Objective: To analyze the causes of abnormal blood agglutination caused by high-titer cold antibodies in blood donors from a serological perspective. Methods: The donor's blood type was identified using the tube method. Direct antiglobulin test (DAT), indirect antiglobulin test (IAT), and antibody titer detection were performed on the samples. Results: The blood type of the donor was type B, and the DAT was negative. No complement components were detected on the surface of the donor's red blood cells. The supernatant of the suspended red blood cells was clear without abnormal coloration, and the agglutinated clumps were intact and difficult to dissociate. The antibody was identified as an IgM-type anti-IH cold agglutinin. At 4℃, this antibody reacted with autologous red blood cells, adult group B red blood cells, adult group O red blood cells, cord blood group B red blood cells and cord blood group O red blood cells, with a stronger reaction intensity observed with group O cells than with B cells. The titers were 512, 128, 256, 32 and 128, respectively. Conclusion: High-titer anti-IH can cause abnormal agglutination of blood at low temperatures. During blood distribution and clinical use, the appearance of blood products shall be strictly inspected to prevent the release of non-conforming blood products.

Objective:To observe the clinical efficacy of Tuina(Chinese therapeutic massage)plus Liu Zi Jue for adenoid hypertrophy(AH)due to Qi deficiency of lung and spleen and its effects on the adenoid-nasopharyngeal cavity ratio(A/N value)and traditional Chinese medicine(TCM)constitution scale score.Methods:A total of 64 children with AH due to Qi deficiency of the lung and spleen were randomized into a trial group and a control group,with 32 cases in each group.The trial group was treated with Tuina plus Liu Zi Jue,and the control group was treated with Tuina alone.The Tuina manipulations were the same in the two groups.Tuina treatment was performed 3 times a week,with an interval of at least 1 d.Liu Zi Jue was performed 2 sets each time and 5 times a week.After 8 weeks of treatment and at the 2-month follow-up,the clinical efficacy was compared between the two groups,and the changes in the main clinical symptom score,A/N value,and TCM constitution scale score were observed.Results:After treatment,the total effective rate of the trial group and the control group was 96.9%and 93.8%,respectively.The difference between the two groups was not statistically significant(P>0.05).At the follow-up,the total effective rate of the trial group was 93.8%,higher than 90.6%in the control group(P<0.05).After treatment and at the follow-up,the main clinical symptom score in both groups was lower than that before treatment(P<0.05);at the follow-up,the main clinical symptom score in the trial group was lower than that in the control group(P<0.05).After treatment,the A/N value in both groups was lower than that before treatment(P<0.05),and the value in the trial group was lower than that in the control group;however,the difference between the two groups was not statistically significant(P>0.05).After treatment and at the follow-up,the TCM constitution scale score in both groups was lower than that before treatment(P<0.05);the score after treatment in the trial group was lower than that in the control group(P<0.05).Conclusion:Tuina plus Liu Zi Jue can effectively improve the main clinical symptoms in children with AH due to Qi deficiency of lung and spleen,reduce the A/N value and TCM constitution scale score,with stable efficacy.

Objective:To explore the effect of preoperative gamma-glutamyl transferase to albumin ratio (GAR) on prognosis of patients with Barcelona clinic liver cancer (BCLC)stage 0-A hepatocellular carcinoma (HCC) after microwave ablation (MWA).Methods:The clinical data of 201 patients with BCLC stage 0 to A who underwent MWA at two centers of Jiaxing Second Hospital and Shengjing Hospital of China Medical University from January 2011 to December 2018 were retrospectively analyzed, including 152 males and 49 females, aged (57.5±9.6) years. X-tile software was used to divide patients into a low GAR group ( n=84, GAR<0.9) and a high GAR group ( n=117, GAR≥0.9). Kaplan-Meier method was used for survival analysis, and log-rank test was used for survival comparison. Univariate and multivariate Cox regression analysis was used to evaluate the relationship between GAR and prognosis. Results:The cumulative survival rates at 1, 3 and 5 years postoperatively were 98.7%, 93.8%, 78.5% for the low GAR group, which were superior to that 97.2%, 87.1%, 70.2% for the high GAR group, and the difference was statistically significant ( χ2=11.89, P=0.001). The recurrence-free survival rates at 1, 3 and 5 years after surgery between the two groups was no significant difference ( χ2=1.70, P=0.192). Multivariate analysis revealed that high GAR ( HR=2.723, 95% CI: 1.508-4.914, P=0.001) was independent risk factors for overall survival after MWA in patients with BCLC stages 0 to A HCC. Male gender ( HR=1.959, 95% CI: 1.127-3.305, P=0.017) and tumor diameter ≥2 cm ( HR=1.547, 95% CI: 1.008-2.373, P=0.046) were independent risk factors for recurrence after MWA in patients with BCLC stages 0 to A HCC. Univariate analysis, GAR≥0.9 was not associated with postoperative recurrence ( HR=1.315, 95% CI: 0.869-1.989, P=0.195). Conclusion:Preoperative GAR (≥0.9) is an independent risk factor affecting overall survival in patients with BCLC stages 0 to A HCC after MWA.

Objective:To explore the efficacy and safety of olverembatinib in treatment of chronic myeloid leukemia (CML) progressed to acute lymphoblastic leukemia with D241E mutation.Methods:The diagnosis and treatment of a patient with D241E mutant CML progressed to acute lymphoblastic leukemia admitted to the Fourth People's Hospital of Jinan in December 2018 were retrospectively analyzed, and relevant literature was reviewed.Results:The patient was a 47-year-old female, and her blood test result was abnormal during physical examination. She was diagnosed as CML and received treatment with imatinib and dasatinib for 2 years. The disease progressed to philadelphia chromosome (Ph)-positive acute B-lymphoblastic leukemia with BCR-ABL mutation (a D241E mutation). After 3 courses of chemotherapy combined with a targeted drug (ponatinib), the patient achieved complete remission, while the minimal residual disease continued to be positive. The patient received 1 course of chemotherapy combined with olverembatinib from the 4th course of treatment. After olverembatinib monotherapy maintenance therapy for 36 months, the patient achieved molecular complete remission with minimal residual disease. The patient developed complications such as skin pigmentation and elevated lipid levels, but all complications were tolerable.Conclusions:The application of olverembatinib in D241E mutant CML progressed to acute lymphoblastic leukemia can help patients obtain sustained molecular biological remission and good safety.

Tailored lipid nanoparticles (LNPs)-mediated small interfering RNA (siRNA) nanomedicines show promise in treating liver disease, such as acute liver injury (ALI) and non-alcoholic steatohepatitis (NASH). However, constructing LNPs that address biosafety concerns, ensure efficient delivery, and target specific hepatic subcellular fractions has been challenging. To evade above obstacles, we develop three novel self-degradable "gemini-like" ionizable lipids (SS-MA, SS-DC, SS-MH) by incorporating disulfide bonds and modifying the length of ester bond and tertiary amino head. Our findings reveal that the disulfide-bond-bridged LNPs exhibit reduction-responsive drug release, improving both biosafety and siRNA delivery efficiency. Furthermore, the distance of ester bond and tertiary amino head significantly influences the LNPs' pK _a, thereby affecting endosomal escape, hemolytic efficiency, absorption capacity of ApoE, uptake efficiency of hepatocytes and liver accumulation. We also develop the modified-mannose LNPs (M-LNP) to target liver macrophages specifically. The optimized M-MH_LNP@TNFα exhibits potential in preventing ALI by decreasing tumor necrosis factor α (TNFα) levels in the macrophages, while MH_LNP@DGAT2 could treat NASH by selectively degrading diacylglycerol O-acyltransferase 2 (DGAT2) in the hepatocytes. Our findings provide new insights into developing novel highly effective and low-toxic "gemini-like" ionizable lipids for constructing LNPs, potentially achieving more effective treatment for hepatic diseases.

Objective:To observe the clinical efficacy of Tuina(Chinese therapeutic massage)plus Liu Zi Jue for adenoid hypertrophy(AH)due to Qi deficiency of lung and spleen and its effects on the adenoid-nasopharyngeal cavity ratio(A/N value)and traditional Chinese medicine(TCM)constitution scale score.Methods:A total of 64 children with AH due to Qi deficiency of the lung and spleen were randomized into a trial group and a control group,with 32 cases in each group.The trial group was treated with Tuina plus Liu Zi Jue,and the control group was treated with Tuina alone.The Tuina manipulations were the same in the two groups.Tuina treatment was performed 3 times a week,with an interval of at least 1 d.Liu Zi Jue was performed 2 sets each time and 5 times a week.After 8 weeks of treatment and at the 2-month follow-up,the clinical efficacy was compared between the two groups,and the changes in the main clinical symptom score,A/N value,and TCM constitution scale score were observed.Results:After treatment,the total effective rate of the trial group and the control group was 96.9%and 93.8%,respectively.The difference between the two groups was not statistically significant(P>0.05).At the follow-up,the total effective rate of the trial group was 93.8%,higher than 90.6%in the control group(P<0.05).After treatment and at the follow-up,the main clinical symptom score in both groups was lower than that before treatment(P<0.05);at the follow-up,the main clinical symptom score in the trial group was lower than that in the control group(P<0.05).After treatment,the A/N value in both groups was lower than that before treatment(P<0.05),and the value in the trial group was lower than that in the control group;however,the difference between the two groups was not statistically significant(P>0.05).After treatment and at the follow-up,the TCM constitution scale score in both groups was lower than that before treatment(P<0.05);the score after treatment in the trial group was lower than that in the control group(P<0.05).Conclusion:Tuina plus Liu Zi Jue can effectively improve the main clinical symptoms in children with AH due to Qi deficiency of lung and spleen,reduce the A/N value and TCM constitution scale score,with stable efficacy.

Objective:To explore the effect of preoperative gamma-glutamyl transferase to albumin ratio (GAR) on prognosis of patients with Barcelona clinic liver cancer (BCLC)stage 0-A hepatocellular carcinoma (HCC) after microwave ablation (MWA).Methods:The clinical data of 201 patients with BCLC stage 0 to A who underwent MWA at two centers of Jiaxing Second Hospital and Shengjing Hospital of China Medical University from January 2011 to December 2018 were retrospectively analyzed, including 152 males and 49 females, aged (57.5±9.6) years. X-tile software was used to divide patients into a low GAR group ( n=84, GAR<0.9) and a high GAR group ( n=117, GAR≥0.9). Kaplan-Meier method was used for survival analysis, and log-rank test was used for survival comparison. Univariate and multivariate Cox regression analysis was used to evaluate the relationship between GAR and prognosis. Results:The cumulative survival rates at 1, 3 and 5 years postoperatively were 98.7%, 93.8%, 78.5% for the low GAR group, which were superior to that 97.2%, 87.1%, 70.2% for the high GAR group, and the difference was statistically significant ( χ2=11.89, P=0.001). The recurrence-free survival rates at 1, 3 and 5 years after surgery between the two groups was no significant difference ( χ2=1.70, P=0.192). Multivariate analysis revealed that high GAR ( HR=2.723, 95% CI: 1.508-4.914, P=0.001) was independent risk factors for overall survival after MWA in patients with BCLC stages 0 to A HCC. Male gender ( HR=1.959, 95% CI: 1.127-3.305, P=0.017) and tumor diameter ≥2 cm ( HR=1.547, 95% CI: 1.008-2.373, P=0.046) were independent risk factors for recurrence after MWA in patients with BCLC stages 0 to A HCC. Univariate analysis, GAR≥0.9 was not associated with postoperative recurrence ( HR=1.315, 95% CI: 0.869-1.989, P=0.195). Conclusion:Preoperative GAR (≥0.9) is an independent risk factor affecting overall survival in patients with BCLC stages 0 to A HCC after MWA.

Bronchopulmonary dysplasia (BPD), characterized by impaired alveolarization and dysregulated vascularization, is a severe health burden for neonates worldwide. Hyperoxia induced acute lung injury is a major contributor to the progression and deterioration of BPD. An increasing number of animal studies have revealed that human umbilical cord blood derived mononuclear cells (hUCB-MNCs) infusion significantly attenuated the hyperoxia-induced acute lung injury through regeneration capacity. Currently, clinical application requires determination of the optimal dose and adjustment to good manufacturing practices. In this work, we comprehensively investigated the optimal dose of hUCB-MNCs in alleviating hyperoxia-induced lung injury in neonatal C57BL6/J mice. Mice with hyperoxia exposure were implanted with low (3×104cells/kg, Dl), middle (3×105 cells/kg, Dm) and high (3×106 cells/kg, Dh) dose of hUCB-MNCs at postnatal day 7. Three weeks after graft, characteristics exhibited in lungs including morphology, function and cytokine expression were thoroughly analyzed. Implantation of hUCB-MNCs sharply reverted the impaired lung architecture induced by hyperoxia exposure dose dependently as evidenced by indicated parameters. Attenuated expression of IL-1β concomitant with enhanced expression of IL-10 and IL-2 were shown in Dh inoculated groups, where Dl and Dm failed to restore the level of IL-10, IL-1β and IL-2. Significantly re-escalated marker of angiogenic marker VEGFA, CD31 in lung tissue were uniquely observed in Dh group. Mechanistically, our study revealed the appropriate dose of intravenous infusion of hUCB-MNCs in alleviating hyperoxia-induced lung injury through modulating reactive oxygen species response in neonatal mice.Therefore, a tight control of hUCB-MNCs density or levels of CB-MNC related products is of great significance.

Objective:The purpose of this study was to examine the clinical features and initial treatment outcomes of elderly individuals with idiopathic membranous nephropathy.Methods:This study retrospectively analyzed the clinical characteristics and therapeutic effect of hospitalized patients aged 60 years or older with renal-biopsy-proven idiopathic membranous nephropathy for at least one year.Results:This study enrolled a total of 91 elderly patients with IMN, consisting of 51 males(56.0%)and 40 females(44.0%). The median age of the patients was 67 years.The urinary protein creatinine ratio(uPCR)and urinary albumin creatinine ratio(uACR)of the patients were 4 454.3 mg/g and 2 258.5 mg/g, respectively.The median 24-hour urinary protein and urinary albumin levels were 5 098.2 mg/24 h and 2 800.6 mg/24 h, respectively.The average estimated glomerular filtration rate(eGFR)was(60.5±20.4)ml·min -1·1.73 m -2.Out of the total of 61 patients, 67.0% achieved remission, including complete and partial remission, within a year of renal biopsy.The levels of uPCR and uACR were significantly higher in the non-remission group compared to the remission group(5 462.5 vs.2 271.1 mg/g, P<0.001; 2 774.4 vs.1 320.0 mg/g, P=0.001). Additionally, the levels of 24h urinary protein and urinary albumin were significantly higher in the non-remission group compared to the remission group(6 526.4 vs.3 210.4 mg/g, P=0.002; 3 067.7 vs.2 102.4 mg/g, P=0.007). The remission group had a higher proportion of patients receiving immunosuppressive therapy(85.2% vs.33.3%, P<0.001). The remission rates were higher in patients treated with glucocorticoid combined with cyclophosphamide, glucocorticoid combined with calcineurin inhibitors, or glucocorticoid combined with mycophenolate mofetil compared to those receiving conservative treatment(88.2% vs.31.0%, P=0.001; 80.0% vs.31.0%, P<0.001; 100.0% vs.31.0%, P=0.007). There was no significant difference in remission rate between the three immunosuppressive therapy groups( P>0.05). However, upon further analysis, it was found that the levels of uPCR, uACR, and serum cystatin C(CysC)were higher in the immunosuppressive therapy groups compared to conservative treatment.Additionally, serum total protein and albumin were lower in the immunosuppressive therapy groups, and these differences were statistically significant( P<0.05). Conclusions:The majority of elderly patients diagnosed with IMN have multiple comorbidities.For those at high risk with elevated urinary protein levels, early initiation of immunosuppressive therapy may lead to a higher initial urinary protein remission rate.Therefore, it is advisable to develop individualized treatment plans for elderly patients with IMN based on their clinical characteristics, as well as the risks and benefits associated with immunosuppressive therapy.

The construction of a medication safety culture is important for medication safety management and rational drug use.The construction of medication safety culture standards is formulated based on relevant national policies and regulations,accreditation standards for hospitals,expert opinions,the current situation,and the development trend of the healthcare industry.With scientificity,general applicability,instructive guidance,and practicality,they standardized basic requirements,management processes,and improvement of the construction of medication safety culture.To facilitate understanding and the implementation of the standards,we describe the process of standards formulation and explain the key points of the standards.