Objective:To explore the clinical efficacy of three different surgical timings of modified cervical cerclage in twin pregnant women with cervical insufficiency.Methods:The clinical data of 73 twin pregnant women who underwent modified cervical cerclage and had pregnancy outcomes in Qilu Hospital of Shandong University (Qingdao) from April 2014 to July 2023 were retrospectively analyzed. According to the different timings of surgery, they were divided into prophylactic cerclage group, ultrasound-indicated cerclage group (further divided into cervical length (CL)≤15 mm and 15 mm10 mg/L was a risk factor for preterm birth before 34 weeks of gestation ( OR=5.230, 95% CI: 1.616-16.929; P=0.006). Conclusions:In twin pregnant women with cervical insufficiency, prophylactic cerclage has the same surgical effect as ultrasound-indicated cerclage, while both prophylactic cerclage and ultrasound-indicated cerclage could significantly improve maternal and fetal outcomes compared with emergency cerclage. Twin pregnancies with CL≤15 mm might benefit from cervical cerclage. Postoperative CRP>10 mg/L is an independent risk factor for preterm birth before 34 weeks of gestation.

Objective:To explore the clinical efficacy of three different surgical timings of modified cervical cerclage in twin pregnant women with cervical insufficiency.Methods:The clinical data of 73 twin pregnant women who underwent modified cervical cerclage and had pregnancy outcomes in Qilu Hospital of Shandong University (Qingdao) from April 2014 to July 2023 were retrospectively analyzed. According to the different timings of surgery, they were divided into prophylactic cerclage group, ultrasound-indicated cerclage group (further divided into cervical length (CL)≤15 mm and 15 mm10 mg/L was a risk factor for preterm birth before 34 weeks of gestation ( OR=5.230, 95% CI: 1.616-16.929; P=0.006). Conclusions:In twin pregnant women with cervical insufficiency, prophylactic cerclage has the same surgical effect as ultrasound-indicated cerclage, while both prophylactic cerclage and ultrasound-indicated cerclage could significantly improve maternal and fetal outcomes compared with emergency cerclage. Twin pregnancies with CL≤15 mm might benefit from cervical cerclage. Postoperative CRP>10 mg/L is an independent risk factor for preterm birth before 34 weeks of gestation.

【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.

Objective:To build a medical consumables demand prediction model to predict the demand for medical consumables,and to reduce the occurrence of emergency replenishment and shortage of medical consumables.Methods:The medical consumables demand prediction model was established using support vector regression(SVR)algorithm,the replenishment strategy and inventory control strategy optimization model was established using multiple population genetic algorithm(MPGA)to build a medical consumables demand forecasting model,and the replenishment strategy and inventory control strategy were automatically generated.The relevant data of supply-processing-distribution(SPD)mode introduced by Benxi Central Hospital for medical consumables management from January 2019 to May 2023 were selected for model training,model validation test(test set)and model application prediction(application set),respectively.The average absolute prediction error,peak prediction error and trough of prediction error of the model were evaluated,and the average ratio of consumption per day to inventory cost,the average number of urgent orders per month,the average number of out of stock per month,the average number of non-urgent orders per month and the decreasing range of the index weekly average were compared.Results:There was no statistically significant difference in the average absolute prediction error between the model test set and the application set(P＞0.05).The average absolute prediction error of the model was 0.033 5±0.024 5,the peak prediction error was 0.071 7 and the trough of prediction error was-0.0090.After the application of the model,the ratio of average daily consumption to inventory cost,the average number of monthly emergency order frequency,the average number of shortage of stock,and the average number of monthly non-emergency orders were(0.457 5±0.060 3),(23.95±6.04),(5.58±2.17),and(20.68±2.77),respectively.The ratio of daily average consumption to inventory cost was higher than that before the application,the average number of monthly emergency order,shortage of stock,and monthly non-emergency order were lower than those before the application,the difference was statistically significant(F=371.912,88.486,124.472,142.138,P＜0.000).After the application of the model,the weekly average inventory amount decreased by 43.66%,and the average number of emergency replenishment decreased by 53.76%,the average number of shortages of stock decreased by 76.95%,and the average shortage of stock normal replenishments decreased by 34.41%.Conclusion:The medical consumables demand prediction model can predict the demand for medical consumables,optimize replenishment and inventory control strategies,reduce the cost of medical consumables inventory,reduce occurrence of emergency replenishment and shortages of stock,and reduce the number of normal replenishment.

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies

Objective:To evaluate the application effect of vascularized iliac crest-tensor fascia lata flap(VIC-TFLF) based on deep circumflex iliac artery and vein in mandibular and oral soft tissue defect reconstruction.Methods:Retrospective analysis of the clinical data of patients with mandible and oral soft tissue defects in Henan Provincial People’s Hospital from October 2020 to March 2022. All cases were performed with computer-aided design and three-dimensional printing to make the models and guide plates. VIC-TFLF was used to repair and reconstruct the oral and mandible defects, the tensor fascia lata flap was used to repair the intraoral soft tissue defect, and the fascia lata was exposed to the mouth directly. After operation, the color, texture and change of intraoral flap were observed, and the recovery and complications were followed up.Results:In this study, 7 patients were included, 4 males and 3 females, aged 27-64 years old, with an average of 50.1 years old. There were 5 cases of squamous cell carcinoma of mandible gingival and cheek, 1 case of postoperative defect of pleomorphic adenocarcinoma of mandible, and 1 case of postoperative defect of ameloblastoma of mandible. According to the defect range of soft and hard tissue after resection, the flap areas of tensor fascia lata were 6.0 cm×3.0 cm-8.0 cm×6.0 cm, and the iliac bones were 3.7 cm×2.4 cm-9.2 cm×2.5 cm. All the composite tissue flaps survived, without distal necrosis, delayed wound healing and marginal fistula. The patients were followed up for 4-19 months, with an average of 11.7 months. The morphology and functions of the mandible and oral soft tissue were well recovered. The surface of tensor fascia lata was exposed to the oral cavity directly, which showed signs of mucosalization within 1 week after operation. The mucosalization was basically completed within 1 month, which was close to normal oral mucosal appearance, and could be reconstructed to produce better oral mucosal appearance in the later period. The wounds in the donor site healed well, and there was no abnormality in lower limb movement and thigh flexion. Among them, 3 patients had numbness on the lateral thigh skin of the donor site 3-5 days after operation. After 6 months of follow-up, the numbness in 2 cases disappeared, and 1 case was significantly reduced.Conclusions:The VIC-TFLF could obtain great appearance and function, with fewer complications and relatively small damage to the donor site, in repair and reconstruction of mandibular defects combined with oral soft tissue defects.

Objective:To evaluate the application effect of vascularized iliac crest-tensor fascia lata flap(VIC-TFLF) based on deep circumflex iliac artery and vein in mandibular and oral soft tissue defect reconstruction.Methods:Retrospective analysis of the clinical data of patients with mandible and oral soft tissue defects in Henan Provincial People’s Hospital from October 2020 to March 2022. All cases were performed with computer-aided design and three-dimensional printing to make the models and guide plates. VIC-TFLF was used to repair and reconstruct the oral and mandible defects, the tensor fascia lata flap was used to repair the intraoral soft tissue defect, and the fascia lata was exposed to the mouth directly. After operation, the color, texture and change of intraoral flap were observed, and the recovery and complications were followed up.Results:In this study, 7 patients were included, 4 males and 3 females, aged 27-64 years old, with an average of 50.1 years old. There were 5 cases of squamous cell carcinoma of mandible gingival and cheek, 1 case of postoperative defect of pleomorphic adenocarcinoma of mandible, and 1 case of postoperative defect of ameloblastoma of mandible. According to the defect range of soft and hard tissue after resection, the flap areas of tensor fascia lata were 6.0 cm×3.0 cm-8.0 cm×6.0 cm, and the iliac bones were 3.7 cm×2.4 cm-9.2 cm×2.5 cm. All the composite tissue flaps survived, without distal necrosis, delayed wound healing and marginal fistula. The patients were followed up for 4-19 months, with an average of 11.7 months. The morphology and functions of the mandible and oral soft tissue were well recovered. The surface of tensor fascia lata was exposed to the oral cavity directly, which showed signs of mucosalization within 1 week after operation. The mucosalization was basically completed within 1 month, which was close to normal oral mucosal appearance, and could be reconstructed to produce better oral mucosal appearance in the later period. The wounds in the donor site healed well, and there was no abnormality in lower limb movement and thigh flexion. Among them, 3 patients had numbness on the lateral thigh skin of the donor site 3-5 days after operation. After 6 months of follow-up, the numbness in 2 cases disappeared, and 1 case was significantly reduced.Conclusions:The VIC-TFLF could obtain great appearance and function, with fewer complications and relatively small damage to the donor site, in repair and reconstruction of mandibular defects combined with oral soft tissue defects.

Since December 2019, Corona Virus Disease (COVID-19), a new emerging infection disease occurred in Wuhan, has spread in 27 countries and regions. The clusters of many cases were reported with the epidemic progresses. We collected currently available information for 377 COVID-19 clusters (1 719 cases), excluded the hospital clusters and Hubei cases, during the period from January 1, 2020 to February 20, 2020. There were 297 family clusters (79%), case median 4; 39 clusters of dining (10%), case median 5; 23 clusters of shopping malls or supermarkets (6%), case median 13; 12 clusters of work units (3%), case median 6, and 6 clusters of transportation. We selected 325 cases to estimate the incubation period and found its range is 1 to 20 days, median was 7 days, and mode was 4 days. The analysis of the epidemic situation in a department store in China indicates that there is a possibility of patients as the source of infection during the incubation period of the epidemic. From February 5, 2020 to February 21, 2020, 634 persons were infected in the Diamond Princess Liner. All persons are susceptible to SARS-CoV-2. The older, patients during the incubation period and the worse environment may be the cause of the cases rising. The progress of the two typical outbreaks clearly demonstrates the spread of the early cases in Wuhan. Whatever happens, screening and isolating close contacts remains essential except for clinical treatment during the epidemic. Especially for the healthy people in the epidemic area, isolation is the key.