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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.
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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.
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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.
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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.
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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.
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Objective To review and sum up cardiopulmonary bypass(CPB)management for aortic arch surgery.Methods All of the 42 patients were scheduled for aortic arch surgery with deep hypothermic circulatory arrest(DHCA)plus selective cerebral perfusion(SCP)techniques.The technique of double arterial lines with single pump head was employed for all of the patients,too.An arterial perfusion cannula was inserted into the femoral artery for cardiopulmonary bypass and the right subclavian artery was also cannulated for selective cerebral perfusion for 28 patients.1～3 aerocyst catheter was/were inserted into brachiocephalic trunk for cerebral perfusion when circulation was arrested for the other 14 patients.Results One patient could not regain consciousness after operation and WaS discharged a week after operation for whose relatives gave up the treatment.One patient'S innominate artery was occluded on the seventh day after operation and who suffered with a coma caused by cerebral infarction.The other patients experienced an uneventful recovery and discharge without any one complication relating to cardiopulmonary bypass.Conclusion The technique of DHCA plus SCP iS safe and effective in the surgery of aortic arch.