Objective To establish a known HPA/HLA genotype platelet donor database in Nanjing,analyze the poly-morphism of HPA-1～6w,-15 and HLA-A,-B and evaluate the matching probability and appropriate capacity of the database for platelet matching transfusion.Methods HPA-1～6w,-15 and HLA-A,-B were genotyped by PCR-SSP and PCR-SBT,respectively.The allele frequency and haplotype frequency of HPA-1～6w,-15 and HLA-A,-B were calculated with SHEsis software,and then the matching probability and appropriate capacity were obtained according to the haplotype frequencies.Results The population genetic polymorphisms data of HPA-1～6w,-15 and HLA-A,-B in Nanjing were obtained.Accord-ing to the subsequent calculating,without considering ABO blood type,in a database size of 527 donors,a patient with hap-lotype frequency＞0.001 has approximate 95％probability to achieve matching of HPA-1～6w,-15 genotype.A database with a total size of 1 875 donors can afford the patient with haplotype frequency＞0.001 to find at least 1 HLA-A,-B matched donor in 95％probability.Conclusion We established a local platelet donor database with known HPA and HLA genotype,which also provided important data support for the subsequent construction,maintenance and clinical application of the data-base.

Objective:To compare the performance and surgical outcomes of domestic single-use digital flexible ureteroscopes with reusable digital flexible ureteroscopes in treatment of upper urinary stones.Methods:A prospective, single-blind, multicenter and randomized controlled study was performed from September 2018 to June 2019. Eligible patients were randomly assigned, in a ratio of 1∶1, to either experimental group or control group. The inclusion criteria for the study were: aged 18-75 years, solitary upper urinary stone with stone size between 0.8 and 2.0 cm and CT value less than 1 400 HU, negative preoperative urine culture and normal renal function. Exclusion criteria included: patients with acute urinary tract infection, intransitable urethral strictures, impassable ureteropelvic junction obstructions, systemic hemorrhagic disease, coagulation function abnormalities or bleeding tendency, severe hypertension or cardiopulmonary insufficiency, severe hip malformation and difficulty in meeting the demand of operation position and pregnant and lactation women. The device used in the experimental group was a domestic single-use digital flexible ureteroscope, and the device used in the control group was an imported Olympus digital flexible ureteroscope. The qualified rate of clinical comprehensive evaluation (including image quality and operational performance), the rate of device failure, the stone-free rate and the occurrence rate of adverse events (including increase in urine red blood cell and white blood cell counts, postoperative hematuria, nausea, vomiting, dizziness, and fever) in the two groups were recorded.Results:A total of 186 eligible study cases were collected from the People's Hospital of Wuhan University, the First Affiliated Hospital of Xiamen University, and the First Affiliated Hospital of Guangzhou Medical University. 90 cases in the final experimental group and 88 cases in the control group completed the trial and were included in the evaluation. There were no statistically significant differences among age [(48.40±11.36) vs. (47.40±12.53)years old, P=0.594], male to female ratio (62/28 vs. 56/32, P =0.874), BMI [(24.8±2.1) kg/m 2 vs. (25.1±2.0)kg/m 2,P =0.331], hydronephrosis (no/slight vs. mild/severe) (62/28 vs. 65/23, P =0.874), stone location and stone size [(12.8±4.7) mm vs. (11.9±5.2) mm, P =0.227]. There were no significant differences in terms of qualified rate of clinical comprehensive evaluation [98.9% (89/90) vs. 100.0% (88/88), P =0.991], lithotripsy success rate [84.4% (76/90) vs. 84.1% (74/88), P =0.888], device failure/defect rate (both 0%), and the incidence of adverse events [50.0% (45/90) vs. 52.0% (51/88), P =0.894]. The highest incidence of adverse events in two groups was the increase of red blood cells and white blood cells of routine urine after operation. There was no serious adverse event in the experimental group and 1 serious adverse event in the control group. Conclusions:There was no significant difference in image quality, device failure/defect rate, lithotripsy success rate, and adverse event rate between single-use digital flexible ureteroscopes and reusable digital flexible ureteroscopes for lithotripsy of upper ureteral and pelvic stones. Domestic single-use digital flexible ureteroscopes have good safety and effectiveness in the treatment and microscopy of upper urinary tract stones.

To characterize the clinical and molecular features of a patient with maturity-onset diabetes of the young 11(MODY11) and literature review. The patient was a 30-year-old female with hyperglycemia for 2 years. Failure to thrivea, primary amenorrhea, intellectual impairment, and severe hyperlipidemia were present at the same time. A novel mutations of the B lymphocyte kinase gene(BLK) c. 1025C>T(p.A342V) was found in the patient. Literature review revealed that there were more than ten mutation sites in BLK-MODY11. Some of them had hyperglycemia, over weight or systemic lupus erythematosus. To date, the clinical characteristics of the patient, such as growth retardation, primary amenorrhea, and intellectual impairment have not been reported in MODY11. Our clinical report further expands the clinical presentations and variabilities of MODY11.

Objective:To investigate the effect of a single-trial transcranial direct current stimulation(tDCS) of the dorsolateral prefrontal cortex (DLPFC) on fairness-related decision-making behavior.Methods:From September 2018 to February 2019, a total of 60 healthy participants between the ages of 18 and 45 were enrolled.Then, the participants were randomly divided into 3 groups with 20 in each group to receive left anode stimulation/right cathode stimulation (left anode /right cathode group), left cathode/right anode stimulation (left cathode /right anode group) or bilateral control electrodes (sham stimulation group) on the bilateral dorsolateral prefrontal cortices (DLPFC), respectively.After tDCS, the participants immediately completed the ultimatum game (UG) task as responders and a fairness questionnaire in turn.SPSS 22.0 statistical software was used to analyze the data with repeated measurement ANOVA and nonparametric test.Results:In the UG task, there was no significant difference in the acceptance rate among the three groups of participants as responders (all P>0.05). When analyzing the acceptance rate facing different proposers (" computer" and " human" ) under different fairness levels in the three stimulus types through the paired samples Wilcoxon test, it was found that the acceptance rate of the sham stimulation group to the extremely unfair proposals proposed by the human opponent was lower than that proposed by the computer(0.28 (0, 0.67), 0.44 (0.33, 0.89), Z=-2.14, P=0.032), while there was no difference in acceptance rates (both P>0.05) in the face of fair or unfair proposals proposed by computer and human opponents.The acceptance rate of the left cathode /right anode group to the unfair(0.90 (0.50, 1.00), 1.00 (0.70, 1.00), Z=-1.90, P=0.046)or extremely unfair(0.44 (0, 1.00), 0.89 (0.50, 1.00), Z=-2.73, P=0.006) proposals proposed by human opponents was significantly lower than the proposals proposed by computer opponent, and there was no differences in acceptance rate when facing fair proposals proposed by computer and human opponents ( P> 0.05). There were no significant differences in acceptance rates in the left anode /right cathode group when faced with fair, unfair, and extremely unfair schemes proposed by computer and human opponents (all P>0.05). For fairness questionnaire scores, a repeated measurements ANOVA showed that the interaction effect between group and proposer types was not significant ( F(2, 54)=2.037, P=0.140), and the group main effect was not significant ( F(1, 54)=0.165, P=0.848), but the proposer type main effect was significant ( F(1, 54)=6.363, P=0.015), indicating that the fairness questionnaire score in the face of the human opponents was lower than when facing the computer opponents( P<0.05). Conclusion:Although a single-trial tDCS on bilateral DLPFC has no significant effect on the overall acceptance rate of fairness-related decision-making, it affects the decision-making of unfair distribution scheme proposed by human or computer.

Objective:To analyze the genetic characteristics of Brucella strains isolated from a human brucellosis epidemic in Baoding City of Hebei Province, and to provide scientific basis for control and prevention of brucellosis. Methods:Brucella antibody was detected in a high-risk population ( n=22) of brucellosis in Baoding City in 2018 by using rose bengal plate test and tube agglutination test. Blood samples of patients with brucellosis were collected for Brucella isolation ( n=3). Conventional methods were used to identify the bacteria strains. Multiple locus variable-number tandem repeat analysis (MLVA) and multilocus sequence typing (MLST) were used to analyze the genetic characteristics of the strains. Results:The sero-prevalence of Brucella antibodies in high-risk populations was 4.55% (1/22). Three suspected Brucella strains were isolated from blood samples of three patients (No. BDY-1, BDY-2 and BDY-3) and were identified as Brucella melitensis biovar 3. The results of MLVA showed that strain BDY-1 and strain BDY-2 were the same genotype. Strain BDY-3 added two tandem repeats at the locus of Bruce04 and Bruce16, respectively, and lost three tandem repeats at the locus of Bruce30. The genotype of panel 1 (MLVA-8) and panel 1 + panel 2A (MLVA-11) were 42 and 116, respectively, which belonged to the "East Mediterranean group". They were closely clustered with Brucella melitensis biovar 3. MLST analysis showed that all isolated strains could be classified into a ST8 type. Conclusions:The isolated strains from the epidemic are Brucella melitensis biovar 3. In the future, the prevention and control of brucellosis in Baoding City should strengthen the health education and behavior intervention of the high-risk population.

【Objective】 To analyze the allele frequencies of the human platelet antigens 1-29 system (HPA-1-29bw) in Nanjing Han platelet donors, so as to provide references for compatible platelet transfusion. 【Methods】 HPA genotyping was performed by Sanger sequencing method in 900 Nanjing Han regular platelet donors who donated at Jiangsu Province Blood Center from February to September 2019. The frequencies of alleles and genotype were calculated using direct counting method. 【Results】 The HPA allele frequencies in Nanjing Han platelet donors were HPA-1a 0.9950, 1b 0.0050, 2a 0.9467, 2b 0.0533, 3a 0.5850, 3b 0.4150, 4a 0.9989, 4b 0.0011, 5a 0.9822, 5b 0.0178, 6a 0.9828, 6b 0.0172, 11a 0.9994, 11b 0.0006, 15a 0.5317, 15b 0.4683, 21a 0.9928 and 21b 0.0072, respectively. Only a allele was detected in HPA-7-10w, -12-14w, -16-20w and -22-29bw systems.The highest mismatch rate of HPA genes in 900 platelet donors was HPA-15 system, followed by HPA-3 system, with the rate of 37.40%(337/900) and 36.77%(331/900), respectively. One heterozygote was detected in HPA-11w system. 【Conclusion】 The chracteristics of HPA alleles frequencies in Nanjing Han platelet donors is that HPA-15 and HPA-3 are the most common heterozygotes, which should be paid attention to in local clinical transfusion.

Objective:To investigate the therapeutic effect of nicorandil on patients with coronary heart disease after interventional therapy, and its influence on serum matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF) and vascular endothelial function.Methods:From January 2018 to December 2019, 120 patients with coronary heart disease who underwent percutaneous coronary intervention(PCI) were selected from Jinhua People's Hospital.They were divided into control group (60 cases) and observation group (60 cases) according the random digital table method.The control group received rosuvastatin on the second day after PCI, and the observation group received nicorandil on the second day after PCI.The course of treatment in both two groups was 12 weeks.The treatment effects, cardiac function, MMP-9, VEGF and vascular endothelial function were compared between the two groups before and after treatment.Results:The total effective rate of the observation group[93.33%(56/60)] was higher than that of the control group[75.00%(45/60)](χ 2=7.566, P<0.05). After treatment, the LVEF [(46.97±1.78)%] of the observation group was higher than that of the control group [(43.83±2.19)%], while the LVEDD [(56.14±2.37)mm] and LVESD [(47.83±2.69)mm] of the observation group were lower than those of the control group [(61.08±2.96)mm and (52.37±2.73)mm], and the difference was statistically significant between the two groups( t=8.618, 10.091, 9.176, all P<0.05). The levels of MMP-9 [(2.36±0.43)μg/L] and VEGF [(45.26±6.89)ng/L] in the observation group were lower than those in the control group [(3.74±0.64)μg/L and (58.42±7.21)ng/L] ( t=13.864, 10.221, all P<0.05). The level of serum NO [(62.31±6.98)μmol/L] in the observation group was higher than that in the control group [(54.39±4.51)μmol/L], while ET-1 [(58.74±6.21)μg/L] was lower than that in the control group [(76.29±4.56)μg/L], and the differences were statistically significant between the two groups( t=7.382, 17.645, all P<0.05). Conclusion:Nicorandil is effective in the treatment of patients with coronary heart disease, and can reduce the levels of MMP-9 and VEGF in serum, and improve the function of vascular endothelium.

Objective:To evaluate the effect of general anesthesia on microelectrode recording (MER) during deep brain stimulation (DBS) of subthalamic nucleus (STN) in the patients with primary Parkinson′s disease (PD).Methods:Forty-four patients of both sexes with primary PD (duration of disease ≥ 5 yr and/or obvious symptom fluctuation), undergoing bilateral STN DBS from March 2008 to March 2018, aged<80 yr, were selected and divided into 2 groups by a random number table method: awake group ( n=26) and general anesthesia group ( n=18). In awake group, 0.5% ropivacaine was used for incision infiltration at skin incision.Patients in GA group received propofol and remifentanil by target-controlled infusion with Narcotrend to monitor the depth of anesthesia, and 0.5% ropivacaine was used for incision infiltration at skin incision.The total number of trajectories and length of STN were recorded during MER.Movement disorders were evaluated at 1 week before surgery and 6 months after surgery, and the improvement rate of dyskinesia was calculated.The postoperative anesthesia-, hardware- and stimulation-related complications were recorded. Results:There were no significant differences between the two groups in the total number of trajectories, length of STN and improvement rate of postoperative movement disorders ( P>0.05). Conclusion:General anesthesia does not affect the MER during STN DBS in the patients with primary PD.

OBJECTIVE: To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China. METHODS: The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI. RESULTS: A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI. CONCLUSIONS The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.
Abdomen ; surgery ; Adult ; Aged ; China ; Cross-Sectional Studies ; Female ; General Surgery ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; prevention & control ; Preoperative Period ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; prevention & control

Objective To investigate the association between the nutritional status and related factors in patients with Parkinson's disease (PD).Methods Seventy-two patients with PD (PD group) and 71 age-and sex-matched healthy controls (control group) were enrolled in this study from September 2014 to November 2017 at the First Affiliated Hospital of Sun Yat-sen University.Their serum nutritional indices,including serum albumin,prealbumin,transferrin,free fatty acid and retinol conjugated protein,were collected.The PD participants were interviewed and assessed using motor and non-motor scales,including Hoehn and Yahr stage,Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS),Non-Motor Symptoms Questionnaire for Parkinson's Disease (NMSS),Mini-Mental State Examination (MMSE),Unified Dyskinesia Rating Scale (UDysRS) and 39-item Parkinson's Disease Questionnaire (PDQ-39).Their medication dosage was indicated by daily levodopa equivalent doses (LEDD).Body mass index (BMI) was used to determine their nutritional status,with abnormal nutritional status defined as BMI lower than 20 kg/m2.Results Levels of serum albumin (41.60 (40.28,43.98) g/L vs 44.00 (42.30,46.20) g/L,Z=4.500,P＜0.01),transferrin ((2.32±0.34) g/L vs (2.51±0.34) g/L,t=-3.305,P=0.001),and free fatty acid (418.00 (289.75,637.25) μmol/L vs 547.00 (386.00,699.00) μmol/L,Z=2.079,P=0.038) of the PD group were significantly lower than those of the control group.There was a significant negative correlation between serum albumin and MDS-UPDRS-Ⅱ score (r=-0.254,P=0.031),MDS-UPDRS-Ⅳ score (r=-0.256,P=0.030),years of dyskinesia (r=-0.240,P=0.043),years of motor fluctuation (r=-0.304,P=0.009) and LEDDs (r=-0.321,P=0.006).Disease duration was negatively correlated with serum albumin (r=-0.285,P=0.015) and transferrin (r=-0.275,P=0.019),and age (r=-0.252,P=0.032) was negatively correlated with prealbumin.The forward binary Logistic regression model indicated that abnormal nutritional status was closely associated with rigidity (OR=1.171,95％CI 1.013-1.354,P=0.032),akinesia (OR=1.070,95％CI 1.000-1.144,P=0.048),UDysRS score (OR=1.051,95％CI 1.004-1.099,P=0.032),MDS-UPDRS-Ⅳ score (OR=1.177,95％CI 1.018-1.360,P=0.027) and MMSE score (OR=0.821,95％CI 0.678-0.994,P=0.043),but not correlated with tremor and axial symptoms.Compared with PD patients with abnormal nutritional status,PD patients with normal nutritional status had higher MMSE scores (28.00 (27.00,29.00) vs 28.00 (25.00,28.00),Z=-2.060,P=0.039),lower rigidity (9.60±3.83 vs 12.00±4.29,t=-2.264,P=0.027),akinesia (19.98 ± 8.00 vs 24.42:±:8.06,t=-2.071,P=0.042) and MDS-UPDRS-Ⅳ scores (8.00 (5.00,11.00) vs 10.00 (9.00,13.00),Z=2.642,P=0.008).Conclusions PD patients tend to have a lower serum nutritional indices.PD patients with lower levels of serum nutritional indices are characterized by more severe motor complication,longer disease duration,older age and higher LEDD.PD patients with abnormal nutritional status have worse cognition and more severe motor symptoms (rigidity,akinesia and motor complication).