Immune repertoire is defined as the sum of T cells and B cells, which possesses high diversity and enables immune system to respond to various antigen stimuli. With the development of sequencing technique, immune repertoire sequencing can be utilized to deeply understand the changes of lymphocyte clones when rejection occurs at the gene level, and also provide the possibility for the emergence of novel non-invasive diagnostic techniques based on immune repertoire sequencing. In recent years, more and more attempts have been made to apply immune repertoire sequencing in solid organ transplantation, especially in the fields of kidney transplantation, liver transplantation, heart transplantation and post-transplantation infection. In this article, research progresses on the application of immune repertoire sequencing in these fields were reviewed, and current status of immune repertoire sequencing in organ transplantation and its potential as a novel technique for early non-invasive diagnosis of rejection were summarized, aiming to provide reference for subsequent development and clinical application of this technique.

Objective:To explore the application value of four-dimensional ultrasound combined with maternal serological screening in fetal facial deformities.Methods:A total of 106 pregnant women at mid pregnancy,whose fetuses with suspected fetal facial deformities and who conducted prenatal screening in Sanya Maternal and Child Health Hospital(Sanya Women and Children's Hospital)from January 2020 to December 2022,were selected.All of them underwent four-dimensional ultrasound and maternal serological screening.The results of delivery or induced labor were used as the gold standard of diagnosis to compare the diagnostic values of single four-dimensional ultrasound,single maternal serological screening and the combination of them for fetal facial deformities.Results:The analysis of the receiver operating characteristic(ROC)curve showed that the area under curve(AUC)values of four-dimensional ultrasound,maternal serological screening and the combination of them were respectively 0.932,0.863 and 0.981 in diagnosing fetal facial deformities.Both the sensitivities and accuracies of four-dimensional ultrasound and maternal serological screening were significantly lower than those of the combined diagnosis of them in diagnosing fetal facial deformities,and the differences of them were statistical significance(x2=11.173,0.064,P<0.05),respectively.Conclusion:Four-dimensional ultrasound combines with maternal serological screening can improve the diagnostic accuracy for fetal facial deformities.

OBJECTIVE To analyse the prognosis and laryngeal function retention of patients undergoing minimally invasive and open surgery after induction chemotherapy.METHODS The clinical data of 54 hypopharyngeal carcinoma patients who received induction chemotherapy and underwent laryngeal preservation surgery in Beijing Tongren Hospital from 2016 to 2022 were retrospectively analyzed.The laryngeal function recovery and survival rate were compared between the two groups.RESULTS Twenty-eight patients underwent transoral minimally invasive surgery and 26 patients underwent partial laryngectomy and/or partial laryngectomy via external cervical approach.The 3-year survival rates of the two groups were 63%and 59%,respectively,and the difference was not statistically significant(P＞0.05).The differences were statistically significant(P＜0.05).CONCLUSION In patients with downstaged hypopharyngeal carcinoma after induction chemotherapy,the survival rate of transoral minimally invasive surgery is similar to that of open surgery,and the laryngeal function recovery of transoral minimally invasive surgery is better.

Objective: To describe the characteristics of clinical manifestations and epidemiology of children with 2019 novel coronavirus (2019-nCoV) infection. Methods: All 34 children with laboratory-confirmed 2019-nCoV infection by quantitative real-time reverse transcription-PCR through nasopharyngeal swab specimens were admitted to the Third People’s Hospital of Shenzhen from January 19 to Febuary 7, 2020. Clinical data and epidemiological history of these patients were retrospectively collected and analyzed. Results: Among the 34 cases, 14 were males, and 20 were females. The median age was 8 years and 11 months. No patients had underlying diseases. There were 28 children (82%) related with a family cluster outbreak. There were 26 children (76%) with a travel or residence history in Hubei Province. These patients could be categorized into different clinical types, including 22 (65%) common cases, 9 (26%) mild cases and 3 (8.8%) asymptomatic cases. No severe or critical cases were identified. The most common symptoms were fever (17 cases, 50%) and cough (13 cases, 38% ). In the 34 cases, the white blood cell counts of 28 cases (82%) were normal. Five cases had white blood cell counts more than 10×10⁹/L. One case had white blood cell counts less than 4×10⁹/L. Neutropenia and lymphopenia was found in one case, respectively. C-reactive protein levels and erythrocyte sedimentation rates were elevated in 1 and 5 case, respectively. Elevated procalcitonin was found in 1 case and D-Dimer in 3 cases. The levels of lactic dehydrogenase (LDH) were more than 400 U/L in 10 cases. The CT images of these patients showed bilateral multiple patchy or nodular ground-glass opacities and/or infiltrating shadows in middle and outer zone of the lung or under the pleura. Twenty patients were treated with lopinavir and ritonavir. Glucocorticoids and immunoglobulin were not used in any cases. All the cases improved and were discharged from hospital. Further following up was need. Conclusions The clinical manifestations in children with 2019-nCoV infection are non-specific and are milder than that in adults. Chest CT scanning is heplful for early diagnosis. Children's infection is mainly caused by family cluster outbreak and imported cases. Family daily prevention is the main way to prevent 2019-nCoV infection.

Objective To evaluate the changes in myocardial glucose transporter 4 ( GLUT4 ) membrane translocation in the rats with high-level spinal cord injury ( SCI ) . Methods Thirty-six clean-grade healthy adult male Sprague-Dawley rats, weighing 250-300 g, were divided into 3 groups using a random number table method: control group (group C, n=6), sham operation group (group S, n=6) and high-level SCI group (group SCI, n=24). The model of SCI was established by a modified Allen's method in anesthetized rats. The spinal cord was only exposed in group S. Six rats were selected in C and S groups and at 4, 12, 24 and 48 h after SCI ( T1-4 ) in group SCI, and blood samples were taken from the abdominal aorta to measure the activities of serum creatine kinase and creatine kinase isoenzyme-MB. The rats were then sacrificed, and myocardial specimens were collected for microscopic examination of the ultra-structure ( with a transmission electron microscope) and for determination of ATP weight ratio, phosphoryla-tion of insulin receptor substrate-1 tyrosine and expression of GLUT4 in cell membrane ( by Western blot) . Results Compared with C and S groups, the serum creatine kinase and creatine kinase isoenzyme-MB ac-tivities were significantly increased at T1-4 , the ATP weight ratio was decreased, the expression of GLUT4 in myocardial cell membrane was down-regulated, the expression of phosphorylated insulin receptor sub-strate-1 tyrosine in myocaradium was down-regulated at T2,3 (P＜0. 05), and the pathological changes of myocardial tissues were found in group SCI. There was no significant difference in the indexes mentioned a-bove between group C and group S ( P＞0. 05) . Conclusion The mechanism of myocardial energy metabo-lism disorder may be related to the reduced membrane translocation of GLUT4 in the rats with high-level SCI.

Objective: To explore the association of the glycosylated hemoglobin (HbA1c) level at admission with 90 days functional outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods: Patients admitted to the Department of Neurology, Tongji Hospital from January to December 2017 were prospectively and continuously enrolled in this study. Clinical data were collected at admission and functional outcomes 90 days after ICH were assessed by using the modified RANKIN scale. Univariate and multivariate conditional logistic regression models were constructed. Patients were divided into four groups according to the quartile of HbA1c values. The median value of HbA1c in each group was taken as the substitute value and P for trend was calculated. The logistic regression model was fitted by restricted cubic splines to investigate the association between HbA1c level and outcome of ICH. Results: A total of 345 patients with ICH were enrolled, including 214 with favorable outcomes and 131 with poor outcomes (99 severe disability cases and 32 deaths). The risk of poor 90 days outcomes was significantly associated with HbA1c level at admission indicated by multivariate logistic regression analysis, and the P for trend test was <0.001 (middle-level group vs. low-level group: OR=2.33, 95%CI: 1.07-5.07; high-level group vs. low-level group: OR=2.52, 95%CI: 1.12-5.64; extremely high-level group vs. low-level group: OR=6.80, 95%CI: 3.01-15.34). Results from the restricted cubic spline showed that there was a linear correlation between HbA1c level at admission and poor 90 days outcomes of ICH (χ²=14.81, P<0.001; non- linear test: P=0.118). Compared with patients with HbA1c level of 6.5%, the risk of poor outcomes in patients with HbA1c level of <6.5% decreased linearly with the decrease in HbA1c level at admission, and the risk in patients with HbA1c level >6.5% was higher but not significantly. Conclusion There was correlation between high HbA1c level at admission and 90 days poor outcome of ICH. High HbA1c level is an independent prediction indicator for ICH.

Objective To examine the adaptability of Carver and White' s behavioral activation/in-hibition scales(BIS/BAS Scales)in a large sample of Chinese military-man,and to revise the instrument and validate its factor structure. Methods A total of 2 921 Chinese military-men completed four subscales:one for the Behavioral Inhibition System,and three for the Behavioral Approach System(drive,reward re-sponsiveness,fun seeking).Data were analyzed using exploratory and confirmatory factor analysis.The internal consistency of the subscales and the complete scale were examined. Results The findings did not support Carver and White's 4-factor structure which was validated in a sample of Chinese college students.A 3-factor structure(behavioral inhibition,reward responsiveness,drive)in Chinese military-man were extracted and validated using confirmatory factor analysis(CFA)(KMO=0.87,CFI=0.94,RMSEA=0.06).The Cronbach α of behavioral inhibition,drive and reward responsiveness were 0.78,0.71 and 0.67 respectively.The internal consistencies of behavioral inhibition and drive were higher than four-factor model of Chinese college students and the internal consistencies of drive and reward responsiveness were less than American young adults.Be-havioral inhibition and drive positively predicted depressive symptoms(βBIS=0.332,βDrive=0.076,P<0.001),and reward responsiveness negatively predicted depressive symptoms(βRRS=-0.140,P<0.001). Conclusion The BIS/BAS Scales(revised Chinese military version)has acceptable reliability and validi-ty,and can be utilized as a measurement tool for assessing the approach/avoidance motivation of Chinese ser-vicemen.

Objective To explore the subtype,incidence and duration of delirium in intensive care unit(ICU).Methods From October 2015 to September 2017,we prospectively collected baseline information of 516 inpatients met the inclusion criteria of ICU in Jinhua Municipal Central Hospital of Zhejiang Province.We assessed patients with the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU),and analyzed subtype of delirium and compared the incidence and duration of delirium.Results Among 516 patients,there were 119 cases with delirium along with 23.06％for the incidence.There were 14 cases with delirium in the type of increased activities,61 cases with delirium in the type of decreased activities and 44 cases with delirium in the mixed type.Delirium of 79.83％of patients occurred for the first time when being admitted to ICU between the second day and fifth day with 63.87％for the incidence of delirium night.The duration of delirium was from two to three days accounting for 52.94％.There were statistical differences in the occurrence time of delirium with three subtypes(χ2=11.116,P=0.025).The differences in duration of delirium with three subtypes were also significant(H=24.728,P<0.001).Conclusions Patients' high-incidence period of delirium is from the second day to the fifth day after being admitted to ICU.The occurrence time of delirium has the volatility showing the characteristic of light daytime and heavy night.We should strengthen assessment for delirium of patients to identify and take steps early,so as to reduce the occurrence risk of ICU delirium and shorten the duration of delirium.

Cancer is a leading cause of death worldwide. Although a variety of cancer therapies, such as surgical resection and local ablation, chemoembolization, radiotherapy, and systemic chemotherapy, have developed rapidly in recent years, the curative effect and 5 year-survival rate of cancer remain to be unsatisfactory. In recent years, with the deepening basic research of hydrogen, its role on the treatment of various diseases including cancer has attracted an increased attention. Hydrogen can promote the apoptosis of colon cancer cells, and which combined with 5-fluorouracil has a synergistic effect and can reduce the renal toxicity induced by cisplatin, without affecting its anti-tumor effect. Hydrogen can alleviate the side effects of radiotherapy, significantly improve the quality of life for patients with liver cancer, and does not affect the effect of radiotherapy. Hydrogen application provides a new therapeutic approach to the treatment of cancer. The specific mechanism of hydrogen in cancer treatment needs further study. This article reviewes the research progress of the role of hydrogen on the treatment of cancer, including antioxidant, anti-inflammatory, adjuvant chemoradiotherapy, and the regulation of signaling pathways.

Objective To analyze the 14 indicators of on-site evaluation at 18 hospitals under Beijing hospital authority in 2016 , and to provide technical support and reference for further optimization of medical quality and service .Methods According to the "Beijing Municipal Administration of Hospital 2016 On-site Evaluation Indicators", the results were analyzed using the fuzzy combined method of TOPSIS and rank sum ratio , and the ranking of the indicators was sorted .Results TOPSIS method and rank sum ratio weighted fuzzy joint analysis showed that the top three indicators from high to low were medical technology management , patient identification and verification system , clinical care service management;and the last three indicators were hospital-acquired infection monitoring , medical malpractice reporting and management , critical value report and disposal .Conclusions Hospitals are recommended to strengthen their exchange , popularize the concept of continuous improvement , the use of management tools to solve practical problems , and further improve the hospital medical quality and service quality .