Background Blood transfusion therapy is extremely important for certain neonatal diseases, but the threshold for neonatal blood transfusion is not the same in different countries. Until now, clinical studies to determine the suitable threshold for newborns in China are lacking. Therefore, it is of high importance to establish a multi-center cohort study to explore appropriate transfusion thresholds for newborns in China. Methods This retrospective cohort study investigated neonatal blood transfusion therapy administered from January 1, 2017 to June 30, 2018, with the aim of evaluating the effect of restricted and nonrestricted blood transfusion on neonatal health. The subjects were enrolled in 46 hospitals in China. A total of 5669 neonatal cases were included in the study. Clinical diagnosis and transfusion treatment of these neonates were collected and the data were retrospectively analyzed. The neonates were followed up 1 week and 1 month after leaving the hospital. The newborns’ and their mothers’ data were collected containing 280 variables in the database. The primary outcome of the study was mortality, and the secondary outcomes were complications, hospital stays, NICU hospital stays and hospital costs. Results Results from the < 1500 g group showed that there was a higher mortality rate in the restricted transfusion group (11.41%) when compared with the non-restricted transfusion group (5.12%) ( P = 0.000). Among the secondary outcomes, the restricted transfusion group had fewer costs. Results from the 1500-2500 g group showed that the mortality rates of the restricted and non-restricted transfusion groups were 3.53% and 4.71%, respectively, however there was no statistical significance between the two groups ( P = 0.345). Among the secondary outcomes, the restricted transfusion group had fewer hospital stays, NICU hospital stays and hospital costs. The incidence of necrotizing enterocolitis was lower in the restricted transfusion group (OR, 2.626; 95% confidence interval [CI], 1.445 to 4.773; P = 0.003). The results from the ≥ 2500 g restricted transfusion group suggested that the mortality rate of (3.02%) was significantly lower than that of non-restricted transfusion group (9.55%) ( P = 0.000). Among the secondary outcomes, the restricted transfusion group had fewer hospital stays and hospital costs. The incidence of retinopathy of prematurity was lower in the restricted transfusion group (OR, 4.624; 95% confidence interval [CI], 2.32 to 9.216; P = 0.000). Conclusions Current transfusion protocols for newborns weighing less than 1500 g may be inappropriate and lead to higher mortality. The current transfusion threshold performed better for the other two weight groups.

目的 调查全国住院输血新生儿血气检测指标,为深入研究不同阶段新生儿血气分析参考范围提供数据支持.方法 本研究采用多中心回顾性调研方式,以全国46家医院2017年1月1日～2018年6月30日收治的输血新生儿5669例为研究对象,按照统一的数据采集表,采集新生儿住院诊治数据,对采集数据按胎龄分为<32 w组,32～36 w组,≥37 w组三组,统计分析新生儿住院期间输血干预前血气分析数据.结果 随着新生儿日龄及胎龄的增大,pH值呈小幅波动,但总体呈升高的趋势.PO2结果显示<32 w组随日龄增大呈降低趋势,≥37 w组自0～1 d(61.80 mmHg)升高至4～5 d(72.50 mmHg)后趋于平稳,相同日龄三组间PO2值比较,日龄0～3 d时早产儿PO2大于足月儿.PCO2结果显示相同日龄三组间比较,随着胎龄的增大PCO2逐渐降低.新生儿随着日龄和胎龄的增大,HCT值均呈逐渐降低的趋势.SaO2结果显示≥37 w组自0～1 d(93％)升高至2～3 d(96.40％)后趋于稳定.结论 不同胎龄不同日龄新生儿血气相关指标变化显著,依据胎龄日龄制定新生儿血气指标参考范围有助于指导临床对新生儿疾病的精准诊疗.

目的 调查我国部分医院的储存式自体输血(PABD)开展情况.方法 自制PABD调查问卷,内容包括医院床位数、年住院人次、PABD量(人次及血液量)等,调查20家中大型综合性医院(床位数≥1000张),按照设计的调查问卷要求回报数据,并进行分析.结果 20家医院回收来自12家医院的有效调查问卷12份;数据离散度很大,2018-2020年3年间,开展最好的医院开展PABD人次占手术人次的百分比最高为1.55％.2020年12家医院开展了PABD,2家医院开展有成分血(单采血浆、血小板和红细胞)采集.结论 在所调查的12家医院中,开展PABD人次占手术人次的百分比差异很大,与医院类型、输血管理和血液供应等多种因素有关.

目的 为了全面掌握黑龙江省输血发展现状,结合2019年临床用血质量控制指标,发现输血科建设中存在的问题,为制定医疗机构输血科建设规范及从业人员考核标准提供决策依据.方法 采取回顾性调查方法,对黑龙江省372家医院2019年1—12月临床用血质量控制指标及单位人员信息进行调研.结果 372家医疗机构,独立设置输血科占39.8％.2019年黑龙江省医疗机构输血申请单合格率96.0％;申请输血患者血型复查率95.3％;室内质控只有64家能100％达标;参加室间质评共70家;输血不良反应上报率为0.3％;一、二级手术台均用血量为0.1 U,三、四级手术台均用血量为0.43 U;自体输血率5.9％;出院患者人均用血量为0.18 U.结论 黑龙江省输血科在各方面均取得了一定的发展,但是很大比例的二级及以下医院都没有独立输血科.今后,还需要加大对输血科的建设,提高输血工作者的专业水平,以保证临床输血医疗质量水平.

BackgroundPreoperative anemia is an important pillar of perioperative patient blood management. However, there was no literature comprehensively described the current situation of preoperative anemia in China.MethodsWe conducted a national retrospective cross-sectional study to assess the prevalence and intervention of preoperative anemia in Chinese adults. Data were from the National Preoperative Anemia Database based on hospital administration data from January 1, 2013 to December 31, 2018.FindingsA total of 797,002 patients were included for analysis. Overall, 27.57% (95% CI 27.47–27.67) of patients had preoperative anemia, which varied by gender, age, regions, and type of operation. Patients who were female, age over 60 years old, from South China, from provinces with lower per capita GDP, underwent operations on the lymphatic and hematopoietic system, with laboratory abnormalities were more likely to have a high risk of preoperative anemia. Among patients with preoperative anemia, 5.16% (95% CI 5.07–5.26) received red blood cell transfusion, 7.79% (95% CI 7.67–7.91) received anemia-related medications such as iron, erythropoietin, folic acid or vitamin B12, and 12.25% (95% CI 12.10–12.40) received anemia-related therapy (red blood cell transfusion or anemia-related medications) before operation. The probability of preoperative RBC transfusion decreased by 54.92% (OR 0.46, 95% CI 0.46–0.47) as each 10-g/L increase in preoperative hemoglobin. Patients with preoperative hemoglobin less than 130 g/L was associated with longer hospital stay and more hospital costs. Patients with severe preoperative anemia given iron preoperatively had lower intra/post-operative RBC transfusion rate, shorter length of stay and less hospitalization costs, but no similar correlation was found in patients with mild and moderate preoperative anemia and patients given erythropoietin preoperatively.InterpretationOur present study shows that preoperative anemia is currently a relatively prevalent problem that has not been fully appreciated in China. More researches will be required to optimize the treatment of preoperative anemia.FundingNational Natural Science Foundation of China and the Logistics Support Department of the Central Military Commission.

目的:通过对系统性红斑狼疮(SLE)合并血小板减少患者血清中的促血小板生成素(TPO),血小板特异性抗体(HPA)以及各实验室指标的检测,分析TPO,HPA与各实验室指标的相关性,探究TPO及HPA与SLE合并血小板减少患者的关系,从而初步分析SLE合并血小板减少症的发病机制.方法:收集SLE合并血小板减少患者30例(SLE合并组),单纯SLE患者22例(SLE组),健康对照者18例(对照组),应用酶联免疫吸附法(ELISA)分别检测血清中TPO、HPA含量,应用免疫比浊方法检测SLE合并组C反应蛋白(CRP),类风湿因子(RF),补体C3,补体C4实验室指标,沉降法检测红细胞沉降率(ESR),电阻法检测血小板值,分析TPO与各实验室指标的相关性.结果:TPO含量在3组间差异有统计学意义(P＜0.01);HPA阳性率在3组间差异无统计学意义(P＞0.05).在SLE合并组中,TPO与CRP(r =0.387,P=0.035)、血沉(r=0.669,P=0.001)呈正相关;与C3(r=-0.397,P=0.030)、C4(r=-0.462,P=0.010)呈负相关;与RF、血小板计数无相关性.结论:SLE患者血清中TPO含量明显升高,而HPA则无差异,TPO可能在SLE患者血小板减少作用机制中发挥一定作用.

目的:探讨血栓弹力图(TEG)检测在下肢动脉硬化闭塞症凝血功能的作用.方法:选取2017-01-2017-12治疗的99例下肢动脉硬化闭塞症患者,根据病程将其分为3组(轻度病变组、中度病变组和重度病变组);选择同期入院的40例健康者作为对照组.所有研究对象均进行TEG与凝血常规及血小板含量检测并分析其相关性.TEG参数与动脉硬化闭塞症不良事件进行相关性分析.结果:轻度病变组R值和K值低于对照组,差异有统计学意义(P＜0.05);中度病变组Angle角、MA值、FIB值和D-D值明显高于对照组和轻度病变组,差异有统计学意义(P＜0.05),中度病变组R值、K值降低,差异有统计学意义(P＜0.05);重度病变组R值低于中度病变组,MA值、FIB值和D-D值明显高于中度病变组,差异有统计学意义(P＜0.05);相关性分析显示,R值与FIB值、D-D值呈负相关;K值与FIB值、PLT值、D-D值呈负相关;Angle角和MA值分别与FIB、PLT、D-D呈正相关.下肢动脉硬化闭塞症不良事件相关性分析发现MA与脑血管和截肢有显著相关性.结论:在下肢动脉硬化闭塞症患者中,患者处于高凝状态,与常规凝血检查相比,TEG能更好的反映患者血液状态.

目的 探讨同源形成素蛋白2(formin homology proteins,FMNL2)在肺癌细胞系中的表达,及其与肺癌细胞侵袭、迁移的相关性.方法 通过细胞转染siRNA降低FMNL2的表达,采用细胞增殖实验、划痕实验和侵袭实验等观察FMNL2对肺癌HCC827细胞的影响.结果 敲低FMNL2的表达,发现肺癌HCC827细胞的活力以及增殖能力均降低,而在划痕实验和侵袭实验中,敲低FMNL2也降低了划痕的愈合速度和侵袭细胞数量.结论 FMNL2的高表达能够促进肿瘤的恶性生物学行为,FMNL2参与并调控了肺癌细胞的发生和发展过程,并可能成为影响患者预后的关键因子.

目的:探讨不同胎龄早产儿凝血功能及其在输注新鲜冰冻血浆后相关指标的变化情况.方法:随机选取实施输血治疗的102例住院早产患儿,按胎龄分为早期早产儿组(胎龄27～31+6周,28例)、中期早产儿组(胎龄32～33+6周,34例)和晚期早产儿组(胎龄34～36+6周,40例).分析各组输注新鲜冰冻血浆前后凝血指标的变化.结果:实施输血治疗的102例早产儿在输注新鲜冰冻血浆前后检测凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)的差异有统计学意义(P＜0.05),表现为PT、APTT缩短,FIB升高.中期早产儿组、晚期早产儿组输注新鲜冰冻血浆后PT、APTT均较早期早产儿组时长,FIB水平均较早期早产儿组低,差异有统计学意义(P＜0.05).结论:早产儿凝血功能检测指标的参考范围明显异于成人,输注新鲜冰冻血浆可有效改善早产儿凝血功能.早期早产儿组较中期和晚期早产儿组的指标改善更为明显.

Rh血型系统是人类红细胞抗原中最复杂的血型系统,其在临床输血中的重要性仅次于ABO 血型.Rh 抗原缺失是非常罕见的,目前报道的有D--、Dc-、DCw-[1,2,3]等,其分子基础也不尽相同,包括基因删除、基因突变等.本实验室收到一份疑难配血样本,患者的RhCE抗原缺失,为D--表型,血清中含有针对高频抗原的抗体.本文对患者及其家系的Rh系统表型和基因型进行了分析研究.并通过中国稀有血型库为其找到了相合的供者,做好了输血的准备,现报道如下.

目的:探讨不同比例输注新鲜冰冻血浆对大量输血患者凝血功能的影响.方法:回顾性分析本院2018年1月至2018年12月收治的123例大量输血患者的临床资料,依据所输注新鲜冰冻血浆与红细胞比例不同,将其分为低比例组(1∶3)、中比例组(1∶2)、高比例组(1∶1),比较三组患者输血前后凝血功能、血小板计数及电解质变化.结果:输血后,三组患者FIB较输血前明显降低,而PT、APTT较输血前显著升高(P＜0.05),高比例组PT和APTT明显低于中比例组和低比例组,FIB、血小板均高于中比例组和低比例组(P＜0.05),电解质水平优于低比例组和中比例组(P＜0.05).结论:在大量输血时,提高血浆与红细胞比例有利于改善大量输血患者凝血功能障碍,减少电解质紊乱.

目的:研究血栓弹力图肝素酶对比试验(hmTEG)指标在下肢深静脉血栓(DVT)患者上是否存在差异,探讨常规凝血功能指标与hmTEG在诊断DVT上是否存在相关性,监测患者体内是否有肝素残留,指导临床用药治疗.方法:选取2018-01-2018-06就诊的患者,试验组为57例新发急性期DVT患者,对照组为57例同期来医院常规体检人员.2组均行常规凝血功能检查以及枸橼酸化高岭土激活样品TEG检测,而试验组另行下肢深静脉超声检查,患者经治疗后行枸橼酸化高岭土激活样品肝素酶杯TEG检测.结果:试验组在TEG指标包括凝血反应时间R值、凝固时间K值、最大血凝块强度MA值、凝固角α值上的差异均有统计学意义(均P＜0.05),且常规凝血指标包括活化部分凝血活酶时间(APTT),凝血酶原时间(PT)、D-二聚体(D-D)与R值具有相关性;PT、APTT、D-D与K值具有相关性;PT与a值具有相关性;APTT、D-D与MA值具有相关性.经治疗后,57例患者中5例提示肝素残留,52例提示肝素未存在或未起效.结论:DVT患者的hmTEG相关指标差异有统计学意义,对于评估DVT患者具有一定的实用价值.在诊断下肢深静脉血栓DVT方面,TEG相关指标与常规凝血指标具有一定相关性,且hmTEG能更好的指导临床用药.

目的:探讨血栓弹力图(TEG)预测下肢骨折围手术期深静脉血栓的临床价值.方法:选择在我院进行体检的健康志愿献血者作为对照组(Ⅰ),同时选择82例在我院进行骨科手术的下肢骨折患者作为实验组(Ⅱ).分别在骨折后第2天、手术当天、术后第3天、术后第7天和术后第10天进行血栓弹力图检测,比较实验组(Ⅱ)与对照组(Ⅰ)TEG各参数差异,并对所有数据进行相关性分析.结果:实验组(Ⅱ)82例研究对象中有63例(76.83％)于术后一周内出现高凝状态.与对照组(Ⅰ)比较,实验组(Ⅱ)骨折第2天、手术当天、术后第3天、术后第7天和术后第10天R、K缩短,Angle角、MA、CI值均延长.与手术当日比较,实验组(Ⅱ)术后第3天、术后第7天R和K明显缩短,Angle角、MA、CI值均明显延长(P＜0.05),与术后第3天、术后第7天比较,术后第10天R、K延长,Angle角、MA、CI值有缩短趋势.结论:血栓弹力图能及时准确监测下肢骨折患者凝血状态变化情况,及时预测下肢深静脉血栓(LDVT)发生风险,为抗凝药物的合理使用提供参考依据.

This study compared the corrective effects of storage of platelets at 4 degrees C and at 22 degrees C in an in vitro model of massive blood loss and thrombocytopenia to provide an experimental basis for the storage of platelets for clinical applications. In vitro model of massive blood loss and thrombocytopenia were constructed by the in vitro hemodilution method and cell washing method. Using storage of platelets at 4 degrees C (1, 3, 5, 7, 10, 14 days) and at 22 degrees C (1, 3, 5 days) to correct the coagulation condition of the different models, by thromboelastography and by routine blood indices. Platelets stored at 4 degrees C (1, 3, 5,7, 10, 14 days) and at 22 degrees C (1, 3, 5 days) to correct the in vitro model of massive blood loss. Platelet count results improved from 17 to 27 x 10(9)/L to greater than 120 x 10(9)/L for 4 degrees C storage, and 20 to 27 x 10(9)/L to greater than 120 x 10(9)/L for 22 degrees C storage. Thromboelastography maximum amplitude (TEG-MA) results improved from 8.8 to 15.4mm to greater than 43mm for 4 degrees C storage, and 12.2 to 14.4mm to greater than 44.8mm for 22 degrees C storage. Thromboelastography reaction time values decreased from 9.9-24.9 minutes to 3.8-5.5 minutes for 4 degrees C storage, and 9.9-22.7 minutes to 4.3-4.5 minutes for 22 degrees C storage. Platelets stored at 4 degrees C (1, 3, 5,7, 10, 14 days) and at 22 degrees C (1, 3, 5 days) to correct the in vitro model of thrombocytopenia. Platelet count results improved from 12 to 34 x 10(9)/L to greater than 99 x 10(9)/L for 4 degrees C storage, and 12 to 34 x 10(9)/L to greater than 120 x 10(9)/L for 22 degrees C storage. TEG-MA results improved from 21.4 to 32.1mm to greater than 49.1mm for 4 degrees C storage, and 21.4 to 31.6mm to greater than 50.5mm for 22 degrees C storage. Platelets stored at 4 degrees C and 22 degrees C have the same correcting effect for 1, 3, and 5 days. Platelets stored at 4 degrees C for 7 to 14 days have similarly hemostatic effect on the in vitro model of massive blood loss and thrombocytopenia.

目的:本文探讨血小板减少的病因与补体C 1 q降低并且ANA阳性的相关性.方法:选择2017-05-09～2017-12-31期间的230例来我院就诊病人,方法用固相凝集法检测血小板抗体.结果:230例病人中共检出血小板抗体阳性68例(29.6％)、弱阳性135例(58.7％);阴性27例(11.7％);并对其中血小板抗体阳性86例、弱阳性54例与补体C 1 q降低且ANA阳性进行统计学分析,有显著相关性(P<0.01).结论:自身免疫性疾病(AID)是引起血小板抗体阳性重要因素.血小板抗体的筛查,常用于临床的有配合型输血、早期流产发生的风险提供诊断和治疗依据,有利于新生儿同种免疫性血小板减少性紫癜预防,对血小板抗体引起的血小板减少疾病进行对症治疗和预防有着重要意义.

Objective To explore the effect and its regulation of immunoglobulins of As2O3combined with all-trans retinoic acid in the treatment of acute leukemia children after transfusion. Methods 160 children with acute leukemia after transfusion were enrolled in this study in our hospital between Oct 2013 and Oct 2017. The effect of As2O3combined with all-trans retinoic acid in the treatment of acute leukemia children after transfusion and its regulation of immunoglobulin were assayed. Acute leukemia children in the control group were given As2O3or all-trans retinoic acid. Results As2O3combined with all-trans retinoic acid showed better effect on acute leukemia children than As2O3or all-trans retinoic acid alone with statistical differences (P<0.05). And the concentrations of IgA, IgM, Caspase3, and Cas-pase9 were decreased greatly after As2O3combined with all-trans retinoic acid treatment (P<0.05). Conclusion As2O3combined with all-trans retinoic acid is effective for the treatment of acute leukemia children after transfusion and can regulate immunoglobulin concentration.

Neonatal alloimmune thrombocytopenia (NAIT), caused by maternal antibodies raised against alloantigens carried on foetal platelets, is a very common haematological abnormality in newborns worldwide. However, baseline data on NAIT in China are lacking. Therefore, this study seeks to explore the incidence of alloantibody against the human platelet antigen (HPA) in pregnant women and its associations with NAIT in China.

BACKGROUND:Long noncoding RNAs (lncRNAs) can act as competitive endogenous RNAs (ceRNAs) to compete with mRNAs for binding miroRNAs (miRNAs). The dysregulated triplets, composed by mRNAs, lncRNAs, and miRNAs, contributed to the development and progression of diseases, such as cancer. However, the roles played by triplet biomarkers are not fully understand in glioblastoma multiforme (GBM) patient survival. OBJECTIVES:Here, we constructed a differential triplet interaction network (TriNet) between GBM and normal tissues and identified GBM survival related triplets. METHODS:Four significantly dysregulated modules, enriched differentially expressed molecules, were identified by integrating affinity propagation method and hypergeometric method. Furthermore, knockdown of TP73-AS1 was implemented by siRNA and the expression of RFX1 was examined in U87 cells by qRT-PCR. The apoptosis of U87 cells was investigated using MTT assay and Acridine orange/Ethidium bromide (AO/EB) assay. RESULTS:We randomly split GBM samples into training and testing sets, and found that these four modules can robustly and significantly distinguish low- and high-survival patients in both two sets. By manually curated literatures for triplets mediated by core interactions, we found that members involved tumor invasion, proliferation, and migration. The dysregulated triplets may cause the poor survival of GBM patients. We finally experimentally verified that knockdown of TP73-AS1, an lncRNA of one triplet, could not only reduce the expression of RFX1, an mRNA of this triplet, but also induce apoptosis in U87 cells. CONCLUSIONS:These results can provide further insights to understand the functions of triplet biomarkers that associated with GBM prognosis.

According to recent reports, aberrant miRNA expression has been observed in human cancers, and their alterations contribute to multiple cancer development and progression. In the present study, we indentified miR-186 by analyzing quantitative real-time PCR data of chronic myeloid leukemia (CML). miR-186 was found to be markedly reduced in CML samples compared with that in corresponding normal MSCs. However, little is known about its molecular mechanism in CML development. Here, we reported the effect of miR-186 on CML cell proliferation and epithelial-mesenchymal transition (EMT). MTT, Transwell and Western blot assay were used to assess the effect of miR-186 on A562 and KCL-22 cell proliferation and EMT. Target prediction and luciferase reporter assays were performed to investigate the targets of miR-186. Tumor formation assay in vivo was performed to investigate the antitumor effect of miR-186. We found an inverse correlation between miR-186 and CML cell proliferation, EMT, migration, and invasion. Moreover, we validated that rho-associated protein kinase 1 (ROCK1) was a direct target of miR-186, by whichmiR-186 regulated CML cell proliferation, EMT, migration, and invasion. The animal experiments showed that overexpression of miR-186 inhibited the growth of CML tumors. In conclusion, miR-186 functions as a tumor suppressor in the progression of malignant CML, which can be recommended as a potential target.

Objective To comparison and analysis the changes in functional of platelets stored.at 4℃ and those agitated at 22℃ were compared to provide an experimental basis for the cryopreservation technology of platelets.Methods Blood samples were collected for platelets stored at 4℃ for 1,3,5,7,10,14,and 21 days,as well as for those stored with agitation at 22℃ for 1,3,and 5 days.Thromboelastography (TEG),light transmittance aggregometry,and flow cytometry were used to test platelets that had been stored under the different conditions.Results The thromboelastograph of platelets stored at 4℃ showed that their MA values were still within the normal range after 21 days of storage.The five TEG indicators of platelets stored with agitation at 22℃ for 5 days showed low coagulation (P＜0.05).The maximum platelet aggregation rate of platelets stored at 4℃ for 1 day was higher than 50％ and was higher than that of platelets stored with agitation at 22℃ (P＜ 0.05).After 5 days of storage,the COLL-and ACA-induced maximum aggregation rate of platelets stored at 4℃ was maintained at above 80％,while the maximum aggregation rate by the four inducers for platelets agitated at 22℃ was less than 5％.For platelets stored at 4℃ for 10-14 days,although the four aggregation rates were reduced,they were significantly higher those of platelets stored with agitation at 22℃ for 5 days (P＜0.05).Analysis of activated procaspase-activating compound 1 (activated Ⅱb/Ⅲa) and CD62P (P-selectin) on the platelet surface revealed that a large number of platelets stored at 4℃ after 10-14 days remained in the mid and late activation states.Conclusion Platelets stored at 4℃ showed better aggregation,coagulation,and higher activity than platelets stored with agitation at 22℃.Platelets can be stored in vitro for 10-14 days.