Objective To investigate the clinical characteristics of skin lesions of tsutsugamushi disease.Methods The skin lesions and clinical characteristics of 17 hospitalized patients with tsutsugamushi disease were analyzed. Results Of the patients, 88.2% (15/17) developed eschar and skin ulcer, 64.7% (11/17) had skin rashes. The patients often developed solitary, painless and nonpruritic eschar 4 to 10 days after the occurrence of fever, with indefinite locations and average diameter of 1.2 cm (range: 0.5 - 3.0 cm). The eschar was covered with a black and dry surface and surrounded by a ring-shaped erythematous halo, and usually shedded 5 to 9 days after the appearance with the formation of shallow ulcer. Superficial lymphadenectasis was observed near the eschar in 80% of the patients with eschar, and no eschar was observed at the first visit in 66.7% of the patients. Skin rashes mainly included nonpruritic congestive papules (45.5%) and maculopapular rashes (54.5%), and often subsided 2 to 5 days after emergence. Conclusions The skin lesions of tsutsugamushi disease include eschar and skin rashes. Eschar is an important characteristic and highly suggestive of this entity.

Objective To analyze the blood screening results after adjustment of critical value 40 to 50 U/L and to observe the effect of reducing blood scrap rate and to discuss the correlation between ALT and HBV,HCV infection.Methods We screened 2656 blood donors (ALT >40 U/L)by serological and nucleic acid amplification testing(NAT)in Qingdao blood center from 2013 to 2014,and conducted the correlation analysis by chi square test.Results 1 771 cases (66.68%)were ALT 40-50 U/L,including 6 cases of HBsAg ELISA (+),2 cases NAT (+),4 cases NAT(-).In the 8 cases of anti-HCV ELISA (+)samples,4 cases NAT (+),3 cases NAT (-),1 case with positive TP without NAT result.In 885 blood donors with ALT>50 U/L,5 cases were HBsAg-reactive,7 cases were anti-HCV-reactive,and 873 cases were negative.Related statistics showed that there was no signifi-cant difference between ALT and HBV infection (P <0.05),but significant difference was found between ALT and HCV infection (P >0.05).Conclusion The proportion of blood donors with ALT 40-50 U/L is much higher than that with ALT >50 U/L do-nors.Adjustment of the critical value greatly reduces blood scrap rate.Elevated ALT is associated with the infection of HBV but not with HCV.

Objective To investigate the apearance and characteristics of skin rashes in patients suffering from dengue fever.Methods Clinical data were retrospectively analyzed for 126 hospitalized patients with dengue fever collected from August to October,2007.Results Out of 126 patients with dengue fever,69.0% (87/126)had skin rashes,which usually developed from day 1 and 11 after fever.About 59.7%(52/87)of these patients developed skin rashes from day 3 to 7 after fever.No eruption order was evidenced in 59(67.8%)patients.Skin rashes were located in both the trunk and limbs in 38(43.7%)patients,and only in the limbs in 30 (34.5%)patients.The incidence rates of maculae,maculopapules,papules.hemorrhagic rash and mixed eruptions were 14.9%(13/87),14.9%(13/87),18.4%(16/87),26.4%(23/87)and 21.8%(19/87),respectively.Conclusions Most patients with dengue fever developed skin rashes from day 3 to 7 after fever.Limbs and trunk are predilection sites of skin rashes in dengue fever.Skin rashes in dengue fever is complex,including maculae,papules,hemorrhagic rashes,vesicles and mixed rashes.

OBJECTIVE: To investigate the separation and purification technology of total saponins from the root of Thladiantha dubia (TSTR). METHODS: The content of TSTR was determined by UV-visible spectrophotometry. By comparing static adsorption and desorption properties of different types (AB-8, D101, DM130, HPD100, HPD300, HPD450, HPD600, HPD826, NKA-9) of macroporous adsorption resin, the type of macroporous adsorption resin was screened. With the content of TSTR as the index, influential factors of macroporous adsorption resin for adsorbing (ratio of height to diameter of resin, mass concentration of medicine liquid, adsorption volume flow, saturated extent of adsorption) and desorbing (desorption solvent volume fraction, desorption solvent volume flow, volume of desorbed solvent) TSTR were investigated. The optimal technology was screened. The technology validation, purification and preparation were conducted. RESULTS: HPD100 type macroporous adsorption resin had good adsorption and desorption properties for TSTR. The optimal adsorption technology was that the ratio of the height to diameter of the resin column was 1:5; mass concentration of medicine liquid was 1 g/mL; adsorption volume flow rate was 1 BV/h; saturated adsorption capacity was 1. 25 g per 1 g HPD100 resin; the optimal desorption technology was that the volume fraction of desorption solvent ethanol was 75％; volume flow rate of desorption was 3 BV/h; the volume of desorption solvent was 5 BV. The average desorption retention rate of TSTR was 77. 96％ in technology validation (RSD=0. 46％, n=3) and the purity of prepared TSTR in TSTR dry cream was 52. 47％ (RSD =1. 53％, n=3). CONCLUSIONS: The optimal purification technology is stable, feasible and suitable for the separation and purification of TSTR.

【Objective】 To analyze the correlation between the distribution interval of minipool nucleic acid testing(NAT) positive CT value and the resolution rate, so as to improve the retest model and reduce residual risk of blood transfusion. 【Methods】 The resolution testing results by Cobas S201 system of our blood center from January 2017 to December 2021 were retrospective analyzed, and the retest model was developed based on the distribution interval of CT values. For minipool NAT HBV positive samples from March 2022 to March 2023, synchronous detection was conducted by Cobas S201 and Panther detection system, and the detection results were statistically analyzed. 【Results】 From 2017 to 2021, 474 were minipool NAT positive, among which 324 were HBV positive, accounting for 68.35%. From 2017 to 2020, the proportion of HBV positive per year was significantly higher than that of HCV and HIV(P<0.05). In resolution testing, 167 were HBV repeatable positive and 157 were HBV non-repeatable positive, accounting for 51.54% and 48.46% of HBV minipool NAT positive. HBV repeatable positive samples were with three intervals: CT value≤36, 3640, with the resolution rate at 95.8%, 56.5% and 14.8% respectively(P<0.05). The proportion of 3640, 36

【Objective】 To establish a blood quality monitoring indicator system, in order to continuously improve blood quality and standardized management. 【Methods】 Based on the research of literature and standards, and guided by the key control points of blood collection and supply process, the blood quality monitoring indicator system was developed. Through two rounds of Delphi expert consultation, the indicator content was further revised and improved according to expert opinions after six months of trial implementation. The indicator weight was calculated by questionnaire and analytic hierarchy process. 【Results】 A blood quality monitoring indicator system covering the whole process of blood collection and supply was constructed, including five primary indicators, namely blood donation service, blood component preparation, blood testing, blood supply and quality control, as well as 72 secondary indicators, including definitions, calculation formulas, etc. Two rounds of expert consultation and two rounds of feasibility study meeting were held to revise 17 items and the weight of each indicator was obtained through the analytic hierarchy process. After partial adjustments, a blood quality monitoring indicator system was formed. 【Conclusion】 A blood quality monitoring indicator system covering the whole process of blood collection and supply has been established for the first time, which can effectively evaluate the quality management level of blood banks and coordinate blood quality control activities of blood banks in Shandong like pieces in a chess game, thus improving the standardized management level

【Objective】 To objectively evaluate the quality control level of blood testing process in blood banks through quantitative monitoring and trend analysis, and to promote the homogenization level and standardized management of blood testing laboratories in blood banks. 【Methods】 A quality monitoring indicator system covering the whole process of blood collection and supply, including blood donation service, blood component preparation, blood testing, blood supply and quality control was established. The questionnaire Quality Monitoring Indicators for Blood Collection and Supply Process with clear definition of indicators and calculation formulas was distributed to 17 blood banks in Shandong province. Quality monitoring indicators of each blood bank from January to December 2022 were collected, and 31 indicators in terms of blood testing were analyzed using SPSS25.0 software. 【Results】 The proportion of unqualified serological tests in 17 blood bank laboratories was 55.84% for ALT, 13.63% for HBsAg, 5.08% for anti HCV, 5.62% for anti HIV, 18.18% for anti TP, and 1.65% for other factors (mainly sample quality). The detection unqualified rate and median were (1.23±0.57)% and 1.11%, respectively. The ALT unqualified rate and median were (0.74±0.53)% and 0.60%, respectively. The detection unqualified rate was positively correlated with ALT unqualified rate (r=0.974, P<0.05). The unqualified rate of HBsAg, anti HCV, anti HIV and anti TP was (0.15±0.09)%, (0.05±0.04)%, (0.06±0.03)% and (0.20±0.05)% respectively. The average unqualified rate, average hemolysis rate, average insufficient volume rate and the abnormal hematocrit rate of samples in 17 blood bank laboratories was 0.21‰, 0.08‰, 0.01‰ and 0.02‰ respectively. There were differences in the retest concordance rates of four HBsAg, anti HCV and anti HIV reagents, and three anti TP reagents among 17 blood bank laboratories (P<0.05). The usage rate of ELISA reagents was (114.56±3.30)%, the outage rate of ELISA was (10.23±7.05) ‰, and the out of range rate of ELISA was (0.90±1.17) ‰. There was no correlation between the out of range rate, outrage rate and usage rate (all P>0.05), while the outrage rate was positively correlated with the usage rate (r=0.592, P<0.05). A total of 443 HBV DNA positive samples were detected in all blood banks, with an unqualified rate of 3.78/10 000; 15 HCV RNA positive samples were detected, with an unqualified rate of 0.13/10 000; 5 HIV RNA positive samples were detected, with an unqualified rate of 0.04/10 000. The unqualified rate of NAT was (0.72±0.04)‰, the single NAT reaction rate [(0.39±0.02)‰] was positively correlated with the single HBV DNA reaction rate [ (0.36±0.02) ‰] (r=0.886, P<0.05). There was a difference in the discriminated reactive rate by individual NAT among three blood bank laboratories (C, F, H) (P<0.05). The median resolution rate of 17 blood station laboratories by minipool test was 36.36%, the median rate of invalid batch of NAT was 0.67%, and the median rate of invalid result of NAT was 0.07‰. The consistency rate of ELISA dual reagent detection results was (99.63±0.24)%, and the median length of equipment failure was 14 days. The error rate of blood type testing in blood collection department was 0.14‰. 【Conclusion】 The quality monitoring indicator system for blood testing process in Shandong can monitor potential risks before, during and after the experiment, and has good applicability, feasibility, and effectiveness, and can facilitate the continuous improvement of laboratory quality control level. The application of blood testing quality monitoring indicators will promote the homogenization and standardization of blood quality management in Shandong, and lay the foundation for future comprehensive evaluations of blood banks.

【Objective】 To establish an effective quality monitoring indicator system for blood quality control in blood banks, in order to analyze the quality control indicators for blood collection and supply, and evaluate blood quality control process, thus promoting continuous improvement and standardizing management of blood quality control in blood banks. 【Methods】 A quality monitoring indicator system covering the whole process of blood collection and supply, including blood donation services, component preparation, blood testing, blood supply and quality control was established. The Questionnaire of Quality Monitoring Indicators for Blood Collection and Supply Process was distributed to 17 blood banks in Shandong, which clarified the definition and calculation formula of indicators. The quality monitoring indicator data from January to December 2022 in each blood bank were collected, and 20 quality control indicators data were analyzed by SPSS25.0 software. 【Results】 The average pass rate of key equipment monitoring, environment monitoring, key material monitoring, and blood testing item monitoring of 17 blood banks were 99.47%, 99.51%, 99.95% and 98.99%, respectively. Significant difference was noticed in the pass rate of environment monitoring among blood banks of varied scales(P<0.05), and the Pearson correlation coefficient (r) between the total number of blood quality testing items and the total amount of blood component preparation was 0.645 (P<0.05). The average discarding rates of blood testing or non-blood testing were 1.14% and 3.36% respectively, showing significant difference among blood banks of varied scales (P<0.05). The average discarding rate of lipemic blood was 3.07%, which had a positive correlation with the discarding rate of non testing (r=0.981 3, P<0.05). There was a statistically significant difference in the discarding rate of lipemic blood between blood banks with lipemic blood control measures and those without (P<0.05). The average discarding rate of abnormal color, non-standard volume, blood bag damage, hemolysis, blood protein precipitation and blood clotting were 0.20%, 0.14%, 0.06%, 0.06%, 0.02% and 0.02% respectively, showing statistically significant differences among large, medium and small blood banks(P<0.05).The average discarding rates of expired blood, other factors, confidential unit exclusion and unqualified samples were 0.02%, 0.05%, 0.003% and 0.004%, respectively. The discarding rate of blood with air bubbles was 0.015%, while that of blood with foreign body and unqualified label were 0. 【Conclusion】 The quality control indicator system of blood banks in Shandong can monitor weak points in process management, with good applicability, feasibility, and effectiveness. It is conducive to evaluate different blood banks, continuously improve the quality control level of blood collection and supply, promote the homogenization and standardization of blood quality management, and lay the foundation for comprehensive evaluation of blood banks in Shandong.

【Objective】 To establish an effective quality indicator monitoring system, scientifically and objectively evaluate the quality management level of blood banks, and achieve continuous improvement of quality management in blood bank. 【Methods】 A quality monitoring indicator system that covers the whole process of blood collection and supply was established, the questionnaire of Quality Monitoring Indicators for Blood Collection and Supply Process with clear definition of indicators and calculation formulas was distributed to 17 blood banks in Shandong. Statistical analysis of 21 quality monitoring indicators in terms of blood donation service (10 indicators), blood component preparation (7 indicators ), and blood supply (4 indicators) from each blood bank from January to December 2022 were conducted using SPSS25.0 software The differences in quality monitoring indicators of blood banks of different scales were analyzed. 【Results】 The average values of quality monitoring indicators for blood donation service process of 17 blood banks were as follows: 44.66% (2 233/5 000) of regular donors proportion, 0.22% (11/50) of adverse reactions incidence, 0.46% (23/5 000) of non-standard whole blood collection rate, 0.052% (13/25 000) of missed HBsAg screening rate, 99.42% (4 971/5 000) of first, puncture successful rate, 86.49% (173/200) of double platelet collection rate, 66.50% (133/200) of 400 mL whole blood collection rate, 99.25% (397/400) of donor satisfaction rate, 82.68% (2 067/2 500) of use rate of whole blood collection bags with bypass system with sample tube, and 1 case of occupational exposure in blood collection.There was a strong positive correlation between the proportion of regular blood donors and the collection rate of 400 mL whole blood (P<0.05). The platelet collection rate, incidence of adverse reactions to blood donation, and non-standard whole blood collection rate in large blood banks were significantly lower than those in medium and small blood banks (P<0.05). The average quality monitoring indicators for blood component preparation process of 17 blood banks were as follows: the leakage rate of blood component preparation bags was 0.03% (3/10 000), the discarding rate of lipemic blood was 3.05% (61/2 000), the discarding rate of hemolysis blood was 0.13%(13/10 000). 0.06 case had labeling errors, 8 bags had blood catheter leaks, 2.76 bags had blood puncture/connection leaks, and 0.59 cases had non-conforming consumables. The discarding rate of hemolysis blood of large blood banks was significantly lower than that of medium and small blood banks (P<0.05), and the discarding rate of lipemic blood of large and medium blood banks was significantly lower than that of small blood banks (P<0.05). The average values of quality monitoring indicators for blood supply process of 17 blood banks were as follows: the discarding rate of expired blood was 0.023% (23/100 000), the leakage rate during storage and distribution was of 0.009%(9/100 000), the discarding rate of returned blood was 0.106% (53/50 000), the service satisfaction of hospitals was 99.16% (2 479/2 500). The leakage rate of blood components during storage and distribution was statistically different with that of blood component preparation bags between different blood banks (P<0.05). There were statistically significant differences in the proportion of regular blood donors, incidence of adverse reactions, non-standard whole blood collection rate, 400 mL whole blood collection rate, double platelet collection rate, the blood bag leakage rate during preparation process, the blood components leakage rate during storage and distribution as well as the discarding rate of lipemic blood, hemolysis blood, expired blood and returned blood among large, medium and small blood banks (all P<0.05). 【Conclusion】 The establishment of a quality monitoring indicator system for blood donation services, blood component preparation and blood supply processes in Shandong has good applicability, feasibility and effectiveness. It can objectively evaluate the quality management level, facilitate the continuous improvement of the quality management system, promote the homogenization of blood management in the province and lay the foundation for future comprehensive evaluation of blood banks.