Objective To improve the clinical blood level Through explore the feasibility of blood free surgery for congenital heart disease.Methods Collected 160 patients with congenital heart disease during January 2014 to December 2016 in our hospital,patients were divided into bloodless surgery experimental group (n =69) and blood transfusion treatment group (n=91) according to perioperative blood use.The basic data which including age,weight and GCS score,preoperative and postoperative hemoglobin(Hb),operation and postoperative pleural effusion drainage,intraoperative extracorporeal circulation time,mechanical ventilation time and blocking time,ICU stay,postoperative hospital stay,total hospital stay,reintubation and re-surgery of the two groups were compared.To investigate the effect of the implementation of bloodless surgical strategy for patients with congenital heart disease.Results 1) The difference between the two groups in age,body weight and GCS was not statistically significant (P＞0.05);2) The differences of Hb and intraoperative and postoperative pleural effusion drainage between two groups were not statistically significant (P＞0.05);3) The differences with cardiopulmonary bypass time,mechanical ventilation time,blocking time,re-intubation,re-surgery and ICU days of two groups were also not statistically significant (P ＞ 0.05);but bloodless surgery patients' postoperative hospitalization days and total hospitalization time was significantly lower than the control group (P＜0.05).Conclusion The implementation of bloodless surgery in congenital heart disease is safe and feasible.It can shorten the patient's hospitalization time.It is worth popularizing in clinical surgical treatment.

Objective To evaluate the clinical application of serum pyridinoline cross-linked carboxy-terminal telopeptide of type Ⅰ collagen(ⅠCTP),anti-cyclic citrullinated peptide(CCP)antibody,rheumatoid factor(RF)and C-reative protein(CRP)detection to the diagnosis and disease monitor of rheumatoid arthritis.Methods Serum ⅠCTP and anti-CCP antibody were measured by ELISA,RF and CRP by immunonephelometry assay in 57 patients with RA and 25 with non-RA as well as 30 normal controls.Results Serum ⅠCTP concentration was positively correlated with that of anti-CCP antibody,RF and CRP(rs=0.474,0.366,0.645,P0.05).Serum ⅠCTP in the patients with active RA was significantly higher than in those with stable RA and normal controls(P0.05).The combined sensitivity of RF and anti-CCP antibody was 87.5%.Conclusion Serum ⅠCTP is a sensitive serum marker to monitor the early damage of arthrosis.Missed diagnosis rate of RA is reduced by detecting anti-CCP antibody and RF together.Combinational monitoring the variance of serum ⅠCTP,anti-CCP antibody,RF and CRP could effectively monitor the disease development in time,which exhibits great sense on impede arthrosis damage.

Objective To discuss the clinical significance of serum pyridinoline cross-linked carboxy-terminal telopeptide of typeⅠcollagen in patients with rheumatoid arthritis (RA). Methods Serum ⅠCTP was measured by ELISA and RF, CRP by immunonephelometry assay in 55 patients with active and 25 with stable RA as well as 52 age and sex-matched normal controls. Results SerumⅠCTP was positively correlated with RF and CRP (rs=0.407, 0.534, P0.05). The sensitivity, specificity and accuracy of serumⅠCTP test were 67.3%, 84.6%, 75.7% in serum of the patients with active RA respectively. The mean serumⅠCTP in normal controls was (3.5?2.0) ?g/L. The serumⅠCTP was more sensitive than CRP in the patients with active RA. Conclusion SerumⅠCTP in patients of RA is a reliable assistant marker for early diagnosis, monitoring of the course and the effectiveness of treatment.

Objective To discuss a convenient and pragmatic method of fitting and optimizing standard curve for determining concentration of serum hepatitis B virus large surface protein(HBV-LP).MethodsEnzyme-linked immunosorbent assay(ELISA)was used to measure the absorbance of standard preparation of HBV-LP.Concentration and absorbance of standard preparation of HBV-LP was carried out curve fitting with 4-parameter formula model and linear model and log-linear model and quadratic polynomial model and cubic polynomial model and S model by program solution of Excel,respectively.The most standard curve for determining concentration of serum HBV-LP was determined with coefficient of determination of regression model.ResultsThe scatterplot of standard preparation of HBV-LP submited nonlinear tendency.There were all significance to regression equation of 4-parameter formula model and linear model and log-linear model and quadratic polynomial model and cubic polynomial model and S model(P

Objective To explore the changes of gut microbiota in response to abdominal and pelvic radiotherapy and its potential relationship with intestinal infection.Methods Irradiation was delivered to the abdominal region of BALB/c mice,following the regular human pelvic-radiotherapy protocol,2.0 Gy/d,continuous 5 d/week.Samples of ileum tissue and the intestinal content were collected at different time points of irradiation procedure,including after 3 and 5 weeks,and at 1 week after 6 weeks of irradiation.Quantitative RT-PCR was used to measure the mRNA level of antimicrobial peptides and pro-inflammtory factors.Bacterial translocation was determined by PCR.The gut microbiota was characterized by the denaturing gradient electrophoresis assay.Results The expressions of cryptdin-1 and cryptdin-4 were decreased after 3 weeks of irradiation and at 1 week after 6 weeks of irradiation(t =-7.43,-3.54,-4.72,-4.27,P ＜ 0.05),while they were significantly increased at the 5 weeks of radiation (t =6.15,5.75,P ＜ 0.05).The diversity index and richness of gut microbiota after 3 or 5 weeks irradiation were significantly decreased (t =-3.49,-4.19,-3.44,-4.97,P ＜ 0.05).The gut microbiota dysbiosis of the irradiated mice was characterized with the decrease of probiotics of Lactobacillus and the increasing of opportunistic pathogen of Escherichia coli,Shigella flexneri,et al.Bacterial translocation episodes were more frequently in the irradiated mice than that of control animal.The mRNA levels of IL-1β、IL-6 and TNF-α were significantly increased after 3 or 5 weeks of irradiation (t =4.85,6.16,7.71,4.60,4.86,5.97,P ＜ 0.05).Compared with the control,the expression levels of IL-1β and TNF-α at the 1 week after 6 weeks of irradiation ending was also obviously enhanced (t =3.67,5.88,P ＜0.05).Conclusions Pelvic radiotherapy can induce abnormality of enteric antimicrobial peptides and may result in gut microbiota dysbiosis.The disturbed gut microbial flora may further trigger an incurrence of bacterial translocation and enteritis.Therefore,the gut microbiota may be a potential interfering target to alleviate radiotherapy adverse effect.

Objective To evaluate the clinical value of apheresis platelets throught heanalysisof case control on the clinical efficacy and safety of cryopreserved apheresis platelets and fresh apheresis platelets.Methods 2 035 clinical cases of platelet transfusion in August 2014 to December 2016 by Using the closed loop intelligent path management and evaluation information system,456 cases were selected as control cases.Platelets were divided into the cryopreserved apheresis platelets group (group A,n=199) and fresh apheresis platelets group (group B,n=257) according to the transfused platelet type.The clinical application value of cryopreserved single platelets was evaluated by comparing the basic data,the effective indexes and safety indexes of the two groups.Results 1) The cases were 43.6％ (199/456) in A groups,and 56.4％ (257/456) in B groups,there were no significant difference in gender,age and medical and surgical cases between A and B group (P＞0.05);2) 199 cases in group A were cryopreserved platelets of 2 275 U,including 121 medicine cases,the total amount of transfusion was about 60.9％ (1 385/2 275),78 surgical cases accounted for 39.1％ (890/2 275);In the distribution of diseases,the blood system diseases accounted for 49.2％ (1 120/2 275),the total amount of obstetrics and gynecology disease infusion accounted for 10.6％ (240/2 275),and the amount of tumor radiotherapy and chemotherapy accounted for 6.2％ (140/2 275);The proportion of ABO blood type distribution was O type 25.9％,A type 22.9％,Btype 20.7％,ABtype 30.5％,respectively;3) The Plt counts of group A and B were significantly different before and after transfusion (P ＜0.05).But there was no significant difference between the two groups of cases before transfusion and 24h Plt count after transfusion,the Plt counts difference,and 24 h CCI (P＞0.05);4) The effective rates of platelet transfusion in group A and B were 76.9％ and 76.7％,respectively.Which has no significant difference between the two groups (P＞0.05)).There was no significant difference between the two groups in medical and surgical cases (P＞0.05),but the effective rate of surgical cases in group A (84.6％) was higher than that in B group (75.3％).The difference effect of medicine and surgery cases in B group were not statistically significant (P＞0.05),but the difference effect of medicine and surgery cases in A group was statistically significant (P＜0.05),platelet transfusion inefficient in surgical cases (15.4％) was significantly lower than that of cases (28.1％);5) The incidence of adverse reactions of blood transfusion was 3.5％,4.7％ in group A and B,and the blood transfusion mortality rate was zero,the difference was not statistically significant (P＞ 0.05).Conclusion The clinical effectiveness and safety of cryopreserved apheresis platelets are similar to those of fresh apheresis platelets,and the former can be widely Used in clinic,in particular,it has certain advantages in the surgical hemostatic effect.but for repeated infusion cases or platelet transfusion ineffective cases should be given priority to fresh apheresis platelets.

Objective Through investigating the current situation of scientific research in medicine graduate students, we can provide scientific basis for training postgraduates effectively and reference for graduate education reform. Methods A total of 243 medicine graduate students in Drum Tower Hospital were surveyed and asked to complete the designed questionnaires which included general situation, the objective to study, the situation of participation projects, the management of student, and achievements. Results 33.74％ (82) of students' purpose was confusion, 51.44％ of (125) graduate students engaged in clinical and basic research, the scientific research graduate students and doctoral students participated in the tutor research project more than the professional type graduate students and Postgraduate student (P<0.05). There were significant differences in the number of SCI related papers published by the postgraduates who differ in their ways of training and in different degrees (P<0.05). Conclusion Graduate students are an important part of high-level talents in China. They are the successors of future scientific research. The effectiveness of training postgraduates' scientific research ability will directly affect the future scientific research level of the country. So we should strengthen the cultivation of graduate students' scientific research accomplishment, construct a scientific training model, set up scientific training mode and supervision mech-anism, in order to promote the research level of medical graduate students.

Objective To analyze the influence of different factors and their relating correlation results on platelet transfusion during the bone marrow empty window period on the patients who have undergone allogeneic peripheral blood stem cell transplantation (allo-HSCT) with retrospective analysis of case-control data.Methods Clinical data of 153 cases were collected by the clinical blood management and evaluation information system with discharge diagnosis of allo-HSCT in the hematology department of The First Affiliated Hospital of Nanchang University within a time frame from January 2014 to December 2016.A total of 90 cases were considered valid for retrospective analysis according to the case exclusion criteria.The average transfusion dose for patients with allo-HSCT during the bone marrow empty window period was defined as the threshold value which divided the 90 cases into the observation group of 38 cases receiving more than 6 Units of platelet transfusion and the control group of 52 cases with less than 6Units of platelet transfusion.The amount of platelets transfused during the bone marrow empty window period,clinical indexes include Hb,ANC,Plt,SF before pretreatment,platelet engraftment time and the number of mononuclear cells implanted were compared and analyzed by Logistic regression.Results (1) There was no significant difference between the two groups in gender,age,primary diagnosis,HLA matching,Hb before pretreatment and the number of mononuclear cells implanted (P＞0.05).The ANC(×109/L) (1.24±0.57 vs 3.36±1.33) and Plt(×109/L) (43.55±68.29 vs 126.62±84.73) counts before pretreatment in the observation group were significantly lower than those in the control group(P＜0.05).SF(μg/L) (2351.05 ± 1 587.96 vs 1 000.96± 362.97)before pretreatment and P LT recovery time (d) (16.84± 2.47 vs 12.73 ± 1.65)was significantly higher than that in the control group(P＜0.05).Donor-recipient ABO blood group typing incompatibility (15 vs 10) was significantly higher than the control group (P＜0.05);(2) Single factor Logistic regression analysis showed that ABO blood group matching,clinical indexes include ANC,Plt,SF before pretreatment,PLT recovery time were statistically significant,Only ANC before pretreatment and PLT recovery time had significant effect on the platelet transfusion during bone marrow empty window period in patients with allo-HSCT in multivariate Logistic regression analysis(P＜0.05).Condusion The ANC before pretreatment and PLT recovery time are independent factors for platelet transfusion of the bone marrow empty window period in patients with allo-HSCT.The PLT recovery time is an independent risk factor,which indicates that the longer the duration of PLT implantation,the greater the amount of platelet transfusion will be needed.Besides,the ANC before pretreatment is the independent protective factor,which indicates that the greater the ANC,the smaller the amount of platelet transfusion is required.

Objective Through analyzing the scientific research performance of recruited doctors in Nanjing Drum Tower hospital,we can understand its current situation and problems,and then provide reasonable suggestions to promote the recruited doctors' scientific research capacity.Methods Descriptive statistics was used to analyze the projects application and outputs in scientific research.Results The proportion of recruited doctors who received National Natural Science Fund Youth Project has been increasing every year (the average growth rate is 16.46 ％).Many recruited doctors gained projects in the first year after admission(25.33％),but still 40.14％ of these doctors did not gained any project.Each recruited doctor published 1.58 SCI papers on average (19.33％).Conclusions We should innovate the training system,optimize the construction of scientific research platform,establish hospital science project,and implement scientific evaluation system to mobilize these youth talents comprehensively.

OBJECTIVES: In recent years, it has been reported that the anti-shock effect of plasma substitutes in adult patients with major burn in shock stage is not good. However, due to the shortage of clinical frozen plasma supply, it is impossible to guarantee that frozen plasma is used as colloidal solution for anti-shock treatment. The purpose of this study is to explore the effect of the infusion ration between frozen plasma and plasma substitutes on the prognosis of adult patients with major burn in shock stage. METHODS: This study enrolled 586 adult patients with major burn by selecting the hospitalization burn patients, who had been hospitalized at the Jiangxi province burn center from September 2014 to April 2019. The patients with the infusion ratio of frozen plasma to plasma substitutes ≥2꞉1 at 48 hours after admission were included in the experimental group, otherwise they were included in the control group. The basic clinical data and clinical prognosis indicator in the 2 groups were compared. Logistic univariate regression analysis was used to screen the influential factors of 30-day mortality in adult patients with major burn, and logistic multivariate regression analysis was used to obtain independent risk and protective factors; Kaplan-Meier method was used to draw the survival curve of the 2 groups, and log-rank test was used to compare the 30-day survival rate of the 2 groups. RESULTS: There were significant differences in the infusion volume of frozen plasma and plasma substitutes between the 2 groups at 48 hours after admission (both CONCLUSIONS Infusion ration between frozen plasma to plasma substitutes at 48 hours after admission is an independent protective factor for 30-day mortality of adult patients with major burn. In the early stage of adult patients with major burn, frozen plasma should be used as the anti-shock therapy as far as possible (frozen plasma꞉plasma substitute ≥2꞉1) to improve the prognosis and reduce the of 30-day mortality.
Adult ; Hospitalization ; Humans ; Plasma Substitutes ; Prognosis ; Retrospective Studies ; Shock