Congenital blood group chimerism refers to the coexistence of two or more distinct blood types within an individual, resulting from the presence of hematopoietic cell populations with different genotypes. Consequently, red blood cells in such individuals may express different blood group antigens. Based on the timing and mechanism of formation, blood group chimerism can be classified as either congenital or acquired. Although congenital blood group chimerism is rare and involves complex mechanisms, it holds significant implications in transfusion medicine, transplantation, and obstetrics. This article reviews the formation mechanisms, detection methods, and clinical significance of congenital blood group chimerism in transfusion medicine. Particular emphasis is placed on the principles, advantages, and limitations of various detection techniques. Furthermore, the potential applications of these technologies in clinical diagnosis are discussed, providing a technical foundation for the development of precise transfusion strategies.

Objective:To review and synthesize the best evidence for non-surgical offloading management in patients with diabetic foot ulcers, so as to provide reference for clinical medical staff.Methods:A literature retrieval strategy was developed to search the related articles on the management of offloading in patients with diabetic foot ulcer on the websites and databases of various guidelines.The retrieval time limit was from the establishment of the database to June 15, 2024. The quality of the literature was evaluated by two graduate students, and the evidence was extracted and synthesized.Results:A total of 15 articles were included, including 5 guidelines, 8 systematic reviews/Meta-analyses, 1 expert consensus and 1 randomized controlled trial, the best 31 pieces of evidence were obtained from 5 aspects: assessment and screening of foot ulcers, preventive offloading intervention, selection of offloading devices, other offloading techniques, and structured education.Conclusions:The evidence of non-surgical offloading management in patients with diabetic foot ulcers summarized in this study is helpful for medical and nursing professionals to provide optimal nursing and treatment outcomes for patients with diabetic foot ulcers, it also reduces the risk of infection, hospitalization and amputation.

Objective:To explore the level of unmet need during chemotherapy for gastric cancer patients, analyze its dynamic trajectory and impact on the economic toxicity of chemotherapy.Methods:Convenience sampling was used to select 385 gastric cancer patients who received chemotherapy from June 2022 to December 2023 at the First Affiliated Hospital of Zhengzhou University. The level of unmet need for patients' first chemotherapy cycle (C 1) , second chemotherapy cycle (C 2) and third chemotherapy cycle (C 3) and economic toxicity at the end of chemotherapy were investigated separately. The latent class growth model (LCGM) was used to analyze classes of unmet need trajectories and to compare differences in patient economic toxicity across classes. Results:Finally 368 patients completed all data collection, and the effective response rate of survey respondents was 95.58%. As chemotherapy progressed, patients' unmet need scores gradually increased, and the unmet need scores of C 1, C 2, and C 3 were (35.54±5.44) , (47.32±6.45) , and (58.19±11.81) , respectively, which were categorized into three latent classes of medium-low level rapid increase group, medium level gradual increase group, and medium level stable group. There were 122 cases (33.15%) in medium-low level rapid increase group, 167 cases (45.38%) in medium level gradual increase group, and 79 cases (21.47%) in medium level stable group. The lowest economic toxicity score was found in medium-low level rapid increase group, followed by medium level gradual increase group, and the highest in medium level stable group, and the difference in economic toxicity scores among the three groups was statistically significant ( P<0.05) . The percentage of patients with positive economic toxicity in the three groups was 45.90% (56/122) , 28.14% (47/167) , and 18.99% (15/79) , respectively, with a statistically significant difference ( P<0.05) . Conclusions:Unmet needs of patients during chemotherapy for gastric cancer show a moderate to high level and gradually increase with the course of chemotherapy. The trajectory can be divided into three latent classes of medium-low level rapid increase group, medium level gradual increase group, and medium level stable group. There are differences in economic toxicity for patients with different classes of unmet need trajectories, with patients in increase or rapid increase groups facing severe economic toxicity.

Objective:To review and synthesize the best evidence for non-surgical offloading management in patients with diabetic foot ulcers, so as to provide reference for clinical medical staff.Methods:A literature retrieval strategy was developed to search the related articles on the management of offloading in patients with diabetic foot ulcer on the websites and databases of various guidelines.The retrieval time limit was from the establishment of the database to June 15, 2024. The quality of the literature was evaluated by two graduate students, and the evidence was extracted and synthesized.Results:A total of 15 articles were included, including 5 guidelines, 8 systematic reviews/Meta-analyses, 1 expert consensus and 1 randomized controlled trial, the best 31 pieces of evidence were obtained from 5 aspects: assessment and screening of foot ulcers, preventive offloading intervention, selection of offloading devices, other offloading techniques, and structured education.Conclusions:The evidence of non-surgical offloading management in patients with diabetic foot ulcers summarized in this study is helpful for medical and nursing professionals to provide optimal nursing and treatment outcomes for patients with diabetic foot ulcers, it also reduces the risk of infection, hospitalization and amputation.

Objective:To explore the level of unmet need during chemotherapy for gastric cancer patients, analyze its dynamic trajectory and impact on the economic toxicity of chemotherapy.Methods:Convenience sampling was used to select 385 gastric cancer patients who received chemotherapy from June 2022 to December 2023 at the First Affiliated Hospital of Zhengzhou University. The level of unmet need for patients' first chemotherapy cycle (C 1) , second chemotherapy cycle (C 2) and third chemotherapy cycle (C 3) and economic toxicity at the end of chemotherapy were investigated separately. The latent class growth model (LCGM) was used to analyze classes of unmet need trajectories and to compare differences in patient economic toxicity across classes. Results:Finally 368 patients completed all data collection, and the effective response rate of survey respondents was 95.58%. As chemotherapy progressed, patients' unmet need scores gradually increased, and the unmet need scores of C 1, C 2, and C 3 were (35.54±5.44) , (47.32±6.45) , and (58.19±11.81) , respectively, which were categorized into three latent classes of medium-low level rapid increase group, medium level gradual increase group, and medium level stable group. There were 122 cases (33.15%) in medium-low level rapid increase group, 167 cases (45.38%) in medium level gradual increase group, and 79 cases (21.47%) in medium level stable group. The lowest economic toxicity score was found in medium-low level rapid increase group, followed by medium level gradual increase group, and the highest in medium level stable group, and the difference in economic toxicity scores among the three groups was statistically significant ( P<0.05) . The percentage of patients with positive economic toxicity in the three groups was 45.90% (56/122) , 28.14% (47/167) , and 18.99% (15/79) , respectively, with a statistically significant difference ( P<0.05) . Conclusions:Unmet needs of patients during chemotherapy for gastric cancer show a moderate to high level and gradually increase with the course of chemotherapy. The trajectory can be divided into three latent classes of medium-low level rapid increase group, medium level gradual increase group, and medium level stable group. There are differences in economic toxicity for patients with different classes of unmet need trajectories, with patients in increase or rapid increase groups facing severe economic toxicity.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the effect of early protein supplementation on the clinical outcomes of elderly ICU patients with critically ill.Methods:The study was a post-hoc analysis of a multicenter, cluster randomized controlled trial (NEED trial), which aimed to evaluate the impact of feeding protocol on nutritional implementation and outcomes in ICU patients. It was planned to include elderly patients aged ≥70 years from the NEED trial, and patients who had not started nutritional therapy by the Day 3 after enrolment, stayed in the ICU less than 7 days, missing the primary outcome were excluded. The primary outcome of this study was 28-day mortality of enrolment. Patients were categorized into Q1 (<0.6 g/kg/d), Q2 (0.6-0.83 g/kg/d), and Q3 (≥0.83 g/kg/d) groups according to the tertiles of protein supply. The log-rank test was used to compare the Kaplan-Meier survival curves for 28-day mortality. The associations between different protein groups and 28-day mortality were tested by Cox proportional hazards regression models. Subgroup analysis was conducted in patients with high (mNUTRIC score≥5) nutritional risk or patients with baseline acute kidney injury.Results:A total of 789 elderly (≥70 years) patients was included in the study, with a mean protein amount of 0.69 (0.53, 0.91) g/(kg·d) during days 3-7 after ICU admission, and mean protein amounts in the Q1 low-protein group, the Q2 medium-protein group, and the Q3 high-protein group were 0.46 (0.36, 0.53), 0.69 (0.63, 0.76), and 1.03 (0.91, 1.23) g/(kg·d), respectively. The results showed that the medium protein group associated with lower 28-day mortality compared to the high protein group, and the association between the medium protein group and lower 28-day mortality still held after controlling for possible confounders by Cox multivariate regression analysis. In the high-nutritional risk subgroup (mNUTRIC≥5), a significant association was also found between the medium protein group and lower 28-day mortality.Conclusions:Early high protein supply are not beneficial for elderly ICU patients by this large sample size post-hoc analysis, and medium protein supply associate with lower 28-day mortality compared with the high protein group. This study may provide a theoretical basis for the optimal dose of early protein supply in elderly ICU patients, as well as a reference for clinical implementation.

Objective To observe and compare the resistance changes of ciprofloxacin (CIP), levofloxacin (LEV), norfloxacin (NOR) to Pseudomonas aeruginosa (PA), and choose the drug which had the best curative effect for PA from the drugs mentioned above.Methods Seven strain of non-repetitive PA which had sensitiveness to ciprofloxacin (CIP), levofloxacin (LEV), norfloxacin (NOR) and the same minimal inhibitory concentration (MIC) of the three drugs were co-cultured with CIP, LEV, NOR in concentrations of 0.5, 1.0, 2.0, and 4.0 times of MIC for evoked drug resistance, respectively.The MIC of CIP, LEV, and NOR to PA which evoked drug resistance by 3 kinds of concentration were detected by the methods of Epsilometer Test and Two-fold Agar Dilution.Results The MIC value of CIP to PA after evoking by 3 concentrations increased from 0.09 μg/ml before evoking to 0.25-16.00 μg/ml.The MIC after evoking was 3 to 178 times that before evoking.The MIC value of NOR to PA after evoking increased from 0.50 μg/ml before evoking to 2.00-64.00 μg/ml.The MIC after evoking was 4 to 128 times that before evoking.The MIC value of LEV to PA after evoking by 3 concentrations increased from 0.50 μg/ml before evoking to 2.00-32.00 μg/ml.The MIC after evoking was 2 to 64 times that before evoking.The differences of MIC of CIP to PA after evoking by different concentrations of CIP, NOR and LEV were not statistically significant (all P>0.05).The MIC value of NOR to PA after evoking by 4.0×MIC CIP was higher than that of evoking by 0.5×MIC CIP (P=0.006).The MIC value of NOR to PA after evoking by 4.0×MIC LEV was higher than that evoked by 1.0×MIC LEP (P=0.006).The MIC value of LEV to PA after evoking by 4.0×MIC CIP was higher than that of evoking by 0.5×MIC CIP (P=0.006).The MIC value of LEV to PA after evoking by 4.0×MIC NOR and LEV were higher than those evoked by 0.5×MIC NOR and LEV (all P=0.007).Conclusion PA can be evoked to develop resistance to different degrees after co-culturing with different concentrations of CIP, LEV, and NOR.The change of resistance of CIP to PA is the least among the three drugs mentioned above.It is suggested that CIP is still one of the best fluoroquinolones for the treatment of PA infection.

Objective To observe and compare the resistance changes of ciprofloxacin (CIP), levofloxacin (LEV), norfloxacin (NOR) to Pseudomonas aeruginosa (PA), and choose the drug which had the best curative effect for PA from the drugs mentioned above.Methods Seven strain of non-repetitive PA which had sensitiveness to ciprofloxacin (CIP), levofloxacin (LEV), norfloxacin (NOR) and the same minimal inhibitory concentration (MIC) of the three drugs were co-cultured with CIP, LEV, NOR in concentrations of 0.5, 1.0, 2.0, and 4.0 times of MIC for evoked drug resistance, respectively.The MIC of CIP, LEV, and NOR to PA which evoked drug resistance by 3 kinds of concentration were detected by the methods of Epsilometer Test and Two-fold Agar Dilution.Results The MIC value of CIP to PA after evoking by 3 concentrations increased from 0.09 μg/ml before evoking to 0.25-16.00 μg/ml.The MIC after evoking was 3 to 178 times that before evoking.The MIC value of NOR to PA after evoking increased from 0.50 μg/ml before evoking to 2.00-64.00 μg/ml.The MIC after evoking was 4 to 128 times that before evoking.The MIC value of LEV to PA after evoking by 3 concentrations increased from 0.50 μg/ml before evoking to 2.00-32.00 μg/ml.The MIC after evoking was 2 to 64 times that before evoking.The differences of MIC of CIP to PA after evoking by different concentrations of CIP, NOR and LEV were not statistically significant (all P>0.05).The MIC value of NOR to PA after evoking by 4.0×MIC CIP was higher than that of evoking by 0.5×MIC CIP (P=0.006).The MIC value of NOR to PA after evoking by 4.0×MIC LEV was higher than that evoked by 1.0×MIC LEP (P=0.006).The MIC value of LEV to PA after evoking by 4.0×MIC CIP was higher than that of evoking by 0.5×MIC CIP (P=0.006).The MIC value of LEV to PA after evoking by 4.0×MIC NOR and LEV were higher than those evoked by 0.5×MIC NOR and LEV (all P=0.007).Conclusion PA can be evoked to develop resistance to different degrees after co-culturing with different concentrations of CIP, LEV, and NOR.The change of resistance of CIP to PA is the least among the three drugs mentioned above.It is suggested that CIP is still one of the best fluoroquinolones for the treatment of PA infection.

AIM: To set the model of rat bone marrow me se nchymal stem cells (BMMSCs) that differentiate into cardiomyocytes and observe t he connection structure between cells. METHODS: BMMSCs were isolated by adhering to culture plates and cultured in vitro to expand. Induction of BMMSCs to differentiate into cardi omyo cytes was conducted by treating the cells with 5-aza. Immunocytochemical stainin g was used to identify sarcomeric actin and intercalated disc-like structure wh en the cells were cultured for additional 1 week, 2 or 3 weeks, respectively. RESULTS: Sarcomeric actin positive cells were observed in 1 week , 2 or 3 weeks after 5-aza treatment. Some cells stained positive for connexin4 3 at 1 week and 2 weeks after 5-aza treatment, with brown pellet located disper sively around nucleus. 3 weeks after 5-aza treatment, connexin43 positive cells s howed brown pellet arranging in thready structure around nucleus, such structure could be seen between very few cells which was similar to intercalated disc-lik e structure in normal heart tissue. CONCLUSION: During the process of BMMSCs differentiating into ca rdiomyocytes, intercalated disc-like structure is gradually formed with increas e in culture time and cell density.