Objective:To investigate the association between triglyceride-glucose (TyG) index and all-cause mortality in elderly patients with hypertension and coronary artery disease.Methods:This was a retrospective cohort study, a total of 5 640 elderly inpatients (≥65 years) with hypertension and coronary artery disease who were admitted to the Department of Cardiology, Liberation Army General Hospital from August 2008 to July 2018 were enrolled in this study. The baseline clinical data of the patients were collected and the TyG index was calculated. Patients were divided into four groups according to their TyG index quartiles: TyG index<8.31 ( Q1 group, n=1 392), 8.31≤TyG index<8.67 ( Q2 group, n=1 417), 8.67≤TyG index<9.07 ( Q3 group, n=1 427), and TyG index≥9.07 ( Q4 group, n=1 404). All patients were followed up by obtaining outpatient/rehospitalization records or by telephone. The primary endpoint was all-cause mortality. Log-rank test was used to compare the cumulative all-cause mortality among groups. Cox proportional hazard regression model was used to analyze the risk of all-cause mortality in each group (the Q2 group with the lowest all-cause mortality was used as a reference), after adjusting for confounding factors, Restricted cubic spline analysis (RCS) was used to determine the association between TyG index and risk of all-cause mortality. Results:During a follow-up of 6.44 (4.70, 8.85) years, 1 037 all-cause deaths (18.39 %) were documented. The cumulative all-cause mortality in Q1- Q4 groups was 16.52%, 16.51%, 17.59% and 22.93%, respectively, and the difference was statistically significant ( χ2=26.49, P<0.01). In the Cox regression model, compared with Q2 group (reference), the HR (95% CI) for all-cause mortality was 1.06 (0.88-1.28) in the Q1 group, 1.23 (1.02-1.48) in the Q3 group and 1.48 (1.23-1.77) in the Q4 group, respectively ( P for trend<0.01). RCS curve analysis showed that when the TyG index was greater than 8.67, the risk of all-cause mortality increased with the TyG index, and there was a linear relationship between TyG index and all-cause mortality in this patient cohort (non-linearity P=0.31). Conclusion:The elevated TyG index is significantly associated with a higher risk for all-cause mortality in elderly hypertension and coronary artery disease patients.

The development trend of intelligent medical laboratories includes laboratory automation, intelligent information management, analysis of medical big data, and artificial intelligence medical equipment. The continuous development and application of these technologies will drive medical laboratories towards higher efficiency, intelligence, and safety, playing an important role in improving the quality of medical services, enhancing patient satisfaction, and promoting high-quality development of the laboratory medicine.

Urine carries rich information of human metabolism, while urine examination facilitates the diagnosis, classification and efficacy observation for acute kidney injury (AKI) and chronic kidney disease (CKD). Urine sediment has characteristics of convenience, screening, qualitation, localization, which provides important basis for distinguishing the source of RBC, assisting in the diagnosis of renal glomerular diseases, urinary infection and various causes of renal parenchymal injury. The urine sediment microscopy based on renal tubular epithelial cell (RTEC) and granular tubular (GC) counts mainly includes urinary sediment score (USS), tubular scoring index (CSI), urine microscopy score (UMS), and continuous urine sediment microscopy score (MicrExUrSed), which can provide laboratory information for early diagnosis, etiological differentiation, staging evaluation, and prognosis assessment of AKI.

Cerebrospinal fluid morphology examination is an important method of diagnosing central nervous system diseases, but manual microscopy has shortcomings such as low efficiency, long staff training period, and poor homogeneity of test results. In recent years, the application of artificial intelligence in the medical field has developed rapidly, providing new technical means for cerebrospinal fluid morphology examination. In the future, AI-assisted morphological examination of cerebrospinal fluid will not only realize digitalization and networking, but also improve the level and efficiency of intelligent diagnosis of cerebrospinal fluid morphology, which has a broad application prospect in the intelligent assisted diagnosis of cerebrospinal fluid.

Rare inherited coagulation disorders(RCD) are defined as diseases caused by deficiency of coagulation factor/factors, other than factor Ⅷ,factor Ⅸ or von Willebrand factor.RCD are mainly autosomal recessive inheritance disorders with prevalences from 1 in 50 0000 to 1 in 200 0000.The clinical manifestations of RCD are heterogeneous, mainly characterized by bleeding, but thrombosis or no clinical manifestations can also occur. Accurate understanding and diagnosis of RCD is of great significance for clinical treatment.

The International Organization for Standardization (ISO) 15189:2022 Medical laboratories-Requirements for quality and compence was officially released. Serving as the scientific foundation for the quality management and capacity construction of medical laboratories in China, the new standard edition will play a pivotal role in elevating the quality level of clinical laboratories in China. Internal quality control is an important component of quality monitoring system, which is of great importance in ensuring the effectiveness of test results. Simultaneously, ISO15189:2022 incorporates internal quality control methods of patient data as a quality control procedure, which is also a new trend in the development of internal quality control. With the continuous development of laboratory informatics and the release of the new standard ISO15189:2022, it is necessary for us to deeply rethink on internal quality control and explore the problems and challenges faced by internal quality control under the current situation.

Pertussis is an acute respiratory tract infectious disease caused by Bordetella pertussis, which is transmitted through airborne droplets and infects humans. The premise of the standardized treatment of pertussis is to identify infected people early, timely, and accurately. Laboratory testing and quality management have important clinical value for diagnosing and monitoring pertussis. The China Maternal and Child Health Care Association Clinical Diagnosis and Experimental Medicine Branch organized experts to refer to relevant domestic and foreign literature guidelines, summarized the research progress of pertussis laboratory detection and quality management, and then formed a consensus that aims to improve the efficiency and quality of laboratory detection and to provide standardized data support and application for clinical diagnosis and treatment of pertussis. This paper focuses on the clinical application of pertussis laboratory testing methods and quality management, making it effective in providing patients with diagnosis, treatment, and prognosis evaluation.

Objective:To explore the application value of intelligent assembly line in emergency examination.Methods:A retrospective study was carried out by collecting the data from emergency examination in Tongji Hospital affiliated to Tongji University from June 24 to 28, 2019, to July 24 to 28, 2023.The changes of sample size before and after intelligent pipeline application (with pneumatic transmission device), and the median and 90th percentile( P90) of pre-test turnaround time (TAT) were compared to collect and analyze the quality control related data of the same batch of quality control products before and after using intelligent assembly line automatic quality control; The median TAT and the 90th percentile in the laboratory were analyzed and compared before and after the application of the intelligent pipeline automatic audit rules Statistical enabling of intelligent pipeline-based real-time quality control (PBRTQC) function for patient samples and quality control-based indoor quality control mode for out-of-control detection efficacy. The normal distribution data were analyzed by two independent samples t-test, and the skew distribution data were analyzed by Mann-whitney U test. Results:After the operation of the intelligent assembly line pneumatic transmission device, TAT decreased from 27.1(18.0, 47.7) min to 24.3(15.2, 34.9) min, with a significant difference ( Z=-9.173, P<0.001); There was no significant difference in the indoor quality control results of potassium (K), sodium (NA), Alanine transaminase (Alt), glucose (Glu), total protein (TP) and UREA before and after the implementation of automatic quality control (P>0.05), the consumption of dry biochemical quality control products was reduced from 750 μl/time to 600 μl/time, and the use amount was reduced by 20%. The operation time of quality control was reduced from 30 min/time to 20 min/time, the time was saved by 33.3%, the number of quality control personnel and the walking distance of personnel were significantly reduced, and the detection rate of out-of-control was increased from 0.82% to 0.98% after the development of PBRTQC function. After using the intelligent pipeline automatic audit system, the TAT in the laboratory decreased from 37.1(21.3, 49.2) min to 34.4(16.5, 46.3) min before using the automatic audit function, with significant difference ( Z=-10.062, P<0.001); The median TOTAT and TAT decreased from 56.7.45.8, 102.5) min, 37.4(21.5, 49.6) min to 53.3(42.1, 98.3) min, 33.2.16.4, 47.9) min respectively, and the difference was significant ( Z=-7.176 and -8.245, P<0.001); The P90 of ToTAT and TAT decreased by 18.1% and 17.0%, respectively, and the percentage of sample timeout decreased by 65.5% and 92.1%, while the rate of timely notification of critical values increased from 82.5% to 99.3%. Conclusion:The application of an intelligent emergency pipeline can significantly shorten the test sample turnaround time, and effectively improve the quality and efficiency of emergency testing.

Objective:To improve work efficiency and reduce errors through intelligent pre-analytical process reengineering.Methods:Tumor and infection marker test samples from outpatients at Peking University Shenzhen Hospital from December 2021 to February 2023 were collected. The process was integrated with sample transportation, sample sorting and secondary transfer, and laboratory automation systems, while achieving full-process information monitoring. The number of manual intervention nodes, the turnaround time (TAT) from sample collection to testing and from collection to reporting, the proportion of intelligent pre-dilution, and the number of pre-analytical errors automatically identified were compared before and after the intelligent pre-analytical process reengineering to evaluate the effect of the reengineering. Chi-square test, Fisher′s exact probability method, and Mann-Whitney U test were used for statistical analysis.Results:After implementing the intelligent process reengineering, the number of manual intervention nodes has been reduced from 13 to 2. For outpatient tumor marker samples, after the first stage of reengineering, the median TAT from collection to reporting decreased from 185 (141, 242) min to 137 (102, 183) min ( Z=-54.932, P<0.001). After the second stage of reengineering, the median TAT from collection to reporting further decreased from 137 (102, 183) min to 100 (64, 150) min ( Z=-61.346, P<0.001). For infection marker samples, after the first stage of reengineering, the median TAT from collection to reporting decreased from 392 (282, 1386) min to 229 (176, 323) min ( Z=-68.636, P<0.001). After the second stage of reengineering, the median TAT from collection to reporting further decreased from 229 (176, 323) min to 160 (110, 236) min ( Z=-62.15, P<0.001). Conclusion:Intelligent pre-analytical process reengineering can optimize workflows, improve efficiency, and reduce errors.

Objective:To investigate the application of patient-based real-time quality control (PBRTQC) using exponentially weighted moving average (EWMA) method in internal quality control (IQC) procedures of thyroid function tests.Methods:The serum thyroid function test results of outpatients and inpatients in the Second Hospital of Shandong University from December 1, 2022 to April 30, 2023 were collected. Based on the PBRTQC professional intelligent software system, normality correction, parameter setting, program preparation and real-time operation of test data were carried out. The results of all patients who underwent thyroid function testing between May 1, 2023 and August 31, 2023 were used as the validation dataset. The estimated EWMA value of thyroid function test results and the cumulative coefficient of variation ( CV) over 4 months were calculated. The cumulative CV was compared with the criteria of precision quality standard (1/3TEa) and the CV of IQC. Westgard 2-2s and 1-3s rules were used for alarm setting. The early warning information of the EWMA quality control program were recorded and the potential causes of performance changes were analyzed. DxLab Mind software was used to conduct normal distribution statistics for all data, and the Kolmogorov-Smirnov test was performed on the test results. Results:The items related to serum thyroid function of the patients were all positively skewed. After data correction by Box-Cox method, the PBRTQC data of free triiodothyronine (FT3) and free thyroxine (FT4) were normally distributed, and their cumulative precisions ( CV) of EWMA within 4 months were 6.26% and 2.86%, respectively, both of which were lower than the precision quality target of 8.33%. However, the data of thyroid-stimulating hormone (TSH), thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibody (TgAb) were still positive skewed after modification. The EWMA cumulative CV of TSH, TPOAb and TgAb were 13.16%, 15.31% and 16.77%, which were higher than the precision quality targets of 8.33%, 10% and 10%, respectively. The EWMA QC program can detect different out-of-control alarms, including FT4 false alarms due to sample source concentration and TSH result bias caused by changes in reagent performance. In addition, the EWMA QC program can also detect differences in FT3 results between different DXI800 fully automated chemiluminescence instrument instruments. Conclusions:The EWMA program based on PBRTQC professional intelligent software tools can monitor the patient data of the detection system in real time and continuously, dynamically identify and monitor the errors generated during the analysis process and give early warning. It can be used as a useful supplement for the daily IQC of thyroid function items, especially FT3 and FT4, and has good clinical application value.