The quality management system of occupational diseases diagnosis is belonged to one part of the hospital quality management system. It must be adhered to the quality management concept of comprehensive, full staff and whole process. To establish and improve the quality management system should be included: (1) Formulated a quality management manual for occupational disease diagnosis, including organization construction, rules and regulations, responsibilities, work flow, operating procedures and clinical pathways, standard instrument, etc. (2) Managed the document of occupational diseases diagnosis. (3) The continuous improvement of quality management. The quality management of occupational diseases diagnosis focuses on the mastery and implementation of the manual by employees, which is reflected in the continuous improvement of daily work, internal assessment and external assessment.

The quality management system of occupational diseases diagnosis is belonged to one part of the hospital quality management system. It must be adhered to the quality management concept of comprehensive, full staff and whole process. To establish and improve the quality management system should be included: (1) Formulated a quality management manual for occupational disease diagnosis, including organization construction, rules and regulations, responsibilities, work flow, operating procedures and clinical pathways, standard instrument, etc. (2) Managed the document of occupational diseases diagnosis. (3) The continuous improvement of quality management. The quality management of occupational diseases diagnosis focuses on the mastery and implementation of the manual by employees, which is reflected in the continuous improvement of daily work, internal assessment and external assessment.

The medicinal history of Zanthoxyli Radix is long,and it is recorded in the Shen Nong Ben Cao Jing under the name of Manjiao.Modern pharmacological research has proven that Zanthoxyli Radix has anti-tumor,antibacterial,antioxidant,and hemostatic effects.This article reviewed the pharmacological effects of Zanthoxyli Radix based on its functional indications.Based on the basic requirements of TCM quality markers(Q-markers),this article predicted and analyzed the Q-markers of Zanthoxyli Radix from the perspectives of plant phylogeny and chemical component specificity,chemical component and pharmacological correlation,and chemical component testability.It is proposed to select alkaloids,flavonoids,and lignans as the Q-markers for the general classification of Zanthoxyli Radix.The candidate components for Q-marker were identified,including chloramphenicol,white croaker alkaloid,magnolian alkaloid,taro alkaloid,vanillin,hesperidin,L-sesamin and L-asarone,providing a reference for further research on the quality standards of Zanthoxyli Radix.

To investigate the prevalence and epidemiological characteristics of diabetic retinopathy (DR) in Yunnan Province, explore its risk factors, and provide a basis for the prevention and treatment of chronic complications of diabetes mellitus (DM). This is a large cross-sectional study, in all, 1 524 DM patients in 16 communities and villages of Yunnan Province who were registered in health service centers were included in this study from August to November 2019. All patients completed a uniform questionnaire, anthropometric measurements, biochemical measurements, and auxiliary examinations. Logistic regression analysis was used to screen the risk factors of DR. The prevalence rates of DR, mild non-proliferative DR (mild-NPDR), and referable DR (RDR) were 16.0% (244/1 524), 4.5% (69/1 524), and 11.5% (175/1 524), respectively. Glycated hemoglobin A 1c (HbA 1c)≥7.0% was the risk factor of mild-NPDR ( OR=1.872, 95% CI 1.055-3.323) and RDR ( OR=4.821, 95% CI 2.917-7.969). Blood pressure≥130/80 mmHg (1 mmHg=0.133 kPa) was the risk factor of mild-NPDR ( OR=1.933, 95% CI 1.112-3.358) and RDR ( OR=1.505, 95% CI 1.063-2.130). In Yunnan Province, 16.0% DM patients had accompanying DR, wherein about 71.7% of them required an ophthalmology referral, and the high incidence of RDR in DM patients was associated with poor control of blood glucose and blood pressure.

Objective:To investigate clinicopathological features and prognosis of transformed mycosis fungoides (TMF) .Methods:A retrospective analysis was performed on clinicopathological data collected from 24 patients with TMF, as well as on flow cytometry results of 16 peripheral blood samples obtained from 11 of the 24 patients, who visited Hospital of Dermatology, Chinese Academy of Medical Sciences between 2014 and 2020.Results:Among the 24 patients, 11 were males and 13 were females. Their average age at diagnosis of TMF was 50.0 years (range: 18 - 77 years), and patients with early-stage TMF (9 cases) and tumor-stage TMF (15 cases) were aged 44.8 and 52.6 years on average, respectively. The average time interval from diagnosis of MF to large cell transformation was 3.7 years, and 8 patients were diagnosed with TMF at the initial visit. Histopathologically, large cells infiltrated in a diffuse pattern in 20 cases, as well as in a multifocal pattern in 4, and the proportion of large cells in 7 cases was greater than 75%. Immunohistochemically, 18 patients showed positive staining for CD30, and the proportion of CD30-positive large cells was greater than 75% in 9; negative staining for CD30 was observed in 6. Flow cytometry of 16 peripheral blood samples showed the presence of cell subsets expressing clonal T cell receptor (TCR) -vβ in 2 of 4 patients with early-stage TMF and 10 of 12 with tumor-stage TMF, and tumor cells with higher forward scatter than normal lymphocytes were detected in 16 samples. During the follow-up, among the patients with early-stage TMF, 3 progressed to tumor-stage TMF 3.3 years on average after large cell transformation, 1 progressed to erythrodermic MF in stage IIIA, and the other 4 still showed an indolent course; among the patients with tumor-stage TMF, 1 progressed to stage-IV TMF, and 5 died 3.3 (1.5 - 6) years after large cell transformation.Conclusion:Large cell transformation may occur in patients with MF in any stage, some patients have poor prognosis, so close follow-up is needed for patients with TMF.

Objective:To investigate clinical and histopathological features and differential diagnostic considerations of mucoepidermoid carcinoma (MEC) .Methods:A retrospective study was carried out on clinical manifestations, histopathological and immunohistochemical features, treatment and prognosis of 8 patients with MEC, who were collected from Department of Pathology, Hospital of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College during 2018 - 2021.Results:Among the 8 patients, 5 were males and 3 were females, and their age at onset ranged from 19 to 67 years. Skin lesions were located on the lip mucosa in 5 cases, on the cheek in 2 cases, and on the nose in 1 case. Tumors were all located in the dermis and subcutaneous tissue, parts of which were connected to the epidermis; different proportions of mucous cells, epidermoid cells and intermediate cells were arranged in nests or clumps, and formed solid or cystic structures accompanied by varying degrees of formation of ducts and mucus lakes; all epidermoid cells and intermediate cells expressed cytokeratins AE1/AE3, CK5/6, P63, carcinoembryonic antigen and epithelial membrane antigen. According to the current Chinese grading system, 1 of the 8 patients was diagnosed with intermediate-grade MEC, and others were diagnosed with low-grade MEC. No abnormalities were found by systemic examination. All patients received surgical resections. After the follow-up of 12 - 36 months, no recurrence or distant metastasis was observed.Conclusion:MEC presents no characteristic clinical manifestations, its diagnosis mainly depends on histopathological features, and mucus in the cytoplasm of mucous cells as shown by alcian blue staining is specific for MEC.

Objective:To investigate the value of flow cytometric analysis of peripheral blood in the diagnosis of erythroderma.Methods:A total of 29 patients with erythroderma were collected from Hospital of Dermatology, Chinese Academy of Medical Sciences from September 2017 to December 2020, including 6 with erythrodermic mycosis fungoides (EMF) , 5 with Sézary syndrome (SS) , 18 with inflammatory erythroderma (IE) with different etiologies. Four healthy volunteers served as healthy controls. Flow cytometry was performed to detect peripheral blood lymphocyte subsets, immunophenotypes and clonality, and their differences were analyzed between inflammatory erythroderma and lymphoma-related erythroderma. One-way analysis of variance and least significant difference- t test were used for comparisons between groups. Results:The proportions of T cells, B cells, NK cells and CD4 -CD8 - cells significantly differed among the EMF group, SS group, IE group and control group (all P < 0.001) . The proportion of T cells was significantly higher in the SS group (93.8% ± 3.4%) than in the EMF group (42.7% ± 6.4%) and IE group (46.0% ± 6.8%, t = 12.8, 14.4, respectively, both P < 0.001) , and the proportion of CD4 -CD8 - cells was significantly lower in the IE group (0.37% ± 0.40%) than in the EMF group (2.93% ± 0.84%) and SS group (2.38% ± 0.74%, t = 9.2, 6.7, respectively, both P < 0.05) . The expression of clonal T-cell receptor β-chain variable region (TCR-vβ) was not detected in healthy controls or IE patients; the T cell subsets expressing clonal TCR-vβ were detected in 3 cases of EMF and all cases of SS, and they were all identified to be cells with a CD4 +CD7 -CD26 - phenotype. There were significant differences among the above 4 groups of subjects in the proportions of CD4 + T lymphocytes expressing chemokine receptors CCR4, CXCR3, CCR5, cutaneous lymphocyte antigen (CLA) or programmed death receptor-1 (PD-1) on the cell surface (all P < 0.001) . Compared with the SS group and EMF group, the IE group showed significant decreased proportions of CD4 + T lymphocytes expressing CCR4, CLA or PD-1 (all P < 0.001) , but significantly increased proportions of CD4 + T lymphocytes expressing CXCR3 or CCR5 (all P < 0.001) . Conclusion:Flow cytometric analysis of peripheral blood lymphocyte subsets, immunophenotypes and clonality can provide a reference for the etiological diagnosis of erythroderma, and is helpful for the differential diagnosis between lymphoma-associated erythroderma and inflammatory erythroderma.

Merkel cell carcinoma (MCC) is a rare, highly invasive skin tumor. In recent years, some new progress has been made in the research of MCC morphology, immunophenotype and pathogenesis. The discovery of Merkel cell polyomavirus (MCPyV) is a major breakthrough in MCC research. MCPyV-positive patients with MCC are significantly different from uninfected patients in pathogenesis, clinical characteristics and prognosis. Studies of MCPyV not only reveal some of the pathogenesis of MCC, but also contribute to exploring the tissue origin of MCC. In addition, detection of MCPyV oncoprotein antibodies in the serum can obtain prognostic information of patients with MCC. Identification of the virus status and the mutation profile of MCC tumors can better guide medication and help to develop individualized clinical treatment strategies.

Objective:To establish fluid intake compliance motivation scale for hemodialysis patients and to test its reliability and validity.Methods:With protection motivation theory as the basic framework, the initial scale was established by means of literature analysis, patient interview and expert consultation. From April 2019 to July 2019, a total of 170 patients with hemodialysis in 10 blood purification center in Jiangsu Province were selected for preliminary investigation by convenient sampling method, and the tentative scale was formed through project analysis and exploratory factor analysis. A total of 550 hemodialysis patients were selected for formal testing to evaluate the reliability and validity of the scale.Results:The final scale consisted of 22 items. 7 common factors are extracted by exploratory factor analysis and the cumulative variance contribution rate was 75.949%. The Cronbach's α coefficient of the total scale was 0.928, Spearman-Brown coefficient was 0.841 and the retest reliability coefficient was 0.899. The content validity index of the scale was 0.987. The confirmatory factor analysis model fitted well.Conclusions:Fluid intake compliance motivation scale for hemodialysis patients has good reliability and validity, which can be used to assess fluid intake compliance motivation of patients.