Objective To investigate whether free heme released in hemolysis could directly damage hepatocytes and disrupt liver function. Methods The mice model of hemolytic transfusion reaction was established, and ALT, AST and other biochemical indexes were detected to analyze the liver function. In vitro, the LO2 cells were stimulated with different concentrations of lysed supernatant of red blood cells and heme respectively. Then the levels of ALT and AST were detected to analyze the liver function. Cell viability was observed by flow cytometry, and cell morphology and skeleton structure were observed by immunofluorescence. Results Abnormal liver function was observed on the mice model of hemolytic transfusion reaction. The results of in vitro experiments showed that LO2 cell viability decreased and the proportion of dead cells increased along with the incremental concentration of free heme. The biochemical indexes such as ALT and AST were aggravated significantly. And free heme could directly destroy the cytoskeleton of LO2 cells. Conclusion Free heme can directly destroy the cell structure of hepatocytes, inhibit cell vitality, induce cell death and abnormal liver function. The degree of damage is positively correlated with the concentration of free heme.

Objective To investigate the effects of platelets with different storage days and quantities on the proliferation of liver cancer cells. Methods Twelve type O platelet braids were collected from Nanning Central Blood Station and sent to the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine. According to the storage days, they were divided into fresh PLT group and old PLT group, of which the fresh PLT group was platelets stored for 1 day. In the old PLT group, platelets stored for 4 days were used. The two groups of platelets were co-cultured with human liver cancer cell Huh-7. The confluence degree of Huh-7 cells in each group within 48 hours was observed by scratch test, and the invasion ability of Huh-7 cells in each group within 24 hours was observed by transwell test. Results The results of scratch test showed that the proliferation ability of Huh-7 cells was significantly enhanced after co-culture with platelets. When the same amount of PLT was added, old PLT could promote the proliferation of Huh-7 cells more strongly. When PLT with the same storage days was added, PLT with a higher number generally showed a relatively stronger ability to stimulate cell proliferation. The results of transwell experiment were similar to the results of scratch. When the number of PLT was the same, the number of Huh-7 cells invaded by old PLT group was more than that of fresh PLT group, and the difference was statistically significant (P<0.05). The more PLT was added into Huh-7 cells, the more invasive cells occurred in the fresh PLT group and the old PLT group, and the difference was statistically significant (P<0.05). Conclusion The ability of platelets to promote cell proliferation and invasion is positively correlated with the storage time of platelets and the number of platelets. The application rules of platelet products need to be analyzed according to the specific clinical conditions. In the treatment of patients with neoplastic diseases, the application of old platelets should be avoided as far as possible, and the transfusion of platelets should be minimized when platelets have to be used, so as to achieve the purpose of slowing down the proliferation and metastasis of tumor cells.

The treatment of chronic non-healing wounds remain challenging in terms of complexity. Although platelet rich plasma (PRP) therapy has been widely proven effective, the traditional method of in vitro activation of PRP leads to the rapid release of all growth factors. Due to the separation of colloid and supernatant after activation, the factor-rich supernatant is easy to flow and lose, and it is difficult to form a stable structure, which affects its therapeutic effect. To overcome this problem, researchers in recent years have explored hydrogels as carriers for PRP to improve the shortcomings of traditional PRP treatment. This article reviews the latest research on hydrogel-loaded PRP for the treatment of chronic non-healing wounds and provides a reference for optimal treatment.

Objective To observe whether neoantigen peptides sequenced from tumor patients can induce allo-donor sourced PBMC to be specific reactive T cell. Methods PBMC were separated from healthy donors' buffy coat, then monocytes were collected using adhesion method, remaining PBL was kept frozen in -80℃. GM-CSF and IL-4 were added to induce monocytes into dendritic cells every three days. At Day 7 mature dendritic cells were harvested and plated in 24 well-plates, then these plates were loaded with 16 neoantigen peptides as one peptide in each well, 13/16 peptides were designed by our team. Five hours later PBLs recovered from -80℃ were added into these plates to be co-cultured with these treated DC in ratio of 4~10∶1. No peptide wells (DC only) were negative controls, and PBL only wells were prepared for adding PHA later as positive control. IL-2 was replenished in these plates every three days. Peptides were pulsed twice more at Day 14 and Day 21 respectively. Supernatant of each well was collected at Day 22 to measure IFN-γ concentration using ELISA methods, remaining cells were analyzed using Flowcytometry to measure the percentages of CD3 ⁺IFN-γ ⁺ or CD8 ⁺IFN-γ ⁺Tcells. Results 10 of 13 peptides can induce more than 3 kinds of PBL to proliferate into reactive CD3 ⁺ or CD8 ⁺ T cells, similar increases were also found in IFN-γ concentration（r=0.66, 0.58 for CD3 ⁺, CD8 ⁺ respectively, P<0.05) in supernatant by ELISA method. Conclusions Our research data demonstrate these neoantigen peptides sequenced from tumor patients can induce allo-blood donors'PBMC proliferate to neoantigen specific reactive T cells.

Anemia leads to increased perioperative blood transfusion rate and blood transfusion volume, prolonged hospital stay in coronary artery bypass grafting patients, and is also an independent risk factor for postoperative complications and mortality.Patient blood management is a patient-centered, systematic, evidence-based approach to improve patient outcomes through the diagnosis and treatment of perioperative anemia and the protection of autologous blood.This paper reviews the research progress in the prevention and treatment of perioperative anemia in patients with coronary artery bypass grafting, which hopely improves the treatment plan and clinical outcome of patients with anemia after coronary artery bypass grafting.

Objective Marvelous advancements have been made in cancer therapies to improve clinical outcomes over last few years. However, therapeutic resistance has always been a major difficulty in cancer therapy, with extremely complicated mechanisms remain elusive. N6-methyladenosine (m6A) RNA modification, a hotspot in epigenetics, has gained growing attention as a potential determinant of therapeutic resistance. As the most prevalent RNA modification, m6A is involved in every links of RNA metabolism, including RNA splicing, nuclear export, translation and stability. Three kinds of regulators, methyltransferase (writer), demethylase (eraser) and RNA binding proteins (reader), together orchestrate the dynamic and reversible process of m6A modification. Herein, we primarily reviewed the regulatory mechanisms of m6A in therapeutic resistance, including chemotherapy and targeted therapy. Then we discussed the clinical potential of m6A modification to overcome resistance and optimize cancer therapy. Additionally, we proposed prospects of m6A modification for future research.

Objective To investigate the mechanism by which evodiamine alleviates blood transfusion related acute lung injury (TRALI) in rats by regulating high mobility group protein Bl (HMGB1)/ toll like receptor 4 (TLR4)/nuclear transcription factor-κB (NF-κB) signaling pathway. Methods A total of 72 SD rats were randomly divided into the model group, low-dose evodiamine group, high-dose evodiamine group, no load group, high-dose evodiamine+HMGB1 overexpression group, and control group with 12 rats in each. Except for the control group, the TRALI model was prepared by intraperitoneal injection of lipopolysaccharide (LPS) combined with infusion of human plasma. After that, we analyzed the lung function indexes such as inspiratory resistance (Ri), minute ventilation (MV) and peak expiratory flow (PEF). Then, in each group we examined the lung wet-dry ratio of rats and the pathological changes of lung tissue by hematoxylin-eosin (HE) staining; the platelet and neutrophil aggregation in lung tissue by immunofluorescence staining; the total number of cells and the percentage of neutrophils in bronchoalveolar lavage fluid (BALF); the levels of pro-inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in BALF and serum by enzyme-linked immunosorbent assay (ELISA); as well as the expression of HMGB1/TLR4/NF-κB signaling pathway-related proteins in lung tissue by western blotting. Results Compared with the model group, the pulmonary function indexes MV and PEF in low-dose evodiamine group and high-dose evodiamine group were increased (P<0.05), while Ri, lung wet-dry ratio, lung histopathological score, platelet-neutrophil optical density in lung tissue, total number of cells in BALF, percentage of neutrophils, levels of pro-inflammatory factors TNF-α and IL-1β in BALF and serum, HMGB1 and TLR4 protein expression in lung tissue and p-NF-κB p65/NF-κB p65 were all decreased (P<0.05). Overexpression of HMGB1 attenuated the improvement of lung function by evodiamine in TRALI rats. Conclusion Evodiamine may inhibit the inflammation in TRALI rats by inhibiting the activation of HMGB1/TLR4/NF-κB signaling, thereby reducing its acute lung injury, and repairing its lung function.

Objective To analyze the efficacy of transfusion in patients with mismatched red blood cells caused by auto-antibodies, thus providing evidence for clinical safety and rational transfusion. Methods The clinical records and blood transfusion data of 35 patients with incompatible transfusion due to positive autoantibodies from May 2021 to June 2022 in our hospital were collected and statistically analyzed. Results A total of 60 transfusion applications had been made by 35 patients, 4 of which were rejected. Among 56 incompatible transfusions, 52 (92.9%) were found to be effective. There was no significant increase in TBIL after transfusion. No significant difference was observed in efficacy between transfusion of washed erythrocytes and that of non-washed erythrocytes (P>0.05). All patients had no transfusion reactions. Conclusion In case positive autoantibodies lead to blood mismatch, transfusion of ABO and Rh homologous red blood cells is safe and effective, whose primary agglutination strength is not higher than that of self-agglutination. It is advisable for blood transfusion departments to enhance doctor-patient communication to avert medical accidents; simultaneously, efforts should be made for more studies to prevent autoantibodies from affecting pre-transfusion tests.

Objective To explore the effect of platelet rich plasma (PRP) on traumatic synovitis of ankle joint. Methods From January 2021 to June 2022, 45 patients with traumatic synovitis of the ankle joint who were treated in the department of orthopedics and traumatology of a tertiary hospital were included. The patients were randomly divided into the observation group (20 cases, PRP treatment) and the control group (25 cases, traditional corticosteroid treatment) according to the random number table method. The ankle joint scores and clinical effects were compared between the two groups at before, 1, 3 and 6 months after treatment. Results The Baird-Jackson score and AOFAS score were higher (P<0.05) and VAS score was lower than before treatment in both groups after 1 month of treatment (P<0.05), and the control group was better than observation group (P<0.05). After 3 months of treatment, Baird-Jackson score and AOFAS score decreased (P<0.05) and VAS score increased (P<0.05) in the control group compared with one month after treatment. Baird-Jackson score and AOFAS score increased (P<0.05) and VAS score decreased (P<0.05) in the observation group compared with one month after treatment ( P<0.05), which was better than the control group (P<0.05). Time to first improvement in the control group was more common in 24 hours after treatment, and which was more common in 2 weeks and 1 month after treatment in the observation group (P<0.05). The total effective rate of the observation group was 95%, higher than that in the control group of 68% (P<0.05). Conclusion Traditional hormone therapy is fast-acting but short-sustained and prone to recurrence. PRP has better long-term effects and can improve patients' clinical symptoms for up to 6 months, which is worthy of clinical application.

Objective To investigate the clinical efficacy of different doses of anthracycline idarubicin in the induction treatment of acute myeloid leukemia（AML）for adults aged less than 60. Methods A total of 265 young AML patients（14~59 years old）were diagnosed at our center from June 2015 to December 2019. We retrospectively reviewed 239 patients treated with the regimen of idarubicin combined with cytarabine（IA 3+7）,focusing on complete remission（CR）rate,recurrence and long-term survival in patients with different prognostic risk groups. Results After the first induction therapy,61（65.6%）and 103（70.6%） patients in the IDA 8 mg/m ² group and the IDA 10~12 mg/m ² group obtained morphological CR（P=0.475）,of which 26 patients（42.6%）in the IDA 8 mg/m ² group and 64 patients（62.1%）in the IDA 10~12 mg/m ² group had minimal residual disease（MRD）negativity. The 3-year cumulative incidence of relapse（CIR） was 45.1%（95% CI：34.1%~57.8%）in the IDA 8 mg/m ² group and 49.6% （95% CI：40.7%~59.3%） in the IDA 10~12 mg/m ² group（P=0.469）. The 3-year overall survival（OS）rate was lower in the IDA 8 mg/m ² group [34.6%（95% CI：24.9%~44.4%）] than in the IDA 10~12 mg/m ² group [46.6%（95% CI：38.2%~54.6%）] （P=0.038）. For intermediate-risk patients,the 3-year OS rate for patients in the IDA 8 mg/m ² group was 31.5%（95% CI：18.9%~45.0%）,which was significantly lower than that in the IDA 10~12 mg/m ² group [43.7%（95% CI：32.3%~54.6%）] （P=0.043）. The 3-year event-free survival（EFS） rate in the IDA 8 mg/m ² group and the IDA 10~12 mg/m ² group were 32.0% （95% CI：22.7%~41.6%）and 37.0%（95% CI：29.2%~44.8%）respectively（P=0.319）. For intermediate-risk patients, there was a lower trend of the 3-year EFS rate in the IDA 8 mg/m ² group [25.4%（95% CI：14.0%~38.4%）] than in the IDA 10~12 mg/m ² group [33.3%（95% CI：23.0%~44.0%）] （P=0.107）. There were no significant differences in the 3-year OS rate and 3-year EFS rate between the favourable risk group and the adverse risk group. Conclusion For young adult patients with AML,the induction therapy with IA (3+7) regimen based on idarubicin 10~12 mg•m ^-2•d ^-1×3 d could achieve higher immunological remission and better long-term survival,especially for patients with intermediate risk according to 2017 ELN risk stratification.

Objective To explore the predictive effect of early pregnancy placental growth factor （PlGF） combined with pregnancy associated protein A（PAPP-A）, mean arterial pressure（MAP）and uterine artery pulsatility index（UtPI）on preeclampsia,and to analyze the positive rate,incidence rate and efficiency of screening, so as to provide some data basis for the clinical application of preeclampsia screening in Anhui Province. Methods From 2019 to 2021, six hospitals in Anhui Province were organized to carry out a multi center research project to collect the clinical information of pregnant women who met the enrollment criteria within 11~13 ⁺⁶ gestational weeks. PlGF and PAPP-A were detected by time-resolved fluoroimmunoassay. The eclampsia risk assessment software was used to calculate the combined risk of multiple indicators in combination with maternal factors,PlGF,PAPP-A,MAP and UtPI,and to track the pregnancy development and pregnancy outcome of pregnant women. The clinical application effect of this screening model was analyzed by data statistics. Results A total of 9 400 pregnant cases were collected. There were 243 pregnant women with pregnancy related hypertension,including 128 cases of preeclampsia,6 cases of chronic hypertension with preeclampsia,101 cases of gestational hypertension,and 8 cases of pregnancy with chronic hypertension. The incidence rate of preeclampsia was about 1.43%. The cases of chronic hypertension with preeclampsia,gestational hypertension and pregnancy with chronic hypertension were excluded,and the remaining 9 285 pregnant women were included in this study. 128 cases of preeclampsia were taken as the study group,and the other 9 157 cases were taken as the control group. The results showed that PAPP-A and PlGF in the study group were lower than those in the control group （P<0.05）,and MAP and UtPI were higher than those in the control group（P<0.05）. A total of 6 139 samples with complete quadruple indicators （PlGF+PAPP-A+MAP+UtPI） were collected for separate statistical analysis. When the cut-off value was 1/137,the false positive rate of PlGF+PAPP-A+MAP+UtPI quadruple screening scheme was 15%,and the positive rates of PE<32 weeks, PE<34 weeks and PE<37 weeks were 1.16%,3.31% and 15.08% respectively,and the detection rates were 90%,80% and 63.64% respectively. Conclusion PlGF combined with PAPP-A,MAP and UtPI in early pregnancy is of high value in predicting early-onset preeclampsia.

Objective To improve HLA genotyping performance in clinical laboratory,the results of National Proficiency Testing（PT）for HLA-A/B/DRB1 low-resolution genotyping were collected and summarized from 2017 to 2020. Methods HLA genotyping results from 2017~2020 PT were analyzed and different kinds of errors were described and classified,and the possible reasons were also analyzed. Results The number of participant laboratories was increasing from 78 to 96 during 2017 and 2020. 12 096 HLA alleles were returned from the participants during the 4 years and total of 127 errors（1.05%）were found. These 127 errors were classified into two major types including 13 technical errors and 114 artificial errors. The proportion of laboratory which made mistakes was 2.56％（2/78）、4.88％（4/82）、8.75％（7/80） and 3.13％（3/96）in 2017,2018,2019 and 2020,respectively. Conclusion There were above 2.5% of laboratories with errors in HLA genotyping PT surveys past four years. More attentions should be greatly paid to clinical HLA genotyping test and the procedure of reporting.

Objective To analyze the relationship between positive direct antiglobulin test （DAT） and efficacy of red blood cell（RBC） transfusion. Methods Medical records of 86 DAT-positive patients accepting RBC transfusion were retrospectively analyzed. The characters including disease type,blood count,DAT-positive type,agglutination intensity and therapeutic impact of RBC transfusion were analyzed,compared with DAT-negative group. Results The common types of diseases in DAT-positive blood transfusion patients were hematological diseases（36,43.37%）,infectious diseases（22,26.51%）,kidney diseases（7,8.43%） and other unknown causes（7,8.43%）. The values of Hb,RBC,and Hct in DAT-positive group were 5.75±3.71（g/L）,0.19±0.14（10 ¹²/L）,1.65±1.28（%）,whereas the values in DAT-negative group were 8.09±3.57（g/L）,0.24±0.15（10 ¹²/L）,2.43±1.28（%）. The values in DAT-positive group were lower than that in DAT-negative group,and there were statistically significant differences（P<0.05）. The effective rate of blood transfusion in DAT-positive group（61.48%, 83/135） was significantly lower than that in DAT-negative group（80.74%,109/135）（P<0.01）. By DAT-positive typing,the values of Hb after blood transfusion in IgG+C3d group,IgG group,and C3d group were 8.20±4.65 U,5.73±3.53 U,2.01±2.55 U,respectively. The value of Hb in C3d group was lower than that in negative group（Hb 8.09±3.57 U）,IgG+C3d group and IgG group,and the difference were statistically significant（P<0.05）. The value of Hb in IgG group was lower than that in negative group and IgG+C3d group,and the difference were statistically significant（P<0.05）. The effective rate of blood transfusion in IgG+C3d type （90.00%）>IgG group（61.34%）>C3d group（16.67%）,and the difference were statistically significant（P<0.05）. There was no statistically significant difference in efficacy of different agglutination intensities on RBC transfusion by DAT-positive typing （P>0.05）. Conclusion DAT-positive is common in patients with hematological diseases and infectious diseases. The effective rate of DAT-positive patients decreases after RBC transfusion,which may be related to DAT-positive typing. Blood transfusion indications for DAT-positive patients should be strictly controlled to ensure safe and effective blood transfusion.

Objective Analyze the influencing factors on Rh（CcEe）alloimmunization in patients with liver cirrhosis after ABO,Rh（D）isotype random matched blood transfusion. Method A total of 301 liver cirrhosis patients who received blood transfusion in the hepatobiliary regions of our hospital from January 1,2019 to June 30,2021 were included,including 206 males and 95 females. Patients with incomplete clinical data and Rh（CcEe） alloantibody detected in the first admission were excluded. Univariate and multivariate Logistic regression were carried out to analyze the influencing factors on Rh（CcEe）alloimmunization in patients with liver cirrhosis after ABO, Rh（D） isotype random matched blood transfusion. Result （1）Within the 301 patients,the positive rate of Rh（CcEe）alloantibody was 6.6%（20 / 301）. The percentage of anti-E antibody, anti-Ec composite antibody,anti-Ec mixed antibody,anti-C antibody,anti-Ce composite antibody were 70.0% （14 /20）,5.0%（1 / 20）,10.0%（2 / 20）,10.0%（2 / 20）,5.0% （1 / 20）,respectively.（2）There were statistical differences in the alloimmunization of Rh（CcEe）in patients with liver cirrhosis after ABO, Rh（D）isotype random matched blood transfusion with different causes,different red blood cell transfusion times and different blood types（P<0.05）.（3）Univariate Logistic regression analysis showed that liver cirrhosis after autoimmune hepatitis, red blood cell transfusion 5~9 times,red blood cell transfusion times more than or equal to 10 and type O blood were the risk factors of the Rh（CcEe）alloimmunization in patients with liver cirrhosis. The OR values were 6.888（95%CI：2.022~23.461）、14.444（95%CI：2.980~70.024）、30.469（95%CI：6.380~145.508）、12.444（95%CI：1.597~97.001） respectively. （4）Multivariate Logistic regression analysis indicated that liver cirrhosis after autoimmune hepatitis, red blood cell transfusion 5~9 times, red blood cell transfusion times greater than or equal to 10 and type O blood were the risk factors of the Rh（CcEe）alloimmunization in patients with liver cirrhosis. The OR values were16.909（95%CI：2.402~119.021）、22.311（95%CI：3.496~142.387）、36.527（95%CI：5.758~231.718）、10.160（95%CI：1.061~97.281）respectively. Conclusion The risk of Rh（CcEe） alloantibody is higher in patients with liver cirrhosis after ABO,Rh（D） isotype random matched blood transfusion.Liver cirrhosis after autoimmune hepatitis,red blood cell transfusion times,and type O blood were the risk factors of the Rh（CcEe）alloimmunization in patients with liver cirrhosis,especially those with 5~9 times of blood transfusion and greater than or equal to 10 times of red blood cell transfusion.It is recommended to adopt ABO,Rh（DCcEe）isotype blood transfusion for patients with liver cirrhosis.

Objective To investigate the diagnostic value and clinical significance of plasma heparin-binding protein (HBP) in patients with rheumatoid arthritis (RA) complicated by bacterial infection. Methods A total of 122 RA patients, 23 patients with simple bacterial infection, and 60 healthy people who underwent physical examination during the same period were included as the research subjects, including 42 patients with RA complicated with bacterial infection, 39 patients in the active RA group, and 41 patients in the RA remission group. The concentration of HBP in venous blood was measured by transmission immunoturbidimetric assay, and its correlation with white blood cells (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) was evaluated. The Kruskal-Wallis H test was used for comparison between different groups, and Spearman for continuous variable correlation analysis; and then the receiver operating characteristic (ROC) curve was drawn to evaluate the sensitivity and specificity of HBP in the differential diagnosis of RA patients with bacterial infection. Results The HBP in the group of RA complicated with bacterial infection was 63.3 (36.83~123) ng/mL, higher than 17 (14~21.6) ng/mL (P<0.01) in the active RA group, 8.3 (6.65~9.6) ng/mL (P<0.01) in the RA remission group, and 7.4 (5.63~8.8) ng/mL (P<0.01) in the healthy control group,compared with 68.70 (42.10~100.60) ng/mL in the simple bacterial infection group, there was no significant difference (P>0.05). The active RA group had higher HBP than the RA remission group (P<0.01) and the healthy control group (P<0.01), there being no statistical difference between the RA remission group and the healthy control group (P>0.05). The level of HBP in the group of RA complicated with bacterial infection was positively correlated with CRP (r=0.332, P<0.05), and the level of HBP in active RA group was positively correlated with CRP and disease activity (DAS28) (r=0.582, P<0.01; r=0.461, P<0.05), with no correlation in the levels of HBP and WBC and ESR between the two groups (P>0.05). The ROC curve showed that when the HBP level was 24.55 ng/mL, it was the best threshold for diagnosing bacterial infection in RA patients, with a sensitivity of 92.9% and a specificity of 84.6%. Conclusion HBP could be a sensitive and specific index for the differential diagnosis of RA complicated with bacterial infection and at the active stage.