The Rh blood grouping system is a critical standardized test in transfusion medicine,espe-cially for the cases related to haemolytic transfusion reactions and neonatal haemolytic disease caused by clinical RhD blood group incompatibility.In the present case report,we presented two cases with the un-common RHD gene variation RHD*DEL37.The blood samples of the two subjects were mistakenly iden-tified as RhD-negative through conventional serological testing.Firstly,both blood samples were tested negative for the RhD antigen using traditional tube test and gel microcolumn methods.The phenotyping of RhCE were identified as ccEe and ccee for each sample,respectively.Secondly,genetic analysis was performed using polymerase chain reaction-sequence specific prime(PCR-SSP)which revealed that nei-ther sample belonging to the several common RHD gene variants which was found in Asia.Moreover,they turned out to be positive for the RHD haplotype,which indicated that exons 1-10 on one of the RHD al-leles were entirely absent.In addition,a T＞C mutation was observed at bases 1154-31 in intron 8 of the other allele,which was located at the intron 8 breakpoint.This result was obtained after further Sanger sequencing of exons 1-10 of the RHD gene.The mutant allele was designated as RHD*DEL37 by the International Society of Blood Transfusion(ISBT)and was identified as D-elute(Del)by phenotype ana-lysis.Both samples were genotyped as RHD*DEL37 and showed positive results.In summary,the true genotype of the two blood samples,of which the screening results only using serological testing method was negative,were RHD*DEL37/RHD-(RHD*01N.01).Notably,this kind of genotype was reported for the first time in Chinese population.Moreover,the two individuals did not have ties of consanguinity,indicating that some of the Chinese individuals could be carriers of the genetic mutation.Therefore,it might be necessary to further confirm the frequency of this mutation in the Chinese population and the possibility of homozygosity for this mutation.This report identifies infrequent RHD gene mutation samples by coupling molecular biology and serological methods to prevent misclassification of blood groups.Com-bining serological and molecular biology test results to determine blood group is critical in protecting pa-tients during clinical transfusion procedures.

Objective:To understand the current status of personal protection in occupational population at high risk for brucellosis in China and provide evidence for the evaluation of implementation of National Brucellosis Prevention and Control Plan (2016-2020).Methods:Four counties in Shanxi Province and Xinjiang Uygur Autonomous Region were selected to conduct a questionnaire survey in occupational population at high risk for brucellosis from December 2019 to July 2020 by using cross-sectional survey methods.Results:A total of 2 384 persons at high risk for brucellosis were surveyed, and the standardized utilization rate of personal protective equipment (PPE) was 20.13% (480/2 384). The utilization rate of glove, mask, rubber shoe, and work cloth were 38.26% (912/2 384), 31.80% (758/2 384), 32.01% (763/2 384) and 30.87% (736/2 384),respectively. There were significant differences in the utilization rate and standardized utilization rate of the four types of PPE among populations in different age, occupation, educational level and area groups (all P<0.001). The utilization rate and standardized utilization rate of PPE were lower in people over 60 years old, women, farmers, and those with lower educational level. The results of multivariate analysis showed that occupation and area were the influencing factors for the standardized utilization of PPE, the standardized utilization rates of PPE were higher in herdsmen and veterinarians. The standardized utilization rate of PPE in Yanggao County and Huocheng County was significantly higher than that in Zuoyun County and Hunyuan County. Conclusions:The utilization rate of the four types of PPE in occupational population at high risk for brucellosis was not high in China, and the standardized utilization rate was low, lower than the requirement in National Brucellosis Prevention and Control Plan, and there were significant differences among different areas. It is urgent to distribute PPE to occupational population at high risk for brucellosis and carry out health education about PPE utilization. Meanwhile, it is necessary to strengthen information exchange or sharing among different areas.

Objective:To understand the current status of knowledge of brucellosis prevention and control among occupational groups at high-risk of brucellosis, and to provide a scientific basis for assessing the effectiveness of brucellosis prevention and control in China.Methods:A total of four counties in Shanxi Province and Xinjiang Uygur Autonomous Region were selected as survey counties from 2019 to 2020, and 600 people from the occupational groups at high-risk of brucellosis in each survey county were selected as survey respondents, and basic information and knowledge of prevention and treatment were collected through questionnaires. Single-factor and multi-factor logistic regression models were used to analyze the factors affecting the population's knowledge of prevention and treatment.Results:A total of 2 411 people participated in the survey and 2 384 valid questionnaires were obtained, including 1 405 males and 979 females, with the youngest age being 18 years old, the oldest being 91 years old, and the median being 57 years old. The overall knowledge of brucellosis prevention and control was 17.74% (423/2 384). The knowledge rate was lower among people over 60 years old, farmers, and people with less than elementary school education (13.99%, 14.50%, and 13.78%), and higher among women, herders, and people with elementary school education (20.02%, 36.33%, and 19.58%); the knowledge rate was lower in Hunyuan County (0.51%), and the differences in overall knowledge rates by age, occupation, education level, and region were statistically significant (χ 2 = 18.25, 87.18, 11.05, 197.43, P < 0.001). Multi-factor logistic regression analysis showed that gender, occupation, literacy and region were associated with knowledge of prevention and treatment ( P < 0.05). Conclusions:The overall knowledge of prevention and treatment among high-risk occupational groups in the key areas of China's brucellosis prevention and treatment program is low, with a large gap with the goals of the national brucellosis prevention and treatment program, and gender, occupation, literacy level, and region are the influencing factors of the knowledge of prevention and treatment. There is an urgent need to carry out a variety of health education activities for high-risk occupational groups and to strengthen the exchange of experience on brucellosis prevention and treatment between regions.

Objective:To understand the drug treatment status of echinococcosis patients in Jimusar County, Changji Prefecture, Xinjiang, and to explore the construction of medical cooperation system for echinococcosis patients, and to provide reference for optimization and popularization of medical cooperation system.Methods:Data of echinococcosis patients registered in Jimusar Center for Disease Control and Prevention from 2009 to 2018 were collected. The data of patients' medical records and follow-up information were collected by the principle of double entry. The research methods of combining quantitative and qualitative methods were applied to investigate the baseline of patient prevention and treatment system (including regional distribution, education level, recurrence, follow-up medication, etc). Follow-up was conducted on the whole treatment process of echinococcosis patients in the pilot counties, and comparative analysis was made on the treatment situation before and after the use of medical cooperation system. Logistic regression model was used to analyze the indicators that might affect the follow-up effect. Semistructured questionnaire survey was used to analyze the implementation effect of the medical cooperation system.Results:Patients were mainly distributed in rural areas (81.48%, 154/189), mostly in high schools and below (94.18%, 178/189), 39.68% (75/189) were relapsed and treated again, and 68.25% (129/189) were treated with non-standard medication. Influencing factors of effective follow-up medication in echinococcosis patients showed that patients with no side effects, abnormal liver function during follow-up, two or more times of B-ultrasound examination and multiple cysts had higher effective follow-up medication rate ( P < 0.01 or < 0.05). After the implementation of the integrated medical cooperation system, the proportion of unknown stages of diagnosis of cystic echinococcosis in Jimusar County decreased by 60.18%. The pilot counties initially formed a management model of echinococcosis patients based on outpatient, disease control and health centers. Conclusions:Echinococcosis patients have high recurrence rate in Jimusar County, and the effective follow-up medication rate is low. The medical cooperation system for echinococcosis patients in Xinjiang is explored, and the working mechanism of medical institutions linked with disease control institutions is formed. The working model suggestion is put forward, which could provide a scientific basis for further promotion and comprehensive evaluation of the medical cooperation system.

Objective To investigate the curative effect of imipenem cilastatin sodium in the treatment of patients with severe infection complicated with multiple organ dysfunction ,and its effect on blood lactic acid.Methods From January 2012 to January 2017,a total of 124 patients with severe organ failure and multiple organ dysfunction in the Second Hospital of Shanxi Medical University were selected ,and they were randomly divided into study group and control group according to the digital meter method ,with 62 cases in each group.The study group received a broad -spectrum antibiotic imipenem cilastatin sodium treatment , the control group received levofloxacin treatment.The curative effect,bacterial clearance rate,infection control time and the change of BLA level in the two groups were recorded and compared.Results The total effective rate was 82.26%in the study group and 79.03%in the control group,there was no statistically significant difference between the two groups (χ2＝1.187,P＞0.05).The bacterial clearance rate in the study group was 80.00%,which was significantly higher than 52.94%in the control group(χ2＝5.176,P＜0.05).The infection control time in the study group was earlier than that in the control group [(3.17 ± 1.14)d vs.(5.21 ±1.18) d),t ＝11.579,P ＜0.05].Before treatment,there was no statistically significant difference in BLA level between the two groups (t＝1.879,P＞0.05).After treatment,the BLA level in the study group was significantly higher than that in the control group (t＝12.179,P＜0.05),the level of BLA in the study group gradually decreased after one week of withdrawal ,which had no statistically significant difference compared with the control group(t＝1.483,P＞0.05).There was no statistically significant difference in BLA level between the two groups after one week of discontinuation (t＝1.237,P＞0.05).Conclusion Imipenem and cilastatin sodium has good curative effect and bacterial clearance rate in the treatment of patients with severe infection complicated with multiple organ dysfunction.It can control the infection more promptly and has a significant effect on the prognosis of patients.It is worthy of widely clinical promotion and application.

Objective To explore the differences and similarities of the cervical lesions and mechanism between Asian variant E6 T178G and European variant E6 T350G, A442C and other variants. Methods We selected 300 clinic or hospitalized patients in our hospital during the period of May 2011 to October 2012. Cervical exfoliated cells were harvested by Thinprep cytologic test (TCT). A PCR sequencing assay was performed to detect HPV16 E2, E6 and E7 gene variants. One year later, the test was repeated. The patients with persistent infection underwent cervical biopsy by colposcopy for pathological examination. SP immunohistochemical method was applied to detect E7 protein expression level in all the patients. Results After one year, of 292 patients who were successfully sequenced, 259 were chronic cervicitis, 32 were cervical intraepithelial neoplasia grade I (CINI), and one was cervical intraepithelial neoplasia grade II (CINII). E7 protein expressed in each variant. But the expression of E7 protein in patients with different variant infection had no significant difference from each other. Conclusions E7 protein may be play a role in the early stages of HPV16?induced cervical lesions. But E7 protein may not be a reference index of the different carcinogenic mechanism between different HPV16 variants.

Objective To evaluate the effects of ischemic postconditioning (IPO) on c-fos protein expression during renal ischemia-reperfusion (I/R) in rats.Methods Seventy-five adult male Sprague-Dawley rats,aged 8-12 weeks,weighing 200-250 g,were randomly allocated into 3 groups (n =25 each) using a random number table:sham operation group (group S),I/R group and IPO group.Renal I/R injury was induced by clamping the bilateral renal pedicles for 1 h followed by 24 h of reperfusion in I/R and IPO groups.Five animals were sacrificed at 1,3,6,12 and 24 h of reperfusion and the left kidneys were removed for microscopic examination and for determination of the expression of c-fos protein by immunohistochemistry.Results Compared with S group,the expression of c-fos protein was significantly up-regulated at each time point during reperfusion in I/R and IPO groups.Compared with I/R group,the expression of c-fos protein was significantly down-regulated at each time point during reperfusion in group IPO.The pathologic changes were significantly attenuated in group IPO as compared with group I/R.Conclusion The mechanism by which IPO attenuates renal I/R injury is related to down-regulation of c-fos protein expression in the renal tissues of rats.

Objective To evaluate the effect of intrathecal ganglioside GM-1 on chronic central pain (CCP) following spinal cord injury in rats.Methods Thirty-two adult male Sprague-Dawley rats,weighing 220-250 g,in which intrathecal catheters were successfully implanted,were randomly divided into 4 groups (n =8 each) using a random number table:control group (group C); group CCP; normal saline group (group N) and ganglioside GM-1 group (group GM).CCP was induced according to modified Allen method in CCP,N and GM groups.In group GM,ganglioside GM-1 20 mg/kg was injected intrathecally once a day,for 5 consecutive days,starting from 14th day after CCP,while the equal volume of nomal saline 10 μl was injected intrathecally in group N.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 4,8,16,24 and 48 h after the end of administration.The rats were then sacrificedat at 7 d after the end of adminmistration and L1 segment of the spinal cord was removed for determination of the expression of NMDA receptor 1 (NR1) by immuno-histochemistry.Results Compared with group C,MWT and TWL were significantly decreased,and NR1 expression was up-regulated in CCP and N groups (P ＜ 0.01),and no significant changes were found in MWT,TWL and NR1 expression in group GM (P ＞ 0.05).Compared with group CCP,no significant changes were found in MWT,TWL and NR1 expression in group N (P ＞ 0.05),and MWT and TWL were significantly increased,and NR1 expression was down-regulated in group GM (P ＜ 0.05).Conclusion Ganglioside GM-1 can alleviate CCP following spinal cord injury in rats and inhibition of expression of NR1 in the spinal cord may be involved in the mechanism.

Objective To investigate the effects of inhaled aerosolized low dose ambroxol on the inflammatory response to one-lung ventilation (OLV) in patients undergoing open-chest esophagus surgery.Methods Sixty patients (aged 39-64 years,weighing 50-85 kg and with height of 153-181 cm) with normal heart and lung function undergoing open-chest esophagus surgery were randomly divided into three groups:20 patients receiving intravenous infusion of normal saline (control group,group C),20 receiving intravenous infusion of ambroxol 10 mg/kg after induction of anesthesia (group IA) and 20 inhaling aerosolized ambroxol 30 mg after induction of anesthesia (group AIA).Arterial blood samples were taken after induction of anesthesia before ambroxol administration (T0,baseline),after 90 minutes of OLV (T1) and at 30 minutes after OLV (T2) for determination of plasma concentrations of tumor necrosis factor-alpha (TNF-α),interleukin-1 beta (IL-1β),IL-8 and IL-10 by enzyme linked immunosorbent assay (ELISA).Results The levels of TNF-α,IL-1β,and IL-8 in plasma significantly increased while the level of IL-10 in plasma significantly decreased at T1 and T2 as compared with the baseline at T0 in all the three groups.The levels of TNF-α,IL-1β,and IL-8 in plasma were significantly lower and the level of IL-10 in plasma was significantly higher at T1 and T2 in groups IA and AIA than in group C.Conclusion Both intravenous injection of large dose ambroxol and inhaled aerosolized low dose ambroxol can inhibit the inflammatory response to OLV in patients undergoing open-chest esophagus surgery.

Objective To investigate the effects of inhaled aerosolized low dose ambroxol on the inflammatory response to one-lung ventilation ( OLV) in patients undergoing open-chest esophagus surgery. Methods Sixty patients with normal heart and lung function undergoing open-chest esophagus surgery were randomly divided into 3 groups ( n = 20 each): control group (group C) ; group IA received Ⅳ ambroxol 10 mg/kg after induction of anesthesia and group AIA inhaled aerosolized ambroxol 30 mg after induction of anesthesia. Arterial blood samples were taken after induction of anesthesia before ambroxol administration (T0, baseline) , at 90 min of OLV (T1 )and at 30 min after OLV (T2) for determination of plasma concentrations of TNF-α, IL-1β, IL-8 and IL-10 by ELBA.Results Plasma TNF-α, IL-1β, and IL-8 concentrations were significantly increased while plasma IL-10 concentration was significantly decreased at T1 and T2 as compared with the baseline at T0 in all 3 groups. Plasma TNF-α, IL-1β, and IL-8 concentrations were significantly lower and plasma IL-10 concentration was significantly higher at T1 and T2 in groups IA and AIA than in group C. Conclusion Both Ⅳ large dose ambroxol and inhaled aerosolized low dose ambroxol can inhibit the inflammatory response to OLV in patients undergoing open-chest esophagus surgery.