Objective Discuss on the significance and define an evaluation indicator for the clinical use of blood management. Improve the evaluation system for clinical transfusion. Method Do a three-dimension analysis among hospitals,blood-demanded departments and doctors by combining transfusion statistics data with the observed data in hospital andreferring to the relevant regulatory requirements and guidelines on blood using. Building management evaluation indexes for clinical transfusion. Results We defined the concept of management evaluation for clinical transfusion,established 13 evaluation index includes names,formulation,significance,and application guidance. Conclusions By developing a complete management evaluation indexes for clinical blood usage,we can provide hospitals and administrative departments with Methods for meeting the requirements of the medical institutions management approach for clinical use of blood. It can also help with strengthening the management of blood for clinical use and raise the level of safety and efficiency of blood using.

Objective To explore the methodology and significance of prospective auditing and evaluation system for blood transfusion and establish an effective system,which can feedback intervene to promote quality of clinical transfusion. Methods First we develop the process of blood transfusion prospective auditing and evaluation. It demands for enhanced medical record and better statistics for optimal auditing and evaluation by transfusion physician. Results Transfusion in Medical treatment should be auditd with laboratory indicators and medical records. Perioperative transfusion risk can be assessed by a scoring system for each disease. For example,the patients with lumbar spinal stenosis scored over 4 points have a ratio of >50% for perioperative transfusion. These Methods could obviously reduce the volume of blood requested and used. Post-transfusion evaluation should be automatically evaluated by transfusion management information system,and then the inappropriate case would be re-evaluated by transfusion physician according to the medical records. Conclusion Clinical data and records are useful tools for prospective auditing and evaluation. Individual prospective auditing and evaluation by transfusion physician can meet the requirements of evidence-based medicine and precision medicine.

Objective By the bood transfusion management system,to establish clinical blood transfusion effect evaluation system for automatic management of clinical blood transfusion. Method By associating,calculating and comparing the information of transfusion management system,hospital patient information management system,laboratory information management system and hospital anesthesia management system,the date can evaluate and manage clinical blood transfusion. Result The systematic classification and analysis of a large number of blood transfusion data cancomplete the automatic evaluation and classification of preset related evaluation indicators,and it can be used in all aspects of clinical blood transfusion management. Conclusion To establish the clinical blood transfusion effect evaluation system in transfusion management systemcan provide a systematic will comprehensive management tool in the blood management evaluation index of doctors,and the dynamic monitoring of blood.

Objective To observe the effect of ozone perfusion combined with ozone autologous blood transfusion on lipid metabolism disorders （LMD） in patients with steroid induced necrosis of the femoral head（SINFH）. Methods One hundred and twenty patients with SINFH and LMD were selected and randomly divided into three groups,with 40 cases in each. The experimental group was given the joint cavity injection of anti-inflammatory analgesic liquid,ozone perfusion combined with ozone autologous blood transfusion; the first control group was given the joint cavity injection of anti-inflammatory and analgesic liquid and ozone perfusion; and the second control group was given the joint cavity injection of anti-inflammatory and analgesic solution and ozone autologous blood transfusion. After 2 months the blood lipid levels and clinical efficacy were compared in the three groups of patients. Results After treatments,the total effective rate of experimental group was 90%,significantly higher than the other two groups（χ²=4.02,P<0.05）. No significant difference was noted between the second control group and the experimental group（χ²=0.95,P>0.05）. The blood lipid level of all patients were decreased but the indexes in experimental group were significantly lower than the other two groups（P<0.05）. Conclusion Ozone perfusion combined with ozone autologous blood transfusion can effectively attenuate the blood lipid level in patients with steroid induced femoral head necrosis,and the therapeutic effect is satisfactory.

Objective To explore the security of DEL red blood cells transfusion to Rh negative recipient. Methods IAT and adsorption-elution were performed on the investigated blood samples to test RhD-negative recipients and DEL phenotype. RHD genotyping were performed with gene sequencing for DEL phenotypes,anti-D alloimmunization was investigated in RhD-negative recipients transfused with DEL red blood cells. Results All the DEL donors were confirmed to carry RHD RHD1227A allele. The titer and strength of anti-D antibodies of 12 true D-negative recipients who were transfused with DEL blood showed no significant difference. However,the titer of anti-D antibodies of one true D-negative recipient increased from 8 to 32.Conclusions Alloanti-D immune response induced by DEL is a rare event in true D-negative recipients. But DEL donors should be excluded for transfusion to D-negative recipients who had carried anti-D.

Objective Based on the evaluation,the relevant evaluation To find the weak link of clinical blood transfusion,medical record of clinical blood transfusion was evaluated. Method 148 cases of medical records about blood transfusion were chosen from 31 hospitals in which have carried out blood transfusion,the medical records of blood transfusion were evaluated by the criteria such as,orders of blood transfusion,inspection Results before blood transfusion,application of blood transfusion,informed consent of blood transfusion,progress notes of blood transfusion,records of blood transfusion progress,grasp of blood transfusion indications,the rate of component transfusion and the rate of red cell utilization. Result 71% of cases had no history of blood transfusion or pregnancy description; 3% of cases had the errors of blood transfusion type; 29% of cases had no signature on the cross matching blood list; 26% of cases had no doctor signature or date on the informedconsent of blood transfusion; 48% of cases didn't establish clinical blood examination and approval system or had unqualified applications; 97% of cases had defective evaluation content of blood transfusion; 3% of cases had no efficacy evaluation after transfusion or the transfusion evaluation was not specific; 45% of cases had no dual signature of transfusion execution; The patient's vital signs were not recorded at the beginning and the end of the 15 minutes of infusion in 84% of cases; 13% of cases had unreasonable indications of red blood cell transfusion. 61% of cases had unreasonable indications of FFP; the preservation of blood bags didn't meet the requirements after the blood transfusion in 19% of cases. Conclusion The specific evaluation of blood transfusion can help to improve the quality of clinical blood transfusion records,improve the management process of clinical blood transfusion,and ensure the scientific and rational use of clinical blood. At the same time,it can improve the management process of clinical transfusion,to find out the unqualified items of blood transfusion medical record,make continuous improvement,ensure scientific and rational use of blood for clinical use.

Objective To explore the clinical significance of thrombelastogragh（TEG） in children immune thrombocytopenia （ITP）. Methods The levels of blood TEG in 146 patients with ITP from the Beijing children's hospital were analyzed,and the Results were analyzed statistically. The cases were divided into three groups including therapy group,observation group and alleviate group according to the PLT levels. Results There were statistical differences among the three groups of R、K、Angle and MA（P<0.01）,while the treatment group was obviously lower than the reference value in MA and Angle,and difference exists in any two group in MA and Angle（P<0.01）. Although there was no difference between therapy group and observation group in R（P>0.05） and K（P>0.017）,there were differences between alleviate group and the others group in R（P<0.01） and K（P<0.017）. Conclusions TEG is important for the treatment of children immune thrombocytopenia。

Objective Clinical observation and exploration of the relevance of the invalid red blood cells （RBCs） transfusion and the undetectable low titer and irregular antibodies. Methods One hundred and ninety-six patients with invalid RBCs transfusion were selected from 1 987 clinical cases frim Jun 2014 to April 2015. The ratio of low titer irregular antibodies in pre-transfusion samples was retested using LISS/Coombs cards. Simultaneously,the relationship between the lower titer irregular antibodies and pregnancy,volume of blood transfusion,ages,gender,adverse effect of transfusion,etc. Results The percentage of invalid RBCs transfusion in the 1987 cases of transfusionwas 9.9%,,among them,30 cases of undetectable low titer irregular antibodies were screened out. The ineffective RBCs transfusion and low titer irregular antibodies were closely related with the number of pregnancy （χ²=4.32,P=0.04）,volume of blood transfusions （χ²=6.43,P=0.01）,ages （χ²=6.74,P=0.01）,gender （χ²=9.32,P<0.01）,and adverse reactions of blood transfusion （χ²=4.33,P= 0.04）. Conclusion The low titer irregular antibodies is one of the reasons for invalid red blood transfusion,and closely related with the number of pregnancy,ages,gender,volume and adverse reactions of blood transfusion.

Objective To evaluate the clinical therapeutic effect of platelet antibody-positive or negative patients who had received transfusion of compatible platelet. Methods The total of 322 cases of the in-patients from Jan to Dec in 2014 were enrolled. Platelet antibodies were determined by solid-phase agglutination and corrected count increment （CCI value） after 1h and 24h of platelet transfusion were compared,betweenrandom and compatible transfusions The rates of platelet transfusion refractoriness of either platelet antibody positive patients or negative patients,who had been transfused with compatible platelets,were analyzed. Results One hundred and thirty-nine cases（43.2%） of positive platelet antibodies were found in 322 cases of patients with platelet transfusion .The rate of platelet transfusion refractoriness was 18.7% and 3.83% respectively in antibody positive and negative groups. The frequency of positive antibodies was significantly higher than that of the negative patients （P<0.01）. For platelet antibody positive patients,the efficiency of compatible platelet transfusion was significantly higher than that of random platelet transfusion（P<0.05）.The efficiency was 81.3%. There was no significant difference in diseases （P>0.05）. Conclusion Platelet antibodies were detected and platelet matching was processed by solid phase agglutination assay,which can significantly improve the transfusion effect of platelet antibody positive patients.

Objective To understand non-small cell lung cancer（NSCLC）epidermal growth factor receptor （EGFR） mutations in Shenzhen,and to provide a basis for target therapy of NSCLC patients. Methods collected from March 2013 to November 2015 in shenzhen area three level 3 district hospital,One hundred and three cases of NSCLC cancer tissues were collected in 3 hospitals from 2013 to 2015,and DNA was extracted followed by detections of EGFR gene mutation in exon 18,19,20 and 2l using mutations specific amplification system （ARMS） amplification. Results All of 103 cases of NSCLC showed an EGFR gene mutation rate of 38.8% （40/103）,among them 18,19,20 and 21 exon mutations rates were 2.5%（1/40）,35.0%（14/40）,5.0%（2/40）,and 57.5%（23/40）,respectively. EGFR mutation rate was 48.7% （37/76）in patients with adenocarcinoma,higher than 11.1%（3/27）in the patients with non-adenocarcinoma.（χ²=25.617,P<0.01）. EGFR mutation rate in NSCLC patients of nonsmookers was 56.1% （32/57）,significantly higher than the smooker patients（ 17.4%,8/46） （χ²=20.195,P<0.01）. The mutation rate in female patients was 52.4%（22/42）,higher than that of the male （29.5%,18/61）（χ²=5.127,P<0.05）. The patients below 56 years exhibited an EGFR mutation rate of 39.5% （17/43）,compared to those over 56 years （38.3%,23/60）（χ²=0.618,P>0.618）.Conclusion EGFR mutations in NSCLC patients are mainly composed of exon 21,followed by exon19. Adenocarcinoma,femal,and nonsmoker patients seem to be the risk factors of EGFR gene mutation.

Objective To verify the measurement performance of low molecular weight heparin（LMWH） anti-Ⅹa activity assay,antithrombin（AT）activity assay and activated partial thromboplastin time （APTT） test. Methods According to the Clinical and Laboratory Standards Institute （CLSI） guidelines,the professional standards and manufacturer's instructions,the performance characteristics of LMWH anti-Ⅹa activity assay,AT activity assay and APTT test were verified as follows： within-run precision,between-day precision,linearity,accuracy or comparability and the limit of detection （LoD,only for LMWH anti-Ⅹa activity assay）. Results The within-run precision,between-day precision,linear range,bias for accuracy and LoD of LMWH anti-Ⅹa activity assay were 0.03 anti-Ⅹa IU/ml and 0.05 anti-Ⅹa IU/ml,0.04 anti-Ⅹa IU/ml and 0.05 anti-Ⅹa IU/ml,0-1.83 anti-Ⅹ a IU/ml,4.3% and 2.2%,0.05 anti-Ⅹa IU/ml,respectively,all of which were acceptable following manufacturer’s instructions. The within-run precision,between-day precision,linear range and bias for accuracy of AT activity assay were 2.0% and 3.5%,2.7% and 5.3%,0%-139%,0.9%,-1.4% and -2.7%,respectively,all of which were acceptable following manufacturer's instructions. The within-run precision,between-day precision and bias for comparability of APTT test were 0.5% and 0.4%,3.4% and 4.4%,within ±15.0%,respectively,all of which were acceptable according to professional standards and manufacturer's instructions. Conclusion The verified data of the LMWH anti-Ⅹa activity,AT activity and APTT detection systems were acceptable according to the professional standards and manufacturer's instructions. It is very important to set up the Methods and specifications of verification for clinical laboratories to implement quality improvement.

Objective To investigate the correlation between 25 hydroxy vitamin D3 （VitD3） and cholesterol（CHOL）triglycerides（TG） high-density lipoprotein（HDL） low density lipoprotein（LDL） 、 Urine albumin creatinine ratio（UACR） 、C peptide（C-P）、 glycosylated hemoglobin（HbA1c） in type 2 diabetes mellitus（T2DM）patients. Methods Serum vitamin D3（VitD3） 、CHOL、TG、 、HDL、LDL、,UACR、C-P and HbA1c detection index were determined in the 83 patients with established diabetes . And according to 25 hydroxy vitamin D3 level,the all of samples were divided into three groups,the VitD3 < 15 ng/ml for severe lack of group,15 ng/ml < VitD3 < 20 ng/ml for mild lack of group,VitD3 > 20 ng/ml for relative normal group . Results The serum VitD3 and CHOL、TG、HDL、LDL have no statistics significance among the three groups（P>0.05）. But,the level of VitD3 were negatively correlated with UACR and HbA1c; and positively correlated with C peptide; They have statistics significance among the three groups（P<0.05） . Conclusion Joint detection of VitD3、C-P and HbA1c can provide the basic information for prevention and control of diabetes,and has guiding significance in diabetes self-monitoring,and can be used as an index to assess the degree of diabetic nephropathy.

Objective To explore the correlation between the cytochrome p4502E1 gene transfer （CYP2EI） and glutathione enzyme sulfur MI （GSTM1） gene polymorphism and genetic susceptibility of non-small cell lung cancer in shenzhen area. Methods Samples were collected from February 2014 to October 2016 in shenzhen,every hospital and diagnosed with non-small cell lung cancer patients and at the same time all the 71 patients with lung benign disease in hospital,CYP2E1 gene was detected by PCR method then by the PCR-RFLP in RsaⅠ/PstⅠ,and the correlation between non-small cell lung cancer and gene polymorphism was analysed.Results There was no statistically significant difference between （χ²=0.891~1.205,P>0.05） non-small cell lung cancer and lung benign disease group patients in GSTM1 gene polymorphism,CYP2E1 gene Rsa I/Pst I polymorphisms of the three genotypes detection.;In non-small cell lung cancer group,GSTM1（-） genotype frequency was 61.79%,significantly higher than 36.62% of lung benign disease group,the difference was statistically significant in genetype frequency between two group （χ²=5.019,P<0.05）;The risk of non-small cell lung cancer is significantly higher in individual carrying GSTM1（-） genotypes than the GSTM1 （+） genotype individuals OR 2.095 （95% CI=1.104~3.173,P=0.032）;with cl/c2 and c2/c2 gene type of nonsmoking individuals,carrying the cl/cl genotypes of smokers significantly increased risk of non-small cell lung cancer （OR= 3.415,95% CI=1.092~11.214,P=0.028）; with cl/cl and GSTM1 （-） genotype individuals had a significantly higher risk of non-small cell lung cancer than individuals with GSTM1 （+） and cl/c2 and c2 / c2 genotype （（OR=3.518,95% CI=3.518~l2.812,P=0.045）.In the crowd,smoking is not allowed to carry GSTM1 （-） and cl/cl genotype had a significantly higher risk of non-small cell lung cancer with GSTM1 （+） and cl/c2 and c2 / c2 gene type of people （OR=2.917,95% CI=1.004~8.316,P=0.043）,and with GSTM1 （-） and cl/c2 and c2 / c2 gene type of crowd is higher than the same risk of non-small cell lung cancer with GSTM1 （+） and cl/c2 and c2 / c2 gene type of people （OR=14.062,95% CI=1.362~147.256,P=0.029）.Conclusion GSTM1 genotypes （-） is regarded as one of the risk factors for non small cell lung cancer were diagnosed in shenzhen area ; At the same time carrying CYP2E1 cl/cl and GSTM1 （-） genotypes can increase risk of non-small cell lung cancer in the smoking and nonsmoking population.

Objective To explore the relationship between hypoxia inducible factor 1α,its controlled genes and clinical pathological characteristics in gastric carcinoma. Methods A total of 87 cases of gastric carcinoma patients gastric mucosa tissue samples （gastric cancer tissue） and adjacent non tumor mucosa epithelial tissue （adjacent issue） were collected,PFKFB3,PFKFB4,HIF-1α protein positive rate were detected by immunohistochemical staining,PFKFB3,PFKFB4,HIF-1α protein relative expression was detected by Western blot assay,PFKFB3,PFKFB4,HIF-1α mRNA relative expression was detected by real-time quantitative polymerase chain reaction. The relationship between PFKFB3,PFKFB4,HIF-1α and clinical pathological data and survival prognosis were analysed. Results The positive rate （exactly number?） of PFKFB3,PFKFB4 and HIF-1α protein expression in gastric carcinoma was significantly higher than that in the adjacent tissues （P<0.05）.The expression level of PFKFB3,PFKFB4 and HIF-1α protein was （2.09±0.17）,（2.33±0.21）,（2.16±0.18）,was significantly higher than that in adjacent tissues（1.03±0.11）,（1.47±0.14）,（1.10±0.12）（P<0.05）.The expression level of PFKFB3,PFKFB4 and HIF-1α mRNA was （1.21±0.17）,（1.41±0.18）,（1.32±0.15）,was significantly higher than that in adjacent tissues（0.55±0.5）,（0.63±0.08）,（0.51±0.04）（P<0.05）.Tumor diameter≥4cm,poorly differentiated gastric cancer,Ⅲ~Ⅳ stage gastric cancer patients PFKFB3,PFKFB4,HIF-1 expression was significantly increased （P<0.05）.The cumulative 3 year survival rate of PFKFB3,PFKFB4 and HIF-1α negative group was significantly higher in gastric carcinoma than that in PFKFB3,PFKFB4 and HIF-1α positive group （P<0.05）.Conclusion The expression level of PFKFB3,PFKFB4 and HIF-1 are highly expressed in gastric carcinoma,and the expression level was related to tumor size,clinical stage and differentiation degree,three of them can be used as predictors for the prognosis of gastric cancer.

Objective To explore the efficacy of local injections via fiberoptic bronchoscopy for the patients with multi-drug resistant tuberculosis. Methods Ninety eight cases of patients with multi-drug resistant tuberculosis were divided into the experiment group （50 cases,3DVThAE/15DVThE+local injections via fiberoptic bronchoscopy） and control group（48 cases,3DVThAE/15DVThE only）. The clinical effects and immune status of the patients were compared. Results The sputum negative conversion rates for 3 months,6 months,and 12 months in the experiment group were higher than those in the control（P<0.05）. The total rates of lesions disapperance and cavity reduction of the lung were higher in the experiment group than those in the control（P<0.05）. The higher levels of CD4+,CD4+/CD8+ and IFN-γ expression were seen in the experiment group than the control（P<0.05）. The number of CD8+ was decreased in the experiment group （P<0.05）. In contrast,IL-4 level was found to be reduced in the experiment group（P<0.05）. Conclusion Local injections via fiberoptic bronchoscopy is promising for the treatment of patients with multi-drug resistant tuberculosis,

Objective To investigate the serum parathyroid hormone （PTH）,Cystatin C （Cys-C） in the combined detection of chronic kidney disease （CKD） application value in the diagnosis and treatment of patients. Methods Retrospective selection of 263 cases of chronic kidney disease patients in our hospital as the research group,28 healthy persons were selected as the control group,The serum levels of PTH,Cys-C,creatinine （Scr） and urea （Urea） were detected in each group,and the Results were analyzed,At the same time,the Results of the study group were compared before and after treatment （32 cases）.Results The detection level of the study group was higher than that of the control group,And increased with the progress of the disease,The difference was statistically significant （P<0.05）;The level of serum PTH was decreased after treatment,The difference was statistically significant （P<0.05）;The difference between the other three indexes was not statistically significant.Conclusion The combined detection of serum PTH,Cys-C,Scr and Urea can be used as an effective index to assess the degree of renal function impairment,PTH can be used as a basis for the treatment of patients with chronic renal failure.

Objective To analyze the positive rates of HBV and HCV to provide effective precautionary measures and select low-risk donor. Methods To analyze the positive rates of HBV and HCV from blood donor specimens from 2011 to 2015. Results The positive rates of HBV and HCV declined from 0.9% to 0.6% and from 0.2% to 0.1%,respectively （P<0.05）. No statistical difference was seen of positive rates of HBV and HCV between males and females （P>0.05）. However,the positive rates of HBV and HCV in planned blood donors were higher than in personal blood donors. Conclusions HBV and HCV infections were decreasing in voluntary blood donors. The positive rates of HBV and HCV in planned blood donors were significantly higher than in personal and co-operative blood donors. It is necessary to choose the regular blood donors,and improve sensibility and specificity of detection to ensure blood safety.

Objective To discuss the necessity of grey area in HIV screening experiment of ELISA. Methods The blood sample which was reactive in the preliminary screening from 2012 to 2016 were sent to the HIV confirmation laboratory. The Results of preliminary screening were analyzed retrospectively according to S/CO value. ResultFrom 2012 to 2016,165189 cases blood donors were detected. 630 cases were reported to HIV confirmation laboratory by double reagent reactive or single reagent was double reactivity. Positive Results were confirmed in 96 cases.514 cases were reactive in the reagent of Sorin. 115 cases of S/CO value in the 0.8-1.0 interval were negative. 239 cases were reactive in the reagent of Jinhao. 17 cases of S/CO value in the 0.8-1.0 interval were negative. Conclusion To set the grey area in the HIV screening test by ELISA is unnecessary.

Objective To investigate the proper screening mode for floating and fixed blood donations. Methods The experiment was conducted in two stages. In the first stage,donors were selected from first blood donation in the streets and the fixed donors of university students,workers and employees of the enterprises and governments from 2011-2013. In the second stage,donors were only selected from the fixed donors in 2014.The primary screening and re-tests included Hb,ALT and HBsAg. Results Compared with the fixed donors,those of the first blood donation in the streets had a high defective rates of Hb,ALT and HBsAg screening tests,while the defective rate of HB tests were lower in the workers of enterprises than in the university students. Primary screening tests were not implemented in the male workers of enterprises and public institutes and university students. No difference of the qualification rates was noted among the three populations within three years. Conclusion A safe and fixed population of blood donation should be grouped,and optimized preliminary screening mode should be used to reduce the unhealthy emotions of donators and increase the work efficiency.

Ojective To prepare recruitment and detection strategies for blood donationsand to ensure the safety of blood transfusion.Methods A total of 434700 blood donors were selectedin Zhongshan area from 2006 to 2015.HIV positive blood donors were grouped according to gender,age,frequency and blood components of donations in comply with the confirmatory tests of the CDC of Zhongshan city.Results Fifty two HIV cases were found in 434700 blood donors,with an incidence of 11.96/104.Among them males were 15.19/104（82.69%）and females were 5.93/104.Young adults,the middle aged and elderly accounted for 9.05/104（53.85%）,19.36/104,and 3.93/104,respectively.Prevalence of HIV infection was found to be 18.34/104（80.77%）,12.22/104,and 23.29/104（11.54%） in the first time,repeated and fixed donors,respectively.All HIV cases （12.56/104） were found in whole blood donations;55.77% of them （10.57/104） came from group blood donations; and 14.37/104 were found to be street blood donators.Conclusions HIV infection in blood donators is a critical issue in Zhongshan area.High technology with sensitivity,reliability and viral sterilization must be used for blood donor screening to ensure the safety of transfusion.

Objective To explore the significance of nucleic acid tests for centralized blood screening in southern Anhui. Methods Qualified samples from five blood stations were detected,with two sets of nucleic acid blood screening systems for HBV DNA,HCV RNA and HIV RNA. The samples with negative ELISA and positive NAT were further identified for hepatitis B. Finally,the positive rates of nucleic acids in five blood stations were analyzed. Results During the centralized detection,39616 samples were tested and 39 HBV positive samples were found,including 12 in Wuhu,16 in Anqing,3 in Chizhou,5 in Huangshan,and 3 in Tongling. Conclusion NAT screening can find positive samples from negative samples tested by ELISA .NAT effectively reduced the risk of diseases through blood transfusion. Nucleic acid concentration detection may improve the quality of blood and blood safety.