Objective To analyze the correlation between miR-149-5p and phosphoglycerate dehydrogenase （PHGDH）in chronic myeloid leukemia（CML）imatinib（IM）resistance and glycolytic activity. Methods The expression of miR-149-5p and PHGDH,and glucose uptake in CML cell line K562 and imatinib-resistant CML cell line K562G were detected. The overexpression of MiR-149-5p was obtained in 149G and control 149N from K562G cells by lentiviral transduction. The expression of miR-149-5p and PHGDH,and glucose uptake in 149G and 149N cells were detected. The Liquid chromatography with tandem mass spectrometry（LC-MS-MS）technology was used to target metabolomics analysis. Results The expression level of miR-149 in imatinib-resistant CML cell line K562G was significantly lower than that in imatinib-sensitive CML cell line K562（P<0.05）. The expression of PHGDH was significantly increased in K562G（P<0.05）. Compared with 149N cells, the expression level of miR-149 in 149G was significantly increased （P<0.05）,while the expression of PHGDH was significantly decreased（P<0.05）. The expression of glucose uptake in K562G was higher than that in K562（P<0.05）. Compared with 149N cells,the glucose uptake of 149G was reduced （P<0.05）. Metabolomics analysis showed that there were 9 metabolites significant differences between K562 and K562G （P<0.05）. Conclusion Expression miR-149-5p was associated with reprogramming glucose metabolism in CML cells, and overexpression miR-149-5p could target downstream inhibition of PHGDH expression. MiR-149-5p targeting the PHGDH pathway may inhibit glycolytic activity in CML cells.

Objective To explore the clinical application of capillary ultracentrifugation in predicting massive maternal transfusion syndrome, which is more convenient to screen massive maternal transfusion syndrome with inconsistent blood types. Methods We mixed EDTA-anticoagulant blood of healthy women (type O on childbearing age) with type A/B umbilical cord blood for 1 hour, to simulate maternal transfusion syndrome. Fetal cells were isolated by capillary ultracentrifugation and performed blood group antigens identification. Furthermore, we performed flow cytometry to quantitatively verify the percentage of fetal red blood cells. Results When the fetal bleeding volume reached 60 and 100 mL, the results of sensitivity, Yoden index, positive predictive value and negative predictive value of capillary ultracentrifugation were respectively 0.8, 0.75; 0.75, 0.7; 0.941, 0.937 5 and 0.826, 0.791. Conclusions Capillary ultracentrifugation technique can serve as effective method for massive maternal transfusion syndrome with inconsistent ABO blood group.

Objective The study aimed to investigate the relationship between the results of the three hemolysis tests,age on admission,and total serum bilirubin（TSB） in ABO hemolytic disease of the newborn(HDN). Methods Four hundred and eleven cases with ABO HDN admitted to the Affiliated Hospital of Qingdao University between December 2016 and April 2020 were selected. The three hemolysis tests and TSB were tested. We did a retrospective analysis of their clinical data,such as age on admission. Results Among the 411 infants,admission age,positive or negative direct antiglobulin test（DAT）, and positive or negative results for the three hemolysis tests were statistically significant differences（P<0.05） in TSB levels,except for gestational age and birth weight. The rates of positive DAT newborns were 50%,46.67% and 3.33% in admission age groups of ≤1 d,2~4 d and ≥5 d,respectively. The difference was statistically significant（P<0.05）. Excluding cases with gestational age less than 35 weeks and birth weight less than 2 500 g,the correlation coefficient between TSB levels and age on admission was 0.42（P<0.001）. The median TSB levels were 176.37 μmol/L,220.20 μmol/L,and 271.10 μmol/L in age on admission group of ≤1 d, 2~4 d and ≥5 d,respectively. After we applied Bonferroni corrections,the difference was statistically significant（P<0.001）. The older the age on admission,the higher TSB levels in newborns the lower the DAT positive rate. Conclusion For newborns with suspected ABO HDN,the three hemolysis tests are performed in time. Earlier diagnosis and intervention reduce the occurrence of major adverse events.

Objective To study the Rh phenotype distribution among blood recipients, and to determine crossmatch compatibility rules of their red blood cells (RBCs). Methods Aigel 300 was used to detect and transmit ABO blood type, Rh phenotype, irregular antibody screening for 1 117 blood recipients, and Rh phenotype for 3 174 blood donors. TMIS9.5 was used to receive and crossmatch the Rh phenotypes for both the donor and the recipient. On the 15th day after transfusion, blood recipients would be followed up for 6 months, and SPSS 25.0 was used for risk assessment. Results Outcomes of donor- recipient matched RBC transfusions in Xi'an area: The probability of transfusion level Ⅲ for recipients was 17.82%, and the probability of matching level Ⅲ for donors was 8.99%. In 918 patients with grade Ⅰ+Ⅱ (matched transfusion), 8 of which had positive screening antibodies before transfusion; One out of 199 patients with grade Ⅲ had a positive screening antibody before transfusion. Six months later, 448 recipients with grade Ⅰ+Ⅱ were traced, and one new case was a positive screening antibody (non-Rh antibody); Among 91 recipients with grade Ⅲ, 4 new cases were anti-screening antibodies (all anti-Rh antibodies). The risk of RBCs transfusion with Rh phenotype grade Ⅲ was significant [χ_Ⅲ²=5.586,P_Ⅲ<0.05;OR_Ⅲ=9.103 ,95%CI_Ⅲ=（1.003,82.633）]; while, that of grade Ⅰ+Ⅱ was not significant[χ_Ⅰ+_Ⅱ²=0.191,P_Ⅰ+_Ⅱ>0.05;OR_Ⅰ+_Ⅱ=1.284,95%CI_Ⅰ+_Ⅱ=（0.418,3.947）]. Conclusion The distribution of donor-recipient Rh phenotype in Xi'an area accorded with the basic demographic characteristics. It is recommended that patients with fertility needs and normal immune function avoid blood transfusion. When transfusion is necessary, they should follow the matched Rh phenotype grade Ⅰ+Ⅱ or avoid the most risky antigens among E, c, C, e and D in sequence.

Objective To explore the application and effect of autotransfusion in patients with gynecological tumor surgery. Methods A retrospective analysis of blood transfusion in 432 gynecological tumor patients undergoing surgery was conducted. Patients with cervical cancer and ovarian tumor were selected and divided into observation group (autologous blood transfusion) and control group (allogeneic blood transfusion). The changes of immunological and hematological indexes were compared between the two groups. Results ①Among the 432 patients diagnosed after operation, cervical cancer accounted for 40%, ovarian tumors accounted for 30%, other gynecological tumors accounted for 30%, and the blood consumption was 1 325.5 U. In 199 cases, 295 U of autologous blood was collected preoperatively, and the rate of autologous blood transfusion was 22.26%. ②In the aspect of immunity, IgG in observation group was significantly decreased after operation in patients with cervical cancer (P<0.05). Comparison between groups, CD4⁺/CD8⁺ ratio of T lymphocytesdecreased significantly in control group (P<0.05). In hematology, TT was significantly prolonged in the observation group (P<0.05). ③In ovarian tumor patients, IgM, IgG and IgA in observation group were significantly decreased (P<0.05). Conclusion There was no significant difference in the effect of the two transfusion methods on the immunological and hematological function of gynecological tumor patients in the short term. The indexes of patients with autologous blood transfusion would not be abnormal due to the decrease of circulating blood volume after blood collection.

Objective Meta-analysis was used to systematically evaluate the blood transfusion strategies guided by Thromboelastography(TEG). Methods We searched computer-published randomized controlled trials (RCT) related to TEG-guided surgical blood transfusions published in PubMed, Web of Science, and ScienceDirect databases from January 1960 to July 2020, and we also manually searched for related papers. The quality of the included studies was assessed by two evaluation members according to the Cochrane collaboration network standard, and then the included studies were analyzed by RevMan 5.3 software. Results A total of 8 articles were included, involving a sample of 863 individuals, 366 cases in the test group and 497 cases in the control group. The meta-analysis results showed that there were no significant difference between test group and control group in Red blood cell (RBC) infusion rate and postoperative mortality. Test group could significant reduce the frequency of Platelet transfusion (P=0.02), the frequency of Fresh frozen plasma (FFP) transfusion(P<0.00001), the frequency of bleeding after surgery (P=0.006). Conclusions The application of TEG to guide blood transfusion during surgical operation can reduce the transfusion rate of Platelet and FFP, meanwhile reduce postoperative bleeding. It is an ideal blood transfusion guidance method.

Objective To explore the significance of combined application of screening cells with different antigen patterns to avoid missed detection of irregular antibodies. Methods Plasma specimens of 1 200 patients undergoing blood transfusion were selected. Gel test was used for irregular antibodies. Positive specimen was further evaluated for identification of specific alloantibody with cell panel. Negative specimen was tested by different methods and screening cells. Results The total positive rate of irregular antibodies was 0.75% (9/1 200), of which the positive rate tested by a single reagent was 0.58% (7/1 200). Two different antigen patterns were used to screen the remaining negative samples, two samples were positive and the missed detection rate was 0.17% (2 /1 193). Conclusion The use of papain enzymatic method can increase the positive rate of alloantibodies detection. The combined application of screening cells with different antigen patterns can effectively prevent the missed detection of irregular antibodies and reduce the occurrence of transfusion reactions.

Objective The drug-coated red blood cells（RBCs）method and the drug-addition method were used for detecting the incidence of drug-induced antibodies in patients developed anemia after antibiotics treatment and comprehensively analyzed related clinical data. Method We selected 358 blood samples from hospitalized patients developed anemia after antibiotics treatment for 3 days or more in a hospital. The drug-coated RBCs method and the drug-addition method were used to detect drug-induced antibodies. We comprehensively analyzed the test results based on the relevant clinical data. Result Among 358 patients with anemia, 12 cases were positive for antibiotic-induced antibodies by the drug-coated RBCs method, with the positive rate of 3.35%. Of these, 284 cases were tested by cephalosporin-type antibodies and 6 were positive with the positive rate of 2.11%; 74 cases were tested by non-cephalosporin-type antibodies and 6 were positive with the positive rate of 8.11%. There was significant difference between the two positive rates of antibiotic-induced antibodies (P <0.05). Twelve patients with positive antibiotic-induced antibodies were statistically compared by gender, age, surgical and non-surgical, and there's no statistically significant difference (P>0.05). No antibiotic-induced antibodies in all samples were detected using drug-addition method. Conclusion The detection rate of antibiotic-induced antibodies was different between the two methods. The positive rate of drug-coated RBCs method was significantly higher than that of drug-addition method. Blood transfusion physicians and clinicians should pay more attention to the adverse effects of antibiotic-induced antibodies.

Objective To investigate the effect of multiple apheresis platelet donation on some blood routine indicators and platelet correlation factors in plasma. Methods Sixty cases of multiple apheresis platelets donors who have donated platelets twenty times or more per year were listed as study group. 28 cases of first-time apheresis platelet donors were listed as control group. Before donating apheresis platelet, hemoglobin (HGB), hematocrit (HCT), platelet counts (PLT), cumulative number of blood donations were collected and analyzed. The level of thrombopoietin (TPO), platelet activation factor (PAF), von Willebrand factor (vWF), β-thromboglobulin (β-TG), platlet factor 4 (PF4) in plasma of two groups of blood donors before donation were measured by ELISA. Then those data were analyzed statistically. Results The mean age of the blood donors in study group was higher than that of the control group (P<0.05). By covariance analysis, we found that donors of different ages donated apheresis platelet 20 times or more per year, their peripheral blood HGB, HCT, PLT had no significant difference. Donors with different cumulative donation times donate 20 times or more per year, their peripheral blood PLT was no significant difference (P=0.142), but the donors with cumulative number of 51~100 times blood donation had higher HCT3, PLT3 than the other two groups (P=0.033, P=0.023). Different age and the cumulative number of blood donation had no significant influence in TPO, PAF, vWF, β-TG and PF4 (P>0.05). Conclusions Multiple apheresis platelets donations had no significant impact on peripheral HGB, HCT, and PLT. Also there was no obvious influence in platelet related factors.

Objective To analyze the characteristics of reactive population in treponema pallidum particle assay (TPPA) among voluntary blood donors (BDs) in Wuhan area. Methods The positive samples by ELISA from voluntary blood donors in Wuhan were collected and confirmed by TPPA from January 2018 to June 2018. Combined with the personal information, the structural characteristics of the population were analyzed. Results Among 78 997 voluntary blood donors, 51 738 were male blood donors and 27 259 female blood donors. 212 cases were confirmed reactive by TPPA, including 119 males and 93 females. The positive rate of syphilis confirmed by TPPA was 0.23% (119/51 738) in male blood donors and 0.34% (93/27 259) in female blood donors, and there was significantly different between gender groups (χ²=8.24, P<0.05). 139 cases were married and 73 unmarried and there was statistical different in marital status groups (χ²=36.13, P<0.05). Among age groups, the highest positive ratio was shown in 36~45 years old with 0.66% and there was statistical different in different age groups (χ²=149.80, P<0.05). Considering education level, the blood donors with technical secondary school degree showed the highest positive rate 0.76% and there was statistical different in education groups (χ²=141.04, P<0.05). Farmers and workers had the highest positive ratio 0.66%, and there was statistical different in occupation groups (χ²=177.10, P<0.05). Conclusion We should focus on the married female blood donors with low education background, who belong to high-risk groups of syphilis. We should do a good job of consultation before blood donation, so as to reduce blood risk and improve blood safety.

Objective To investigate the resistance mechanisms of Carbapenem-resistant Klebsiella pneumonia by genetic analysis, virulence features, phenotypic methods and homology isolated from blood samples. Methods A total of 23 Carbapenem-resistant Klebsiella pneumoniae strains were isolated from blood culture samples between January 2018 and December 2019. Hypervirulent strains and capsular serotypes were identified by string test and Wzi gene sequencing respectively. The exopolysaccharide synthesis regulator gene (rmpA), virulence- associated genes and carbapenemase genes were detected by PCR method. Multilocus sequence typing was used to analyze phenotype of strains. Pulsed field gel electrophoresis was used to analyze the homology of strains. Results All 23 strains of Klebsiella pneumoniae carried KPC-2 genes. There were 18 strains showed positive results of string test and rmpA. Wzi gene sequencing results showed that 22 strains were K14.64 type and 1 strains was K19. All 23 strains were divided into 3 groups by multilocus sequence typing , with the results of ST11 (18/23), ST307 (4/23) and ST15 (1/23). We further identified 18 ST11 strains into three types by pulsed field gel electrophoresis. Conclusions The resistance to carbapenem of Klebsiella pneumoniae strains was mainly associated with KPC-2 gene, which main serotype of capsule was K14.64 and dominant sequence type was ST11 type.

Objective Correlation study between Common parameters of thromboelastography, Coagulatant factor, Vascular endothelial factor, Antithrombin, Plasminogen and traditional coagulation test. Methods Collecting any abnormal sample of the results of thromboelastography in our hospital for nearly one year as the research object, meanwhile, frozen the plasma of same sample. When a certain amount is collected, the test is performed. Results The results of multiple linear regression analysis showed that only PLG and Fig had a regression relationship with the parameters. Conclusions When the blood coagulation state of the patient is evaluated from the whole, the thromboelastogram is superior to other laboratory coagulation tests, but the possible results of the coagulation factor and coagulation cannot be inferred based on the R value, and there is no one-to-one correspondence between them.

Objective To analyze the differences of Epstein-Barr virus (EBV) DNA in peripheral blood mononuclear cells (PBMCs) of patients with non-Hodgkin's lymphoma (NHL), and to discuss its clinical applications in prognosis. Methods A retrospective analysis of 421 NHL patients from the Western Branch of the First Affiliated Hospital of University of Science and Technology of China between April 2017 and September 2020 were conducted. The following clinical information was collected: age, sex, pathological type, clinical stage, lymphoma B symptoms, NHL international prognostic index (IPI), the results of blood routine and biochemical. Ninety-seven NHL patients were followed up regularly to analyze the changes of EBV DNA load before and after treatment to discuss its significance in the prognosis. Results The positive rate of EBV DNA from PBMCs in 421 NHL patients was 41.8%. The EBV DNA positive rate increased with age. Among them, NHL patients with T and NK cells and with lymphoma B symptoms were more susceptible to EBV infection, and the infection rate of patients with different tissue sources was also significantly different.According to International prognostic index, 97 NHL patients were divided into four groups. After treatment, EBV DNA load in the low-risk group, low-medium-risk group and middle-risk group decreased significantly, while the load in the high-risk group did not change significantly. The prealbumin(PA), albumin(ALB), and retinol binding protein (RBP) in NHL patients after EBV infection are significantly lower than those in uninfected patients, and the risk was higher and the survival time was shorter. Among the clinical indicators, pathological types, EBV infection, lymphoma B symptoms, bone marrow infiltration, PA and CysC were significantly correlated with the prognosis of patients. And pathological types, EBV infection, bone marrow infiltration and CysC were found to be independent prognostic factors in NHL. Patients with NHL derived from mature T and NK cells had poor prognosis. Conclusion Different types of NHL patients had differences in EBV DNA in PBMCs. Regular EBV DNA load monitoring before and after therapy could be clinical application value for prognosis monitoring.

Objective To investigate the expression and clinical value of serum microRNA (miR)-633 and miR-601 in patients with early gastric cancer. Methods We enrolled 116 patients with gastric cancer admitted to Danzhou people's hospital, which divided into early gastric cancer group (n=48) and advanced gastric cancer group (n=68) according to the progress of gastric cancer. We also enrolled 50 healthy people as control group. The levels of serum miR-633 and miR-601 detected by real-time quantitative PCR and carbohydrate antigen 72-4 (CA72-4) and carbohydrate antigen 19-9 (CA19-9) detected by chemiluminescence were analyzed. Results The levels of serum miR-633（1.93±0.86 vs. 0.62±0.14）, miR-601（9.16±2.50 vs. 3.80±1.27）, CA72-4（30.74±7.35 vs. 3.28±0.85,U/mL）and CA19-9（51.38±12.95 vs. 15.60±5.83,U/mL） in gastric cancer group were significantly higher than control group (all were P<0.001). The levels of miR-633（2.58±1.16 vs. 1.24±0.57）, miR-601（10.92±3.48 vs. 7.15±1.96）, CA72-4（40.52±10.35 vs. 16.65±4.70,U/mL）and CA19-9（64.15±17.42 vs. 36.20±10.18,U/mL）in advanced gastric cancer group were significantly higher than early gastric cancer group (all were P<0.001). The ROC curve showed that the area under curve (0.917, 95%CI: 0.857~0.975) in four indicators combined diagnosis was the largest, with the sensitivity and specificity of 95.7% and 82.6% respectively. Correlation analysis showed that the levels of serum miR-633 and miR-601 were positively correlated with CA72-4 and CA19-9 in early gastric cancer (r=0.760, 0.712, 0.828, 0.725, P<0.001). Conclusion The levels of serum miR-633, miR-601, CA72-4 and CA19-9 are significantly increased in patients with early gastric cancer, and the combined detection of four indexes showed higher diagnostic value in early gastric cancer.

Objective To explore coagulation disorder and relevant factors in patients with B cell hematological malignancies after CD19 targeted chimeric antigen receptor (CAR)-T cell therapy. Methods We retrospectively enrolled 46 patients with relapsed/refractory (R/R) B cell hematological malignancies from October 2016 to January 2020, and the changes of coagulation parameters after CAR-T therapy were collected and analyzed. Results Among 46 patients, 37 (80.4%) patients occurred coagulation disorders, including elevated D-dimer [ (>5 mg/L) (31/46, 67.4%)], prolonged APTT [ (> 10s) (25/46, 54.3%)], prolonged TT (19/46, 41.3%), decreased fibrinogen concentration [(<1.5 g/L) (22/46, 47.8%)], prolonged PT [ (>3s) (7/46, 15.2% )], and elevated FDP [ (> 20 mg/L (12/18, 66.7%)). Correlation analysis showed that coagulation disorder were associated with dose escalation, the level of inflammatory factors after infusion, and the severity of cytokine release syndrome (CRS) after infusion. Conclusion Coagulation disorder is a common adverse event after CAR-T therapy. Dose escalation infusion can reduce the risk of coagulopathy, and the severity of CRS is significantly associated with coagulopathy.

Objective To investigate the expression of serum miR-222-3p, human epididymal protein 4 (HE4) and carbohydrate antigen 125 (CA125) in epithelial ovarian cancer (EOC) and its clinical significance. Methods A total of 118 EOC patients, 105 in the benign group and 60 in the healthy control group were selected in our hospital. The expression of serum miR-222-3p was detected by real-time quantitative PCR, and the levels of HE4 and CA125 were detected by chemiluminescence. The diagnostic value of serum miR-222-3p, HE4 and CA125 levels to EOC were analyzed by ROC curve. Pearson correlation analysis showed that the expression of miR-222-3p in EOC patients was correlated with HE4 and CA125. Results The levels of serum miR-222-3p (1.62±0.74 vs 0.84±0.35, 0.73±0.24), HE4 (346.20±58.72 pmol/L vs 53.46±11.63 pmol/L, 48.60±9.75 pmol/L) and CA125 (307.60±94.25 U/mL vs 26.83±11.56 U/mL, 20.72± 9.40 U/mL) in EOC group were significantly higher than those in benign group and control group (P<0.001). ROC curve showed that the best cutoff values of serum miR-222-3p, HE4 and CA 125 were 1.16, 187.50 pmol/L and 162.80 U/mL, respectively. The area under the curve (0.948, 95% CI: 0.887~0.995) of the three combined diagnosis of EOC was the largest, and its sensitivity and specificity were 96.8% and 89.5%. Correlation analysis showed that the expression of miR-222-3p in EOC patients were positively correlated with HE4 and CA125（r=0.847,P<0.001,r=0.793,P<0.001）. Conclusion The levels of serum miR222-3p, HE4 and CA125 were significantly increased in EOC patients, and the three combined tests were of high value in the diagnosis of EOC.

Objective To explore the value of combined detection of urinary kidney injury molecule-1, interlukin-18 (IL-18) and serum cystatin C in the early diagnosis of acute kidney injury in children with primary nephrotic syndrome. Methods We enrolled 153 children with primary nephrotic syndrome and detected urinary kidney injury molecule-1, IL-18 and serum cystatin C. We compared the levels of these indicators in children with different degree of renal injury, and analyzed the diagnostic value of combined detection. Results The levels of urine kidney injury molecule-1, IL-18 and serum cystatin C in the acute kidney injury group (49/157, 32.03%) were higher than those without acute kidney injury (108/157, 67.97%) (P<0.05). The levels of urinary renal injury molecule-1, IL-18 and serum cystatin C in children with different acute kidney injury severity levels showed statistically differences (P<0.05). ROC analysis results showed that the diagnostic cut-off values of urinary kidney injury molecule-1, IL-18, and serum cystatin C in children with primary nephrotic syndrome with acute kidney injury were 3.87 μg/mL, 271.04 pg/mL and 1.23 mg/L respectively, and the AUC of combined diagnosis was 0.884, which diagnostic efficiency was higher than that of single examination (P<0.05). Conclusions Urinary kidney injury molecules-1, IL-18 and serum cystatin C can be used as diagnostic indicators for acute kidney injury in children with primary nephrotic syndrome, and combined detection can improve the diagnostic efficiency.

With the rapid development of China's medical and health undertakings, people's requirements for health service level are getting higher and higher, and new challenges have been put forward to clinical transfusion workers. However, the traditional "cramming" educational mode has showed obvious shortcomings. In order to improve the work ability of graduates majoring in blood transfusion and meet the needs of clinical work, a medical college takes the competency model as a tool, summarizes which dominant and recessive characteristics are required for excellent performance in clinical transfusion work and how these characteristics affect an individual's work ability. And the medical college carries on the research of new educational mode with occupational competency as the guide by expanding the teaching staff, using new educational methods. The aim is to cultivate high quality clinical transfusion talents which equipped with both dominant and recessive characteristics. They also want to comprehensively improve students' professional knowledge, occupational skills, social skills and professional quality. So that they could ensure the quality and safety of blood transfusion in clinical work and provide more reliable and high-quality services.

Objective To summarize the standardized nursing experience of 10 patients with refractory and recurrent acute lymphoblastic leukemia who had serious complications after CAR-T treatment. Methods We closely monitored the patient's body temperature, blood pressure, consciousness, pupil, language performance, convulsion or manifestations of pre-convulsion. The central venous catheter was placed to conduct plasma exchange (PE) timely. Sufficient tocilizumab, glucocorticoid, ventilator and other rescue drugs and equipments were prepared. We kept the patient's respiratory tract unobstructed during loss of consciousness and seizures. Health education and psychological nursing for patients and their families were strengthen. Results 8 patients were recovered and discharged and 2 cases gave up treatments after CRS. No nursing-related complication occurred and we got 100% satisfaction rate from patients. Conclusion Early judgment and nursing intervention could alleviate the complication of CAR-T cell therapy and improve the rescue rate.