Kidd血型系统Jk（a-b-）血型的调查研究

1951年Allen在一新生儿溶血病患儿的母亲血清中发现一新的抗体,称抗-Jka,检出相应的Jka抗原。该母亲姓Kidd,故被称为Kidd血型〔1〕。在临床上Kidd血型系统可以引起输血反应与新生儿溶血病,为了解JK（a-b-）抗原在Kidd血型分布的状况,笔者对来我站无偿献血的捐血者14639例进行了血型调查分析,现将情况报道如下。     

11 169例孕产妇不规则抗体筛查结果分析

目的 通过分析孕产妇不规则抗体产生的频率与特异性,探讨不规则抗体筛查在孕产妇整个妊娠周期的临床意义。方法 采用微柱凝胶法对2010年1月-2020年12月在解放军总医院第六医学中心输血医学科生产备血的孕产妇做不规则抗体筛查,对抗体筛查结果阳性的做进一步抗体特异性鉴定。结果 11 169例抗体筛查结果中52例为阳性（0.47%）,其中Rh血型系统26例（50.0%）;MNS血型系统9例（17.3%）;Lewis血型系统5例（9.6%）;kidd血型系统1例（1.9%）;3例（5.8%）抗体水平较弱,未检出特异性;1例（1.9%）温自身抗体;7例（13.5%）患者拒绝检测。A型Rh阳性15例;B型Rh阳性9例;O型Rh阳性11例;AB型Rh阳性4例;A型Rh阴性4例;B型Rh阴性5例;O型Rh阴性2例;AB型Rh阴性2例。结论 孕产妇抗体筛查阳性不仅会造成交叉配血困难,给安全输血带来难度,而且会造成妊娠生产不良反应,严重的会发生新生儿溶血病。整个妊娠周期的不规则抗体筛查是保障孕产妇安全生产,早预防、早治疗新生儿溶血病,以及孕产妇安全输血的前提,具有重要的临床意义。     

配组筛检红细胞与混合O型红细胞筛检新生儿溶血病患儿不规则抗体效果对比

目的对比分析配组筛检红细胞与混合O型红细胞筛检新生儿溶血病患儿不规则抗体效果。方法选取我院2006年12月至2008年3月诊断为新生儿溶血症的高胆红素血症患儿及其母亲的EDTA.K2抗凝血标本316份,设立观察组和对照组,观察组使用配组筛检红细胞方法,对照组使用混合O型红细胞筛检方法,分别对316份血液样本进行血型鉴定、红细胞分散试验、红细胞直接抗球蛋白试验、血浆及红细胞放散液中抗体的检测及不规则抗体特异性鉴定,对比两组新生儿溶血病患儿不规则抗体的检验结果,记录相关数据进行统计学分析。结果 316例诊断为新生儿溶血症的高胆红素血症患儿的EDTA.K2抗凝血标本中,检出母婴ABO血型不合（ABO系统抗体）124例,为红细胞放散液和（或）新生儿血浆中检出具有致敏性;观察组检出婴儿红细胞放散液及母婴血浆中红细胞的血型不规则抗体8例,其中抗-M有4例抗-c有1例,抗-D有1例,抗-cE有1例,抗-E有1例;对照组检出婴儿红细胞放散液及母婴血浆中红细胞的血型不规则抗体6例,抗-M有2例,抗-c有1例,抗-D有1例,抗-cE有1例,抗-E有1例,两组检验结果存在一定差异（P〈0.05）,具有统计学意义。结论配组筛检红细胞的方法检验新生儿溶血病患儿不规则抗体效果优于混合O型红细胞筛检,精确率高,可有效预防抗-M的漏检,具有重要的临床诊断价值。     

西南地区部分人群Rh(D)血型抗原的检测及在输血医学上的应用

目的 :了解西南地区部分人群Rh (D)血型抗原的情况并探讨其潜在的临床应用价值。方法 :采用微孔凝集法初筛 ,以PCR法作对照。对于Rh (D)抗原阴性血样作国产不同批号的抗D血清及盐水抗D试验确诊。同时建立Rh (D)阴性献血者及受血者档案 ,制定有效的Rh (D)阴性血型血源的管理措施。结果 :所调查献血员Rh (D)阴性为 0 2 8% ,第一次需备血、输血的患者Rh (D)阴性为 0 2 3%。结论 :Rh (D)阴性人群的比率在我国较低 ,但有必要开展Rh (D)抗原的检测 ,对保障临床输血治疗安全及预防Rh同种免疫具有重要意义     

血型快速鉴定单克隆抗体的选择与优化

目的：筛选特异性好、亲和力强、效价高、质量稳定,且能批量生产的抗A、抗B及抗D抗体。方法：对抗A、抗BMcAb细胞株生产出的高效价抗A、抗B及抗D抗体,从特异性、亲和力和效价等方面进行检测和选择。结果：3种抗A、抗B单克隆抗体试剂和两种抗D抗体试剂的特异性和亲和力试验均合格;3种抗A、抗B单克隆抗体试剂的效价均为1∶256,两种抗D抗体试剂的效价均为1∶64;ABO、Rh（D）血型快速检测纸卡的抗A、抗B抗体效价为1∶256比较合适,抗D抗体的效价为1∶64比较合适。结论：通过特异性、亲和力和效价检测,3种抗A、抗B单克隆抗体试剂差异不显著,两种抗D抗体试剂差异也不显著。     

献血者血清中抗-E抗体致交叉配血不合的原因分析

Rh血型是已知最复杂的红细胞血型系统,其抗原已发现40多种,在输血医学上的临床重要性仅次于ABO血型系统。因患者血清中存在Rh血型抗体导致配血不合的报导较多,而因献血者血清Rh血型抗体导致的配血不合则较少见。现将因献血者血清存在抗-E抗体引起交叉配血不合1例的情况,分析报告如下。     

O型血孕妇766例ABO血型IgG抗体效价检测的比较

新生儿溶血病（hemolysis disease of newborn, HDN）源于胎儿从父方遗传到一些母亲没有的红细胞抗原,这些抗原通过胎盘进入母体,遭到母体免疫抗体的攻击,从而使胎儿红细胞遭到破坏而发生溶血[1],导致胎儿贫血、水肿、肝脾大、进行性黄疸,甚至核黄疸、智力障碍、听力障碍、运动功能不全、流产或死胎等.孕妇体内的血型IgG抗A（B）的滴度是目前临床上预测ABO新生儿溶血的常用方法.     

特殊血型报告1例

1病例报告患者男,21岁。因急性腹痛就诊。常规检查血常规及血型,进行ABO血型鉴定（玻片法）,正定型试验抗-A凝集强度为1＋,抗-B凝集强度为4＋,反定型A1细胞±,B细胞无凝集,Rh（D）抗原阳性,正反定型不一致。再用手工试管法重复ABO正反定型试验及其他血清学试验,所有试验均严格按照《中国输血技术操作规程》操作。（1）ABO血型鉴定试管法：患者红细胞与抗-AB、抗-B标准血清反应凝集强度均为4＋,与抗-A标准血清     

脾内注射法免疫小鼠制备抗—HBc单克隆抗体的研究

用基因工程菌产乙型肝炎核心抗原(HBcAg)对 Balb/c 小鼠脾内多点注射法免疫,将该鼠的脾淋巴细胞与鼠骨髓瘤细胞在 PEG 作用下融合,用固相放射免疫分析法(SPRIA)筛选,成功地获得了2株抗-HBc 阳性的杂交瘤细胞株。通过中和试验和交叉鉴定,2株抗-HBc 单克隆抗体只能与 HBcAg 起反应,而不能与 HBsAg 和 HBeAg 反应。经多次亚克隆后,所得腹水中的抗-HBc 滴度达1:64000～1:28000。这2株单克隆抗体做包被抗体检测 HBcAg 和(125)~Ⅰ标记查患者血清标本时,所测得的结果与人抗-HBc 多克隆抗体做包被或(125)~Ⅰ标记所测得的结果相一致。2株杂交瘤细胞连续传代3个多月,冻存复苏后仍能稳定地分泌特异的抗-HBc 单克隆抗体。     

新生儿溶血病误诊1例

1病例报告患儿为第2胎第1产,女婴,胎龄34周,早产,由外院转入我院。出生体重2000g,羊水Ⅲ度粪染,出生后24h内出现皮肤黄染并逐渐加重。给予蓝光照射治疗,效果欠佳。考虑为新生儿溶血,新生儿肺炎。因其母血型O型,Rh阴性,故临床医师诊断为Rh系统溶血。急查血型：患儿血型为A型Rh阳性,其母为O型Rh阴性。但患儿不规则抗体筛查结果为阴性,经与Rh阴性同型血交叉配血,     

The evolution and formation of RH genes

The Rh system clinically is one of the important blood groups. The major Rh antigens, which are constituted by over 40 types, are RhD, RhC/c, and RhE/e. Furthermore, Rh blood group system is characterized by the existence of many variants.It was considered that Rh blood group system was encoded on two genes termed the RHCE and RHD, which are composed of ten exons, respectively. It is inferred that the RHD gene encodes the RhD antigen and that the RHCE gene encodes the Rh C/c and RhE/e antigens. There are RHce, RHCe, RHcE and RHCE alleles as polymorphisms of RHCE gene. In 2000, the entire nucleotide sequences in all introns of both the RHD and RHCE genes were determined. Due to the new findings on RH genes, it is thought that multiple recombination (and/or gene conversion), nucleotide substitutions, small nucleotide gaps, replication slippage of microsatellite, large nucleotide gaps (due to Alu sequence) and the high level of the homology (%) between both RH genes are the important factors in the formation and evolution of both RH genes and Rh variants. Based on the advance of human genome project, the new interpretations on the evolution and formation of RH genes and Rh variants will be performed.Human Rh family (superfamily) and its counterparts in primates, mammals, fish, amphibians, bacteria, lower eukaryotes, archaea and plants have been identified. A lot of findings have been accumulated in their evolution and function. As gene conversions or recombination events confuse the phylogenetic tree of human RH genes and their counterparts, careful attention is necessary for researchers to calculate the time of gene duplication and to discuss the evolution of Rh family and its counterparts.Rh genotyping methods will never be perfect and both the clinicians and researchers have to recognize the limitation of Rh genotyping, especially RhD genotyping, because new Rh variants must have formed continually. In applying the Rh genotyping to clinical medicine, especially transfusion medicine, it is necessary to compare and examine the serological (phenotypic) data in Rh blood group system with caution.     

新生儿71例血样的血型血清学监测及分析

目的　通过新生儿血样检测及其母血清血型抗体水平调查 ,探讨诊断新生儿溶血病 (HDN)的有效方法。方法　选择 71例新生儿血样 ,采用血型血清学方法进行HDN的相关检测分析。结果　明确母婴血型不合HDN诊断 2 2例 ,可疑 1例 ,排除 4 8例 ;排除HDN组血型分布均匀 ,确诊HDN组均为A或B ,且B抗原分布为 14例 ;HDN血型血清学检出 1项阳性 9例 ,2项阳性 7例 ,3项阳性 7例 ,确诊HDN组母血清IgG抗体效价明显高于非HDN组。结论　检测新生儿血样及其母血清型抗体水平 ,对预防HDN发生及胎儿受害有重要意义     

Prevention, screening and therapy of thyroid diseases and their cost-effectiveness

Cost-effectiveness analyses focused on benign thyroid diseases are under-represented in the literature. The calculation of costs per additionally gained life year is difficult: The benefit of prevention is shifted into the distant future. The influence of an untreated subclinical thyroid disease on life expectancy can only be demonstrated by a long-term follow-up and by epidemiological databases. Iodine supplementation and programs for the prevention of tobacco smoking (primary prevention) are very cost-effective. Smoking increases the risk both of multinodular goiter and of Graves' disease. Screening programs (secondary prevention) are discussed for the laboratory parameters thyrotropin (TSH), calcium and calcitonin. TSH testing seems to be very cost-effective for epidemiological considerations in a certain lifespan (newborn, pregnancy, postpartal, older persons, hospitalisation due to acute diseases) and in persons with previously elevated TPO-antibodies or TSH-values >2 mU/l, but dedicated cost-effectiveness analyses are lacking. On the other hand, the cost-effectiveness of a routine TSH testing beyond the age of 35 years has been shown by a high-quality decision analysis. Therapeutic strategies (tertiary prevention) aim at the avoidance of complications (atrial fibrillation, myocardial infarction, death for cardiac reasons) and of iatrogenic complications. Examples of a tertiary prevention are: firstly the definitive therapy of Graves' disease in patients who have an increased risk of relapse after antithyroid drugs (ATD), secondly the radioiodine therapy for subclinical hyperthyroidism and the radioiodine therapy of large goiters in older patients or in patients suffering from a relevant comorbidity. Cost-effectiveness analyses for different therapeutic strategies of Graves' disease were published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a first line therapy if the risk of relapse after ATD exceeds 60%.     

Sudden death in a case of sickle cell anemia: Post-mortem computed tomography and autopsy correlation from a radiologist’s perspective

Sickle cell anemia (SCA) is a hemolytic disease characterized by the production of abnormal hemoglobin chains and distorted red blood cell morphology or sickling. “Sickle cell crisis” includes vaso-occlusive crisis, a plastic crisis, sequestration crisis, haemolytic crisis and often culminating in serious complications, organ damage and even sudden death. Post-mortem computed tomography (PMCT) findings of sickle cell disease have never been reported in literature. This case of sudden death from acute hemolytic crisis in SCA where post-mortem computed tomography (PMCT) and autopsy findings complemented each other, both revealing findings invisible to the other and both crucial to the case.     

D-二聚体检测在新生儿重度溶血病中的应用价值

目的探讨D-二聚体(D-D)在新生儿重度溶血病中的临床意义。方法将我院住院治疗的50例重度溶血病新生儿作为观察组,将同期在我院出生的50例正常足月新生儿作为对照组,检测两组新生儿D-D水平,并比较两组间差异。结果重度溶血病新生儿组存在高凝状态,两组新生儿D-二聚体比较差异有统计学意义(P<0.05)。结论测定血浆D-D对新生儿溶血病高凝状态的早期诊断、及指导治疗有重要意义。     

Systematic reviews of t'ai chi: an overview

Several systematic reviews (SRs) have assessed the effectiveness of t'ai chi for many conditions including hypertension, osteoarthritis and fall prevention; however, their conclusions have been contradictory. The aim of this overview was to critically evaluate the SRs of t'ai chi for any improvement of medical conditions or clinical symptoms. English, Chinese and Korean electronic databases were searched for relevant articles, and data were extracted according to predefined criteria; 35 SRs met our inclusion criteria. They were related to the following conditions: cancer, older people, Parkinson's disease, musculoskeletal pain, osteoarthritis, rheumatoid arthritis (RA), muscle strength and flexibility, improving aerobic capacity, cardiovascular disease and risk factors, lowering resting blood pressure, osteoporosis or bone mineral density, type 2 diabetes, psychological health, fall prevention and improving balance, and any chronic conditions. In several instances, the conclusions of these articles were contradictory. Relatively clear evidence emerged to suggest that t'ai chi is effective for fall prevention and improving psychological health and was associated with general health benefits for older people. However, t'ai chi seems to be ineffective for the symptomatic treatment of cancer and RA. In conclusion, many SRs of t'ai chi have recently been published; however, the evidence is convincingly positive only for fall prevention and for improvement of psychological health.     

新生儿溶血病换血术前后凝血功能的变化分析

目的探讨新生儿溶血病换血术前后凝血功能的变化。方法对52例重度溶血病新生儿换血术前后的凝血功能、血小板进行测定分析,以同期出生的正常新生儿为对照组。结果换血术后的患儿活化的部分凝血活酶时间(APTT)明显延长,纤维蛋白原(FIB)含量增高,血小板计数(PLT)数量减低,差异有统计学意义(P<0.05),血浆凝血酶原时间(PT)有轻度延长,但差异无统计学意义(P>0.05)。结论新生儿溶血病换血术前后应进行凝血功能的检测,并及时处理,以防止发生大出血及DIC。     

Selective arterial spin labeling (SASL): perfusion territory mapping of selected feeding arteries tagged using two-dimensional radiofrequency pulses.

To date, most perfusion magnetic resonance imaging (MRI) methods using arterial spin labeling (ASL) have employed slab-selective inversion pulses or continuous labeling within a plane in order to obtain maps derived from all major blood vessels entering the brain. However, there is great potential for gaining additional information on the territories perfused by the major vessels if individual feeding arteries could be tagged. This study demonstrates noninvasive arterial perfusion territory maps obtained using two-dimensional (2D) selective inversion pulses. This method is designated "selective ASL" (SASL). The SASL method was used to tag the major arteries below the circle of Willis. A combination of 2D selective tagging and multislice readout allows perfusion territories to be clearly visualized, with likely applications to cerebrovascular disease and stroke.