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【Objective】 To investigate the correlation between perioperative zero red blood cell(RBC) transfusion and the prognosis of patients with acute Stanford type A aortic dissection. 【Methods】 A retrospective analysis was made on 96 patients who underwent one-stop Hybrid surgery for acute Stanford type A aortic dissection in our hospital from May 2021 to May 2022. The patients were divided into two groups according to whether they received perioperative RBC transfusion: zero RBC transfusion group (group A, n=26) and RBC transfusion group (group B, n=70). The preoperative general data and laboratory indexes were recorded and the propensity score matching method was used to screen the patients with the same preoperative baseline data, with comparison of operation-related indicators, intraoperative and postoperative blood component dosage and prognostic indicators. 【Results】 With BMI index, hemoglobin, platelet count, and troponin T as co variables, 48 patients were included in the study after matching according to 1∶1 propensity score: Group A (n=24) and Group B (n=24). Compared with group A, hemoglobin and hematocrit in group B decreased significantly at the end of operation and 24 h after operation, with a statistically significant difference (P0.05). 【Conclusion】 The perioperative hemoglobin of patients with acute Stanford type A aortic dissection with zero RBC transfusion did not significantly decrease, and the postoperative complications and mortality did not increase.
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Objective:To explore the clinical characteristics and influencing factors of refractory lupus thrombocytopenia (RLTP) secondary to systemic lupus erythematosus (SLE).Methods:A retrospective analysis of 113 patients with thrombocytopenia secondary to SLE in the outpatient and inpatient Department of Rheumatology of the First Affiliated Hospital of Soochow University from January 2015 to June 2018 was carried out. The medical record and laboratory tests of patients were collected, and they were divided them into the refractory group (RLTP, n=25) and non-refractory group (NRLTP, n=88). The clinical manifestations, blood count, biochemical and immunological test of the two groups were analyzed and compared. All data were analyzed by t-test, Mann-Whitney test, χ2 test, Logistic regression analysis and Kaplan-Meier survival analysis. Results:Compared with NRLTP patients, RLTP patients had longer disease course [72(30, 120) months vs 38.5 (8.5, 93) months, H=-2.401, P=0.016), nervous system damage (28% vs 7%, χ2=8.58, P=0.016), higher bleeding risk [(4.6±1.7) vs (3.8±1.3), t=2.548, P=0.012] and higher mortality rate (8% vs 0, χ2=7.167, P<0.01). Meanwhile, the positive rate of anti-GPⅠb/Ⅸ in RLTP group was significantly higher than that in NRLTP group (27% vs 4%, χ2= 8.647, P<0.01). Further unconditional multivariate logistic regression analysis showed that anti-GPⅠb/Ⅸ positive was one of the main influencing factors of RLTP. Kaplan-Meier survival curve analysis revealed that the cumulative survival rate of RLTP group was significantly lower than that of NLTP group ( χ2=7.909, P<0.01). Conclusion:RLTP has a long course of disease, prone to nervous system impairment and positive anti-GPⅠb/Ⅸ antibody, and has a high risk of bleeding. It is necessary to identify these patients early, adjust treatment strategies and improve the prognosis of patients.
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Objective@#To explore the efficacy and safety of chimeric antigen receptor T (CAR-T) cells in the treatment of central nervous system leukemia (CNSL).@*Methods@#Two leukemia patients with CNSL were treated with CD19-CAR-T cells. The process and results of the entire treatment is reported and related literature review is conducted.@*Results@#The patients were diagnosed as acute myeloid leukemia (AML)-M2 with B lymphoid antigen expression and B cell acute lymphoblastic leukemia(B-ALL) by morphology and immunophenotype assay. The immunophenotype was consistent with the abnormal manifestations of AML-M2 and B-ALL. Their clinical manifestations and laboratory tests met the diagnostic criteria of CNSL. The diagnosis was clear and the two patients were treated with CD19-CAR-T cell immunotherapy. Central nervous system symptoms were relieved. The imaging abnormalities of patient one has disappeared but cytokines release syndrome (CRS) occurred during the treatment. Cerebrospinal fluid of patient two was negative and no obvious CRS reaction was found.@*Conclusions@#CAR-T cell immunotherapy is likely to induce the remission of CNSL and improve the prognosis.
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Objective To examine the value ofprocalcitonin (PCT) in differential diagnosis of bloodstream infections (BSI) caused by coagulase-negative Staphylococcus (CNS) from contamination in Department of Hematology.Methods One hundred and fifty-six patients with bloodstream or intravenous catheter-related CNS infection were included in this study.The patients were treated in Department of Hematology,the First Affiliated Hospital of Soochow University during the period from January 2013 to December 2015.The patients were divided into CNS bloodstream infection group (n=66) and blood culture contamination group (n=90).The two groups were compared in terms of sex,age,diagnosis,length of hospital stay,duration of neutropenia,neutrophil count and lymphocyte count,peak fever,C-reactive protein (CRP) and PCT.The receiver operating characteristic (ROC) curve was plotted with SPSS 21.0 software to analyze the value of PCT in differential diagnosis.Results Age,sex,clinical diagnosis,length of hospital stay,duration of neutropenia,neutrophil count and lymphocyte count did not show significant difference between bloodstream infection group and contamination group (P＞0.05),while peak fever (P＜0.001),CRP (P=0.002) and PCT (P=0.018) were significantly higher in bloodstream infection group than in contamination group.ROC analysis indicated that PCT provided optimal discrimination between these two groups at cnt-offvalue of 0.374 μg/L,with sensitivity of 54.5％ and specificity of 94.4％.The area under the curve (AUC) was 0.830±0.032 (95％ CI:0.767-0.893,P＜0.001).Conclusions PCT may be a good marker for differentiating CNS bloodstream infection from contamination with higher specificity than the commonly used marker CRP.This finding may help clinicians reduce the overuse of antibiotics.