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Background: Lymphoma is a common hematological malignancy with many subtypes and considerable heterogeneity. Traditional treatments include chemotherapy, radiotherapy, and surgery. Patients with relapsed, refractory or advanced stage lymphoma have a dismal prognosis. In recent years, chimeric antigen receptors (CARs) have been recognized as powerful tools that redirect antigen-specific T cells independent of human lymphocyte antigen (HLA) restriction and specifically kill tumor cells. Satisfactory results with CAR-based treatments have been achieved in relapsed/refractory B cell leukemia/lymphoma. Our center explored the strategy of subcutaneous injections combined with intravenous drip to overcome certain issues.Case Presentation: A patient with stage IV refractory and relapsed diffuse large B cell lymphoma was treated with regional and intravenous CAR-T cells. During the observation period, the temperature of the skin at the abdominal wall mass was slightly elevated, and tolerable pain in the injection area was reported. Imaging showed regional liquefactive necrosis. After the sequential administration of ibrutinib and venetoclax, the abdominal wall mass significantly decreased in size. Conclusion:The regional injection of CAR-T cells might be safe and feasible for the treatment of regional lesions in patients with refractory and relapsed advanced lymphoma.

BACKGROUNDStroke is a type of cerebrovascular disease with high prevalence, mortality, and onset of disability. As a neurodevelopmental therapy, neuromuscular joint facilitation (NJF) is widely used in the treatment of orthopedic and neurological disorders in the clinical practice. It is mainly used for central nervous system diseases or orthopedic diseases, movement disorders, and pain rehabilitation. According to related studies, NJF can also be used as a rehabilitation treatment in patients with hemiplegic shoulder pain (HSP).AIMTo investigate the clinical efficacy of acupuncture combined with NJF in patients with HSP.METHODSForty patients with HSP were randomly divided into a treatment group and a control group. The treatment group was treated with acupuncture combined with NJF and the control group was treated with acupuncture alone. All patients were assessed by using the visual analogue scale (VAS), Fugl-Meyer assessment (FMA), Barthel index (BI), and passive range of motion (PROM) before and after the training. All the clinical data were analyzed using SPSS 20.0 statistical software.RESULTSThere was no statistical difference in the general characteristics between the two groups. In the terms of duration of treatment, age, and pre-treatment indicators, the two groups were comparable (P > 0.05). After the treatment, VAS, PROM, BI, and FMA scores were significantly improved in the two groups of patients (P < 0.05). The VAS, PROM and FMA scores were significantly higher in the treatment group than in the control group (P < 0.05). However, there was no significant difference in BI scores between the two groups (P > 0.05).CONCLUSIONBoth acupuncture alone and acupuncture combined with NJF in the treatment of HSP are effective, and can improve the clinical symptoms of patients. Acupuncture combined with NJF can improve the upper limb motor function, relieve pain, and increase joint mobility in patients with HSP. The combination therapy is better than acupuncture alone. However, there is no significant difference in improving the score of patients’ self-care ability.

Objective: This study aimed to determine the incidence of iron-deficiency anemia (IDA) complicated by splenomegaly in our hospital over the past 6 years and to analyze the possible causes of this result. Methods: This is a retrospective study. In total, 668 patients with IDA who were hospitalized in the hematology department of our hospital from 2013 to 2019 were selected as the research subjects and included in the IDA group, and 3201 patients who underwent outpatient physical examinations in our hospital during the same period were included in the control group. The incidences of splenomegaly in the IDA and control groups were calculated, and the difference was analyzed by means of statistical methods. Results: Among the 668 IDA patients, 46 (6.9%) had splenomegaly, and among the 3201 patients in the control group, 21 had splenomegaly (0.7%). The incidence of splenomegaly was significantly higher in the IDA group than in the control group, and the severity of anemia in the IDA group was associated with the occurrence of splenomegaly. Specifically, the incidence of splenomegaly was 12.4% among patients with severe anemia and as high as 50% among patients with extremely severe anemia. Conclusion: IDA is correlated with the incidence of splenomegaly, and the incidence of splenomegaly significantly increases as the severity of IDA increases. This is considered to be caused by extramedullary hematopoiesis.

Objective: The aim was to investigate the clinical characteristics and molecular pathogenic mechanism of twins with congenital factor V (FV) deficiency. Methods: We comprehensively analyzed the clinical manifestations and laboratory test results of a set of twins and their parents and performed point mutation analysis with direct high-throughput exon sequencing. Results: The prothrombin time and activated partial thromboplastin time were prolonged for both probands, and the FV activity levels were 13.0% and 9.8%. Next-generation sequencing showed that the affected individuals harbored a paternal c.5113A>C (p.S1705R) and a maternal c.4949C>T (p.A1650V) heterozygous variants in the FV gene, which conformed to an autosomal recessive inheritance pattern. This is the first report of these point mutations. The older boy also had a congenital patent foramen ovale. Conclusion: In this set of twins, missense mutations of the FV gene were related to congenital FV deficiency but unrelated to the patent foramen ovale observed in the older boy.

Objective: This study analysed the relationships between the main thromboelastography (TEG) parameters, the platelet (PLT) count and clinical bleeding in patients with blood diseases. We explored the threshold of the relevant parameters in the pathological condition of bleeding, aiming to scientifically guide clinical prophylactic PLT transfusion.Methods: In total, 268 patients with clear diagnoses of blood diseases and thrombocytopenia were enrolled and divided into five groups, A, B, C, D and E, corresponding to PLT counts of 0-10 Â 10 9 /L, 11-20 Â 10 9 /L, 21-30 Â 10 9 /L, 31-50 Â 10 9 /L and 51-100 Â 10 9 /L, respectively. TEG and routine blood testing were performed simultaneously, the main TEG parameters and the PLT count were analysed, and the thresholds of the main TEG parameters in each group when the patient had bleeding were obtained. Results:The maximum amplitude (MA) in groups A, B and C increased gradually, with a significant difference between each pair of these groups (P < 0.05). In groups A, B, C, D and E, the corresponding MA at the time of bleeding was 43.5 mm, 39.6 mm, 38.0 mm, 35.2 mm and 50.5 mm, respectively, with statistically significant differences (P < 0.05). Conclusions:The MA can be used as a reference indicator for preventive PLT transfusion to a certain extent. When the PLT count is within different ranges, the MA threshold for preventive PLT transfusion also differs. It is recommended that different PLT counts be correlated with different MA thresholds to guide clinical prophylactic PLT transfusion.bleeding risk, blood transfusion, platelet count, thrombocytopenia, Thromboelastography 1 | BACKGROUND Thrombocytopenia and bleeding are common clinical manifestations of blood system diseases, and platelet (PLT) transfusion is often used for clinical treatment. However, as a rare resource, blood is in short supply in China and worldwide, but the demand is increasing yearly.According to statistics, approximately 1.25 and 2.2 million units of PLTs were used in clinical applications in China and the United States, respectively, in 2014; however, these numbers are currently on the rise. 1 In current clinical practice, the preventive infusion is generally given when the PLT count is 10 Â 10 9 /L or lower 2-5 ; however, in clinical practice, the setting of this index cannot fully reflect the real haemostatic state of the body, and there are some disadvantages. Therefore, it is very important to explore comprehensive and effective haemostatic detection indexes to guide PLT transfusion. As a new technology, thromboelastography (TEG) can not only be used to

Background: Acute myeloid leukemia (AML) is a common hematologic malignancy with a generally unfavorable prognosis. Cuprotosis as a new form of programmed cell death has been shown to play an important role in tumorigenesis and progression; However, the relationship between cuprotosis and the prognosis of AML patients remains unclear. Methods: Transcriptomic and genomics data, along with clinical information, were obtained from the TCGA and GEO databases. Especially, unsupervised clustering and machining learning were used to identify molecular subtypes and cuprotosis-related risk scores respectively. Kaplan-Meier analysis, univariate and multivariate Cox regression, and Receiver Operator Characteristic curve (ROC) were performed to assess the prognosis based on cuprotosis-related genes (CRGs). Moreover, multiple algorithms were used to evaluate immunological heterogeneity among patients with different risk scores. For in vitro analysis, the expression of genes involved in CRGs was detected by Quantitative Reverse Transcription Polymerase (qRT-PCR) in AML patients. Results: Transcriptomic and genome data indicated the immense heterogeneity in the CRGs landscape of normal and tumor samples. Cuprotosis subtype A and cuprotosis regulatory subtype B in the genomics map and biological characteristics were significantly different from the other groups. Furthermore, these two subtypes had lower risk scores and longer survival times compared to other groups. Cox analyses indicated that risk score was an independent prognostic factor for AML patients. In addition, our risk score could be an indicator of survival outcomes in immunotherapy datasets. Conclusions: Our study demonstrates the potential of CRGs in guiding the prognosis, treatment, and immunological characteristics of AML patients.

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