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.

[This corrects the article DOI: 10.11909/j.issn.1671-5411.2017.08.005.].

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objectives:To analyze the risk factors of atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy(NOHCM)and explore the relationship between left ventricular/atrial volume and atrial fibrillation.Methods:Consecutive NOHCM patients admitted at Fuwai Hospital from January 2023 to January 2024 with complete clinical data,satisfactory echocardiography imaging data were included in this analysis,patients were divided into atrial fibrillation group(n=28)and non-atrial fibrillation group(n=57).Left-sided volumetric and functional parameters were measured by one-beat real-time full-volume three-dimensional echocardiography,including left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),left atrial volume(LAV).The left ventricular end-diastolic volume(LVEDVi)index,left ventricular end-systolic volume index(LVESVi)and left atrial volume index(LAVi)were calculated.Other echocardiographic parameters including interventricular septum(IVSmax)thickness,left ventricular posterior wall thickness(LVPW),and left atrial diameter(LAD)were routinely measured.Mitral valve forward flow spectrum,tissue Doppler,tricuspid regurgitation velocity,and left atrial size were used to evaluate the left ventricular diastolic function of patients,and diastolic dysfunction was classified into grade I,II,and III.Multivariate logistic regression was used to analyze the influencing factors of atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy Results:Compared with the non-atrial fibrillation group,LVEDV([143.8±26.7]ml vs.[117.1±21.9]ml)and LVEDVi([79.4±11.9]ml/m2 vs.[64.2±10.6]ml/m2)were smaller in atrial fibrillation group(both P<0.001).Compared with the non-atrial fibrillation group,LAD([40.2±4.7]mm vs.[48.6±4.8]mm)and LAVi([37.3±8.9]ml/m2 vs.[64.4±17.1]ml/m2)were lager in atrial fibrillation group(both P<0.001).Compared with the non-atrial fibrillation group,the proportion of NYHA functional classification≥Ⅲ was higher(15.8%vs.50.0%,P<0.001),LVEF was lower([61.5±5.5]%vs.[57.6±5.0]%,P=0.002),and proportion of severe diastolic dysfunction was higher in atrial fibrillation group(P<0.001).Logistic regression analysis showed that the factors associated with atrial fibrillation in NOHCM patients were LVEDVi(OR=0.744,95%CI:0.575-0.962,P=0.024)and LAVi(OR=1.602,95%CI:1.032-2.486,P=0.036).Conclusions:LVEDVi and LAVi are related factors for atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy.LVEDVi is negatively,while LAVi is positively associated with the occurrence of atrial fibrillation in NOHCM patients.

Approximately 300 million tons of plastic are produced globally each year,which has a serious impact on human health,marine life and the livestock industry.Microplastics have also been detected in meat and milk samples.Research has shown that nanoplastics(NP)(＜1 μm)and mi-croplastics(MP)(1 μm-5 mm)can affect the digestive,immune and reproductive systems of ani-mals.This experiment aims to investigate whether NP and MP regulate autophagy and damage the nervous system and spatial memory of animals.This experiment was divided into control group,nanoplastic group(PS-NP group,0.1 μm)and microplastic group(PS-MP group,1 μm),with 20 mice in each group.The mice were given 0.5 mL of PS-NP and PS-MP every day for 35 consecutive days,followed by neck amputation and brain analysis.The results showed that NPs and MPs of dif-ferent diameters caused varying degrees of damage to the brains of mice.In the behavioral tests of new object recognition,barnes maze and Y-shaped maze spatial memory,compared with the control group,the PS-NP group and PS-MP group showed a significant decrease in spatial memory ability of mice.HE staining results showed that neuronal cells in the PS-NP and PS-MP groups of mice exhibited shrinkage,decreased cell volume and deepened staining.The number of Nissl bodies de-creased,leading to dissolution and disappearance.RT-PCR and Western blot results showed that compared with the control group,the expression of glutamate receptors NR1,NR2A and NR2B in-creased in mice administered NP and MP orally,while the expression of autophagy related proteins Parkin,LC3B and Beclin1 was inhibited.In summary,this study suggests that nanoplastics and mi-croplastics stimulate glutamate receptors in mice by inhibiting the autophagy pathway,leading to impaired spatial memory.

Aim To investigate the regulatory mecha-nisms of donepezil on the expression and enzymatic ac-tivity of cytochrome P450 3A4(CYP3A4),elucidate the synergistic impact of hypoxia on CYP3A4 function,and reveal its potential association with drug-induced cardiotoxicity,particularly QT interval prolongation.Methods Western blot,co-immunoprecipitation,and gene knockdown techniques were employed to evaluate the effects of donepezil and hypoxia on CYP3A4 pro-tein expression.CYP3A4 enzymatic activity was as-sessed using an in vitro incubation system with rat liver microsomes combined with high-performance liquid chromatography(HPLC),and the half-maximal inhib-itory concentration(IC50)was determined.Results Donepezil(10 μmol·L-1)and hypoxia reduced CYP3A4 protein expression to 31.75％and 45.90％of the control levels,respectively.Both interventions activated the gp78-mediated ubiquitin-proteasome path-way,significantly increasing CYP3A4 ubiquitination levels by 2.1-fold compared to the control group,thereby promoting proteasomal degradation.Donepezil inhibited CYP3A4 enzyme activity with an IC50 of 83.4μmol·L-1,and hypoxia synergistically enhanced this inhibitory effect,reducing the IC50 to 20.79 μmol·L-1.Conclusion Donepezil downregulates CYP3A4 function through dual mechanisms involving ubiquitin-mediated proteasomal degradation and direct enzymatic inhibition.Hypoxia potentiates this effect,leading to impaired metabolism of CYP3A4 substrate drugs,ele-vated plasma drug concentrations(1.6-2.3-fold in-crease compared to normal metabolic conditions),and an increased risk of QT interval prolongation and other forms of cardiotoxicity.

Objective:To investigate the application and safety of cardiopulmonary bypass precharge with 4% succinylated gelatin during surgery for children with cyanotic congenital heart disease (CCHD).Methods:A prospective case-control study was conducted. One hundred and thirty children with CCHD undergoing cardiac surgery admitted to Shaanxi Provincial People's Hospital in 2021-2024 were selected as study participants. Participants were divided into control group ( n=65) and gelatin group ( n=65) by random number table method based on the principle of matching baseline characteristics between groups. Children in the control group were pre-filled with 10-20 ml/kg of fresh frozen plasma, while the gelatin group was pre-filled with 10-20 ml/kg of 4% succinyl gelatin. Thrombelastogram parameters [fibrin formation time, blood clot strength, fibrinogen maximum amplitude, fibrinogen content], hematological parameters [platelet count, prothrombin time (PT), prothrombin activity (PTA), hemoglobin], myocardial function [troponin, creatine kinase, creatine kinase isoenzyme (CK-MB)] and liver-kidney function were compared before and after treatment.Measurement data with normal distribution was expressed as " xˉ±s", independent sample t-test was used on comparison between groups, paired t-test was used for intra-group comparisons before and after treatment. Counting data was expressed as rate or composition ratio, χ2 test was used on comparison between groups. Results:Comparison between groups showed that before treatment, the difference of various thromboelastography parameters, haematological parameters, myocardial function indexes, liver and kidney function indexes were not statistically significant ( P>0.05). Compared to before treatment, R, PTA, troponin and creatine kinase increased in both groups after treatment [control group:(51±4) s vs. (43±3) s, (98±15)% vs. (95±12)%, (0.624±0.085) μg/L vs. (0.040±0.005) μg/L, (711±50) U/L vs. (96±11) U/L, (60±7) U/L vs. (22±4) U/L, t values were -17.92、-2.13、-104.63、-165.15、-57.43, respectively, all P<0.001; gelatin group: (51±4) s vs. (42±3) s, (100±16)% vs. (94±13)%, (0.631±0.113) μg/L vs. (0.041±0.004) μg/L, (717±52) U/L vs.(97±11) U/L, (62±7) U/L vs.(24±4) U/L, t values were -19.79、-3.09、-81.31、-157.70、-54.67, respectively, all P<0.001], while MA, MAf, FLEV, platelet count, PT and hemoglobin decreased [control group: (50±4) mmHg vs. (57±5) mmHg、(5.5±0.9) mmHg vs. (13.8±1.3) mmHg、(1.58±0.22) g/L vs.(2.64±0.31) g/L、(217±21)×10 9/L vs. (275±25)×10 9/L、(13.3±0.5) s vs.(14.7±0.8) s、(116±12) g/L vs.(127±17) g/L, t values were 14.79、61.26、32.25、20.58、17.21、6.09,respectively, all P<0.001; gelato group: (49±3) mmHg vs. (57±5) mmHg、(5.7±0.8) mmHg vs. (14.0±1.4) mmHg、(1.62±0.27) g/L vs.(2.59±0.26) g/L、(214±20)×10 9/L vs.(273±23)×10 9/L、(13.4±0.5) s vs.(14.7±0.8) s、(114±12) g/L vs.(128±17) g/L, t values were 16.34、62.05、29.51、22.77、14.91、7.41, respectively, all P<0.001], but the differences between groups were not statistically significant (all P>0.05). The difference of albumin, alanine aminotransferase, aspartate aminotransferase and creatinine before and after treatment were not statistically significant (all P>0.05). Conclusion:4% succinylated gelatin does not increase the risk of coagulation dysfunction during perioperative period in children with CCHD. It has small influence on liver-kidney function and has high safety.

Objective To evaluate the application effect of perioperative cluster nursing interventions in patients under-going robot-assisted radical prostatectomy.Methods A total of 122 prostate cancer patients who underwent robot-assisted sur-gery from January 2023 to December 2024 were divided into the control group(routine care,55 cases)and the observation group(cluster nursing,67 cases)according to the nursing methods.The psychological status,surgery-related indicators,postoperative recovery,incidence of perioperative complications,and patient satisfaction were compared between the two groups.Results The observation group demonstrated a statistically significant decrease in postoperative anxiety and depression scores compared to the control group(P=0.034,P=0.005).The observation group exhibited shorter operative time and less intraoperative blood loss,with both differences being statistically significant(P=0.016,P＜0.001).In terms of postoperative recovery,the obser-vation group showed faster recovery of bowel function,shorter time for catheter insertion and postoperative hospital stay compared to the control group(P=0.010,P＜0.001,P＜0.001).In the observation group,the incidence of systemic postoperative in-fection was lower than that of the control group(4.5％vs 18.2％,P=0.015).The perioperative hypothermia rate in the obser-vation group was lower than that of the control group(38.8％vs 60.0％,P=0.020).There was no statistically significant difference in postoperative urinary fistula rate between the two groups(P=0.477).The observation group achieved an overall patient satisfaction rate of 98.51％,with higher satisfaction scores compared to the control group(P=0.008).Conclusion Perioperative cluster nursing measures yield favorable outcomes in patients undergoing robot-assisted radical prostatectomy.It can not only shorten the operation time,promote the postoperative recovery of patients,but also reduce the anxiety and depression of patients and complica-tions,and improve patient satisfaction.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective:This study aims to explore the characteristics of body temperature(BT)of the elderly population in China and the relationship with health status.Methods:This is a cross-sectional study.The data were derived from the China Health and Nutrition Study(CHNS)in 2015.A total of 4 176 elderly people over 60 years old were enrolled for analysis(1968 males, and 2208 females). The participants were divided into three groups according to their BT values: hypothermia group(BT<36.5℃), moderate BT group(36.5℃≤BT<37.0℃), and hyperthermia group(37.0℃≤BT<37.5℃). The differences in health status among each group were compared based on the disease conditions(four-week prevalence rate)in the past four weeks.Multivariate logistic regression analysis was performed to explore the relationships between BT and the four-week prevalence rate.Results:Among the elderly population included in the analysis, the average age was 68.4 ± 6.9 years(ranging from 60 to 99 years). The average BT of the elderly was 36.40 ± 0.37℃(males: 36.42 ± 0.37℃; females: 36.38 ± 0.37℃).3 348 study subjects were aged between 60-74 years old, while 828 study subjects were aged between75-99 years old.The older the age, the lower the body temperature.Of the participants, 2 212(53.0%)elderly people belonged to the hypothermia group, 1 656(39.6%)belonged to the moderate BT group, and 308(7.4%)belonged to the hyperthemia group.Among 4 176 elderly people, a total of 1368 had suffered from disease in the past four weeks(31.3%)The four-week prevalence rates of each group were as follows: the hypothermia group(33.1%), the moderate BT group(29.8%); hyperthemia group(26.6%)( χ2=8.403, P=0.015). Multivariable logistic regression analysis indicated that for every 1℃ increases in BT among the elderly, the four-week prevalence rate decreased by 22%( OR=0.78, 95% CI=0.65-0.94, P=0.01). Conclusions:The BT of the elderly is generally lower than the current standard, and the lower the BT, the higher the four-week prevalence rate.Raising the BT of the elderly may help them improve their physical condition.