Objective: To explore the application value of biochemical and immunological assembly line in emergency test by comparatively analyzing the changes in sample test process and turnaround time (TAT) in emergency test before and after installation of the assembly line. Methods: A retrospective study was performed with the run data of the emergency biochemical and immunodetection project in Department of Clinical Laboratory in Tongji Hospital Affiliated to Tongji University from July to September in 2017 and from July to September in 2018. (1)The changes in sample circulation mode and test process were compared in emergency test before and after installation of the assembly line.(2)The changes in TAT of sample test and distribution of time interval in emergency laboratory report were statistically analyzed before and after installation.(3)The number of samples tested between instruments and occurrence of instrument failure were statistically compared before and after installation. (4)Biosafety risk assessment was performed on the sample test process before and after installation to analyze the effects of the assembly line installation on biosafety control in emergency test. Results: (1) By applying the assembly line, the sample test process was well controlled and the workload for laboratorians was eased greatly through reduction of manual work.(2) Report TAT was remarkably shortened after installation compared to that before installation; the TAT of dry biochemistry and myocardial zymogram report in emergency test was shorted from 39 min and 48 min to 34 min and 42 min respectively, with a reduction of 12.82% an 12.50% compared to those before installation; the TAT of dry biochemistry and myocardial zymogram report in inpatient emergency was shorted from 37 min and 43 min to 29 min and 35 min respectively, with a reduction of 21.61% an 18.60% compared to those before installation; distribution of report TAT was comparatively analyzed, the percentage of reports in 0-30 min and 31-45 min increased remarkably compared to that before installation, the percentage of TAT of dry biochemistry report falling into 0-45 min increased to 74.58% and 85.66% after installation from 57.91% and 78.28% before installation, respectively in emergency and inpatient emergency. (3)For the model VITROS5600, the percentage of samples tested changed from 30.29% and 69.71% before installation to 47.63% and 52.37% after installation, respectively; for the model DXI800, the percentage of samples tested changed from 28.77% and 71.23% before installation to 53.49% and 46.51% after installation, respectively. After installation, there was a tendency of balance in the number of samples tested between instruments. Instrument failure was significantly reduced: for the model VITROS5600, the frequency of instrument failure decreased from 3.5 times a month/instrument before installation to 2 times a month/instrument after installation on average; for the model DXI800, the frequency of instrument failure decreased from 2.8 times a month/instrument before installation to 1.8 times a month/instrument after installation on average.(4) Installation of the assembly line lowered the risks biosafety events in sample test process in emergency test and the two risks of accidental contact with aerosol in sample tubes before detection and accidental contact with biological specimen due to overturning and spilling during detection were reduced from a high level before installation to a low level after installation. Conclusion In emergency test, biochemical and immunological assembly line is of certain value in process improvement, reduction of workload for laboratorians, improvement of work efficiency, TAT reduction and optimization, as well as control of biosafety conditions.

Objective To evaluate the effect of therapeutic patient education on improving life quality of children with atopic dermatitis (AD). Methods A total of 109 children with AD were enrolled, including 53 patients in the intervention group and 56 patients in the control group. The intervention group was given therapeutic patient education in addition to routine treatment, while the control group was given routine treatment without therapeutic patient education. After three months two groups were compared with the disease severity and quality of life in children and their families. Results Compared with control group, the intervention group had significant improvements in severity of AD (P?=?0.003) and also significant improvements in quality of life (IDQOL and CDLQI) (P?=?0.004). The family life quality (DFI) of the two groups were both improved, but the difference was not signiifcant (P?=?0.492). Conclusions Therapeutic patient education can improve symptoms of atopic dermatitis, and the quality of life of children as well.

Objective:To investigate the predictive value of serum C-type lectin-like receptor 2 (CLEC-2) combined with insulin resistance in the outcome of patients with acute ischemic stroke (AIS) after intravenous thrombolysis.Methods:Patients with AIS received alteplase intravenous thrombolytic therapy in the Department of Neurology, the Second Affiliated Hospital of Nantong University from October 2019 to March 2021 were enrolled retrospectively. According to the modified Rankin Scale score at 90 d after onset, they were divided into good outcome group (0-2) and poor outcome group (>2). Homeostasis model assessment of insulin resistance (HOMA-IR) was used to evaluate insulin resistance. Person correlation analysis was used to determine the correlation between CLEC-2 and HOMA-IR. Multivariate logistic regression analysis was used to determine the correlation between serum CELC-2, HOMA-IR and the outcome after intravenous thrombolysis. Receiver operating characteristic (ROC) curve was used to determine the predictive value of serum CLEC-2 combined with HOMA-IR for poor outcome after intravenous thrombolysis. Results:A total of 100 patients were enrolled (56 males, 56.0%; aged 70.6±10.86 years, range 49-83 years). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 10.00±6.36. Senenty-four patients (74.0%) had a good outcome and 26 (26.0%) had a poor outcome. Person correlation analysis showed that there was a significant positive correlation between serum CLEC-2 and HOMA-IR ( r=0.523; P<0.001). Multivariate logistic regression analysis showed that after adjusting for confounding factors (C-reactive protein, baseline NIHSS score, onset-to-needle time), the highest quartile of serum CLEC-2 (compared with the lowest quartile: odds ratio [ OR] 4.836, 95% confidence interval [ CI] 1.105-21.169; P=0.036) and the highest quartile of HOMA-IR (compared with the quartile 1-3: OR 15, 95% CI 2.647-30.722; P=0.002) were the independent risk factors for the poor outcome in patients with AIS after intravenous thrombolysis. ROC curve analysis showed that the area under the curve for serum CLEC-2 combined with HOMA-IR to predict poor outcome was 0.785 (95% CI 0.688-0.883; P<0.001), the optimal cut-off value was 0.72, and the sensitivity and specificity were 76.0% and 95.0%, respectively. Conclusion:CLEC-2 combined with insulin resistance has a certain predictive value for the poor outcome of patients with AIS after intravenous thrombolysis.

OBJECTIVE: To assess the maturation disparity of hand-wrist bones using the BoneXpert system and Greulich and Pyle (GP) atlas in a sample of normal children from China. MATERIALS AND METHODS: Our study included 229 boys and 168 girls aged 2-14 years. The bones in the hand and wrist were divided into five groups: distal radius and ulna, metacarpals, proximal phalanges, middle phalanges and distal phalanges. Bone age (BA) was assessed separately using the automatic BoneXpert and GP atlas by two raters. Differences in the BA between the most advanced and retarded individual bones and bone groups were analyzed. RESULTS: In 75.8% of children assessed with the BoneXpert and 59.4% of children assessed with the GP atlas, the BA difference between the most advanced and most retarded individual bones exceeded 2.0 years. The BA mean differences between the most advanced and most retarded individual bones were 2.58 and 2.25 years for the BoneXpert and GP atlas methods, respectively. Furthermore, for both methods, the middle phalanges were the most advanced group. The most retarded group was metacarpals for BoneXpert, while metacarpals and the distal radius and ulna were the most retarded groups according to the GP atlas. Overall, the BAs of the proximal and distal phalanges were closer to the chronological ages than those of the other bone groups. CONCLUSION: Obvious and regular maturation disparities are common in normal children. Overall, the BAs of the proximal and distal phalanges are more useful for BA estimation than those of the other bone groups.
Age Determination by Skeleton ; Asian Continental Ancestry Group* ; Bone and Bones ; Child* ; China ; Developmental Disabilities ; Female ; Hand ; Humans ; Metacarpal Bones ; Pattern Recognition, Automated ; Radiography ; Radius ; Ulna ; Wrist

Objective:To investigate clinical features of congenital triangular alopecia.Methods:Clinical data were collected from 10 children with congenital triangular alopecia, who were diagnosed and treated in Xiamen Children′s Hospital from August 2020 to June 2021, and their clinical and dermoscopic features were analyzed.Results:All the 10 patients were males, aged from 2 months to 6 years and 4 months. Hair loss occurred at birth or within 1 month after birth in 6 children, and occurred between the age of 4 months and 6 years in 4. The alopecic area was located in the left frontotemporal region in 5 patients, in the right frontotemporal region in 3, and in the vertex region in 2. In all the patients, thin vellus hair could be seen in the alopecic areas, and the hair pull test was negative, while in 1 patient showed some normal terminal hair scattered in the alopecic area. Dermoscopy showed a lot of vellus hair surrounded by normal terminal hair in the alopecic area with a clear boundary, and no yellow or black dots, or 'exclamation mark’ hair was observed. Seven patients had visited department of dermatology due to hair loss, of whom 5 were diagnosed with alopecia areata, and 2 with sebaceous nevus.Conclusions:Congenital triangular alopecia is common in children, and mostly occurs in the left frontotemporal region. It is characterized by the replacement of normal terminal hair by thin vellus hair in the alopecic area. Dermoscopy is helpful in its diagnosis and differential diagnosis.

Machine learning(ML)technology has been gradually applied in clinical anesthesia,and the application and research in the perioperative period are increasing.ML can warn occurrence of high-risk events,assist the diagnosis of difficult airway and ultrasound imaging in the perioperative period.Intrao-peratively,ML can predict hypotension,hypoxemia,cardiac arrest,and depth of anesthesia to help achieve precise and safe control of anesthesia.Postoperatively,ML can predict anesthesia-related adverse outcomes.This article summarizes the ML models commonly used in the field of anesthesiology,and reviews the rele-vant studies of ML application in all stages of the perioperative period.The application of ML can improve the perioperative anesthesia management,help to warn the occurrence of high-risk events and reduce anes-thesia-related risks.

Objective:To evaluate the relationship between the severity of preoperative brain injury and postoperative delirium (POD) in elderly patients using latent class analysis based on markers of brain injury.Methods:One hundred and thirty-one American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, aged 65-84 yr, with a body mass index of 18-28 kg/m 2, scheduled for elective unilateral total hip arthroplasty in our hospital, were selected. Cognitive function was assessed using the Mini-Mental State Examination before surgery. Arterial blood samples were collected before anesthesia to measure the plasma concentrations of brain-derived neurotrophic factor, inducible nitric oxide synthase, prostaglandin E2, central nervous system-specific protein (S100β), glial fibrillary acidic protein, neurofilament light chain, matrix metalloproteinase-9, fibroblast growth factor 23, complement 3, complement 3a, complement 5a and irisin using enzyme-linked immunosorbent assay. POD was evaluated using the Confusion Assessment Method within 3 days after operation, and the patients were divided into POD group and non-POD group. The patients were divided into different injury severity subtypes based on the levels of brain injury markers using latent class analysis, and logistic multivariate regression was used to analyze the independent risk factors for POD. Results:Compared with non-POD group, the concentrations of neurofilament light chain, glial fibrillary acidic protein, S100β and prostaglandin E2 were significantly different in POD group ( P<0.05). Using these four brain injury markers for latent class analysis, patients were divided into a high severity of brain injury group (91.51%) and a low severity of brain injury group (8.49%). The results of logistic multivariate regression analysis showed that subtypes of brain injury ( OR=8.31, 95% confidence interval [ CI] 1.77-38.90, P=0.007), age ( OR=1.14, 95% CI 1.03-1.24, P=0.007), and plasma irisin concentrations ( OR=0.99, 95% CI 0.98-0.99, P=0.027) were independent risk factors for POD. Conclusions:Higher severity of preoperative brain injury is an independent risk factor for POD in elderly patients.

Objective To investigate the correlation between oral frailty and POD in elderly patients undergoing non-cardiac surgery.Methods A total of 268 elderly patients,115 males and 153 fe-males,aged ≥ 65 years,BMI 14-36 kg/m2,ASA physical status Ⅱ or Ⅲ,undergoing elective non-cardiac surgery from February 2023 to July 2023 were selected.The oral frailty index-8(OFI-8)was used to measure the oral frailty status of patients one day before surgery.The 3-minute delirium diagnostic scale(3D-CAM)was used to evaluate the occurrence of POD 1,2,3 days after surgery.The patients were divid-ed into delirium group(POD group)and non-delirium group(non-POD group)according to whether POD occurred 3 days after surgery.Multivariate logistic regression model was used to analyze the relationship be-tween oral frailty and POD.Results POD occurred in 61 patients(22.7％).Multivariate logistic regression analysis showed that postoperative use of analgesic pump(OR=2.298,95％CI 1.034-5.108,P=0.041)and oral frailty(OR=2.295,95％CI 1.193-4.415,P=0.012)are significantly correla-ted with the occurrence of POD,after adjusting for age,ASA physical status,hemoglobin,anesthesia time and infusion volume.Conclusion The incidence of postoperative POD in elderly patients with preoperative oral weakness is significantly increased undergoing non-cardiac surgery,and preoperative oral weakness is correlated with the occurrence of POD.

The intensifying aging of the population has led to a growing severity of multimorbidity,significantly impacting patients'quality of life.Current anesthetic management approaches primarily target individual diseases,which struggle to effectively address the complexity of multimorbidity.This article re-views the concept and research status of multimorbidity,analyzes the interconnections among aging,multi-morbidity,and frailty,and discusses the influence of multimorbidity on perioperative risks.For patients with multimorbidity,the article proposes perioperative management strategies encompassing preoperative assess-ment,multidisciplinary collaboration,personalized anesthesia plans,intraoperative monitoring,and postop-erative care.Furthermore,the article underscores the shift from single-disease assessments to comprehensive multimorbidity assessment frameworks,and explores novel management models utilizing big data and artificial intelligence to enhance surgical safety and improve patient prognosis.

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.