Objective: To evaluate the safety and efficacy of therapeutic whole blood exchange combined with lymphoplasmapheresis in the treatment of refractory autoimmune hemolytic anemia (AIHA). Methods: A retrospective analysis was performed on the clinical data of AIHA patients who underwent therapeutic whole blood exchange combined with lymphoplasmapheresis at our hospital from March 2022 to May 2025. Efficacy was assessed by comparing changes in hemoglobin, platelet count, and bilirubin levels before and after treatment. Safety was evaluated by analyzing vital signs before and after the procedure, parameters during the exchange, and adverse reactions. Results: A total of 12 AIHA patients were enrolled, completing 19 exchange procedures. The number of procedures per patient ranged from 1 to 3. The median treatment duration was 67 (65-73) minutes, with a median exchange volume of 2 025 (1 851-2 121) mL, comprising 4.5 (4-6) units of red blood cells and 1 350 (1 200-1 400) mL of plasma. Ten patients achieved partial remission, one achieved complete remission, and one showed no response, yielding an response rate of 91% (11/12). After a single session, hemoglobin increased significantly by 17.58±9.85 g/L (P<0.01), while platelets counts decreased by 45 (17.5, 79)×10 /L (P<0.05), and both systolic and diastolic blood pressure showed a significant elevation (P<0.05). However, no statistically significant differences were observed in total bilirubin, indirect bilirubin, white blood cell count, or heart rate. During the procedures, 4 adverse reactions occurred in 3 patients: one child experienced severe heart rate fluctuation twice consecutively, and two adults developed plasma allergies. All reactions resolved spontaneously without pharmacological intervention. Conclusion: The combination of therapeutic whole blood exchange and lymphoplasmapheresis appears to be a safe and effective treatment for refractory AIHA patients.

Objective:Malnutrition is prevalent among patients with chronic obstructive pulmonary disease(COPD)and closely associ-ated with adverse outcomes.This study aimed to evaluate the effectiveness of three nutritional indices in predicting all-cause mortality among COPD patients.Methods:Based on the National Health and Nutrition Examination Survey(NHANES),this study included 1640 patients with COPD surveyed from 1999 to 2018.The optimal cutoff values for controlling nutritional status(CONUT)score,geri-atric nutritional risk index(GNRI),and prognostic nutritional index(PNI)were determined using receiver operating characteristic curves.The predictive value of these nutritional indices was assessed using the area under the receiver operating characteristic curve and C-index.Their predictive abilities were compared using the net reclassification improvement and integrated discrimination improvement.A Cox regression analysis was conducted to explore the association of the three nutritional indices with all-cause mortality.Results:Log-rank tests revealed lower overall survival rates in patients with higher nutritional risks(P<0.001).In multivariate Cox regression adjusting for all covariates,CONUT score(hazard ratio[HR]=1.31,95%CI=1.03-1.67,P=0.030),GNRI(HR=2.02,95%CI=1.26-3.24,P=0.004),and PNI(HR=2.05,95%CI=1.53-2.75,P<0.001)were independently associated with all-cause mortality.Conclusion:This study confirms that the three nutritional indices are effective predictors of all-cause mortality in COPD patients.Compared with PNI,CONUT score and GNRI demonstrate im-proved predictive abilities,and they are recommended for routine screening for high-risk malnutrition in COPD patients.

Purpose: The risk stratification of pediatric anaplastic large cell lymphoma (ALCL) has not been standardized. In this study, new risk factors were included to establish a new risk stratification system for ALCL, and its feasibility in clinical practice was explored. Materials and Methods: On the basis of the non-Hodgkin’s lymphoma Berlin–Frankfurt–Munster 95 (NHL-BFM-95) protocol, patients with minimal disseminated disease (MDD), high-risk tumor site (multiple bone, skin, liver, and lung involvement), and small cell/lymphohistiocytic (SC/LH) pathological subtype were enrolled in risk stratification. Patients were treated with a modified NHL-BFM-95 protocol combined with an anaplastic lymphoma kinase inhibitor or vinblastine (VBL). Results: A total of 136 patients were enrolled in this study. The median age was 8.8 years. The 3-year event-free survival (EFS) and overall survival of the entire cohort were 77.7% (95% confidence interval [CI], 69.0% to 83.9%) and 92.3% (95% CI, 86.1% to 95.8%), respectively. The 3-year EFS rates of low-risk group (R1), intermediate-risk group (R2), and high-risk group (R3) patients were 100%, 89.5% (95% CI, 76.5% to 95.5%), and 67.9% (95% CI, 55.4% to 77.6%), respectively. The prognosis of patients with MDD (+), stage IV cancer, SC/LH lymphoma, and high-risk sites was poor, and the 3-year EFS rates were 45.3% (95% CI, 68.6% to 19.0%), 65.7% (95% CI, 47.6% to 78.9%), 55.7% (95% CI, 26.2% to 77.5%), and 70.7% (95% CI, 48.6% to 84.6%), respectively. At the end of follow-up, one of the five patients who received maintenance therapy with VBL relapsed, and seven patients receiving anaplastic lymphoma kinase inhibitor maintenance therapy did not experience relapse. Conclusion This study has confirmed the poor prognostic of MDD (+), high-risk site and SC/LH, but patients with SC/LH lymphoma and MDD (+) at diagnosis still need to receive better treatment (ClinicalTrials.gov number, NCT03971305).

Objective:To explore the relationship between the long-term dynamic change in alanine aminotransferase(ALT) level and metabolic associated fatty liver disease(MAFLD).Methods:A retrospective study was conducted on 6 864 subjects who underwent four consecutive physical examinations from 2017 to 2020 in a cohort study of physical examination population in Henan Province. The relation between ALT level and the shift of MAFLD risk was analyzed using a multi-state Markov model, and the bidirectional relationship between ALT level and MAFLD was explored using a random intercept cross-lagged model.Results:Multi-state Markov model after adjusting for confounding factors showed that the risk of MAFLD in ALT Q2, Q3, Q4 group was gradually higher than that in Q1 group; Compared with health status, non-alcoholic fatty liver disease and MAFLD status gradually increased the risk of ALT shifting from normal to abnormal. The random intercept cross-lagged model after adjusting for confounding factors showed that there was a significant positive bidirectional relationship between MAFLD and ALT level. The cross-lag effect of MAFLD→ALT level was 0.083(95% CI 0.078-0.087), and the cross-lag effect of ALT→MAFLD was 0.044(95% CI 0.039-0.050). And with the extension of time, the cross-lag effect gradually decreased. Conclusions:There is a significant bidirectional relationship between the long-term dynamic change of ALT level and MAFLD. The occurrence of MAFLD is more likely to increase the risk of elevated ALT level, emphasizing the need for enhanced early prevention and treatment of MAFLD.

Objective:To summarize the efficiency and long-term outcomes of limited-stage Hodgkin lymphoma in children and adolescents with ABVD therapy and determined whether omitting radiotherapy for a low-risk patient enabled the achievement of complete response (CR) after chemotherapy.Methods:We retrospectively analyzed data from 13 y (2004-2016) from patients aged ≤18 y with limited-stage HL admitted to the Sun Yat-sen University Cancer Center. Patients received treatment with ABVD chemotherapy alone or ABVD chemotherapy followed by low-dose involved field radiotherapy.Results:Total 85 subjects were eligible for study inclusion; the median age was 12 (3-18) y; 66 (77.6%) were men, 80 (94.1%) had stage-II disease, 56 (65.9%) were at low-risk, and the median follow-up duration was 72 (8-196) months; 12 relapsed, 2 had secondary neoplasm, and 2 died. The 5-year event free survival (EFS) was (85.6±3.8) %, and the overall survival (OS) was 100%. The 5-year EFS and OS was (89.1±4.2) % and 100%, respectively, for the low-risk cohort and (79.3±7.5) % and 100%, respectively for the intermediate-risk cohort. Among the 39 low-risk patients who achieved CR after chemotherapy, 15 received treatment with chemotherapy followed by LD-IFRT. In the exploratory subset analysis, the low-risk cohort who achieved CR after chemotherapy, the 5-year EFS for comparing ABVD alone with chemotherapy followed by LD-IFRT was (87.0±7.0) % versus 100% ( P=0.506) , and the OS was 100% for both the groups. Conclusions:Our retrospective analysis showed excellent survival of limited-stage HL patients with ABVD therapy. For patients who achieving CR after chemotherapy with low-risk HL, received chemotherapy followed by LD-IFRT does not improve 5-year OS and EFS. The use of risk- and response-based stratification may facilitate the development of effective and less toxic protocols.

Objective To investigate the incidence and risk factors of neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture. Methods Live born infants, including those diagnosed with neonatal asphyxia, were recruited from 16 different hospitals in Hubei Enshi Tujia and Miao Autonomous Prefecture from January to December of 2016. The 16 hospitals included four grade A tertiary hospitals (three general hospitals and one traditional Chinese medicine hospital) and 12 grade A secondary hospitals (eight general hospitals, one maternal and child health hospital and three traditional Chinese medicine hospitals). A retrospective investigation was conducted using questionnaire to analyze the basic information, perinatal risk factors and prognosis of those infants. Chi-square test was used for statistical analysis. Results Among 22 294 recruited live born infants, 733 (3.29%) were diagnosed with neonatal asphyxia on discharge, including 627 (85.54%) mild cases and 106 (14.46%) severe cases. And neonatal asphyxia resulted in deaths of 27 cases (3.68%). The risk factors for neonatal asphyxia included multiple pregnancy, pregnancy conceived with assisted reproductive technology, premature infant, low birth weight infant, fetal malposition, congenital malformation, male infant, born during transfer, mother of Tujia nationality, low educational level (primary school or lower), living in rural area, the number of antenatal visits ≤3, history of early threatened abortion, anemia in pregnancy, hypertensive disorders of pregnancy, chorioamnionitis, abnormal pregnancy history and abnormality of umbilical cord, amniotic fluid or placenta. Conclusions The incidence of neonatal asphyxia in Enshi area is obviously higher than the national average. The main risk factors for neonatal asphyxia in this area are related to maternal background and the living condition of the mother during pregnancy, delivery as well as the newborn at birth.

Objective To analyze the characteristics and correlated factors of attempted suicide among psychological aid hotline callers,and provide a reference for suicide prevention and intervention to the domestic psychological aid hotlines.Methods From September,2010 to August,2015,1 299 callers who had the database of attempted suicide among hotline callers were collected.During the calling,the callers were interviewed on their attempted suicides,depression and 10 correlated factors associated with caller's suicidal behaviors.Results Among 1 299 callers who received assessment of suicidal behavior relates factors,361 (27.8％) had evaluated of current suicidal ideation or behavior,223 (17.2％) had history of prior suicidal attempts.There was no significant difference in the incidence of suicide attempts among different gender,age and occupation.1 024 (78.8％) had symptoms of mental illness,794 (61.1％) had symptoms of anxiety,708 (54.5％) had symptoms of depression,864(66.5％) had concomitant two or more symptoms.Compared the caller's occurrence rate of suicidal attempter between single depression and concomitant other symptoms,the results found single depression and concomitant anxiety,concomitant obsession,concomitant panic and concomitant fear were statistically significant.Multiple logistic regression analysis showed that high depression emotion (β=O.389,OR=1.48,95％CI=1.08-2.02),the history of prior attempted suicide (3=0.487,OR=1.63,95％CI=1.19-2.22) and high hopelessness (β=0.618,OR=1.86,95％CI=1.32-2.60) were associated with the caller of ever attempted suicide behaviors.Conclusion Among the callers with attempted suicide,in order to improve the effectiveness of hotline prevention and invention,the psychological consultant should focus on the evaluation of concomitant mental symptoms,high depression emotion,history of prior attempted suicide and hopelessness.

Objective To investigate the differences in expression profile of long non-coding RNA (lncRNA) in retina between normal newborn mice and those with oxygen-induced retinopathy (OIR) to lay a foundation for further study of regulatory mechanisms of lncRNA in retinal neovascularization, and to provide a new theoretical basis for the prevention and treatment of retinopathy of prematurity (ROP). Methods A total of 48 cleaning grade C57BL/6J neonatal mice were randomly divided into two groups with 24 in each: OIR group and control group. Those in the OIR group were exposed to hyperoxia [(75±2)％ O2] from 7th to 12th day after birth, and then re-exposed to normoxia (room air) for five days to establish a OIR mouse model. Mice in the control group were raised in room air all the time. Retinal tissues were collected from each mouse on the 17th day after birth. Retinal angiography and hematoxylin-eosin (HE) staining were performed to confirm the establishment of OIR mouse model. Expression profiles of lncRNAs were analyzed by lncRNA high-throughput sequencing and the results were verified by real-time fluorescence quantitative polymerase chain reaction (PCR). Based on the expression of lncRNAs and mRNA and the relationship between their genomic locations, potential target genes of lncRNAs were obtained. Gene ontology analysis (GO) and Kyoto Encyclopedia of Genes and Gnomes (KEGG) pathway analysis were used for bioinformatics analysis of lncRNA expression profile in OIR. T test and Graphpad prism were used for statistical analysis and spreadsheet. Results Retinal angiography and HE staining identified serious retinal damage in the OIR group. In total, 1118 differentially expressed lncRNAs ( ≥ 2.0-fold difference in expression, P<0.05) relating to OIR between the two groups were identified by lncRNA high-throughput sequencing. Results of real-time fluorescence quantitative PCR confirmed that XLOC_150632 and XLOC_150636 were upregulated in the OIR group as compared with those in the control, while XLOC_122045,XLOC_100454, XLOC_170009 and XLOC_122042 were downregulated. GO analysis showed that 852, 1148 and 2100 target genes of differentially expressed lncRNAs were relating to biological process, cellular component and molecular function, respectively. KEGG analysis showed that the target genes were associated with 36 biological pathways, mainly relating to retinal development, chemotaxis, migration and energy metabolism of vascular endothelial cells. Conclusions lncRNAs are differentially expressed in healthy newborn mice and newborn mice with OIR. Fibroblast growth factor 2 (FGF2), the potential target gene of XLOC_150632 and XLOC_150636, is related to phosphatidylinositol-3-kinase (PI3K) signaling pathway and may be involved in retinal neovascularization. This might be a potential target for ROP prevention and treatment.

Objective To characterize hotline callers and related factors in Xiamen psychological aids hotline.Methods The data of 8397 callers who had used hotline were recruited from September 2010 to August 2015.During the calling,the callers were interviewed on their demographic characteristics,main counseling problems and suicidal related factors.Results Among the 8397 callers,1304 (15.5％) were frequent callers.Frequent callers had a high proportion of love and interpersonal problems,learning problems,mental illness problems.After adjusted for demographic characteristics,suicidal ideation or behavior (OR=1.417,95％CI:1.083～1.853),prior suicidal behavior 2 weeks before calling (OR=1.453,95％CI:1.058～1.996),symptoms of mental illness (OR=1.909,95％CI:1.188～3.065) were associated with repeated calls among hotline caller.Conclusion Counselor should pay attention to the suicidal related factors in psychological aids hotline to provide better service for hotline caller.

Objective:To design and synthesize photosensitizers with different substituents and to identify its physicochemical characteritics and photodynamic effect on tumor cells.Methods:Two kinds of BODIPY photosensitizers BPOI and BPCI were synthesized through condensation reaction between aldehyde and reactive hydrogen of pyrrole,followed with electrophilic substitution reaction.Physicochemical properties were characterized by 1H NMR,FT-IR and UV-visible absorption spectra and fluorescence emission spectra.The ability to produce reactive oxygen species was detected by BPDF and DCFH-DA.Photodynamic therapy effect on rat glioma C6 cells in vitro was determined by MTT method.Results:Two kinds of BODIPY photosensitizers BPOI and BPCI were successfully synthesized with different substituents,which were confirmed by 1H NMR,FT-IR.Both materials had low toxicity and could be readily taken up by tumor cells.The ability of synthesized photosensitizers to produce reactive oxygen species was strongly influenced by solvent polarity when the substituent belongs to electron-donating group,while no effect was found when the substituent belongs to electron-withdrawing group.Conclusion:Photosensitizer BPOI with electron-donating substituent produces reactive oxygen species with a slow rate in a highly polar environment,while the ability to produce reactive oxgen is greatly improved in a low polarity environment,which is expected to be used for environmental-selective photodynamic therapy in tumor cells.