Objective To explore the internal audit for homogeneous assay in a multi-campus hospital and provide references for the homogeneous quality management of clinical laboratory.Methods We adopted the unified process of internal audit and the inspection criteria(CNAS-CL02:Guidelines for the Accreditation of Quality and Competence of Medical Laboratories),and collected the non-con-forming items of 3 internal audits in a public hospital with 4 campuses from 2022 to 2024.The non-conforming items and the distribu-tion were statistically analyzed and then the corrective actions were discussed.Results A total of 294 non-conforming items were col-lected in 3 internal audits,and the median of professional group(25th percentile,75th percentile)was 39(34,49).The non-confor-ming items were mainly concentrated in"7.3 testing process"(98),"6.2 personnel"(36),and"6.6 reagents and consumables"(28).Among them,28 non-conforming items related to 2 or 3 different professional areas,and 14 items related to 4 or more areas.The 14 non-conforming items occurred repeatedly in 3 internal audits and crossed multiple areas and multiple campuses simultaneously and involved 6 clauses.Conclusion The homogeneous internal audit for multi-campus hospital could find the shared problems,formulate effective rectification measures,and promote quality management of homogenized assays in clinical laboratories.

The construction of the National Medical Center and the National Regional Medical Center in the Chengdu-Chongqing Economic Circle (referred to as the dual medical center construction) faces the challenges of insufficient integration of industry, academia, research, and medicine, as well as limited joint development and sharing of high-quality resources. It is urgent to promote the integration and coordinated development of regional education and technology talent resources through the integration of higher medical education, and to enhance the "four chains" synergy with the integration of industry and education as the core, thereby promoting the dual medical center construction. This study investigated and summarized the key issues in the dual medical center construction and the integration of higher medical education in the Chengdu-Chongqing Economic Circle. Based on the theoretical framework of four chain coordination (industry chain-talent chain-education chain-city chain), this study clarified the mechanisms by which integrated higher medical education can promote dual medical center construction. The study found that the integration of higher medical education can effectively promote the optimization of resources for dual medical center construction by constructing a collaborative mechanism of "industry education integration-joint talent cultivation-coordinated discipline construction-intercity cooperation". Based on the strengths in higher education resources in Chengdu and Chongqing, a five-dimension collaborative path was proposed: integrated development; technological leadership; talent oriented; government guidance; and market assistance. The research conclusion not only enhances the understanding of the integration of higher medical education, but also provides theoretical basis and practical reference for the dual medical center construction in the Chengdu-Chongqing Economic Circle. The proposed coordinated development also has reference value for the construction of medical centers in urban agglomerations such as the Beijing-Tianjin-Hebei Urban Agglomeration and the Yangtze River Delta.

Objective To explore the internal audit for homogeneous assay in a multi-campus hospital and provide references for the homogeneous quality management of clinical laboratory.Methods We adopted the unified process of internal audit and the inspection criteria(CNAS-CL02:Guidelines for the Accreditation of Quality and Competence of Medical Laboratories),and collected the non-con-forming items of 3 internal audits in a public hospital with 4 campuses from 2022 to 2024.The non-conforming items and the distribu-tion were statistically analyzed and then the corrective actions were discussed.Results A total of 294 non-conforming items were col-lected in 3 internal audits,and the median of professional group(25th percentile,75th percentile)was 39(34,49).The non-confor-ming items were mainly concentrated in"7.3 testing process"(98),"6.2 personnel"(36),and"6.6 reagents and consumables"(28).Among them,28 non-conforming items related to 2 or 3 different professional areas,and 14 items related to 4 or more areas.The 14 non-conforming items occurred repeatedly in 3 internal audits and crossed multiple areas and multiple campuses simultaneously and involved 6 clauses.Conclusion The homogeneous internal audit for multi-campus hospital could find the shared problems,formulate effective rectification measures,and promote quality management of homogenized assays in clinical laboratories.

The construction of the National Medical Center and the National Regional Medical Center in the Chengdu-Chongqing Economic Circle (referred to as the dual medical center construction) faces the challenges of insufficient integration of industry, academia, research, and medicine, as well as limited joint development and sharing of high-quality resources. It is urgent to promote the integration and coordinated development of regional education and technology talent resources through the integration of higher medical education, and to enhance the "four chains" synergy with the integration of industry and education as the core, thereby promoting the dual medical center construction. This study investigated and summarized the key issues in the dual medical center construction and the integration of higher medical education in the Chengdu-Chongqing Economic Circle. Based on the theoretical framework of four chain coordination (industry chain-talent chain-education chain-city chain), this study clarified the mechanisms by which integrated higher medical education can promote dual medical center construction. The study found that the integration of higher medical education can effectively promote the optimization of resources for dual medical center construction by constructing a collaborative mechanism of "industry education integration-joint talent cultivation-coordinated discipline construction-intercity cooperation". Based on the strengths in higher education resources in Chengdu and Chongqing, a five-dimension collaborative path was proposed: integrated development; technological leadership; talent oriented; government guidance; and market assistance. The research conclusion not only enhances the understanding of the integration of higher medical education, but also provides theoretical basis and practical reference for the dual medical center construction in the Chengdu-Chongqing Economic Circle. The proposed coordinated development also has reference value for the construction of medical centers in urban agglomerations such as the Beijing-Tianjin-Hebei Urban Agglomeration and the Yangtze River Delta.

Objective:To investigate the clinical features, efficacy and risk factors for the development of anemia in newly-diagnosed multiple myeloma (NDMM) patients with anemia.Methods:A retrospective case-control study was conducted. General data and laboratory findings of 165 NDMM patients hospitalized at the People's Hospital of Qiannan in Guizhou Province and Affiliated Zhongshan Hospital of Dalian University from January 2018 to December 2022 were retrospectively analyzed. The patients were treated with chemotherapy regimens based on at least 2 new drugs including proteasome inhibitors and immunomodulators, and the efficacy was assessed after 4 cycles of treatment. According to peripheral blood hemoglobin (Hb) concentration, patients were divided into anemia group (Hb < 100 g/L) and non-anemia group (Hb ≥ 100 g/L). The general data, hematological indexes, and treatment effects of the two groups were compared. Pearson correlation coefficient was used to analyze the correlation between Hb and hematological indexes; multivariate logistic regression was used to analyze the risk factors for the occurrence of anemia in patients with NDMM; anemia defined by Hb was used as the gold standard, and receiver operating characteristic (ROC) curve was used to analyze the effect of the above risk factors for anemia on judging the occurrence of anemia in MM patients.Results:There were 120 cases in the anemia group with a median age [ M ( Q1, Q3)] of 64 years old (59 years old,74 years old), including 61 (50.8%) males and 59 (49.2%) females, and 45 cases in the non-anemia group with a median age of 61 years old (54 years old, 68 years old), including 27 (60.0%) males and 18 (40.0%) females. The age of patients and the proportion of patients with Durie-Salmon (DS) stage Ⅲ, international staging system (ISS) stage Ⅲ, renal impairment, and hypercalcemia in the anemia group were higher than those in the non-anemia group (all P < 0.05); peripheral blood platelet counts and serum albumin concentrations in the anemia group were lower than those in the non-anemia group, and the differences were statistically significant (all P < 0.05); the concentrations of globulin, the erythrocyte sedimentation rate (ESR) and serum β 2-microglobulin (β 2-MG) concentration, creatinine concentration, uric acid concentration, serum corrected calcium concentration, and the proportion of abnormal plasma cells in bone marrow in the anemia group were higher than those in the non-anemic group, and the differences were statistically significant (all P < 0.05). The objective remission rate in the anemia group was lower than that in the non-anemia group [42.5% (51/120) vs. 71.1% (32/45), χ2 = 10.72, P = 0.001]. Pearson correlation coefficient showed that Hb concentration was positively correlated with serum albumin concentration and platelet count ( r values were 0.569 and 0.229, both P < 0.05), and it was negatively correlated with ESR, globulin, β 2-MG, creatinine, uric acid, serum corrected calcium concentration and the proportion of abnormal plasma cells in bone marrow ( r values were -0.318, -0.465, -0.373, -0.230, -0.303, -0.248, and -0.368, all P < 0.05). Multivariate logistic regression analysis showed that the increased serum albumin concentration was the independent protective factor for the occurrence of anemia in patients with NDMM ( OR = 0.891, 95% CI: 0.798-0.994, P = 0.039), and the increased proportion of abnormal plasma cells in bone marrow was the independent risk factor for the occurrence of anemia in patients with NDMM ( OR = 0.941, 95% CI: 0.908-0.974, P = 0.001). ROC curve analysis showed that the areas under the curve for the occurrence of anemia in NDMM patients based on serum albumin concentration and the proportion of abnormal plasma cells in bone marrow were 0.813 (95% CI: 0.743-0.882, P < 0.001) and 0.792 (95% CI: 0.715-0.870, P < 0.001). Conclusions:Compared with NDMM patients without anemia, NDMM patients with anemia have abnormalities in several tests and poor treatment outcomes, and these patients should be actively corrected for anemia and hypovitaminosis, and clear plasma cell load as early as possible in conjunction with antimyeloma therapy.

Objective:To investigate the clinical features and family gene mutation results of the adult onset Gaucher disease patient.Methods:The diagnosis and treatment of a patient with Gaucher disease who was admitted to the Affiliated Zhongshan Hospital of Dalian University in March 2020 were retrospectively analyzed, and the literature was reviewed.Results:The patient (the proband) was a 34-year-old female, the anemia, thrombocytopenia and splenomegalia were found in 2005. After regular physical examination, the decrease of leukocyte, red blood cell and platelet was gradually aggravated, and the progressive enlargement of the spleen was aggravated. She visited the clinic on March 19, 2020 due to worsening of fatigue. The physical examination revealed hepatomegaly, splenomegaly; blood routine examination showed pancytopenia, and bone marrow morphology showed a large number of Gaucher cells. Peripheral blood β- glucocerebrosidase (GBA) of the proband was 1.8 nmol·mg -1·h -1 (reference value 10-25 nmol·mg -1·h -1), and the GBA of her father, mother, brother, and daughter was normal. The second-generation sequencing results showed that the proband had a mutation in the BCL2 gene at locus c.127G>A p.A43T, with a mutation frequency of 49.53%. GBA gene testing showed that the proband had a heterozygous mutation at c.1448T>C (a pathogenic mutation), heterozygous mutations at c.1026A>G and c.1038C>T (homozygous mutations), and a heterozygous mutation at c.1075G>T (mutation of unknown clinical significance). The proband's father had c.1448T>C heterozygous mutation, and he was a carrier; the proband's mother had c.1075G>T heterozygous mutation; the proband's brother had no gene mutation; the proband's daughter had c.1448T>C heterozygous mutation, and she was a carrier. The diagnosis was type Ⅰ Gaucher disease (non-neuropathic). The patient was proposed to participate in the clinical trial of imiglucerase, and during the follow-up, the blood routine was relatively stable, and the spleen remained progressively enlarged. Conclusions:Gaucher disease is rare, which is easy to be misdiagnosed and underdiagnosed. It is necessary to be alert to the possibility of Gaucher disease when there are patients with unexplained hemocytopenia, liver and spleen enlargement and multiple organs involvement, and enzyme and genetic tests should be performed as soon as possible.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and highly aggressive hematological malignancy, there is no standard treatment and the prognosis is very poor. Affiliated Zhongshan Hospital of Dalian University report a case of 85-year-old BPDCN male patient treated with DVT regimen (decitabine combined with Venetoclax and thalidomide) and achieved complete remission. The patient with skin nodules and the pathology diagnosed BPDCN, the next generation sequencing of skin nodules showed mutations of IDH2 and ASXL1. DVT (decitabine combined with Venetoclax and thalidomide) has significant efficacy with rapid and deep remission for BPDCN, and the adverse effects is less, especially suitable for elderly patients who cannot tolerate intense chemotherapy.

This article reported a rare case of congenital median cleft of upper lip and palate. A 9-month-old male child was admitted to the Department of Plastic Surgery, Tianjin Children’s Hospital in October 2021. The examination showed that the child’s upper lip was completely split from the red lip to the nose. The nasal alar collapsed and the nasal columella nasal septum was dysplasia and short retraction. Maxillary defects were seen in the oral cavity, and a wide palatal cleft was seen. The patient received surgical treatment to reconstruct the nasal cavity and upper lip. The patient was followed up for one month after operation and recovered well.

This article reported a rare case of congenital median cleft of upper lip and palate. A 9-month-old male child was admitted to the Department of Plastic Surgery, Tianjin Children’s Hospital in October 2021. The examination showed that the child’s upper lip was completely split from the red lip to the nose. The nasal alar collapsed and the nasal columella nasal septum was dysplasia and short retraction. Maxillary defects were seen in the oral cavity, and a wide palatal cleft was seen. The patient received surgical treatment to reconstruct the nasal cavity and upper lip. The patient was followed up for one month after operation and recovered well.

Objective:To observe the effect of acupressure and ear acupoint pressure bean on alleviating the adverse reactions of polyethylene glycol electrolyte powder in patients undergoing colonoscopy, and analyze the effect on patients' medication compliance and intestinal cleanliness.Methods:The study was designed as a prospective, single-center, randomized controlled clinical trial. The subjects were selected from patients who planned to undergo colonoscopy in the Endoscopy Center of the Affiliated Hospital of Hangzhou Normal University and were divided into trial group (50 patients) and control group (50 patients) in terms of random number table method. Patients in the control group was given colonoscopy routine nursing, and those in the trial group was treated with acupressure and ear acupoint pressure bean therapy on the basis of routine nursing. The incidence of adverse reactions of polyethylene glycol electrolyte powder, medication compliance (8-item Morisky medication adherence scale), and intestinal cleanliness (Boston bowel preparation scale) in patients were compared between the 2 groups.Results:A total of 100 patients were included initially, 8 fell off during the study, and 92 were finally entered in the analysis, including 46 in the trial group and control group respectively. There were 26 males and 20 females in the trial group, aged (47±6) years with a range from 35 to 56 years, and 25 males and 21 females in the control group, aged (46±6) years with a range from 33 to 57 years. Differences in age, gender, education level, and marital status of patients between the 2 groups were not significant (all P>0.05). The overall incidence of adverse reactions of polyethylene glycol electrolyte powder in the trial group was lower than that in the control group [30.4% (14/46) vs. 65.2% (30/46), χ2=11.152, P=0.001]. Adverse reactions in the trial group included nausea (11 cases), fullness (2 cases), and abdominal pain (1 case), while those in the control group included nausea (17 cases), fullness(5 cases), abdominal pain (4 cases), vomiting (2 cases), anal discomfort and rash (1 case each). The scores of 8-item Morisky medication adherence scale and Boston bowel preparation scale in the trial group were both higher than those in the control group [8 (7, 8) points vs. 6 (6, 6) points, χ2=-7.711, P<0.001; 9 (8, 9) points vs. 7 (7, 7) points, χ2=-6.721, P<0.001]. Conclusion:The addition of acupressure and ear acupoint pressure bean to the routine nursing process in colonoscopy can effectively alleviate the adverse reactions of polyethylene glycol electrolyte powder, and improve patients' medication compliance and intestinal cleanliness.