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Drug-induced immune hemolytic anemia (DIIHA) is a rare cytopenia caused by damage to RBCs by drug-induced antibodies or non-immune protein adsorption (NIPA). The drugs associated with DIIHA and the mechanistic hypotheses that are thought to be involved have been controversial, with complex serological tests often required by specialized Immune Hematology laboratories for diagnosis. It is necessary to know the clinical manifestation and laboratory diagnosis of DIIHA in order to distinguish the immuno-hematological abnormality caused by drugs from other causes. How to improve the diagnostic ability of DIIHA and establish a scientific and reasonable idea of DIIHA serological examination is urgent to help clinical diagnosis and correct treatment.
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【Objective】 To strengthen the management of transfusion adverse events, so as to reduce the occurrence of medical damage and accidents, and guarantee the safety of blood transfusion. 【Methods】 The adverse events of blood transfusion reported in our hospital from July 2016 to December 2022 were collected, the reasons were tracked, and continuous improvements were made. 【Results】 From 2016 to 2022, a total of 315 transfusion adverse events were reported, including 233(73.97%, 233/315) cases of transfusion reactions and 82(26.03%, 82/315) transfusion adverse events. There were 271 328 transfusion cases in the same period, and the incidence of transfusion reactions was 0.858 7‰(233/271 328). The number of transfusion application was 129 887, and the incidence of transfusion adverse event is 0.631 3‰(82/129 887). Sixty-eigtht(82.93%, 68/82) cases of transfusion adverse events were caused by human factors, while the other 14(17.07%, 14/82) cases were non-human factors. According to the linear regression analysis, we have concluded that the year is a significant indicator for transfusion reaction rates (P0.05). 【Conclusion】 Strengthening the management of reporting adverse events in clinical blood transfusion, monitoring the incidence, analyzing and improving different types of adverse events by management tools can reduce the medical risks of blood transfusion and help to guarantee the safety of clinical blood transfusion.
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Purpose@#Pyrotinib is a newly-developed irreversible pan-ErbB receptor tyrosine kinase inhibitor. This study reported the first real-world data of pyrotinib-based therapy in metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC), focusing on efficacy in lapatinib-treated patients and in brain metastasis. @*Materials and Methods@#One hundred thirteen patients with metastatic HER2-positive BC treated with pyrotinib-based therapy in Fudan University Shanghai Cancer Center under non-clinical trial settings from September 1, 2018 to March 1, 2019 were included. @*Results@#Over half patients have received more than two lines of systematic therapy and exposed to two or more kinds of anti-HER2 agents. Most patients received a combined therapy, commonly of pyrotinib plus capecitabine, or vinorelbine or trastuzumab. Median progression-free survival (PFS) was 6.3 months (range, 5.54 to 7.06 months) and objective response rate (ORR) was 29.5%, with two patients (1.9%) achieving complete response. Lapatinib-naïve patients had significantly longer PFS than lapatinib-treated patients (9.0 months vs. 5.4 months, p=0.001). ORR for lapatinib-treated patients was 23.2%. Thirty-one of 113 patients have brain metastasis. Median PFS was 6.7 months and intracranial ORR was 28%. For patients without concurrent radiotherapy and/or brain surgery, the ORR was very low (6.3%). But for patients receiving concurrent radiotherapy and/or brain surgery, the ORR was 66.7%, and three patients achieved complete response. Most common adverse event was diarrhea. @*Conclusion@#Pyrotinib-based therapy demonstrated promising effects in metastatic HER2-positive BC and showed activity in lapatinib-treated patients. For patients with brain metastasis, pyrotinib-based regimen without radiotherapy showed limited efficacy, but when combined with radiotherapy it showed promising intracranial control.
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Background and purpose:The third generation of aromatase inhibitors (AI) in postmenopausal hormone receptor-positive patients is the routine treatments in endocrine therapy. The 500 mg fulvestrant showed clini-cal beneifts in patients with previous AI treatment. This study aimed to access the effcacy and safety of 500 mg fulves-trant in estrogen receptor (ER) positive postmenopausal patients who had previous AI treatments with locally advanced and metastatic breast cancer.Methods:This study retrospectively analyzed the clinical data from 188 post-AI ER positive and (or) progesterone receptor (PR)-positive locally advanced and metastatic breast cancer patients treated with 500 mg fulvestrant in Fudan University Shanghai Cancer Center from Jul. 2011 to Dec. 2015. Primary end point was progression-free survival (PFS). Secondary end points were objective response rate (ORR), clinical beneift rate (CBR) and safety proifle.Results:After the median follow-up of 11.3 months, median PFS was 5.9 months (95%CI: 4.2-7.5), CBR was 40.0% and ORR was 3.4%. COX proportional hazards regression analysis indicated that PFS was correlated with the number of metastatic sites (HR=1.92, 95% CI: 1.2-2.9,P =0.002) and previous lines of chemotherapy (HR=1.52, 95%CI:1.0-2.1,P=0.022). Six patients stopped the treatment for intolerable adverse events.Conclusion:The treatment of 500 mg fulvestrant has a favorable effcacy and safety in treatment of post-AI ER positive postmenopausal patientswith metastatic breast cancer.
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Objective Objective To determine the potential factors for development of post-traumatic hydrocephalus (PTH) after decompressive craniectomy (DC).Methods A retrospective study was performed on 62 patients undergone DC after craniocerebral trauma.Based on the incidence of hydrocephalus after DC,the patients were divided into hydrocephalus group (n =15) and non-hydrocephalus group (n =47).The factors including general data information,pre-operative condition,imagine manifestation,operation methods,and surgical parameters were compared between groups to identify the risk factors contributing to the development of PTH.Results No statistical differences were found between the two groups in aspects of gender,age,injury severity score (ISS),pupillary size,pupillary light reflex,Fisher scale of subarachnoid hemorrhage,volume of intracranial occupation,ambient cistern compression,midline shift,intracranial infection,and distance of superior margin of the craniectomy to midline.But there were significant differences of the two groups in whether underwent bilateral craniectomy (x2 =9.235,P ＜0.05),height of craniectomy (t =3.751,P ＜ 0.01),area of craniectomy (t =3.171,P ＜ 0.01) and whether underwent reoperation (x2 =8.335,P ＜ 0.01).Logistic regression analysis indicated that the development of PTH was significantly affected by bilateral craniectomy,large craniectomy and reoperation.Conclusion Bilateral craniectomy,large craniectomy and reoperation are risk factors for the development of PTH after DC.
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Objective To explore the effect and mechanism of early hyperbaric oxygen in the treatment of patients with diffuse axonal injury ( DAI ). Methods A total of 45 cases of DAI were randomly divided into hyperbaric oxygen treatment group ( n =25 ) and normal treatment group ( n =20).The changes of intracranial pressure,Glasgow Comb Scale (GCS) and prognosis were observed.Results Compared with group treated with routine therapy,early intracranial pressure scores were reduced obviously,while GCS and prognosis were increased obviously in group treated with hyperbaric oxygen therapy ( P ＜ 0.05 ). Conclusion Early hyperbaric oxygen can significantly lower the level of intracranial pressure and improve the prognosis in the treatment of DAI patients.
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Objective To identify a case of Para-Bombay phenotype and analyze it's molecular background.Methods Routine serological methods were used to identify the antigens on red cells and antibodies in serum,the weak antigens on red cells were detected by absorption and elution test.ABO substances were determined by agglutination inhibition test in saliva.FUT1 and FUT2 gene were sequenced with molecular methods.Results The para-Bombay was confirmed as Ah-secretion.Two of the three T repeats located at the nucleotides 880-882 were deleted.This deletion causes the shifting of the open-reading frame.The FUT2 genotype was Se357Se357.Conclusion Para-Bombay phenotype is rare.Homozygous genotype of FUT1 allele,hh(nt880-882de1TT)might be the cause of H-antigens deficiency..The wild type of FUT2 allele was consistent with the secretor status.
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Objective To analyze inhibitions and working memory impairments in children with different subtypes of attention deficit hyperactivity disorder (ADHD) with saccade tasks. Methods Participants,aged 10～ 13 years with ADHD-combined ( n= 19) ,ADHD-inattentive ( n= 11 ) and control subjects ( n= 18) ,were selected according to DSM-Ⅳ diagnosis,Conners teacher rating scale and parent symptom questionnaire from 1500pupils from 2 primary schools in Jinhua city by stratified cluster sampling method. Participants performed 3 different saccade tasks: 1 prosaccade and 2 antisaccades executed in a single-task and a dual-task situation. One of the antisaccade tasks was performed under the verbal secondary task condition to investigate verbal working memory.Saccades were registered by Eyelink Ⅱ Tracker. Errors and correct rate were analyzed. One-way ANOVA and repeated measures ANOVA were used to analyze the data. Results (1) Each group showed more response suppression errors on antisaccade task without load than on prosaccade task, ADHD-combined and ADHD-inattentive exhibited more errors than non-ADHD (P＜0.01) ,and errors was lower in ADHD-inattentive than in ADHD-combined ( ( 70.90 ± 15.78 ) % vs ( 84.04 ± 12.84 ) %, P ＜ 0.05 ). (2) The interactions between group and load were not significant in error rate on antisaccade tasks (P ＞ 0.05 ), but in correct rate (P ＜ 0. 05 ). The two subtypes of ADHD were affected more than non-ADHD, their correct rates tended to decrease under verbal working memory load. Conclusion An integrative view of deficits in inhibition and verbal working memory in two subtypes of ADHD is proposed, and ADHD-inattentive has a better response suppression than ADHD-combined.
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Objective To study the therapeutic efficacy of cryoprecipitate in the treatment of disseminated intravascular coagulation(DIC).Methods 28 healed cases of DIC from 2006 to 2007 were enrolled in the study.The changes of thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(Fbg)were compared and analyzed before and after cryoprecipitate infusion.Results The therapeutic efficacy of 28 cases was satisfactory after cryoprecipitate treatment,and the findings of TT,PT,APTT and Fb were improved.Conclusion The cryoprecipitate plays an important role in the treatment of DIC.Cryoprecipitate offers various kinds of blood coagulation factors for control of DIC,provides the opportunity of successful remedy,and improves the treatment achievement ratio.