Background: Accreditation of healthcare institutions serves as a fundamental mechanism for ensuring patient safety and validating the quality of medical services provided to the population. At Intermed Hospital, a quality measurement system for healthcare services has been established since 2015, encompassing 126 quality indicators at both institutional and departmental levels. This system facilitates continuous quality improvement efforts. In this context, quality indicators specific to the endoscopy department play a pivotal role in objectively assessing the quality of endoscopic services. Aim: To assess the quality indicators in gastrointestinal endoscopy unit. Materials and Methods: A retrospective single-center study was conducted by collecting data from the Intermed hospital’s electronic information systems which included HIS and PACS and Quality and Safety Department’s Database and the results were processed using the SPSS software. Ethical approval was granted by the Intermed hospital’s Scientific research committee. The quality of endoscopic services in the Intermed hospital was assessed based on: a) the average values of four quality indicators measured monthly; b) sample survey data from five categories of quality indicators. Results : Between 2016 and 2024, the quality indicators of the endoscopy unit measured as the level of early warning score evaluations for patients was 95.97%±3.33, the level of cases where peripheral blood oxygen saturation decreased during sedation was 1.54%±3.78, the level of cases where patients experienced paradoxiical response during sedation was 5.82%±1.75, surveillance culturing level for validation of endoscopy reprocessing was 11.6%. The endoscopic documentation quality by peer review showed 95.7-100%, the colonoscopy quality indicators were followings as adenoma detection rate: 24.5% Cecal intubation rate: 99.1%, 95.2%, Colonoscope withdrawal average time: 13.28±10.62 minutes, Bowel preparation quality (Boston Scale): 89.3% 95.7%), patient discharge from the recovery room, Average discharge time post-procedure: With propofol alone: 30.92 minutes; With propofol and fentanyl combined: 31.52 minutes, The intermediate risk was 0.28% by the TROOPS evaluation during procedural sedation. Conclusion The quality benchmark levels for these endoscopic units, as determined by a single-center study, can be effectively implemented by benchmark endoscopy centers to enhance their quality and safety operations.

Objective: To identify BRAF V600E mutations in adult Wilms tumor (WT) with overlapping histologic features of metanephric adenoma (MA) and to investigate the clinicopathological features of adult WT. Methods: The clinical features of adult WT diagnosed at the Fudan University Shanghai Cancer Center, Shanghai, China from 2012 to 2021 were reviewed. HE-stained slides of all cases were reviewed by 2 expert pathologists. Representative tissues were selected for BRAF V600E immunohistochemical (IHC) staining and gene sequencing. Results: In adult WT with MA-like areas (cohort Ⅰ, n=6), 5 of the 6 cases were composed of epithelial-predominant and were positive for WT-1 and CD56, respectively, and all were positive for CD57. All 6 cases revealed highly variable Ki-67 indices, ranging from 1% in some areas to 60% in others. 5 of the 6 cases harbored a BRAF V600E mutation. All cases in cohort I were followed up for 23 to 71 months, and all survived. In classical adult WT without MA-like areas cohort (cohort Ⅱ, n=13), all 7 cases with available material were negative for BRAF by IHC and none of them had any BRAF mutation. Conclusions: BRAF V600E mutations are frequently present in adult WT with overlapping morphologically features of MA, but not in those without. More importantly, adult WTs with overlapping histologic features of MA may be an intermediate entity between typical MA and WT that may have a favorable prognosis and possible therapeutic targets.
Adult ; Humans ; Proto-Oncogene Proteins B-raf/genetics* ; China ; Wilms Tumor/genetics* ; Kidney Neoplasms/pathology* ; Mutation ; Adenoma/genetics* ; Biomarkers, Tumor/genetics*

Introduction: Hepatocellular carcinoma incidence and mortality per 100,000 population in Mongolia is the highest in the world. The individual’s genetic factors and new genetic changes are considered an important effect on the origin and development cancer. We aimed to investigate whether p53R72P polymorphisms were associated with the risk of hepatocellular carcinoma in Mongolian patients. Material and Method: p53R72P polymorphisms were evaluated in 80 controls and 38 HCC cases using a PCRrestriction fragment length polymorphism assay. Results: The mean age was 58.5±13.6 years in the case group and 63.2±8.1 years in the control group. Hepatocellular carcinoma is most common in 50-59 (n=14, 36.8%) and 60-69 (n=14, 36.8%) ages. Of the HCC group, 4 (10.8%) were diagnosed with tumor at stage II, 23 (62.2%) at stage III, and 11 (27%) at stage IV.
The results revealed that the heterozygous (Arg/Pro (PR)) genotype of p53R72P increased statistically significant the risk of hepatocellular carcinoma (OR=4.222, 95% CI 1.669-10.684) compared to the wildtype (R/R) genotype. (p=0.002). Moreover, the homozygous (Pro/Pro (P/P)) genotype of p53R72P increased the risk of carcinoma (OR=1.333, 95% CI 0.414-4.299) but not statistically significant. (p=0.63). Heterozygous (Arg/Pro (PR)) genotype of p53R72P in the tumor tissue was associated with a statistically significant (OR=3.3, 95% CI 1.274-8.57) increase in the risk of HCC (p=0.014). Pro/Pro (PP) genotype increased the risk of the carcinoma by 2.4 times (OR=2.44, 95% CI 0.865-6.908), but it was not significant. (p=0.092). Pro/Pro (PP) genotype of p53R72P in the tumor tissue compared to normal tissue of a case group increased the risk of cancer by 1.8 times (OR=1.833, 95% CI 0.472- 7.126), which was not statistically significant (p=0.382). Conclusion Taken together, Heterozygous (Arg/Pro (PR)) genotype of p53R72P increases the risk of hepatocellular carcinoma in Mongolians. Further studies with larger populations are needed to confirm these results.

INTRODUCTION: Salba-chia (Salvia hispanica L.) is a popular functional food containing high levels of protein, total dietary fiber, and is an excellent source of α-linolenic acid. Chia seeds significantly decreases weight, suppresses appetite, and has a potential benefit in the management of Type 2 diabetes mellitus (T2DM). This study aimed to determine the effectiveness of chia seeds as an adjuvant treatment for T2DM. METHODS: Randomized controlled trials from 1990 onwards involving Type 2 diabetic patients given chia seed were included. PubMed, Cochrane, ClinicalKey, Google Scholar, and Hinari were searched systematically using MeSH terms “chia”, “Salvia hispanica”, “dietary supplement”, and “diabetes”. The quality of trials was assessed using the Cochrane Collaboration tool. Data on the study design, blinding status, characteristics of participants, medications taken by participants, chia seed intervention, comparator, duration of intake, and interval of assessment were extracted. The percent change of outcome from baseline was compared between the chia and control groups. RESULTS: Four randomized trials with a total of 213 diabetic patients were enrolled in the treatment group using ground salba-chia or the control group using bran. The supplementation of chia resulted in a statistically significant decrease in fasting glucose (-2.90 mmol/L; 95% CI, -3.08, -2.72; p < 0.001), waist circumference (-2.49 cm; 95% CI -2.81, -2.17; p < 0.001), total cholesterol (-2.72 mmol/L; 95% CI -3.68, -1.74; p < 0.001), HDL (-3.69 mmol/L; 95% CI -3.95, -3.42; p < 0.001), LDL (-3.22 mmol/L; 95% CI -4.08, -2.36; p < 0.001); and an increase adiponectin levels (6.50 mg/L; 95% CI 6.25, 6.25; p < 0.001). CONCLUSION Intake of chia seeds resulted in a statistically significant decrease in fasting blood glucose, waist circumference, total cholesterol levels, HDL and LDL cholesterol levels, and increased adiponectin. Chia seeds are generally safer and have lesser side effects compared to the placebo. Chia is effective as adjunctive treatment for Type 2 diabetic patients.

Objective: To evaluate the effect of "healthy eating plate" based dietary management on diabetic inpatients. Methods: The patients with type 2 diabetes mellitus (T2DM) admitted to Daishan First People's Hospital from November 2019 to November 2020 were selected and randomly divided into two groups. The intervention group was given "healthy eating plate" based dietary management, while the control group was given routine dietary management. Demographic data and physical examination results were collected. Fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), triglyceride (TG) and total cholesterol (TC) were detected at admission, discharge and 3 months after discharge, and compared between the two groups by covariance and generalized estimating equation. Results: here were 52 patients aged (55.83±9.67) years in the intervention group, with 29 (55.77%) males and 23 (44.23%) females. There were 53 patients aged (57.54±11.09) years in the control group, with 32 (60.38%) males and 21 (39.62%) females. There were no significant differences in FPG, HbA1c, TG and TC levels between two groups at discharge (P>0.05). The level of HbA1c in the intervention group was significantly lower than that in the control group at 3 months after discharge (P<0.05); there were no significant differences in FPG, TG and TC levels (P>0.05). Conclusion The "healthy eating plate" based dietary management can better control the blood glucose of diabetic patients, and can help maintain the dietary treatment. It is worthy of promotion in diabetic patients.

Exercise-associated muscle cramps (EAMC) is prevalent among athletes during training or competitions where they are subjected to strenuous activities for a prolonged period. To manage this painful condition, health practitioners have used numerous treatment modalities having massage done with adjunct application such as cold compress or liniment. Studies show that it is debatable which combination of treatment modalities is more effective on people affected by EAMC. Hence, this study aimed to present evidence-based data to show if there is a difference in the effectiviteness of the two modalities in treating EAMC. A total of thirty-two (32) athletic participants were enrolled in this study and a total of 40 treatment trials were included in the analysis of data. Each participant performed strenuous exercises meant to induce muscle cramps. The onset of muscle cramps was identified using a set criteria. After which, treatment was applied and the length of time that the cramp was resolved was recorded. Determining relief from muscle cramps was based on the characteristic of muscle hardness and the level of pain by using a numerical rating scale. Results showed that though majority of the participants verbalized preference for the ice treatment, analysis of data using one-way ANOVA revealed that there is no evidence to prove that there is a difference in the effectivity among the treatment modalities performed. In conclusion, though all modalities performed were able to relieve the EAMC, the use of adjunct treatment in addition to massage and stretching may have a placebo effect component, which improves the patient's perception of greater efficacy.
Exercise ; Muscle Cramp ; Massage ; Physiology

Objective: To explore the reliability and validity of the Chinese Pediatric Quality of Life Inventory（PedsQL）in influenza children. Methods: From January 2017 to February 2018,we selected laboratory-diagnosed influenza cases and healthy children according to age and gender ratio by stratified random sampling and systematic sampling method. We employed Chinese version of PedsQL 4.0 to investigate their quality of life,used Cronbach's α to evaluate the reliability,and used Pearson correlation coefficient, t-test,confirmatory factor analysis（CFA）and ROC curve to evaluate the validity. Results: Totally 300 influenza cases and 300 healthy children were surveyed,with 294（98.00%）and 295（98.33%）valid questionnaires recovered. The general Cronbach's α was 0.89,and the Cronbach's α of each dimension ranged from 0.79 to 0.84. The Pearson correlation coefficients between the items and their belonged dimension ranged from 0.537 to 0.755,between the items and other dimension ranged from 0.203 to 0.384. The CFA resulted in RMSEA of 0.06,GFI of 0.88,AGFI of 0.90,CFI of 0.91 and NFI of 0.89. The scores in total and in all the dimensions in influenza cases were significantly different with those in healthy children（P<0.05）. Taking the scores in influenza cases as a golden standard,the area under the ROC curve was 0. 985（P<0.05）,the sensitivity was 0.92,and the specificity was 0.95. When the limit score was 82.18,the Youden index was the largest. Conclusion The Chinese version of PedsQL4.0 has good reliability and validity, which can be applied to quality of life assessment in children.

Objective: To investigate the association between milk intake at breakfast and nutritional status of students attending the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES) in 2016, and to provide basic data for improving the nutritional status of the poor rural pupils. Methods: Using the multi-stage stratified random cluster sampling method, 22 315 students from grade three to nine from primary and junior high schools were randomly selected from the 50 key counties under the monitor programs, in 22 provinces of NNIPRCS. Questionnaire was used. Among all the students, with equal number of genders, morning fasting height and weight were measured by trained investigators. Status of nutrition was classified as malnutrition, normal, overweight/obesity, by age-specific height and BMI. Multivariate linear and logistic regression methods were used to analyze the relationship between milk consumption and the status of nutrition of the students. Results: Only 31.4% of the students that were on the monitoring programs would drink milk at breakfast. Proportions of milk intake at breakfast were higher in students from the western regions, in lower grades and in girls (P<0.05). The proportions of malnutrition and overweight/obesity were 11.0% and 10.0% respectively. After controlling factors as gender, age, ethnicity, region of residency and types of parental employment, students who drank milk at breakfast showed an average height of 0.4 cm taller than those who did not drink milk (P=0.001). However, no significant relationships were noticed between milk intake at breakfast and weight, malnutrition or overweight/obesity. Conclusion: Milk intake at breakfast seemed associated with the height of the students under study, suggesting that this program can be promoted, especially in students from the poor rural areas.
Animals ; Breakfast ; Feeding Behavior ; Female ; Humans ; Male ; Milk ; Nutritional Status ; Overweight ; Poverty Areas ; Rural Population ; Schools ; Students

Introduction:Cutaneous adverse drug reactions are one of the most common adverse drug reactions. Publicationson clinical correlation between cutaneous presentations and causative agents are limited among thelocal population. This study aims to determine the clinical presentations of cutaneous adverse drugreactions and the causative drugs in the local population.Methods:A retrospective, cross sectional study was conducted from the pharmacy cutaneous adverse drugreaction database from January 2014 to December 2016 in Tawau, Keningau & Queen Elizabeth (KotaKinabalu) Hospitals.Results:A total of 859 cases of cutaneous adverse drug reactions were identified. Out of these, 53.3% (n=458)were females and 46.7% (n=401) were males. The mean age was 36 years old. Majority of patients were20-29 years old (16.6%) followed by 50-59 years old (15.1%). Most of the cases were reported amongthe Chinese community (16.4%), followed by the Malay (15.9%), Dusun (14.7%) and Bajau (14.0%)populations. The most common cutaneous manifestations were urticaria and or angioedema (49%, n=421) and maculopapular rash (39.6%, n=340). Severe cutaneous adverse reactions (SCAR) constituted2.8% in total. The major causative agent was antibiotic which accounted for 55.1% (n=473), followedby nonsteroidal anti-inflammatory drugs (NSAIDs), 28.1% (n=241) and analgesics, 10.8% (n=93).Conclusion:The types of cutaneous manifestations and causative drugs in Sabah are similar to those reported inother states of the country and abroad. This study provides evidence of local cutaneous adverse drugreaction characteristics in different ethnic group.

Objective: To explore the relationship of family environment in childhood and adolescence and mental health in adulthood. Methods: A total of 791 subjects aged ≥25 years were selected through the Chinese National Twin Registry (CNTR). The short-form of Family Environment Scale-Chinese Version (FES-CV) was used to evaluate the family environment during childhood and adolescence in three dimensions: relationship, system maintenance and personal growth. The mental health status in adulthood was assessed with the Chinese version of 6-item Kessler Psychological Distress Scale (K6). The generalized linear mixed model was used to examine their relationship. Results: About 4.6% of the subjects reported general or worse mental health status. Compared with the subjects with good mental status, statistical difference was observed only in parenting way among twins (living together or not). After adjusting the potential confounders, such as age, sex, zygosity, education and lifestyle (smoking, drinking and physical activity), good family relationship and system maintenance had a positive effect on mental health, with the OR (95%CI) of 0.66 (0.51-0.87) and 0.70 (0.50-0.98) respectively. Furthermore, parenting way did not modify the effect of family environment on mental health status in adulthood (interaction: P>0.05). In each scale, scores of cohesion and organization were positively correlated with mental health, while the score of conflict was negatively correlated with the mental health. Conclusion: Good family relationship and system maintenance in childhood and adolescence had a positive impact on mental health in adulthood.
Adolescent ; Adult ; Child ; China ; Family Relations ; Female ; Humans ; Interpersonal Relations ; Male ; Mental Health ; Parenting