Objective To investigate the clinical symptoms,laboratory tests,and treatment strategies of a case of fetal/neonatal alloimmune thrombocytopenia(FNAIT)complicated with piperacillin drug antibody.Methods The platelet anti-bodies in the mother were screened and identified by ELISA.The HLA antigens of the newborn were genotyped through PCR-SSO,while the specificity of HLA antibodies in the mother was determined using a Single Antigen kit.The drug anti-body was detected by a piperacillin kit.Results Maternal antibodies against paternally-derived platelet antigens were de-tected.The HLA genotypes of the newborn were identified as HLA A∗33∶03 and HLA B∗58∶01.The mother exhibited strong positive antibodies against the specific platelet antigens of the newborn,namely anti-HLA-A33 and anti-HLA-B58 antibod-ies.The piperacillin antibody was detected in the newborn.Following treatment of continuous intravenous immunoglobulin(IVIG),platelet transfusions,red blood cell transfusions and discontinuation of piperacillin treatment,the platelet count and hemoglobin levels increased in the newborn.Conclusion The newborn in this case was diagnosed with FNAIT compli-cated by the presence of anti-HLA-A33 and anti-HLA-B58 antibodies,as well as drug-induced hemolytic anemia caused by piperacillin drug antibody.The condition is more complicated under the influence of dual immune antibodies.Laboratory detection techniques such as platelet antibody and drug antibody tests can assist in early clinical diagnosis.At the same time,more active drug and blood transfusion treatments should be given in clinical practice to improve the prognosis.

Platelets not only participate in thrombosis and hemostasis but also interact with tumor cells and protect them from mechanical damage caused by hemodynamic shear stress and natural killer cell lysis, thereby promoting their colonization and metastasis to distant organs. Platelets can affect the tumor microenvironment via interactions between platelet-related factors and tumor cells. Metastasis is a key event in cancer-related death and is associated with platelet-related factors in lung, breast, and colorectal cancers. Although the factors that promote platelet expression vary slightly in terms of their type and mode of action, they all contribute to the overall process. Recognizing the correlation and mechanisms between these factors is crucial for studying the colonization of distant target organs and developing targeted therapies for these three types of tumors. This paper reviews studies on major platelet-related factors closely associated with metastasis in lung, breast, and colorectal cancers.

BACKGROUND:Recently, various techniques have been developed to accurately and sensitively detect tumor biomarkers for the early diagnosis and effective therapy of cancer. The electrochemiluminescence (ECL) method holding outstanding features including high sensitivity, ease of operation, and spatiotemporal controllability exhibited great potential for DNA/RNA detection, immunoassay, cancer cell detection, and environmental analysis. However, a glaring problem of ECL approaches is that the layer-by-layer modification on the electrode leads to poor stability and sensitivity of the sensors. Therefore, new simple and efficient methods for electrode modification which can effectively improve the ECL signal have attracted more and more research interests. RESULTS:Based on the dual amplification strategy of target-induced CHA and nanocomposite probes leading to self-generated co-reactant (H2O2), we proposed a highly sensitive miRNA-ECL detection system. The introduction of the target miRNA-21 triggers the CHA cycle amplification of DNA1 and biotin-modified DNA2, releasing the target miRNA-21 sequence for the target cycle reaction. After the reaction, the newly introduced DNA2 was combined with Au NPs modified with SA and Glucose oxidase (GOD). In the presence of oxygen, glucose was decomposed by GOD to produce H2O2, and then H2O2 was immediately catalyzed by the Hemin/G-quadruplex at the double-stranded end of the CHA product to produce a large amount of O2-•. As a co-reactant of luminol, the ECL signal was significantly enhanced, thereby achieving highly sensitive detection of miRNA-21 content and obtaining a low detection limit of 0.65 fM. The high specificity of the ECL biosensor was also proved by base mismatch. SIGNIFICANCE:Compared with other current detection methods, this sensor can achieve quantitative analysis of other target analytes by flexibly changing the probe DNA sequence, and provide a new feasible solution for the detection of tumor-associated markers. Benefiting from the improved sensitivity and selectivity, the proposed biosensing platform is expected to provide a new strategy for biomarkers analysis and outstanding prospect for further clinical application.

目的 调查格林巴利综合征患者(GBS)乙肝病毒感染情况,针对乙肝病毒感染与GBS的相关性进行研究,分析探讨乙肝病毒感染是否为GBS短期预后不良的危险因素.方法 采用回顾性研究方法,选择2010年1月～2019年12月于本院神经内科住院的115例GBS患者作为研究对象,选择该科同期住院非GBS患者150例为对照组,通过检测患者乙肝五项指标,比较分析乙肝病毒感染情况以及乙肝病毒感染与GBS患者病情转归的相关性,同时还收集GBS患者自发病至入院的时间、住院时间、前驱感染史、出入院时四肢肌力情况、血液生化指标、病情转归等数据,统计分析影响GBS患者预后的危险因素.结果 GBS患者HBcAb阳性率(52.2％)高于对照组(37.3％),GBS患者HBcAb阳性组的MRC重度及预后不良患者的比例都明显高于HBcAb阴性组,具有统计学差异(P<0.05).对预后不良患者进行Longistic回归分析显示乙肝病毒感染、呼吸肌麻痹、MRC评分重度是影响GBS短期预后的独立危险因素.结论 本研究发现GBS患者乙肝病毒感染阳性率较高,乙肝病毒感染与GBS的发生及短期预后相关.

Objective:To investigate the clinical characteristics and prognosis of Philadelphia (Ph) chromosome-positive chronic myeloid leukemia (CML) patients with additional chromosomal abnormalities.Methods:The data of 351 CML patients with Ph-positive in the Affiliated Hospital of Qingdao University from January 2009 to January 2019 were retrospectively analyzed. The bone marrow chromosomal karyotype analysis of all patients was performed by using R-banding technique. The clinical characteristics and karyotype of Ph-positive CML patients with additional chromosomal abnormalities at initial diagnosis were summarized, and Kaplan-Meier was used to analyze the differences in overall survival (OS) of patients with different karyotypes.Results:Among 351 patients with Ph-positive CML, 32 (9.1%) cases had variant translocation. At initial diagnosis, 47 cases had additional chromosomal abnormalities including 29 cases in chronic phase accounting for 9.15% (29/317) of all patients in chronic phase, 3 cases in accelerated phase accounting for 25.00% (3/12) of all patients in accelerated phase, 15 cases in blast crisis accounting for 68.18% (15/22) of all patients in blast crisis; there was a statistically significant difference in the chromosomal abnormalities rate of all different phases ( χ2=50.799, P<0.05). Among 47 Ph-positive CML patients with additional chromosomal abnormalities, 13 patients had complex karyotypes with more than 3 additional chromosomal abnormalities, the proportion of complex karyotypes in chronic phase, accelerated phase and blast crisis was 13.79% (4/29), 33.33% (1/3) and 53.33% (8/15), respectively, and the difference was statistically significant ( χ2=9.26, P<0.05). The study showed that the most common additional chromosomal abnormalities in chronic phase were double Ph (48.28%, 14/29) and -Y (10.34%, 3/29), while the most common chromosomal abnormalities in the blast crisis were +8 (26.67%, 4/15) and double Ph (26.67%, 4/15). Kaplan-Meier survival analysis showed that at initial diagnosis the OS time of patients with additional chromosomal abnormalities was worse than that of those with the non-additional chromosomal abnormalities group ( χ2 = 61.138, P<0.05). The OS of patients with complex karyotypes for Ph - positive CML patients with additional chromosomal abnormalities at initial diagnosis was worse than that of patients with non-complex karyotypes, and the difference was significant ( χ2 = 4.945, P < 0.05). Conclusions:The additional chromosomal abnormalities is closely related to the progression of CML, and the prognosis of CML patients with additional chromosomal abnormalities is poorer than that of patients with only Ph translocation. Moreover, the more complex the additional chromosomes are, the more likely blastic changes are, and the poorer prognosis. And additional chromosomeal abnormalities during the treatment of CML patients may also lead to the progression of blastic changes.

目的 探讨电子配血技术应用对减少受血者Rh血型同种抗体产生的意义.方法 将本院2018年1月1日-2020年3月31日期间住院且仅输注去白悬浮红细胞的Rh(D)阳性的患者(22 528人,将电子配血符合优先级Ⅰ级、Ⅱ级的患者21 334人设为对照组,将符合优先Ⅲ级的患者共1 194人设为试验组,对用血者和献血者进行ABO和Rh血型系统5种抗原(D、C、c、E、e)的血清学检测,并运用输血管理系统,建立Rh表型数据库.并对对照组和试验组进行输注红细胞过程中引入新的抗原相对应不规则抗体的产生率进行比较.结果 C抗原和e抗原所占的比例明显高于c和E抗原.同时表现型为DCCee和DCcEe的比率最高,表现型为Dccee和DCCEE的极为罕见.在本院输血患者达到优先Ⅰ级(85.2％)和Ⅱ级(9.5％)输血标准的比例达到94.7％,达优先Ⅲ级的输血比例仅为5.3％.对照组(n=21 334)中患者输血后产生Rh系统同种抗体共6人,比率小于0.001％;试验组(n=1 194)中患者输血后共24人出现与引入外来抗原相符的Rh系统同种抗体,比率为2.01％.试验组与对照组差异存在临床意义(P＜0.01).结论 依据Rh抗原检测的电子配血技术可明显降低输血后Rh血型系统不规则抗体阳性率,从而有效的保证临床输血安全.

目的:探讨重离心法分离红细胞进行Rh表型混合视野样本鉴定中的应用效果及价值.方法:分析2019年1-10月收集的30例Rh抗原检测结果为混合视野患者标本,应用重离心技术和毛细管超速离心技术分离患者红细胞,对分离后的红细胞近心端和远心端分别进行Rh表型的鉴定.结果:重离心技术分离的30例标本结果,其中26例能准确鉴定患者血型;毛细管超速离心技术分离的30例标本结果,其中27例能准确鉴定患者血型,2种方法分离效果比较差异无统计学意义(P＞0.05).结论:重离心法可较好的分离Rh表型呈混合视野的红细胞,辅助输血后患者Rh血型的鉴定,方法简便快捷,值得在精准输血中推广应用.

目的 探讨毛细管超速离心技术在Rh表型精准鉴定以及临床输血中的应用.方法 对本科室2019年5月～2020年2月血型鉴定结果中Rh表型呈混合外观的132例标本,使用毛细管超速离心技术进行分离后,分别取近心端和远心端红细胞进行Rh表型鉴定,然后选择与近心端Rh表型相同的献血者进行交叉配血.结果 132例标本经过毛细管超速离心后,128例(96.97％)标本近心端均能成功分离患者新生红细胞,精准鉴定出其Rh表型,检出CcDEe 47例(36.72％),CcDee 12例(9.38％),ccDEE 11例(8.59％),CCDee 52例(40.63％),ccDEe 5例(3.91％),ccDee 1例(0.78％);4例标本离心后Rh表型仍呈混合外观,此4例患者近2d内均有输血史.128例精准鉴定出Rh表型的患者,均选择Rh表型同型献血者,4例未能确定Rh表型的患者,根据表型分布频率和减少抗原输注原则选择CCDee表型献血者,132例患者交叉配血均相合.结论 毛细管超速离心技术能有效分离患者新生红细胞,辅助Rh表型的精准鉴定,为临床精准输血提供安全保障.

目的 运用信息化平台实现院内用血费用报销,推动无偿献血事业健康发展.方法 通过医院信息化平台,加强对患者用血费用报销内容的入院宣教,利用血站-医院报销血费管理系统及钉钉办公平台,对无偿献血者及其亲属临床用血实行医院内直接报销.结果 与患者出院后经血站报销血费的传统模式相比较,将用血费用报销 、前移至医院后,用血费用报销流程更简化,亲属往返路程明显缩短,所需时间显著减少,献血者及亲属满意度明显提升.结论 将用血费用报销前移至医院后,提供了新的用血费用报销模式,提高了献血者及亲属的满意度,可促进无偿献血事业的健康发展.

目的 构建手术用血智慧管理体系,探讨该体系在促进手术患者合理用血和及时用血方面的有效性.方法 基于医院HIS闭环式输血信息管理系统、临床输血移动护理APP系统,并联合物联网血库前移管理系统,构建手术用血智慧管理体系,对围术期输血管理全过程进行动态指导、监管与评价.选取手术用血智慧管理体系应用前(2018年5～10月)后(2018年11月～2019年4月)各100例心脏大血管手术患者用血管理数据,并进行比较,以评价该体系在手术用血管理中的作用.结果 术中用血从发起申请到输注,由实施前的30 min缩短到不足2 min;心脏大血管手术患者术中输血后血红蛋白超过110 g/L比例明显降低,由智慧管理体系实施前的30.5％ (25/82)降低至8.5％(4/47) (P＜0.01);手术备血使用率由原来的82.0％(82/100)下降至47.0％(47/100) (P＜0.01).结论 手术用血智慧管理体系实施后,创新了手术患者临床用血管理模式,促进了患者术中及时用血和合理用血,对提升手术安全具有重要意义.

Purpose As a type of cancer with the highest morbidity and mortality, lung squamous cell carcinoma (LUSC) has a very poor prognosis. Long-non-coding RNA (lncRNA) has recently attracted attentions because it can play the role of competing endogenous RNA (ceRNA) to inhibit microRNA (miRNA) functions. In this study, we aimed to find prognosis-related lncRNAs, miRNAs and mRNAs and construct a prognosis-related ceRNA network. Methods The original LUSC RNA-sequencing data and miRNA profiles data were downloaded from the cancer genome atlas (TCGA) database. Differentially expressed lncRNAs, miRNAs and mRNAs were then identified between patients with lymph node metastasis and no lymph node metastasis. Univariate Cox regression analysis was performed to find the survival-associated lncRNAs, miRNAs and mRNAs. Subsequently, prognostic-related ceRNA network was established. By multivariate Cox regression analysis, three lncRNA signatures and three mRNA signatures were developed and used for predicting LUSC patients' survival. Results A total of 224 lncRNAs, 160 miRNAs, 913 mRNAs were identified between samples with lymph node metastasis and no lymph node metastasis. Univariate Cox regression analysis showed that, among them, 28 lncRNAs, 8 miRNAs, 105 mRNAs were significantly associated with patients' overall survival time. Further pathway and enrichment analysis suggested that these mRNAs were associated with the regulation of transmembrane transport, regulation of blood circulation, plasma lipoprotein particle organization. Then we constructed a survival-related ceRNA network including 9 lncRNAs, 8 miRNAs and 23 mRNAs. Additionally, a multivariate Cox regression analysis demonstrated that three lncRNAs (AL161431.1, LINC02389, APCDD1L.DT) and three mRNAs (KLK6, SLITRK5, CCDC177) had a significant prognostic value. Risk score indicated that lncRNA signature and mRNA signature could independently predict overall survival in LUSC patients. Conclusion The current study provided a better understanding of the ceRNA network in the progression of LUSC and laid a theoretical foundation for LUSC prognosis.

Nuclear factor, erythroid 2 like 2 (NFE2L2, NRF2) is a transcription factor that regulates various antioxidant enzymes. It plays a vital physiological role in regulating oxidative stress and inflammatory response. However, the roles of NFE2L2 in human cancers are still unclear. Our study is aimed at analyzing the prognostic value of NFE2L2 in pan-cancer and at revealing the relationship between NFE2L2 expression and tumor immunity. The present study revealed that NFE2L2 was abnormally expressed and significantly correlated with mismatch repair (MMR) gene mutation levels and DNA methyltransferase expression in human pan-cancer. In particular, pan-cancer survival analysis indicated that NFE2L2 expression was associated with adverse outcomes—overall survival (OS), disease-specific survival (DSS), and progression-free interval (PFI)—in adrenocortical carcinoma (ACC), brain lower grade glioma (LGG), and pancreatic adenocarcinoma (PAAD) patients. A positive relationship was also found between NFE2L2 expression and immune infiltration, including B cells, CD4+ T cells, CD8+ T cells, neutrophils, macrophages, and dendritic cells, especially in breast invasive carcinoma (BRCA), colon adenocarcinoma (COAD), kidney renal clear cell carcinoma (KIRC), LGG, liver hepatocellular carcinoma (LIHC), and prostate adenocarcinoma (PRAD). Additionally, NFE2L2 expression was positively correlated with the immune score and the expression of immune checkpoint markers in LGG. In conclusion, these results indicate that transcription factor NFE2L2 is a potential prognostic biomarker and is correlated with immune infiltration in LGG.

目的 探讨血型基因检测在ABO和RhD血型鉴定困难患者输血中的应用价值.方法 收集2015年7月 —2017年10月于我院行ABO和RhD血型血清学鉴定困难的临床样本80例,其中ABO血型正反不符37例,RhD血型鉴定困难43例.采用聚合酶链反应-特异性序列引物(PCR-SSP)技术和Sanger测序方法进行基因检测.结果 37例ABO血型正反定型不符的样本经Sanger测序确定抗体减弱样本13例,A亚型8例,B亚型5例,AB亚型4例,Cis AB型4例,B(A)型3例,检测出A102、Ael05、A311、B301、O02、CisAB01、B(A)04等位基因.在43例RhD血型鉴定困难样本中,通过PCR-SSP技术检测出RhD阳性 、弱D15型 、RhD-CE-(2-9)-D型和RhDⅥ Ⅲ型.根据基因检测确定的血型为受血者选择ABO和RhD血型相合的血液,经抗人球蛋白卡式法进行交叉配血试验,实现临床精准化输血.结论 采用血型基因测序分析的方法,可以鉴定血清学实验无法判定的ABO血型 、RhD血型,从而提升解决疑难配血的能力,提高输血治疗的安全性,为精准输血提供保障.

目的 构建智慧输血标本管理系统,实现输血标本全流程信息化、智能化和精准定位管理,提高输血标本管理效率,保障输血安全.方法 本院从2017年10月-2018年3月整合临床医师输血申请管理系统、临床护理PDA(Personal Digital Assistant)技术和移动护理APP(Application)系统,对输血标本医嘱的开具和采集执行实施信息化、智能化自动管理;通过输血科实验室信息管理系统、输血信息管理系统,对输血标本检验实施全流程记录和信息监管;研发智能标本储存冰箱和APP信息管理系统,对检验后输血标本实施信息化和精准定位管理;同时将智能标本储存冰箱APP信息管理系统与医院输血信息管理系统实施数据共享,反复输血无需采血输血申请,系统自动定位并反馈输血标本储存位置.结果 智慧输血标本管理系统构建与应用,对输血标本从医嘱开具、核查抽血,到输血科检验和检验后存储,实现了全流程信息化和智能化管理;同时通过标本储存智能冰箱和其APP信息管理系统的使用,实现了标本精准定位管理并自动向HIS输血管理系统提供标本信息,72 h内反复使用的输血标本由原来人工查找的3 min缩短到10 s,提高了输血标本管理效率,降低了医务人员院内感染的风险.结论 智慧输血标本管理系统构建与应用,实现了输血标本全流程信息化、智能化和数字化管理,提高了输血标本管理水平和管理效率,降低了医务人员院内感染的风险,杜绝了因输血标本管理环节引起的医疗差错事故,对于保障输血安全具有重要意义.

Objective This project aims to establish a digitized,informatization based and intelligent management system for plasma thawing.Methods In June 2015,our hospital implemented a quality control management system for blood transfusion thalassemia.In order to record temperature data and its variation curve during the whole plasma thawing process,a sample plasma bag was introduced to simulate the plasma thawing process.The temperature monitoring performed on this sample is designed to reflect the temperature change of a real plasma bag.When the plasma is melted,thawing was observed in the sample bag as well.The thawing end point was set at 33℃ above but no more than 37℃.Meanwhile,a wireless transmission device is used to uploaded the blood bag identification (blood code and product code) and the plasma thawing data (thawing start time,end time and end temperature) to the transfusion information management system,where the two sets of data were coupled.Results The establishment of this quality control management system for plasma thawing granted digital,intelligent and informatized management,which helps to reduce coagulation factors loss in the plasma and maximized their bio-function activity after thawing.Meanwhile,by coupling with the blood transfusion information management system,this quality control system can remotely monitor,transmit,record and store plasma thawing relevant data.Thus,important data like the thawing start time,thawing end time and temperature,can be easily traced.Conclusion The establishment and application of the quality control management system for plasma thawing in our blood transfusion department can improve the quality management level of plasma thawing,facilitating blood quality control and quality tracing.This is very important to ensure the safety of blood transfusion and related curative effect.

Objective:To investigate the feasibility of precise blood transfusion compatible with ABO and five Rh antigens by the application of Rh antigen detection,the automatic analysis software for blood group and transfusion information management system.Method:Red blood cells (RBCs) from patients and donors were detected for ABO and Rh antigens (D,C,c,E and e).The results were uploaded to transfusion information management system (TIMS).The computer recognition technology automatically chose the appropriate blood compatible with ABO and Rh antigens.The blood cross-matching was done with Polybrene and Microcylinder Gel Card Antiglobu lin method (MGC-AGH) to realize the precise blood transfusion.Result:Over 90 percent of patients could receive the blood completely compatible with ABO and five types of Rh antigens after the operation of the precision blood transfusion programme.All the blood transfusion was successful and no adverse transfusion reaction happened.The occurrence of irregular antibody in patients with repeated transfusion or transfusion history decreased significantly.The blood matching rate in patients with irregular antibody greatly increased.Conclusion:The detection of Rh antigens can promote the precise blood transfusion.It can help to avoid the occurrence of irregular antibody in Rh system and reduce the adverse transfusion reaction.The ability of problematic matching blood and safety of transfusion therapy were improved efficiently.