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OBJECTIVE To evaluate the development of blood transfusion services in Mainland China within the context of health-care system reform. BACKGROUND China launched a health-care reform program in 2009 to redistribute health-care resources, which are currently over-concentrated in well-developed cities. A geographically equitable blood transfusion service is key to achieving this goal. METHODS Based on the national survey of blood establishments in July 2015, total blood collection, whole-blood donations per 1000 population and the supply and demand relationship were analysed at the administrative region level. Areas at different developmental levels were compared in terms of total blood collection and human resources. RESULTS In 2014, Mainland China's 31 provinces showed wide variation, with total blood collection in blood facilities ranging from about 1000 units to over 600 000 units (each 200 mL), and the whole-blood donation rate per 1000 population, ranging from 1·48 to 17·09. 69% of the country's total collection, was concentrated in 29 provincial capitals, and 31% was in 311 non-capital cities. Of 97 personnel with doctorates, 74 worked in 32 provincial blood establishments, whereas the remaining 23 worked at the other 318 blood stations. In most provinces, per permanent resident donation was within 2-4 mL, and blood volume per inpatient was 10-35 mL regardless of the development of the transfusion service. CONCLUSION In 2014, China had an imbalanced development and insufficient access to blood transfusion services. This service must be redeployed at the national level to facilitate health-care reform in China.

BACKGROUND The coronavirus disease 2019 (COVID‐19) epidemic affected blood collection in Guangzhou, China. STUDY DESIGN AND METHODS This paper included three studies. The observational study reported the trends of blood collection during the epidemic in Guangzhou, China. The cross‐sectional survey investigated factors influencing blood donation during the COVID‐19 epidemic, and a self‐administered questionnaire was given to 1,584 street whole blood donors (SWBDs) who donated during the epidemic. The randomized controlled trial involved 19,491 SWBDs who donated in 2019 but did not donate during the epidemic. Trial participants were randomly assigned to two intervention groups: group 1 completed Questionnaire 1, which contained precautionary measures in response to COVID‐19 and other messages about blood donation during the epidemic; and group 2 completed Questionnaire 2, which did not include this information. A control group did not receive any questionnaire. RESULTS As measures implemented, the number of blood donors increased accordingly. Both first‐time and repeat SWBDs perceived the same level of blood need and donated blood because it would save lives. SWBDs who completed Questionnaire 1 expressed a greater intention to donate during the epidemic. Enabling blood donors to perceive a higher level of blood need and a lower level of COVID‐19 infection risk related to blood donation mobilized experienced SWBDs to donate within three weeks. Intention‐to‐treat analyses and average‐treatment‐effect‐on‐the‐treated estimations confirmed that Questionnaire 1 could motivate SWBDs to actually donate blood. CONCLUSION Various measures could ease blood shortage during the COVID‐19 epidemic. Administration of Questionnaire 1 could increase blood donations during the epidemic. This article is protected by copyright. All rights reserved.

SUMMARYObjective The aim of this study was to evaluate the effectiveness of recruitment of inactive donors by telephone call and cell phone short message service (SMS), to assess the causes of donor self-deferral and to determine the appropriate sample size for a formal study Background Blood donor retention is essential for sustaining blood safety and sufficiency. Methods We conducted a single-centre open-label parallel randomised controlled trial in Guangzhou, China. A total of 1188 inactive donors with the last donation between 2009 and 2013 were enrolled and randomly assigned to two intervention groups (telephone call and SMS groups) and one control group without any intervention. Donors were followed up for 7 months; their responses including donation activities were analysed. Results The re-donation rates among the three groups were statistically significantly different (P = 0.044), particularly between the phone call group and the control group (P = 0.017). Within the phone call group, the re-donation rate was positively associated with the frequency of prior donation (P = 0.026), and the age of the donors (P = 0.043). Medical issues, time constraints and group donation were the main causes of self-deferral. The appropriate sample size for each group for a formal study to detect difference between the phone call and SMS groups was estimated to be 1429 participants. Conclusions Our findings suggest that active interventions, especially phone call reminders, can increase blood donation. Further studies are required to compare the efficacy and effectiveness between phone call and SMS reminders using a larger sample size.

Background: Recruiting of sufficient numbers of donors of blood products is vital worldwide. In this study we assessed the efficacy and cost-effectiveness of telephone calls and SMS reminders for re-recruitment of inactive blood donors. Methods: This single-centre, non-blinded, parallel randomized controlled trial in Guangzhou, China included 11,880 inactive blood donors whose last donation was between January 1 and June 30, 2014. The donors were randomly assigned to either one of two intervention groups (received telephone or short message service [SMS] communications) or to a control group without intervention. SMS messages with altruistic appeal were adopted in the SMS group; in addition to altruistic appeal, reasons for deferral of blood donation were also asked in the telephone group. All participants were followed up for 1 year. The primary outcome were re-donation rates, compared by intention-to-treat (ITT) analysis, average treatment effect (ATE) and average treatment effect on the treated (ATT) estimations. Secondary outcomes were the self-reported deterrents. Other outcomes included the re-donation interval, and the incremental cost-effectiveness ratio (ICER) of telephone calls versus SMS reminders on re-recruitment. Results: ITT analysis discovered no significant differences in the re-donation rate among the three groups. ATE estimation showed that participants who were randomly assigned to the telephone group were more likely to re-donate than those in the SMS group. ATT estimations indicated that among compliers, telephone calls significantly increased re-donation compared to both SMS reminders and no intervention. Donor return behaviour was positively associated with receiving reminders successfully, being male, older age, and previous donation history. The SMS reminder prompted donors to return sooner than no reminder within 6 months, and according to ICER calculations, SMS reminders were more cost-effective than telephone calls. Donors reported time constraints as the most main causes of self-deferral in the telephone group, and altruistic appeal had a positive effect on these donors. Conclusions: Interventions to reactivate inactive blood donors can be effective, with telephone calls prompting more donors to return but at a greater cost than SMS messages. SMS reminder with altruistic appeal can urge donors to re-donate sooner within 6 months than no reminder.

To study the relationship between the interleukin (IL)6 -572G/C polymorphism and risk of hepatocellular carcinoma (HCC) in men.A hospital-based case-control study was conducted with 500 male HCC patients without tumor history in other organs and 590 healthy male controls without history of tumors or chronic diseases. All HCC cases were diagnosed by histopathology. The controls were recruited from the Department of Orthopedic Trauma and Ophthalmology at the same hospital. The IL-6 promoter -572G/C polymorphism and its genotype variants were detected by real-time fluorescence quantitative PCR. The Chi-squared test and unconditional logistic regression analyses were applied to determine the risk of HCC among men carrying the different genotype variants.The frequencies of alleles and distribution of genotypes in the -572G/C loci were not significantly different between the HCC cases and controls (P more than 0.05). The Chi-squared test indicated that the polymorphisms of the loci were not associated with HCC in our male population. However, after adjusting by multivariate logistic regression, the odds ratio (OR) of HCC for the G allele (CG + GG genotypes) carriers was 1.31 (95% confidence interval (CI): 1.00 - 1.71) compared with the CC genotype. Among the male HBV carriers, the CG genotype increased HCC risk significantly (OR = 1.60, 95% CI: 1.14 - 2.24) compared with the CC genotype. A trend test indicated that HCC risk was significantly increased with the numbers of G alleles (P trend less than 0.05). Breslow-Day tests of homogeneity of the ORs indicated an interaction between hepatitis B virus (HBV) infection and polymorphisms of IL-6 (P less than 0.05). The synthetic odds ratio (OReg) of HBV infection and harboring a G allele was 5.95 (95% CI: 3.99-8.87), which represented a super multiplication interaction.Polymorphism of the IL-6 promoter -572 loci may be associated with HCC occurrence in men. Moreover, there is a super multiplication interaction for HCC risk between HBV infection and harboring the IL-6 G allele.

To investigate the association between single nucleotide polymorphisms (SNPs) in cytokine IL-6, IL-10 genes and HBV-related hepatocellular carcinoma (HCC).A hospital-based case-control study was conducted in 381 cases with HBV-related HCC, 340 HBsAg carriers and 359 non-tumor controls. Genotypes of -572 site of IL-6 gene and -819, -592 sites of IL-10 gene were determined by real-time polymorphism chain reaction. Unconditional logistic regression was used to estimate the odds ratios (ORs) and 95 confidence intervals (CIs).For the G/C alleles of -572 loci on IL-6 gene, there were significant differences between the three groups (P0.05). Compared with CC genotype, GG genotype increased the risk of HBV infection (OR = 2.171, 95%CI: 1.068 - 4.415), but did not seem to be associated with HCC. For the alleles of -819 and -592 site of IL-10 gene, there were significant differences between the three groups (P0.05). Compared with CC genotype, TT genotype increased the risks of both HCC (OR = 2.791, 95%CI: 1.326 - 5.874), and HCC in HBsAg carriers (OR = 3.522, 95%CI: 1.707 - 7.266). When compared with CC genotype on -592 site, the AA genotype reduced the risk of both HCC (OR = 0.389, 95%CI: 0.173 - 0.875), and HCC in HBsAg carriers (OR = 0.336, 95%CI: 0.154 - 0.734).The SNPs in -572 site of IL-6 gene might be associated with the risk of HBV infection. The SNPs in -819 site of IL-10 gene increased the risk of HCC, but -592 site of IL-10 gene decreased the risk of HCC.

To investigate the value of serum soluble CD40 ligand (sCD40L) detection in risk evaluation of acute coronary syndromes (ACS).This study involved 200 patients with established diagnosis of ACS, with death or nonfatal myocardial infarction as the end point of observation during the 6-month-long follow-up. Blood samples were obtained from the patients within the initial 72 h of ACS onset, and the levels of sCD40L and C-reactive protein (CRP) were determined with enzyme-linked immunosorbent assay (ELISA). Cardiac troponin I (cTnI) measurement was performed using chemiluminescent immunoassay.Of the 200 patients, 108 had serum sCD40L levels higher than 5.0 microg/L, and the levels of sCD40L, CRP and cTnI were found to significantly correlate with ACS.Independent detection of serum sCD40L, CRP and cTnI can help predict the risks of ACS, and their combined measurement may increase the sensitivity of the risk prediction and provide new cardiac makers to replace the cardiac enzymes for laboratory diagnosis and risk evaluation of cardiovascular events.

To observe the effects of percutaneous coronary intervention (PCI) on QT dispersion (QTd) and explore its clinical significance in patients with acute myocardial infarction (AMI).The electrocardiograms recorded before and one day after PCI were analyzed in 138 patients with AMI. The duration from the onset of AMI to PCI operation was less than 6 h in 72 patients and 6 to 12 h in the other patients. All the patients underwent emergency percutaneous transluminal coronary angioplasty and subsequent coronary stenting. QT intervals, QTd, and heart rate-corrected QT intervals (QTc) and QTd (QTcd) were measured and calculated.In both patient groups receiving PCI with delay shorter and longer than 6 h after AMI, QT and QTc after PCI were not significantly different from that before PCI, but the QTd and QTcd were remarkably decreased after PCI (all the P0.01). Moreover, the QTd and QTcd in the patients with delay of PCI less than 6 h were significantly shorter than those in patients the with greater-than-6-hour delay (P0.05), and the inhospital mortality was 4.2% and 7.6% in the two groups, respectively (P=0.394).Successful PCI may notably reduce QTd in the patients with AMI, whose earlier performance usually produces better effects.

To evaluate the inflammatory response and immune function of subeschar tissue fluid (STF) in early stage of severe burn.Eight patients were observed and samples from blood as well as STF were collected at 16, 24, 32, 40, 48 hours following burn to measure white blood cell (WBC) counts, levels of immunoglobin (IgA, IgG, IgM), complement (C3, C4) values as well as proinflammatory cytokines as tumor necrosis factor-alpha (TNF-alpha), interleukin-6(IL-6) and IL-8. In addition, twenty Balb-c mice were used for the lethal experiment by STF collected at 48 hours after burn.The levels of IgA, IgG, IgM in STF were about half of those in the blood samples (all P0.01). The WBC counts in STF were 1/100 time of that in the blood (all P0.01). The contents of TNF-alpha, IL-6 and IL-8 in STF were comparable with those in the blood (P0.05). Following STF challenge, none of the mice died during 7-day observation period.The cells and large molecules seems to be more difficult to enter STF compared with small molecules. No marked local inflammatory response occurs in STF during early stage of severe burn, and STF challenge has no lethal effect. The low WBC counts and low immunoglobin as well as complement levels imply the limited effect of STF on local infection, and effective antibiotics should be timely used after major burn.

To explore the half life and retention of Imipenem in the third space.Eight severely burned patients and eight healthy volunteers were enrolled as the burn group (B) and normal control group (C), respectively. HPLC (high performance liquid chromatography) was employed to determine the contents of Imipenem in the plasma, subeschar tissue fluid (STF) and the changes in its pharmacokinetics. Furthermore, the Imipenem content in the third space was calculated according to the systemic edema degree.The half life of Imipenem in STF (2.53 h) was longer than that in plasma (1.73 h), P0.05). The Imipenem content in STF increased gradually along with the lapse of time after repeated intravenous infusion of Imipenem, and at the same the total content of imipenem was increased significantly in the third space.There was antibiotic retention in the third space after severe burn injury, and a prolonged action of the drug could be expected when the drug re-entered the blood stream.