【Objective】 To explore the risk factors for the production of anti-HLA antibodies in patients with hematological diseases before hematopoietic stemcell transplantation. 【Methods】 The results and clinical data of 1 008 patients with hematological diseases in our hospital who underwent anti-HLA antibody testing were collected by using Luminex technology platform before transplantation from 2016 to 2018 for statistical analysis. 【Results】 The total positive rate of anti-HLA antibodies in 1 008 patients was 24.08%. Multivariate analysis showed that independent risk factors associated with the production of anti-HLA antibodies included age≥30 years old(P=0.046, OR1.467, 95%CI1.007-2.136), time from disease diagnosis to antibody testing≥41 days(P=0.000, OR1.830, 95%CI1.306-2.565), initial platelet count<20×10⁹/L(P=0.020, OR1.543, 95%CI1.072-2.220), prior pregnancy(P=0.000, OR5.187, 95%CI3.689-7.293), transfusions before admission(P=0.001, OR1.762, 95%CI1.257-2.470)and total platelet transfusion volumes after admission≥30 U(P=0.000, OR2.352, 95%CI1.638-3.376). Age ≥30 years old(P=0.023, OR=1.839, 95%CI1.088-3.108)and prior pregnancy(P=0.042, OR=5.258, 95%CI1.062-26.038)are associated with the production of anti-HLA class Ⅰ and class Ⅱ antibodies, respectively. The time from disease diagnosis to antibody testing≥41 days(P=0.000, OR=2.873, 95%CI1.612-5.119), initial platelet count<20×10⁹/L(P=0.008, OR=2.164, 95%CI1.225-3.822), prior pregnancy(P=0.002, OR=6.734, 95%CI1.993-22.751), transfusions before admission(P=0.001, OR=2.746, 95%CI1.531-4.925)and total platelet transfusion volumes after admission>30 U(P=0.006, OR=3.459, 95%CI1.416-8.451)are associated with the production of anti-HLA class Ⅰ and Ⅱ antibodies. 【Conclusion】 Older age, longer course of disease, lower PLT count, history of pregnancy and blood transfusion, and higher total amount of PLT transfusion are risk factors which affect the production of anti-HLA antibodies.Therefore, it is advisable to test for anti-HLA antibodies according to the situation before transplantation, which is of great value in guiding donor selection, monitoring antibody changes and improving transplant prognosis.

Objective:To explore the prenatal diagnosis, clinical intervention and pregnancy outcome of fetal goiter complicated by hypothyroidism.Methods:Three fetuses diagnosed with goiter and hypothyroidism in the First Affiliated Hospital of Anhui Medical University from January 2021 to December 2022 were retrospectively included. Thyroid function tests were performed using umbilical cord blood samples after the fetuses were diagnosed with goiter by prenatal ultrasound. Oral L-thyroxine was given to pregnant women diagnosed with fetal goiter complicated by hypothyroidism, and the changes in fetal thyroid ultrasound imaging and serological indexes were monitored. Clinical manifestations, pregnancy outcomes and postnatal follow-up were summarized using descriptive statistical analysis.Results:Case 1, 2 and 3 were diagnosed as having fetal goiter with rich blood flow signals in the thyroid by ultrasound at 24, 21 and 23 +5 weeks of gestation, respectively. Thyroid function tests showed abnormal increase of thyrotropin in umbilical cord blood and the fetuses were diagnosed with congenital hypothyroidism. Oral administration of L-thyroxine to pregnant women had no significant impact on the sizes of the enlarged thyroid glands, but the blood flow richness was significantly reduced. Moreover, the level of thyrotropin in umbilical cord blood decreased significantly after intervention. Case 2 was terminated due to social factors in another hospital at 34 + weeks of gestation. Cases 1 and 3 were full-term deliveries and followed up for 12 or 18 months. The thyroid function of both neonates were normal at birth and during follow-up. Conclusions:Ultrasound combined with thyroid function tests using umbilical cord blood are helpful in the prenatal diagnosis of fetal goiter complicated by hypothyroidism. Oral administration of L-thyroxine to pregnant women may have practical clinical significance in improving fetal thyroid function.

Objective:The research aims to determine the potential mediating role of psychological insecurity based on the correlation between death anxiety and obsessive-compulsive symptoms in college students during the pandemic of Covid-19 pandemic. The effects of negative coping styles were also investigated.Methods:The objective was achieved using a convenient sampling method. There were a total of 523 participants including 368 girls and 155 boys, aged 16-30 (19.93±2.19) years from Renmin University of China. Participants completed online the Chinese Version Templer Death Anxiety Scale, Self-Rating Feeling of Insecurity Scale, Symptom Checklist-90-Obsessive Compulsive and Simplified Coping Style Questionnaire. Mediational analysis with multiple regression was conducted to reveal the potential roles of psychological insecurity as a mediation factor. Negative coping style was used as a moderator between death anxiety and obsessive-compulsive symptoms, and a simple slope was used to further analysis.Results:Pearson correlation analysis showed that there were significant correlations between death anxiety, obsessive-compulsive symptoms, psychological insecurity, and negative coping style ( r=0.12-0.40, P<0. 01). Death anxiety was positively related to obsessive-compulsive symptoms (β=0.30, t=7.09, P<0.01).This correlation remained significant when psychological insecurity was introduced as a mediating factor (β=0.22, t=5.33, P<0.01). Negative coping style could moderate the relationship of death anxiety and obsessive-compulsive symptoms. Simple slope analysis showed that a higher tendency of negative coping style was associated with the enhanced impact of death anxiety on obsessive-compulsive symptoms (simple slope=0.27, P<0.01 and simple slope=0.08, P=0.17) for high negative coping style individuals and low-score ones, respectively. Conclusions:This research revealed that death anxiety could trigger obsessive-compulsive symptoms by increasing psychological insecurity; overall, higher levels of negative coping styles reinforce the relationship between death anxiety and obsessive-compulsive symptoms.

Objective:The research aims to determine the potential mediating role of psychological insecurity based on the correlation between death anxiety and obsessive-compulsive symptoms in college students during the pandemic of Covid-19 pandemic. The effects of negative coping styles were also investigated.Methods:The objective was achieved using a convenient sampling method. There were a total of 523 participants including 368 girls and 155 boys, aged 16-30 (19.93±2.19) years from Renmin University of China. Participants completed online the Chinese Version Templer Death Anxiety Scale, Self-Rating Feeling of Insecurity Scale, Symptom Checklist-90-Obsessive Compulsive and Simplified Coping Style Questionnaire. Mediational analysis with multiple regression was conducted to reveal the potential roles of psychological insecurity as a mediation factor. Negative coping style was used as a moderator between death anxiety and obsessive-compulsive symptoms, and a simple slope was used to further analysis.Results:Pearson correlation analysis showed that there were significant correlations between death anxiety, obsessive-compulsive symptoms, psychological insecurity, and negative coping style ( r=0.12-0.40, P<0. 01). Death anxiety was positively related to obsessive-compulsive symptoms (β=0.30, t=7.09, P<0.01).This correlation remained significant when psychological insecurity was introduced as a mediating factor (β=0.22, t=5.33, P<0.01). Negative coping style could moderate the relationship of death anxiety and obsessive-compulsive symptoms. Simple slope analysis showed that a higher tendency of negative coping style was associated with the enhanced impact of death anxiety on obsessive-compulsive symptoms (simple slope=0.27, P<0.01 and simple slope=0.08, P=0.17) for high negative coping style individuals and low-score ones, respectively. Conclusions:This research revealed that death anxiety could trigger obsessive-compulsive symptoms by increasing psychological insecurity; overall, higher levels of negative coping styles reinforce the relationship between death anxiety and obsessive-compulsive symptoms.

A 59-year-old male patient received targeted drug recombinant human endostatin injection 15 mg intravenously once daily for 14 days for poorly differentiated adenocarcinoma of lung with brain metastasis. On the 17th day after drug withdrawal, erythema and pruritus appeared on the neck and chest, and then the erythema quickly spread to the whole body, with blisters and extensive epidermal exfoliation, accompanied by pruritus, pain, and mild fever. Toxic epidermal necrolysis caused by recombinant human endostatin was considered. High-dose of glucocorticoid and human immunoglobulin were given and 2 weeks later, the skin lesions healed basically.

A 59-year-old male patient received targeted drug recombinant human endostatin injection 15 mg intravenously once daily for 14 days for poorly differentiated adenocarcinoma of lung with brain metastasis. On the 17th day after drug withdrawal, erythema and pruritus appeared on the neck and chest, and then the erythema quickly spread to the whole body, with blisters and extensive epidermal exfoliation, accompanied by pruritus, pain, and mild fever. Toxic epidermal necrolysis caused by recombinant human endostatin was considered. High-dose of glucocorticoid and human immunoglobulin were given and 2 weeks later, the skin lesions healed basically.

Objective: To investigate the short-term outcome of patients with acute myocardial infarction complicating cardiogenic shock due to left main disease. Methods: A total of 24 patients with acute myocardial infarction complicating cardiogenic shock due to left main artery disease hospitalized in Fuwai hospital from June 2012 to May 2018 were included. The clinical data were analyzed,and the patients were divided into survivor group (11 cases) and death group (13 cases) according to survival status at 28 days post the diagnosis of shock. The patients were further divided into thrombolysis in myocardial infarction(TIMI) flow grade 0-2 group (11 cases) and TIMI flow grade 3 group (13 cases) according to TIMI flow grade after the procedure. The patients were then divided into non-three-vessel lesions group (14 cases) and three-vessel lesions group (10 cases) according to coronary angiography results. Results: Compared with survivor group, patients in death group presented with lower worst systolic blood pressure within 24 hours after admission (50(48, 70) mmHg (1 mmHg=0.133 kPa) vs. 73(70, 80) mmHg, P<0.01), lower worst diastolic blood pressure with in 24 hours after admission ((33.5±12.4) mmHg vs. (48.9±9.4) mmHg, P<0.01), higher respiratory rates ((27.3±2.5) times/min vs. (21.5±4.0) times/min, P<0.01), less 24 hours urine output ((422±266) ml vs. (1 680±863) ml, P<0.01), lower platelet counts ((161.9±81.9)×10⁹/L vs. (241.6±94.0)×10⁹/L, P=0.03), higher serum creatinine ((250.0±36.8) μmol/L vs. (132.7±34.2) μmol/L, P<0.01), higher alanine aminotransferase (288(76,846) IU/ml vs. 81(42, 109) IU/ml, P=0.04), lower artery pH (7.11±0.17 vs. 7.39±0.09, P<0.01), higher lactic acid ((10.29±3.62) mmol/L vs. (4.21±2.85) mmol/L, P<0.01), higher incidence of invasive ventilation (7/13 vs. 2/11, P=0.02), higher scores of acute physiology and chronic health evaluation (APACHE) Ⅱ (35.4±6.8 vs. 18.7±1.7, P<0.01) and simplified acute physiology score (SAPS) Ⅱ (73.5±17.4 vs. 47.0±4.3, P<0.01), and higher incidence of target vessel TIMI flow grade 0-2 (10/13 vs. 1/11, P<0.01). Kaplan-Meier survival curve analysis showed that survival rate at 28 days post the diagnosis of shock in TIMI flow grade 3 group was higher than that in TIMI flow grade 0-2 group (76.9% vs. 9.1%, log-rank test, P<0.01), and mortality rate was similar at 28 days post the diagnosis of shock between non-three-vessel lesions group and three-vessel lesions group (35.7% vs. 60.0%, log-rank test, P=0.14). Multivariate logistic regression analysis showed that compared with TIMI flow grade 0-2 group, the OR value of death at 28 days post the diagnosis of shock in TIMI flow grade 3 patients with acute myocardial infarction complicating cardiogenic shock due to left main disease was 0.030(95%CI 0.003-0.340, P<0.01). Conclusion Short-term outcomeof patients with acute myocardial infarction complicating cardiogenic shock due to left main disease remains poor, and final flow of TIMI grade 3 is confirmed as independent protective factor of death at 28 days post the diagnosis of shock in these patients.

Objective: To evaluate the prognostic value of the thrombolysis in myocardial infarction (TIMI) and global registry of acute coronary events (GRACE) risk scores for in-hospital mortality in Chinese non-ST-segment elevation myocardial infarction (NSTEMI) patients. Methods: Data of present study derived from the prospective, multi-center registry trial of Chinese AMI (CAMI). Among 31 provinces, municipalities or autonomous districts in China, at least one tertiary and secondary hospital was selected. From January 2013 to September 2014, 5 896 consecutive non-ST-segment elevation myocardial infarction patients who were admitted to 107 hospitals within 7 days of symptom onset were enrolled. For each patient, TIMI and GRACE risk scores were calculated using specific variables collected at admission. Their prognostic value was evaluated by the endpoint of in-hospital mortality. Results: Among 5 896 NSTEMI patients (age was (65.4±12.1) years old), 68.2% (n=4 020) were males. The in-hospital mortality was 6.0% (n=353) and the median length of hospital stay was 10.0 (7.0, 13.0) days. The incidence of pre-hospital cardiac arrest was 3.6% (n=213) among 5 896 NSTEMI patients. Six hundreds and forty five patients (10.9%) received primary percutaneous coronary intervention, and 6 patients underwent emergent coronary artery bypass grafting surgery (0.1%), and the median time of reperfusion was 529.5 (256.0, 1 065.0) minutes. The prescription percentage of statins, β-blocker, angiotensin converting enzyme inhibitors or angiotensin Ⅱ receptor blockers, and aldosterone antagonists were 94.8% (n=5 587), 71.7% (n=4 228), 65.5% (n=3 864) and 26.0% (n=1 533) respectively. The area under the curve of GRACE risk score for in-hospital mortality (0.7930 (95%CI 0.767-0.818)) was better than that of TIMI risk score (0.5588 (95%CI 0.532-0.586), P<0.001). Conclusion GRACE risk score demonstrates better predictive accuracy than TIMI risk score for in-hospital mortality in NSTEMI patients in this patient cohort.

Objective: To investigate the effect of touch combined with acupoint massage on relieving anxiety and pain in patients undergoing oral implant surgery. Methods: Seventy-two patients undergoing implant surgery who were eligible for inclusion were randomized into a treatment group and a control group using the envelope method, 36 in each one. The control group was given routine care, and the treatment group was treated with touch combined with acupoint massage on the basis of routine care for 20 minutes. State Anxiety Inventory (SAI) in the State-Trait Anxiety Inventory (STAI) was used to measure the intraoperative anxiety status of patients in the two groups. The degree of intraoperative pain was measured by verbal rating scales in both groups. Results: The mean SAI score of the patients in the treatment group and the control group was 36.5±7.6 and 46.6±12.1, respectively, and the difference was statistically significant (t=4.219, P<0.05). In addition, the pain levels in the treatment group were significantly lower than those in control group (Z=-2.009, P<0.05). Conclusion The combination of touch and acupoint massage can effectively alleviate the anxiety and pain of patients and enhance the comfort of patients during oral implant surgery, which further ensure the safe and smooth operation.