Objective To evaluate the impact of X-ray irradiation on the quality of suspended red blood cells by comparing and analyzing the change in quality control indicators and some physicochemical indicators related to suspended red blood cells treated with X-ray irradiation and g-ray irradiation. Methods Totally 49 bags of 2 U suspended red blood cells that failed the glutamate aminotransferase (ALT) test were randomly collected and divided into the γ group (21 bags) and X group (28 bags) according to the irradiation source. Group γ and group X were subjected to corresponding irradiation treatments on the 13th day after collection, and the irradiated blood samples were stored in a 2~6 ℃ blood refrigerator. Quality indicators of irradiated bloods were measured on the 1st and 22nd days after irradiation, respectively. Results The hemolysis rate, K⁺ concentration, Na⁺ concentration, Cl^- concentration, and Ca²⁺ concentration of group X and group γ were (0.10± 0.03) % vs. (0.09±0.06) %, (46.50±7.94) mmol/L vs. (45.03±4.65) mmol/L, (99.44±3.86) mmol/L vs. (100.83±4.79) mmol/L, (68.35±2.79) mmol/L vs. (67.59±1.26) mmol/L, and (0.40±0.11) mmol/L vs. (0.43±0.08) mmol/L on the first day after irradiation, and (0.29±0.07)% vs. (0.27±0.06)%, (64.22±4.58) mmol/L vs. (63.05±3.57) mmol/L, (81.50±5.56) mmol/L vs. (81.76±3.91) mmol/L, (68.72±1.97) mmol/L vs. (68.28±1.36) mmol/L, (0.39±0.10) mmol/L vs. (0.41±0.04) mmol/L on the 22nd day after irradiation. No significant difference (P>0.05) was observed between group X and group g in terms of the same quality indicator at the same storage time. With the prolonged storage time, the hemolysis rate and K⁺ concentration of group X and group γ significantly increased, while the Na⁺ concentration significantly decreased and the concentration of Cl^- and Ca²⁺ remained unchanged. Conclusion There is no significant difference in the quality control and physicochemical indicators of suspended red blood cells treated with either X-ray or γ-ray irradiation. With safety completely considered, X-ray irradiator could replace γ-ray irradiator for the preparation of irradiated blood.

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 The coagulation function of children with Kawasaki disease (KD) was tested by Century Clot (Activated Clotting Time (ACT), Platelet Function (PF), Clot Rate (CR))parameters and conventional coagulation testing (CCT). The consistency of the two detection methods were analyzed. Methods A total of 38 KD children admitted to our hospital from July 2022 to October 2022 were selected to test Century Clot, CCT and platelet count (PLT) to evaluate the coagulation function. The consistency of the two methods was compared by Kappa analysis. Results ACT (s) in subacute stage (148.50±37.18) was significantly shorter than that in acute stage (184.23±39.2), and PLT (×10⁹/L) in subacute stage (491.50±126.91) was significantly higher than that in acute stage (374.35±105.70) (both P<0.05). There was no significant difference between the two stages in other test indicators. PF values in acute stage (4.34±0.8) and subacute stage (4.21±0.92) were significantly increased compared with control group (3.54±0.89) (P<0.05). The value of CR (Condensation signal/min) in acute stage (45.03±15.99) and subacute stage (48.19±7.79) was significantly increased compared with control group (21.59±4.45) (P<0.05). Fibrinogen and D-dimer in acute and subacute stages were significantly increased (P<0.05). There was no significant difference in other indicators. The Kappa consistency analysis of Century clot and CCT showed poor coagulation function. Conclusion KD Children mainly showed hypercoagulability with increased platelet count and Fibrinogen function and content, and Fibrin cleavage products. The platelet content in subacute stage was higher than that in acute stage, and the function of coagulation factor was enhanced. The consistency of Century clot and CCT in detecting coagulation function in KD children was poor, and the two methods are irreplaceable. Combining the two methods can improve diagnosis and treatment of KD children

Objective To investigate the expression of CD38 on erythrocyte surface of ABO with different blood groups and different preservation periods, in order to clarify the blood selection problem of daretuzumab in m ultiple myeloma (MM) patients. Methods Donor blood samples collected from the Blood Collection and Supply Centers of the Whole Army from May 25, 2022 to June 30, 2022 were selected. The four blood groups of type A, B, O and AB were divided into 5 preservation cycles from the date of blood collection. There were 15 normal specimens in different preservation periods of the four blood groups, totaling 300 specimens. For each preservation cycle, 5 people with different blood types were randomly mixed into a group and divided into three groups of specimens. The concentration gradient of CD38 monoclonal antibody was determined by diluting 100 mg/5 mL of CD38 monoclonal antibody with normal saline. Standard pre-transfusion tests were used for detection. Red blood cells and different levels of CD38 antibodies were added to anti-human globulin card in proportion (50 μL for red blood cells and 25 μL for CD38 antibodies), incubated for 15 min, and centrifuged for 10 min to observe the results. Results The monoanticoagulant strength of red blood cells was consistent with that of CD38 for blood groups A, B, O and AB, and there was no statistical significance (P>0.05). The concentration of CD38 monoclonal antibody of the four blood groups ranged from 200 μg to 256 μg, and the red blood cells of different preservation periods all showed 2+ agglutination, with no statistical significance (P=0.062). When the concentration of CD38 mab was 128 ng and 64 ng, erythrocyte agglutination was weakened in five preservation cycles, and the difference was statistically significant (P<0.05). Conclusion The expression of CD38 in different ABO blood groups is basically the same without significant difference. Red blood cells with different storage periods will not increase hemolysis in patients with m ultiple myeloma.

Objective To observe the effect of Daratumomab on detection of IgG anti-D antibody by polybrene test. Methods Ten plasma samples with AB RhD positive blood type and negative irregular antibody screening were selected, and each sample was divided into 3 groups by 2 mL in 3 tubes. Any substance was added in the antibody screening negative control group. IgG anti-D antibody was added in the antibody screening positive control group. Daretozumab (400 mg/20 mL) and IgG anti-D reagent were added in the experimental group. The irregular antibody screening test was performed by microcolumn gel card test and polybrene test to identify IgG anti-D antibody. Results There was significant difference between the experimental group (23.80±1.40) and the positive control group (18.80±1.40) by microcolumn gel card test (P<0.05). There was no significant difference between the experimental group (14.80±2.53) and the positive control group (14.80±2.53) by polybrene test (P>0.05). The lower limit of detection of IgG anti-D in the experimental group by polybrene test after dilution was the same result as that in the positive control group (1∶64). Conclusion Daretozumab has no effect on the detection of IgG anti D antibody by polybrene test, but has effect by the microcolumn gel card test.

Objective To analyze the specificity of HLA-I antibody in patients with platelet transfusion refractoriness. Methods Samples from 65 patients with platelet transfusion refractoriness were collected. Luminex platform was used to screen platelet-related antibodies and identify the specificity of HLA-I antibodies. The relative immunogenicity of different alleles was calculated according to the frequency of HLA-I alleles in Henan Han population reported in the laboratory and the number of positive antibodies detected in this experiment. Results HLA-I antibodies were detected in 51 of 65 samples including HLA-A antibodies and HLA-B antibodies. The antibody positive rates of A*11:01 and B*13:02 with the highest alleles frequencies of HLA-A and B loci were 0.33 and 0.65, respectively, and the relative immunogenicity was 0.113 0and0.183 8. The allele frequency of A^*34:01 in Henan population was only 0.000 4, but the relative immunogenicity of corresponding antigen was as high as 48.795 3. Similarly, the allele frequency of B^*44:02 is only 0.000 1, but the relative immunogenicity of its corresponding antigen is up to 127.420 4. Conclusion The characteristics of HLA-I antibodies are different in the patients with platelet transfusion refractoriness, and the immunogenicity of their corresponding antigens is different. The analysis of antibody characteristics and antigen relative immunogenicity can provide data support for the selection of appropriate donors for the patients, improve the infusion effect, and prevent the production of new antibodies.

Objective To improve a set of new plasma collector program management and disposable lines to achieve the blood collection, O3 treatment,plasma virus inactivation and return effective integration in order to provide multifunctional fusion blood treatment technology for some diseases. Methods The design abandoned on the NGL XJC-2000 plasma collection procedure, the control scheme of single-chip machine was improved to the overall solution of“control system + interactive system”. A blood collection bag was connected at the front of the line for ozonated -autohemotherapy technology(AOBT) and a set of plasma collection bag was connected for autologous plasma virus inactivation (APVI),so effectivelly integrated two treatment techniques. Results The plasma collector successfully extended the single function of plasma collection to the multifunctional blood therapy integrated machine, which provided more convenience for some patients' blood treatment. Conclusion The fusion of improved plasma collector and the pipelines has achieved good application results, which improved the timeliness of blood therapy treatment. It was worthy of clinical application and promotion.

Objective To learn the change of platelet collection and supply capacity of prefecture-level blood stations in China during the COVID-19 epidemic, and to provide reference for prefecture-level blood stations to ensure the supply of platelets when dealing with public emergencies. Methods The data from 2018 to 2021 were obtained from 27 prefecture-level blood stations who were the members of the practice comparison network for blood institutes in China. The number of active apheresis blood donors, the total apheresis platelet collection, the percentage of apheresis platelets donated by first-time donors to all donors, the leukocyte removal rate before apheresis platelet storage, apheresis platelet supply, the percentage of apheresis platelet supply to total platelet supply, and the total number of expired apheresis platelets were collected. The statistical year was divided into two periods: before the outbreak (2018-2019) and during the epidemic (2020-2021), and the statistical differences of platelet collection data before and after the epidemic were compared by SPSS software T-test. Results Before and after the outbreak of the epidemic in 27 prefecture-level blood stations, the total number of platelet-collecting active blood donors was 73,866 and 89,021 respectively, and the number of apheresis platelets was 438 573.4 U and 527 174.2 U, the total distribution amount of apheresis platelets was 425 799 U and 515 451.5 respectively, with significant differences. Before and after the outbreak of the epidemic, the average percentage of apheresis platelets donated by the first blood donors was 4.68% and 5.37%, respectively. Except for one blood station, the leukocyte removal rate of apheresis platelets in other 26 blood stations before storage ranged from 55.06% to 100%, and the percentage of apheresis platelets in total supply ranged from 91.48% to 100%. There are 12 blood stations with expired apheresis platelets, and the expired apheresis platelets in the outbreak period and the epidemic period are 24 U and 53 U, respectively. 12 blood stations had expired apheresis platelets, and the apheresis platelets expired during the outbreak and epidemic period were 24U and 53U, respectively. There is no significant difference between before and after the outbreak. Conclusion The epidemic situation in COVID-19 has no lasting adverse effects on the recruitment, collection and supply of platelet donors in prefecture-level blood stations in China, and blood stations constantly adjusted emergency measures to ensure the supply of platelets.

Objective To retrospectively analyze the clinical efficacy of auxiliary steel plate combined with autologous platelet rich plasma (PRP) and replacement of intramedullary nails with steel plate fixation in the treatment of femoral shaft nonunion after intramedullary nail fixation. Methods A total of 30 patients with femoral fracture and bone nonunion after intramedullary nail fixation were selected from the Department of Orthopedics of our hospital from June 2019 to June 2022, including 26 males and 4 females. The average age was (36.8±7.1) years, ranging from 20 to 58 years. In the experimental group of 13 patients, intramedullary nails were retained and the fracture end was fixed with side plates. During the operation, autologous iliac bone mixed PRP was implanted in the bone defect site, and autologous PRP 10 mL/ (person) was injected into the bone non-union site 14 d and 28 d after surgery. In the control group, intramedullary nails were removed, and locking compression plates were fixed instead, followed by intraoperative autologous iliac bone grafting. Follow up observation and comparison of perioperative conditions and clinical fracture healing between the two groups of patients were conducted. Results All the 30 patients received complete follow-up for 2~33 months, with an average of (15.2±3.5) months. The operative time (min), intraoperative blood loss (mL) and postoperative drainage volume (mL) of the two groups were 95.7±47.2 vs. 167.6±71.5, 292.3±147.2 vs. 686.9±238.9, and 102.8±67.5 vs. 166.2±87.3, respectively, showing significant differences (P<0.05), and the length of hospitalization (d) was 10.3±5.2 vs. 12.5±6.8, with no significant difference (P>0.05). The clinical healing time of fractures (month) was 5.36±1.27 vs. 7.63±1.57 (P<0.05); the healing rates at 6 and 9 months after surgery were 92.3% (12/13) vs. 52.9% (9/17) (P<0.05), and 100% (13/13) vs. 82.4% (14/17) (P>0.05), respectively. Conclusion sIntraoperative and postoperative use of autologous PRP in the treatment of femoral fracture after intramedullary fixation is simple, short, less bleeding, and fast healing, which is an ideal treatment for clinical selection.

Objective To observe the diagnostic value of low hemoglobin density (low hemoglobin density, LHD) for iron deficiency anemia (iron deficiency anemia, IDA) and iron deficiency (iron deficiency, ID) in hemodialysis anemia patients, and to clarify the clinical application value of LHD in the differential diagnosis of anemia of different causes in hemodialysis patients. Methods 375 maintenance hemodialysis patients in Longgang Central Hospital from January 2020 to January 2022 were divided into: hemodialysis non-anemia group, renal anemia, renal anemia and iron normal group, renal anemia and absolute iron deficiency group, renal anemia and functional iron deficiency group. At the same time, 157 people from health examination and 65 people with iron deficiency anemia in Longgang Central Hospital were selected as healthy control group (negative control group) and iron deficiency anemia group (positive control group) respectively. The differences in red blood cell parameters LHD and iron metabolism were analyzed among the groups. ROC curve analysis of the diagnostic power of LHD in IDA and ID was tested in the hemodialysis anemia population. Results In IDA screening, the diagnostic value of LHD was> 23.05 (P<0.05), sensitivity 100% and specificity 99.49%. For screening of functional iron deficiency in the hemodialysis anemia population,, its the diagnostic value> 7.705 (P<0.05), sensitivity 61.11% and specificity 58.67%. Conclusion sLHD has high diagnostic efficacy for IDA in hemodialysis anemia patients with diagnostic threshold> 23.05. LHD is weak in diagnose ID in patients with hemodialysis anemia.LHD has no obvious differential diagnosis value for renal anemia combined with functional iron deficiency and absolute iron deficiency.

Objective The serological characteristics and pre S1 gene sequencing in hepatitis B virus (HBV) infected pregnant women with negative Pre-S1 antigen (Pre-S1Ag) were analyzed to provide a basis for explaining the negative Pre-S1Ag in HBV-infected pregnant women and preventing vertical transmission. Methods Pregnant women who underwent health examination in Shandong Maternal and Child Health Hospital from July 2021 to December 2022 were selected as the study objects. Five tests of hepatitis B and Pre-S1Ag were detected. A total of 14 cases with positive hepatitis B surface antigen (HBsAg) and negative Pre-S1Ag were selected as the experimental group, and 20 cases with both positive HBsAg and Pre-S1Ag were randomly selected as the control group. HBV DNA was detected, and PreS/S gene was amplified and sequencing was performed. Results In HBV-infected pregnant women, Pre-S1Ag negative was found only in five serologic patterns of hepatitis B with positive HBsAg, anti-HBe and anti-HBC, accounting for 4.17%, but not in other serologic patterns of HBV infection. There were significant differences in the positive rates of HBeAg and anti-HBe between the experimental group and the control group (P<0.001). Compared with the control group, HBsAg detection were （29±91） IU/mL and （2 070.6±714.8） IU/mL, respectively. HBV DNA were （1.63±0.05） lg IU/mL and （5.79±1.53） lg IU/mL, and the differences was statistically significant (P<0.001). The sequencing results showed 3 genotype B cases and 17 genotype C cases in the control group. The 14 samples in the experimental group were all genotype C. There was no significant difference in the positive rates of Pre-S1 protein between the two groups (P>0.05). Conclusion The no reactivity of Pre-S1Ag in HBV-infected pregnant women was not related to PreS gene mutations, but was related to the low HBV DNA load resulting in the expression level of Pre-S1Ag below the detection limit. The possibility of vertical transmission in HBV-infected pregnant women with negative Pre-S1Ag cannot be ignored.

Objective The first case of blood stream infection with Candida auris in Tongling of Anhui province was reported, the drug resistance and source of the strain were analyzed. Methods MS and gene sequencing were used to identify the strain of Candida auris from a patient with blood infection in the intensive care unit (ICU) of a tertiary hospital in Anhui Province, China, and its resistanceto various drugs, bacterial origin and virulence were analysed. Results The drug sensitivity test showed that the fungus was resistant to azoles and polyene, but sensitive to 5-fluorocytosine.Mutations in ERG11 and CDR1 were found in the whole genome sequencing. The former mutated from tyrosine to L-Phenylalanine at position 132 and the latter mutated from glutamate to L-Aspartic Acid at position 709.No mutation was detected in ergosterol pathway related genes ERG1, ERG2, ERG6, Erg13. In addition, a phylogenetic tree drawn by comparing Internally Transcribed Spaer（ITS）sequences revealed that the strain with the closest relationship to the strains we isolated was the Indian strain. Conclusion This is the first report of blood stream infection caused by Candida auris in Anhui Province.MS and gene sequencing enable accurate identification of Candida auris. In addition, gene sequencing enables in-depth analysis of the species origin, resistance to multiple drugs, and high virulence of Candida auris.

Autoimmune hemolytic anemia (AIHA) is a hemolytic disease caused by its own red blood cell antibodies, which is mainly characterized by accelerated destruction of red blood cells. The diagnosis of AIHA is based on direct antiglobulin test (DAT) and hemolysis related indexes.And the treatment for AIHA based on the type and etiology includes blood transfusion,symptomatic supportive care and immunotherapy. In immunotherapy, glucocorticoids are the main first-line therapy, rituximab the second-line therapy, and splenectomy and cytotoxic immunosuppressants the third-line therapy for warm-antibody type; rituximab is the main first-line therapy, rituximab plus bendamustine the second-line therapy and complement inhibitor the third-line therapy for cold-antibody type. The current treatment regimens are not specific and poor efficacy, and there are side effects. New drugs including foctatinib , orilanolimab ( SYNT 001) , rozanolixizumab (UCB7665), nipocalimab (M281) , PI3K inhibitors, venetoclax, ofamulimab, alemtumab and daratumab are undergoing in clinical trials. In addition, traditional Chinese medicine treatment regimens may bring a new potential breakthrough point for the treatment of AIHA.

Blood donors and the blood components they willingly provide play a key role in the healthcare system service in all over the world. As a result of one donation, particularly whole blood donors will loss part of their total iron stores. The cumulative effect of repeat blood donations without sufficient iron replacement or a longer interval between donations results in iron deficiency (ID) in many donors, even anemia in some. Moreover, ID can be associated with side effects that can impact a blood donor's health, such as fatigue, cognitive changes and other factors, that may prevent the donors from maintaining long-term blood donation. In an effort to better identify and prevent ID, blood collection agencies are recommending various strategies, including changes in the donation interval, donation frequency, testing of iron status and iron supplementation. This review summarizes the progress in related research area.

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.