Objective To analyze the related factors of donor′s donation reaction in first time apheresis platelets to provide a basis for formulating the preventive measures of donation reactions in apheresis platelets.Methods The donation data in 743 cases of first time apheresis platelet in this blood station were retrospectively analyzed,and the factors possible influencing the donation reaction occurrence in donors of the first time apheresis platelet were performed the univariate Logistic regression analysis,then observation indicators with statistical significance were performed the multivariate Logistic regression analysis.Results The univariate Logistic regression analysis showed that gender,age,body mass,whole blood donation history were the influencing factors of donors′ donation reaction in the first time apheresis platelets.In multivariate Logistic regression analysis,the main factors were age (OR=0.301,P<0.05),body mass (OR=0.411,P<0.05)and whole blood donation history(OR=0.441,P<0.05).Conclusion Age,body mass and whole blood donation history are the main influencing factors of donors′ donation reactions in the first time apheresis platelets.

Objective To evaluate the value of CT and MRI in diagnosis and directing clinical management of vertebral burst fracture.Methods The imaging features of vertebral burst fracture in 66 cases were analyzed,including cervical vertebrae 6,thoracic vertebrae 3,thoracolumbar area 48,and lumbar vertebrae 9 cases.There were 50 male and 16 female,the average age was 35 years.CT and MRI were taken in all patients.Results CT clearly demonstrated the vertebrae and accompanying appendix fracture,spinal canal stenosis and retropulsed fragment.While MRI in showing injury and tear of ligament and intervertebral disc,abnormal signals due to spinal cord compression were superior to CT.Conclusion CT in combination with MRI in diagnosis and directing surgical management is of important value.

Objective To investigate the protection effects of teprenone in aspirin-induced gastric mucosa injury.Methods From 2008 to 2010,a total of 296 patients who took aspirin for the first time at the Department of Cardiovascular,First Hospital Affiliated to Zhejiang Chinese Medicine University were randomly divided into two groups.There were 166 cases in aspirin group,which took aspirin 100mg daily; 130 cases in aspirin and teprenone group,the aspirin dose equivalent with aspirin group and took teprenone 50mg/time,3 times/day orally.Gastrointestinal symptoms and gastric mucosa injury of patients in these two group were inspected at 3 month,6 month and 1 year.Results A total of 143 cases were recruited in aspirin group and 118 cases in aspirin and teprenone group.After taking medicine for 3 months,the occurrence rate of gastrointestinal symptoms in aspirin group was 1.40 ％.Compared with aspirin and teprenone group,the difference was statistical significant (0,x2 =1.663,P＝ 0.197).Follow up after taking medicine for 6 months,the occurrence rate of gastrointestinal symptoms in aspirin group was 4.96％.Compared with aspirin and teprenone group,the difference was statistical significant (0,x2 ＝6.021,P＝0.014).Follow up after taking medicine for 1 year,the occurrence rate of gastrointestinal symptoms in aspirin group was 20.15 ％.Compared with aspirin and teprenone group,the difference was statistical significant (1.69％,x2 =20.984,P=0.001).Compared with aspirin group,the symptom and endoscopy score of aspirin and teprenone group decreased significantly at follow-up for 6 months and 1 year (P＜0.05; P＜0.01 ).Compared with at 6 month,the symptom and endoscopy score of aspirin group at 1 year increased significantly (P＜0.05 ; P＜0.01).Conclusion Teprenone has certain protection effects in aspirin-induced gastric mucosa injury.Long-term use of conventional doses of aspirin may cause vary degrees of gastric mucosal injury,and the gastric mucosal injury get more severe as the time of taking medicine increases.

Objective To evaluate the clinical applications and surgical methods of combined laparoscopic common bile duct (CBD) exploration with choledochoscopy. Methods From 2006 to 2009,clinical data of 42 patients with choledocholithiasis undergoing laparoscopic common bile duct exploration were retrospectively analyzed. We applied a step-by-step electric coagulating incision technique on the CBD,the step-by-step suturing technique, and the step-by-step clamping technique with alligator forceps, and soft tube irrigating technique with suctioning by selecting the proper exploration route, improving the common bile duct incision technique and calculus removing techniques. Results Procedures were successful in all the cases. There was no conversions to open surgery, no postoperative bleeding and no operative mortality. The mean operating time was 120 minutes (ranging, 90 to 150 minutes) with minimal intraoperative blood loss ( ranging, 20 to 40 ml). Ductal stone clearance was successful in 41 out of 42 patients ( 93% ). The largest number of the common bile duct stones was 16. With the diameter of stones larger than 15 mm in 18 cases in which the biggest was 30 mm. Bile leak developed in 1 patient, retained stones found in 3 patients,including intrahepatic cholelithiasis in one case. As a result, 38 out of 42 patients underwent common bile duct exploration. 35 patients were placed on T-tubes. Four patients underwent cystic duct exploration in which 3 had primary suture of the cystic duct and 1 had drainage. There was no infection and stenosis of biliary tract in the 42 followed-up cases. Conclusions Laparoscopic common bile duct exploration with stone extraction can be performed with high efficiency, minimal morbidity and without mortality. Improving the way of operation and selecting suitable exploration can result in better clinical outcomes.

Objective To study the effects of experiment-related factors on hematological parameters in SD rats, analyze the data difference and causes, understand the effects of anesthetics and stress responses on the physiological aspects of animals, and to provide a reference for the standardization of animal welfare and compound toxicity testing methods.Methods According to gender (A), fasting time (B), anesthesia (C) and blood collection mode (D), SPF SD rats were divided into 24 groups.Blood samples were collected from each group.Then, red blood cell count, hemoglobin levels, white blood cell count and classification indicators were measured.Results The primary and secondary order of the factors affecting the white blood cell count was D > C > A > B, and the levels of white blood cell count of each factor were male rats > female rats, and venous blood > arterial blood, chloral hydrate > pentobarbital sodium > no anesthesia.The primary and secondary order of the factors affecting the white blood cell classification was C > D=A=B, and factors affecting the levels of white blood cell classification were chloral hydrate > pentobarbital sodium > no anesthesia.The primary and secondary order of the effects of the factors on the red blood cell count and hemoglobin level was C > D=A=B, and the levels of red blood cell count and hemoglobin level were pentobarbital sodium > chloral hydrate> no anesthesia.There was no significant difference in the blood indexes between the different fasting time groups.Conclusions There is no effect of fasting on hematological parameters, but there are differences in the blood parameters between arteries and veins.The effect of chloral hydrate anesthesia on the count and classification of white blood cells is greater than that of pentobarbital sodium.The effect of chloral hydrate anesthesia on the red blood cell count and hemoglobin level is greater than that of pentobarbital sodium.The two kinds of anesthesia methods have their own advantages and disadvantages.

Objective To evaluate the role of necroptosis in intestinal ischemia-reperfusion (I/R) injury in rats.Methods Thirty-two healthy male Sprague-Dawley rats,weighing 200-220 g,were randomly assigned into 4 groups (n =.8 each) using a random number table:sham operation group (Sham group),I/R group,necroptosis inhibitor necrostatin-1 group (Nec-1 group) and solvent dimethyl sulfoxide (DMSO) group (group DMSO).Intestinal I/R injury was produced by clamping the superior mesenteric artery for 1 h followed by 24 h reperfusion in rats anesthetized with chloral hydrate.Necrostatin-1 1.0 mg/kg was administered intraperitoneally at 30 min before occlusion in Nec-1 group,while the equal volume of DMSO was given instead in group DMSO.The rats were sacrificed at 24 h of reperfusion and the intestinal tissues were removed for microscopic examination.Intestinal damage was assessed and scored according to Chiu.Blood samples were taken for determination of serum diamine oxidase (DAO) activity.The expression of activitied caspase-3 and receptor-interacting protein 1 (RIP1) in intestinal tissues was detected using Western blot.Results Compared with Sham group,Chiu's score,serum DAO activity,and the expression of activitied caspase-3 and RIP1 was up-regulated in I/R,DMSO and Nec-1 groups.Compared with I/R and DMSO groups,Chiu's score and DAO activity were significantly decreased,the expression of RIP1 was down-regulated,and no significant change was found in the expression of activitied caspase3 in group Nec-1.Conclusion Necroptosis is involved in intestinal I/R injury in rats.

Objective: To study laparoscopic ultrasound assisted hepatectomy in treatment of intrahepatic and extrahepatic bile duct stones. Methods: The data of 52 patients with hepatolithiasis who underwent laparoscopic hepatectomy from May 2014 to January 2019 at the Fuyang District First People's Hospital in Hangzhou were analyzed retrospectively. There were 28 men and 24 women. The median age was 56 years. Operative laparoscopic ultrasonography was used to detect the location, size, distribution of stones and their relations to blood vessels. A total of 43 patients underwent anatomic hepatectomy, while 38 patients underwent choledochoscopic stone extraction. A " T" tube was used according to intraoperative conditions. Results: Laparoscopic surgery was successfully carried out in 50 patients, while conversion to open surgery was required in 2 patients because of adhesions and bleeding. Laparoscopic ultrasonography revealed intrahepatic calcifications in 5 patients and choledochoscopy in 2 patients. Postoperative complications included 5 patients who devleoped abdominal abscesses. The operation time was (289.0±132.0) minutes. The intraoperative blood loss was (451.0±256.0) ml. The hospitalization after operation was (12.0±3.0) days. In 52 patients, 4 patients had residual stones and the residual rate was 7.7%. All of them were completely removed by T-tube sinus 8 weeks after operation. Conclusions Laparoscopic ultrasound helped to detect relevant bile ducts containing stones, reduced chance of bleeding in surgery, helped to clarify location and distribution of stones, improved accuracy of diagnosis, and reduced unnecessary hepatectomy by clearly defining intrahepatic bile duct stones intraoperatively. The residual intrahepatic and intrahepatic bile duct stones rates were reduced, and the safety and accuracy of the operations were improved.

Objective To analyze the clinical characteristics and relevant factors of 88 cases of cirrhotic portal hyper-tension complicated with gallstone. Methods A total of 366 patients with cirrhotic portal hypertension complicated with gallstone were selected. 88 patients were assigned to a gallstone group and 278 patients were assigned to a control group on the basis of clinical diagnosis. Retrospective analysis was carried out for clinical data and auxiliary examina-tion data of the two groups, and single-factor and multi-factor analyses were applied for the risk factors of cirrhotic portal hypertension complicated with gallstone. Results Child-Pugh grade ≥B, ascites, peak systolic flow velocity of hepatic artery, portal thrombosis, peripancreatic varicose veins, and varicose veins of gallbladder were independent risk factors of cirrhotic portal hypertension complicated with gallstone (P<0.05). Conclusion Cirrhotic portal hypertension complicated with gallstone is related to hepatic functions, ascites, hemodynamics of hepatic artery, and collateral circu-lation of portal vein, and Child-Pugh grade≥B, ascites, peak systolic flow velocity of hepatic artery, portal thrombosis, peripancreatic varicose veins, and varicose veins of gallbladder are independent risk factors.

Objective To evaluate the effect of evidence-based bundle intervention strategy on reducing the inci-dence of central line-associated bloodstream infection (CLABSI).Methods Prospective and multicenter study was adopted,patients admitted to 54 intensive care units (ICUs)of 41 hospitals and with central venous catheters (CVCs)between October 1 ,2013 and September 30,2014 were monitored .Baseline data between October 2013 and March 2014 were collected as pre-intervention data;from April to September 2014,the participated hospitals performed intervention strategy,post-intervention data were compared with pre-intervention data.Results The usage rate of CVCs before and after intervention was significantly different (44.18% vs 44.63%,χ2 =5.526,P =0.019).Incidence of CLABSI before and after intervention was not significantly different(RR ,0.82[95%CI ,0.59-1 .13],P =0.10).Constituent ratio of catheter insertion sites between pre-and post-intervention was significantly different (χ2 =76.264,P <0.001),femoral vein catheterization rate as well as proportion of two and above catheter insertion sites after intervention decreased(17.25% VS 13.72%;2.27% VS 1 .44%,respectively);hand hygiene implementation rate and accuracy rate after intervention were both higher than before intervention (79.73% vs 76.14%,P <0.001 ;91 .47% vs 74.26%,P <0.001 ,respectively);constituent ratio of skin disinfectant applica-tion before and after intervention was significantly different(χ2 =3.861 ,P <0.001 ),proportion of chlorhexidine ethanol increased (29.62% VS 50.56%);except daily assessment and record,compliance to other prevention and control measures before and after intervention were all significantly different(all P <0.001);utilization rate of max-imal sterile barrier,qualified rate of dressing of operators,and port disinfection were all significantly enhanced. Conclusion Bundle intervention in intubation and maintenance are implemented effectively,but intervention effect on CLABSI needs further study.

Objective To investigate the status and risk factors of surgical site infection (SSI)in hospitals in Chi-na,so as to provide theoretical basis for the prevention and treatment of SSI.Methods Four types of surgeries (colorectal surgery,abdominal hysterectomy,femoral neck repair surgery,and vascular surgery)in 29 hospitals were monitored prospectively,risk factors for SSI were analyzed.Results A total of 6 309 surgical procedures were investigated,incidence of SSI was 1 .60%.Incidences of SSI in patients receiving colorectal surgery,abdominal hys-terectomy,femoral neck repair surgery,and vascular surgery were 4.47%(74/1 655 ),1 .03%(22/2 139),0.21 %(5/2 372),and 0.00% (0/143 )respectively.The incidences of SSI were different among different regions (χ2 =114.213,P <0.05).The most common SSI was superficial incisional infection,the next was deep incisional infec-tion.The major pathogens causing SSI were Escherichia coli ,Enterococcus spp .,coagulase negative staphylococ-cus ,Staphylococcus aureus ,and Klebsiella pneumoniae .The independent risk factors for SSI were male patients, long duration of surgery,and high NNIS score.Conclusion The risk of SSI is varied with different types of surger-ies.Male,long duration of surgery,and high NNIS score can increase the risk of postoperative SSI.