a heterozygous mutation at c. 48G/C, and exon 2 had five heterozygous mutations at c. 150C/T, c. 178C/A, c. 201A/G, c. 203A/G and c. 307C/T. Third-generation sequencing results: RHCE genotype was RHCE 02N. 08/RHCE-D(5-9)-CE; RHD genotype was RHD 01/RHD 01; RHAG genotype was RHAG 01/RHAG 01 (c. 808G>A and c. 861G>A). Conclusion: This Dc-individual carries the allele RHCE 02N. 08 and the novel allele RHCE-D(5-9)-CE. The findings of this study provide data support and a theoretical basis for elucidating the molecular mechanisms underlying RhCE deficiency phenotypes.

Objective To discuss the application of the"rotating guidewire and correcting the filter recovery hook direction technique"("rotation-correction loop technique"for short),a technique invented by the authors in clinical practice,in the retrieval of complex inferior vena cava filter(IVCF),and to discuss its technical skills and advantages.Methods The clinical data of 417 patients carrying an IVCF,who were admitted to the Department of Vascular Surgery of Second Hospital of Shanxi Medical University of China to retrieve IVCF between January 2022 and December 2022,were retrospectively analyzed.Taking the time spent on the retrieval of IVCF and the intraoperative radiation dose as the evaluation indicators,the advantages and disadvantages of the standard filter retrieval technique,the"rotation-correction loop technique"and the other loop-assisted techniques were compared.Results Both the intraoperative radiation dose and the time spent on the retrieval of IVCF using"rotation-correction loop technique"were remarkably lower than those of other loop-assisted techniques(P＜0.000 1).Conclusion For the retrieval of complex IVCF,especially for the IVCF which is heavily tilted and/or its recovered hook is attached to the vascular wall,the use of"rotation-correction loop technique"can shorten the time spent on the the retrieval of IVCF and reduce the intraoperative radiation dose.This technique carries high safety and practicability,the device is simple and it can be manipulated by single physician,which is conducive to clinical application and promotion.(J Intervent Radiol,2024,33:289-294)

Objective:Continuous glucose monitoring (CGM) technology is used to compare the advantages of insulin degludec (IDeg) as a basal insulin regimen compared with insulin glargine (IGlar) in the treatment of adult type 1 diabetes mellitus.Methods:30 adult patients with T1DM admitted to Heji Hospital Affiliated to Changzhi Medical College from September 2019 to December 2020 were screened. According to the random number table method, the patients were randomly divided into two groups (insulin degludec group and insulin glargine group) at a ratio of 1∶1, respectively treated with IDeg, IGlar and aspartate insulin for 12 weeks. The main outcome measures were the coefficient of variation of blood glucose (CV), mean amplitude of glycemic excursions (MAGE), time in range (TIR), time above range (TAR) and time below range (TBR). The secondary outcome measures were mean blood glucose (MBG), standard deviation of blood glucose (SD), fasting blood glucose (FPG), 2 h postprandial blood glucose (2 h BG), hemoglobin A1c (HbA 1c), means of daily differences (MOOD), and the frequency of hypoglycemic events. Results:At 12 weeks of treatment, the HbA 1c, FPG, 2 h BG, MBG, SD, CV and MAGE of insulin degludec group were lower than those of insulin glargine group, with statistically significant difference (all P<0.05). The TIR in the insulin degludec group was significantly higher than that in the insulin glargine group [73(63, 75)% vs 43(28, 63)%, P<0.001], and the TAR was lower than that in the glycerine group [25(17, 23)% vs 35(33, 64)%, P=0.003]. From the curve spectrum of blood glucose level of the two groups, the stability of blood glucose in the insulin degludec group was better than that in the insulin glargine group. After 12 weeks of treatment, 8 cases (8/15) in insulin degludec group had HbA 1c<7.0%, and 4 cases (4/15) in insulin glargine group had HbA 1c<7.0%, without statistically significant difference ( P=0.264). There were 7 cases (7/15) in the insulin degludec group and 1 case (1/15) in the insulin glargine group who achieved high quality blood glucose control, with statistically significant difference ( P=0.035). At the 12th week of outpatient follow-up, the incidence of nocturnal hypoglycemic events in insulin degludec group was significantly lower than that in insulin glargine group (4/15 vs 11/15, P=0.027). Conclusions:Compared with insulin glargine, insulin degludec can achieve higher blood glucose compliance rate, lower blood glucose level and reduce blood glucose fluctuations in patients with type 1 diabetes.

Environmental endocrine disrupting chemicals are a kind of exogenous chemicals that generally exist in the environment, and can disturb the endocrine homeostasis and adversely affect reproductive, immune, neurological, and other functions after entering the body, among which the damage to the reproductive system is the most significant one. Studies have confirmed that the long-term exposure to environmental endocrine disrupting chemicals have irreversible and harmful effects on primordial germ cell growth, reproductive organ development, and reproductive endocrine regulation, and also have obvious correlations with the occurrence and development of various reproductive system tumors. This paper reviewed various reproductive toxicities induced by common environmental endocrine disrupting chemicals in the developmental and reproductive stages, and associated mechanisms involved in the occurrence and development of reproductive system tumors.

Objective:To compare the clinical features between chronic active Epstein-Barr virus infection(CAEBV) and infectious mononucleosis(IM)in adult patients.Methods:Clinical data from 56 adult IM patients and 14 adult CAEBV patients admitted in the First Affiliated Hospital of Nanjing Medical University during January 2011 to December 2019 were enrolled. Clinical manifestations, laboratory indicators, treatment and outcomes were compared between two groups. Chi-square test and Mann-whitney U test were used to analyze data. Results:The average age of CAEBV patients was higher than that of IM patients [36.0(23.8, 50.5)years vs. 19.0(17.3, 22.8) years; U=90.0, P<0.05]. The symptoms of sore throat, throat congestion, tonsilla enlargement and lymphadenopathy in IM group were more common than those in CAEBV group( χ2=14.088, 16.875, 31.855 and 10.938, all P<0.01). However, the incidence of pulmonary infection, sleepiness/dysphoria and splenomegaly in CAEBV group were significantly higher than those in IM group( χ2=17.217, 5.809 and 6.254, P<0.05 or <0.01). The white blood cell counts, hemoglobin levels, platelet counts, alanine aminotransferase(ALT) and albumin in CAEBV group were significantly lower than those in IM group( U=47.0, 49.5, 158.5, 173.0 and 263.5, all P<0.01). The levels of neutrophil ratio, C-reactive protein, serum ferritin and EBV DNA load in CAEBV group were significantly higher than those in IM group( U=145.0, 140.0, 128.5 and 115.0, P<0.05 or <0.01). The proportions of CD3 + T cell counts and CD8 + T cell counts in CAEBV group were significantly lower compared to those in IM group( U=42.0 and 24.5, P<0.01); the proportions of CD4 + T cell counts, the CD4 + T/CD8 + T cell counts ratio and B lymphocytes in CAEBV group were significantly higher compared to those in IM group( U=29.0, 23.5 and 34.5, P<0.01). Fifty-six IM patients were all cured and discharged from hospital. In CAEBV group, 8 cases died, 3 cases were improved and 3 cases lost follow-up. Conclusions:Patients with IM represent a favorable prognosis, while the prognosis of CAEBV is relatively poor and complication with HLH may occur. For older patients with EBV infection complicated with pulmonary infection, lethargy/irritability, attention should be paid to monitor blood routine, liver function, serum EBV DNA load and peripheral blood lymphocyte subsets.

Objective:To determine the effect of pelvic floor electrical stimulation combined with conventional treatment on neurogenic bladder dysfunction after spinal cord injury.Methods:The Pubmed/Medline, Embase, Cochrane, CINAHL, China National Knowledge Infrastructure, CQVIP and Wanfang databases were electronically searched for reports published before April 2019 of randomized and controlled trials testing the effect of electrical stimulation of the pelvic floor on neurogenic bladder after spinal cord injury. Meta-analysis of all the reports collected was performed.Results:Seven randomized and controlled trials with 319 patients were identified. Together they showed that compared with conventional treatment, pelvic floor muscle stimulation better increased bladder capacity and reduced the volume of residual urine. Average single urination output was increased, while the frequency of urination decreased along with episodes of urinary incontinence. Average lower urinary tract symptoms scores were also significantly better.Conclusions:Electrical stimulation of the pelvic floor combined with conventional therapy may be more effective than conventional therapy alone in alleviating the symptoms of neurogenic bladder.

Objective:To establish an intelligent management system and explore its application in the management of high-value consumables in Interventional Operating Room.Methods:Supply and processing and distribution (SPD) combined with the intelligent management system was applied in the Intervention Center at Ningbo First Hospital of Zhejiang Province in October 2019. High-value consumables managed with traditional information management between October 2018 and September 2019 were included into the control group, while those managed with SPD combined with the intelligent management system from October 2019 to September 2020 were included into the observation group. The high-value consumable system and inventory compliance rate, average daily inspection time, average daily claim time, timely supply of consumables, return rate of unused consumables, and nurse satisfaction under the two different management modes were compared.Results:The coincidence rates of the high-value consumable system inventory and actual inventory in the observation group and the control group were 98.26% (226/230) and 85.21% (196/230) , respectively; the average daily inspection time, (67.44±1.42) min in the observation group was less than (108.00±2.51) min in the control group, and the average daily claim time, (53.41±5.24) min was less than (118.22±4.68) min in the control group; the total rate of untimely supply of consumables and unreturned unused consumables in the observation and control groups were 3.46% (138/3 986) and 20.86% (881/4 224) , respectively; and the satisfaction of nurses in the two groups were 93.75% (135/144) and 63.89% (92/144) . The differences between the two groups were all statistically significant ( P<0.05) . Conclusions:The construction and application of the intelligent consumable management system can effectively improve the standardization and refinement of the management of high-value consumables in the Interventional Operating Room, and reduce the operating cost of the department.

【Objective】 Toexplore the viability of preparing washed RBCs ordeglycerolized RBCs(referred as frozen RBCs)from blood containing irregular antibodies, so as to provide references for formulating processing procedures of blood containing irregular antibodiestosave blood resources and reduce blood wastage. 【Methods】 Once irregular antibodies were yielded, their type and titerwere determined.The plasma was discarded, and the suspended RBCs were prepared and processed according to the standardized washing scheme.The processing effect of blood with different titers and types of antibodies was observed, and theirfurther clinical application was followed up. 【Results】 From May 2017 to July 2019, a total of 45 blood samples containing irregular antibodies were screened in our center. The overall qualified rate reached 91.1% after processing. 100%(25/25) was qualified in IgM, and 80.0%(16/20)in IgG.4samples, initially noncom for mingdue to IgG-Dwith titerranged8~16, met the requirements after one or two additional washing processes. Among them, 23 cases were issued and appliedin clinicaland noadeverse reactions to blood transfusionoccurred. 【Conclusion】 After appropriate processing, blood containing irregular antibody can be applied to the clinical to save blood resources. When the irregular antibody is IgG-D and the titer is high, the washing times should be increased, and only when there is no residual antibodycan the samples be issued to the clinical.

Objective To observe the effect of surface electromyographic biofeedback (sEMG BFB) combined with routine swallow training in treating dysphagia among those with nasopharyngeal carcinoma after radiation therapy.Methods Fifty dysphagic patients with nasopharyngeal carcinoma after radiation therapy were randomly divided into a biofeedback training group and a routine treatment group,each of 25.Both groups were given routine training including orofacial function training,sensory irritation,behavioral swallowing training,and electrical stimulation.The biofeedback group was additionally given behavioral swallowing training based on sEMG BFB.Before and 4 weeks after the treatment,a videofluoroscopic swallowing study was performed to observe the opening of the upper esophageal sphincter (UES).The penetration aspiration scale (PAS) and the functional oral intake scale (FOIS) were used to evaluate the subjects' swallowing function.Results Before the treatment there were no significant differences between the two groups in terms of UES opening,average PAS score or average FOIS score.Everyone improved significantly after the treatment,but compared with the routine treatment group,UES opening was significantly better after the treatment,the average PAS score was lower and the average FOIS score was higher in the biofeedback training group.Conclusion sEMG BFB combined with routine swallowing training can improve the UES opening and swallowing ability of dysphagic patients with nasopharyngeal carcinoma after radiation therapy.

Objective To investigate the risk factors of ICU delirium in critically ill patients. Methods A total of 1 74 critically ill patients in ICU who were older than 18 yrs and stayed in ICU exceeding 24 hs from January 201 5 to June 201 5 were enrolled.Patients were divided into delirium group and non delirium group.Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU)during the first 7 days.The factors such as history of alcoholism and other 12 factors were analyzed by univariate and multivariate logistic regression analysis to identify those risk factors associated with delirium.Results With 22 cases of delirium in 1 74 patients,the in-cidence of delirium was 12.64% (delirium group).Variables associated with delirium were coronary heart history,operation,tracheal intubation,clinical use of mechanical ventilation,hypoxemia and Benzodiazepine.Multivariate logistic regression analysis showed that coronary heart disease (OR 3.932,95%CI 1.225-12.61 7),surgery(OR 9.691,95%CI 2.103-44.657),hypoxemia(OR 6.595, 95%CI 1.377-31.585),Benzodiazepine use (OR 7.620,95%CI 1.713-33.899)was independent risk factors of delirium in critically ill patients (P < 0.05 or P < 0.01 ).Conclusion Coronary heart disease,surgery,hypoxemia and Benzodiazepine are independent risk factors of ICU delirium in criti-cally ill patients.Early screening and prevention of delirium should be given to reduce the occurrence of delirium for patients in ICU.