Autologous blood donation is an important strategy of blood conservation. The Administrative Measures for the Clinical Use of Blood in Medical Institutions (Order No. 85 of the National Health Commission) requires medical institutions to promote the implementation of autologous blood donation actively. The clinical practice guidelines for patient blood management also recommend the proactive use of autologous blood donation to reduce the reliance on allogeneic blood. Preoperative autologous blood donation (PABD) is one of the autologous blood donation with wide range of indications, easy to operate, and can effectively reduce the transfusion of allogeneic blood. However, the performance of PABD in China is unsatisfactory due to various factors such as the patient composition of medical institutions, the implementation of outpatient department of blood transfusion, the level of attention paid to this issue, and the fact that traditional PABD do not meet clinical requirements. Therefore, improving the PABD model and exploring new PABD technology, as well as promoting their clinical application, are critical measures to meet the development requirements of patient blood management and to alleviate the shortage of blood supply. This article summarizes the improvements in the PABD model, and a novel PABD technology of PABD—preoperative deep apheresis of autologous red blood cells and/or platelets (deep apheresis autologous blood storage technology), and the current situation of clinical application of PABD to provide paradigm for clinical transfusion.

A 38-year-old male patient with ulcerative colitis was treated with mesalazine enteric- coated tablets 2 g twice daily, and developed pruritus, dark urine and jaundice approximately 8 months later. Laboratory tests revealed severe liver function abnormalities, showing alanine aminotransferase (ALT) 1 251 U/L, aspartate aminotransferase (AST) 1 102 U/L, γ-glutamyl transferase (GGT) 615 U/L, alkaline phosphatase (ALP) 715 U/L, total bile acid (TBA) 244.72 μmol/L, total bilirubin (TBil) 456.9 μmol/L, direct bilirubin (DBil) 350.6 μmol/L and indirect bilirubin (IBil) 106.3 μmol/L. Abdominal CT showed no significant abnormalities. Mesalazine was discontinued, and hepatoprotective therapy was initiated with magnesium isoglycyrrhizinate, ademetionine 1,4-butanedisulfonate, acetylcysteine, and ursodeoxycholic acid. Viral hepatitis, Wilson′s disease, and hemochromatosis were ruled out in further investigations and liver biopsy. Severe drug-induced liver injury (DILI) caused by mesalazine was suspected, but autoimmune hepatitis (AIH) could not be entirely excluded. The hepatoprotective treatments were continued, and the patient′s liver function was improved significantly, showing ALT 48 U/L, AST 35 U/L, GGT 144 U/L, ALP 202 U/L, TBA 24.72 μmol/L, TBil 71.8 μmol/L, DBil 62.3 μmol/L and IBil 9.5 μmol/L by day 24 of treatments. Later, he was treated only with ursodeoxycholic acid and bicyclol. The patient′s liver function normalized approximately one and a half months later. However, the patient self-reinitiated mesalazine several days thereafter, and the liver function tests showed ALT 155 U/L and AST 80 U/L after about 2 months of resumed use. Mesalazine was discontinued again, and his liver function returned to normal within 1 week with supportive treatments. AIH was excluded, DILI induced by mesalazine was considered at last.

A 38-year-old male patient with ulcerative colitis was treated with mesalazine enteric- coated tablets 2 g twice daily, and developed pruritus, dark urine and jaundice approximately 8 months later. Laboratory tests revealed severe liver function abnormalities, showing alanine aminotransferase (ALT) 1 251 U/L, aspartate aminotransferase (AST) 1 102 U/L, γ-glutamyl transferase (GGT) 615 U/L, alkaline phosphatase (ALP) 715 U/L, total bile acid (TBA) 244.72 μmol/L, total bilirubin (TBil) 456.9 μmol/L, direct bilirubin (DBil) 350.6 μmol/L and indirect bilirubin (IBil) 106.3 μmol/L. Abdominal CT showed no significant abnormalities. Mesalazine was discontinued, and hepatoprotective therapy was initiated with magnesium isoglycyrrhizinate, ademetionine 1,4-butanedisulfonate, acetylcysteine, and ursodeoxycholic acid. Viral hepatitis, Wilson′s disease, and hemochromatosis were ruled out in further investigations and liver biopsy. Severe drug-induced liver injury (DILI) caused by mesalazine was suspected, but autoimmune hepatitis (AIH) could not be entirely excluded. The hepatoprotective treatments were continued, and the patient′s liver function was improved significantly, showing ALT 48 U/L, AST 35 U/L, GGT 144 U/L, ALP 202 U/L, TBA 24.72 μmol/L, TBil 71.8 μmol/L, DBil 62.3 μmol/L and IBil 9.5 μmol/L by day 24 of treatments. Later, he was treated only with ursodeoxycholic acid and bicyclol. The patient′s liver function normalized approximately one and a half months later. However, the patient self-reinitiated mesalazine several days thereafter, and the liver function tests showed ALT 155 U/L and AST 80 U/L after about 2 months of resumed use. Mesalazine was discontinued again, and his liver function returned to normal within 1 week with supportive treatments. AIH was excluded, DILI induced by mesalazine was considered at last.

Objective:To evaluate the efficacy and safety of vedolizumab (VDZ) monoclonal antibody in maintenance therapy for ulcerative colitis (UC) .Methods:A retrospective case control study was conducted, including 84 patients with active UC undergoing VDZ therapy for an average of (22±8) weeks in the Department of Gastroenterology, the Second Affiliated Hospital of Zhejiang University School of Medicine from December 2020 to September 2023. These patients achieved a response or remission by (22±8) weeks and continued follow-up until (54±8) weeks. They were divided into effective and ineffective groups based on whether they achieved clinical remission by (54±8) weeks after using VDZ; those who required optimized treatment with shortened injection intervals were included in the ineffective group. Baseline clinical data, medication history and endoscopic imaging data were recorded. The clinically modified Mayo score, Mayo endoscopic score, and other assessments were used to evaluate UC disease activity. Adverse reactions related to treatment were also recorded to assess the efficacy of VDZ treatment up to (54±8) weeks was assessed and key factors affecting clinical remission of the disease were analyzed.Results:Among the 84 UC patients with followed up to (54±8) weeks, 47 cases (55.95%) achieved clinical remission and were classified as the effective group, while 37 cases (44.05%) did not achieve clinical remission and were classified as the ineffective group. The endoscopic remission rate in the effective group was 68.09% (32/47), and the mucosal healing rate was 36.17% (17/47). Joint pain occurred in 2.38% of patients, hepatic dysfunction in 3.57%, and one patient died from leukemia following a COVID-19 infection during the maintenance therapy period.Conclusion:VDZ has a certain efficacy in the continuous treatment of UC patients and in maintaining clinical and endoscopic remission, with generally high overall safety and a low incidence of adverse reactions.

Objective:To evaluate the efficacy and safety of vedolizumab (VDZ) monoclonal antibody in maintenance therapy for ulcerative colitis (UC) .Methods:A retrospective case control study was conducted, including 84 patients with active UC undergoing VDZ therapy for an average of (22±8) weeks in the Department of Gastroenterology, the Second Affiliated Hospital of Zhejiang University School of Medicine from December 2020 to September 2023. These patients achieved a response or remission by (22±8) weeks and continued follow-up until (54±8) weeks. They were divided into effective and ineffective groups based on whether they achieved clinical remission by (54±8) weeks after using VDZ; those who required optimized treatment with shortened injection intervals were included in the ineffective group. Baseline clinical data, medication history and endoscopic imaging data were recorded. The clinically modified Mayo score, Mayo endoscopic score, and other assessments were used to evaluate UC disease activity. Adverse reactions related to treatment were also recorded to assess the efficacy of VDZ treatment up to (54±8) weeks was assessed and key factors affecting clinical remission of the disease were analyzed.Results:Among the 84 UC patients with followed up to (54±8) weeks, 47 cases (55.95%) achieved clinical remission and were classified as the effective group, while 37 cases (44.05%) did not achieve clinical remission and were classified as the ineffective group. The endoscopic remission rate in the effective group was 68.09% (32/47), and the mucosal healing rate was 36.17% (17/47). Joint pain occurred in 2.38% of patients, hepatic dysfunction in 3.57%, and one patient died from leukemia following a COVID-19 infection during the maintenance therapy period.Conclusion:VDZ has a certain efficacy in the continuous treatment of UC patients and in maintaining clinical and endoscopic remission, with generally high overall safety and a low incidence of adverse reactions.

Objective:To investigate the clinical features,therapeutic methods,therapeutic efficacy,and prognostic characteristics of older patients with acute myeloid leukemia(AML).Methods:We collected data from 134 older patients with AML treated at Peking University International Hospital between January 2015 and February 2023.White blood cell count,bone marrow primitive cell count,cytogen-etic and molecular characteristics,and European LeukemiaNet(ELN)risk stratification at initial diagnosis were retrospectively ana-lyzed.Patients were assigned into two groups according to treatment plan―high-intensity chemotherapy and low-dose treatment―to determine whether intensive chemotherapy would yield survival benefits during treatment and the factors affecting survival.Results:Among 36 patients treated with high-intensity chemotherapy,22(61.1%)achieved complete response(CR);among 90 treated with low-intensity therapy,46(51.1%)achieved CR;and among 19 treated with azacitidine(AZA)+ venecra(VEN),14(73.7%)achieved CR.Medi-an overall survival(OS)was 15 months for high-intensity chemotherapy and 14.5 months for low-intensity treatment(P=0.226).According to ELN risk stratification,patients in the low,medium,and high risk groups exhibited OS of 18,14,and 9 months,respectively(P=0.009).OS for high-intensity chemotherapy and low-dose therapy was 22 and 15 months in the low-risk group(P=0.745),9 and 15 months in the medium-risk group(P=0.783),and 9 and 8 months in the high-risk group(P=0.739),respectively.Patients in the intensive chemotherapy group(n=36)had an OS of 15 and 17 months(P=0.689)compared with AZA+VEN treatment(n=19).The prognosis of six patients with TP53 mutation was significantly worse than those without the mutation,and the median OS was 2 months and 14 months,respectively(P=0.004).One-and 3-year survival rates for the low-,medium-and high-risk groups were 79%,53%,and 44%,and 41%,20%,and 3%,respectively.Multivariate analysis revealed that high peripheral blood white blood cell count(P=0.034),ELN risk stratification(P=0.002),and complications(P=0.017)were correlated with OS,while treatment intensity,age,sex,and bone marrow primitive cell count were not significantly correlated with OS.Conclusions:High-intensity chemotherapy did not yield a significant survival benefit in older patients with AML;however,this result needs to be confirmed in patients at low risk.Patients with TP53 mutations had a poor prognosis.Multivariate analyses revealed that baseline mo-lecular characteristics,leukocyte count,and comorbidities were more important than treatment intensity in predicting survival among older patients with AML.

Objective: To investigate the role of HIV-1 envelope protein gp120 in cognitive impairment induced by neuronal damage. Methods: Western blot and immunofluorescence assay were used to detect microglia activation, inflammatory factor expression and neuronal damage after gp120 treatment. Neuronal damage and neurocognitive performance in gp120-transgenic mice were evaluated using immunohistochemical staining and behavioral analysis, respectively. Results: In vivo and in vitro experiments showed that HIV-1 gp120 significantly induced the expression of caspase-1 and IL-1β, and indirectly caused neuronal synaptic shortening and neuronal damage (P<0.05). Compared with wild-type mice, gp120-transgenic mice showed significant cortical and hippocampal glial activation, neuronal loss, dendritic damage and neurocognitive disorders. Conclusions HIV-1 gp120 might cause neuronal damage through activating the release of inflammatory factor by microglia and involve in neurocognitive impairment.

Objective: To explore the efficacy and prognostic factors of hematopoietic stem cell transplantation (HSCT) for the treatment of patients with anaplastic large cell lymphoma (ALCL) . Methods: The clinical records of 33 ALCL patients after HSCT were collected and analyzed retrospectively to evaluate the rates of overall survival (OS) and recurrence after autologous (auto-HSCT) and allogeneic HSCT (allo-HSCT) and the factors influencing prognosis. Results: The median-age of this cohort of 33 ALCL cases at diagnosis was 31 (12-57) years old with a male/female ratio of 23/10, 24 cases (72.7%) were ALK⁺ and 9 ones (27.3%) ALK^-. Of them, 25 patients (19 ALK⁺ and 6 ALK^-) underwent auto-HSCT and 8 cases (5 ALK⁺ and 3ALK^-) allo-HSCT with a median follow-up of 18.7 (4.0-150.0) months. Disease states before HSCT were as follows: only 6 patients achieved CR status and received auto-HSCT, 16 patients achieved PR (14 cases by auto-HSCT and 2 ones allo-HSCT) , the rest 11 cases were refractory/relapse (5 cases by auto-HSCT and 6 ones allo-HSCT) . There were 7 cases died of disease progression (5 after auto-HSCT and 2 allo-HSCT) and 5 cases treatment-related mortality (TRM) (2 after auto-HSCT and 3 allo-HSCT) , TRM of two groups were 8.0% and 37.5%, respectively. Both the median progression-free survival (PFS) and OS were 15 months after auto-HSCT, the median PFS and OS after allo-HSCT were 3.7 (1.0-90.0) and 4.6 (1.0-90.0) months, respectively. There was no statistically significant difference in terms of survival curves between the two groups (OS and PFS, P=0.247 and P=0.317) . The 2-year OS rates in auto-HSCT and allo-HSCT groups were 72% and 50%, respectively. The 5-year OS rates in auto-HSCT and allo-HSCT groups were 36% and 25%, respectively. Conclusion ALCL treated by chemotherapy produced high rates of overall and complete responses. Chemotherapy followed by auto-HSCT remained to be good choice for patients with poor prognostic factors. High-risk patients should be considered more beneficial from allo-HSCT.

Objective: To evaluate clinical outcomes of autologous (auto-HSCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for angioimmunoblastic T-cell lymphoma (AITL) . Methods: From June 2007 to June 2017, clinical data of AITL patients who underwent HSCT in eight hospitals were assessed retrospectively. Results: Of 19 patients, 13 male and 6 female with a median age of 50 (32-60) years old, 12 auto-HSCT and 7 allo-HSCT recipients were enrolled in this study, all donors were HLA-identical siblings. Two of allo-HSCT recipients were relapsed auto-HSCT ones. There were 5 patients (5/12) in complete response (CR) status and 7 (7/12) in partial remission (PR) status before transplantation in auto-HSCT group, and 2 (2/7) in PR status and 3 (3/7) in progression disease (PD) status before transplantation in allo-HSCT group. The median follow-up for the surviving patients was 46.5 months (range, 1-100 months) for the whole series, two patients lost in auto-HSCT group. Three patients developed acute graft-versus-host disease (aGVHD) and 5 chronic graft-versus-host disease (cGVHD) after allo-HSCT. Three patients died of primary disease and 1bleeding in auto-HSCT group. One patient died of primary disease and 2 transplantation-related mortality in allo-HSCT group. The 3-year cumulative overall survival (OS) were 56% (95%CI 32%-100%) and 57% (95%CI 30%-100%) for auto-HSCT and allo-HSCT, respectively (P=0.979) . The 3-year cumulative progression-free survival (PFS) were 34% (95%CI 14%-85%) and 57% (95%CI 30%-100%) for auto-HSCT and allo-HSCT, respectively (P=0.451) . Conclusion Both auto-HSCT and allo-HSCT were optimal choices for AITL. In clinical practice, which HSCT was better for AITL patients should be based on comprehensive factors including sensitivity to chemotherapy, risk stratification and disease status at transplantation.