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Recombinant human erythropoietin (rHuEPO) is a drug given to patients who have low hemoglobin related to chronic kidney disease or other anemia-related diseases. Some patients who receive rHuEPO repeatedly develop anti-rHuEPO-neutralizing antibodies, leading to the occurrence of pure red cell aplasia (PRCA). PRCA associated with rHuEPO includes severe rHuEPO resistance, blood transfusion dependence, high serum ferritin, severe reticulocytopenia, and presence of anti-rHuEPO antibody. However, the optimal treatment of erythropoietin (EPO)-induced PRCA is unclear. Therapeutic options against it remain a major clinical challenge. Herein we report on 2 male patients with PRCA during rHuEPO treatment, who received a combination therapy of roxadustat plus rituximab but had completely different clinical outcomes. The results obtained in this study show that roxadustat in combination with rituximab could be one of the treatment options for EPO-induced PRCA, but the treatment efficacy can vary from one individual to another. Additionally, we recommend starting reticulocyte monitoring and immunosuppressive agent therapy as early as possible to shorten the course of the disease and improve the outcomes of the patients.

In accounting firms, human resource has no doubt to play an important role in it. If human resource management does not work, it will weaken the core competencies of accounting firms, what's more, it can also lead to low quality of auditing, lack of independence of auditors. All of above will be potential motivations for financial scandal. ‘Quality Controlling Standard 5101-Engagement Quality Controlling’ is the safeguard for Human Resource Management of accounting firms. This paper analyzes the current problems from survey's result and gives some suggestions. We find that accounting firms face plenty of difficulties due to the specific industry. As for accounting firms in China, it is obvious that local firms play a poorer performance in many aspects while compared with Big Four. We suggest that slow down information asymmetry in recruiting; improve self-efficacy in staffs' learning; set up effective evaluation system for performance; make good use of immaterial incentive and so on.