No abstract

No abstract

The authors declare that the study was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.Acknowledgements: We acknowledge LNW, YC, and LZL for analyzing possible diagnosis for this patient. We also express thanks to LWW, LD, and LXL for assistance in collecting serum samples (LWW, Luwei Wang, a member of the

BackgroundDrug-induced immune hemolytic anemia (DIIHA) is a rare but potentially life-threatening drug-related complication. There are no previous reports of pemetrexed plus cisplatin as first-line chemotherapy for non-small cell lung cancer, resulting in DIIHA.Case presentationIn this report, a patient with advanced-stage lung adenocarcinoma developed severe immune hemolytic anemia 21 days after pemetrexed plus cisplatin chemotherapy. Laboratory findings showed severe hemolysis, including a rapid decrease in hemoglobin (HGB) and an elevated level of reticulocytes (Rets), indirect bilirubin (IBIL), and lactate dehydrogenase (LDH). A workup for the possibility of DIIHA was performed, including a direct antiglobulin test (DAT), a test in the presence of the soluble drug, and a drug-treated red blood cell (RBC) test. It showed a strongly positive (3+) result for anti-C3d but not for anti-immunoglobin G (IgG) in DAT. Enzyme-treated RBCs reacted weakly with the patient's serum and pemetrexed when complement was added. In addition, the patient's serum and normal sera were reactive with cisplatin-treated RBCs. However, eluates from the patient's RBCs and diluted normal sera were non-reactive with cisplatin-coated RBCs. Untreated and enzyme-treated RBCs reacted with the patient's serum in the presence of soluble cisplatin. In vitro serological tests suggested that complement-dependent pemetrexed antibodies and cisplatin-associated non-immunologic protein adsorption (NIPA) might combine to cause immune hemolytic anemia. The patient's anemia gradually recovered when pemetrexed and cisplatin were discontinued.ConclusionThis rare case demonstrated that complement-dependent pemetrexed antibodies and cisplatin-associated NIPA might occur simultaneously in a patient with DIIHA.

Aiming at the weight reduction optimal design of short shell structure of rocket fuel tank, this paper deals with the structural optimization under the action of axial load. First, the accuracy of equivalent stiffness method is verified by post-buckling analysis of short shell in ABAQUS. Then, according to the parametric model of short shell, based on Kriging surrogate model and EGO algorithm, the optimal structure without and with fillet are obtained under the given design load. Finally, a parametric study is carried out on the influence of fillet on the bearing capacity per unit mass of short shell. The results show that when the width of rib or the spacing of transverse rib is small, and the height of rib, the thickness of skin or the spacing of longitudinal rib is large, processing large fillet for load-bearing purpose is less beneficial or even disadvantageous.