In 2024, a total of 27 309 cases of medication error (ME) from 484 hospitals in 27 provincial administrative regions were collected in the National Monitoring Network for Clinical Safe Medication. Among them, 279 (1.02%) were classified as grade A, 22 081 (80.86%) as grade B, 4 268 (15.63%) as grade C, 472 (1.73%) as grade D, 96 (0.35%) as grade E, 105 (0.38%) as grade F, 6 (0.02%) as grade H, and 2 (<0.01%) as grade I; no MEs of grade G occurred. Among the 27 030 patients involved in MEs of grade B to I, 15 124 (55.95%) were male and 11 906 (44.05%) were female; their ages were from 1 day to 104 years; 3 369 (12.46%) were children (<18 years old), 12 113 (44.81%) were young and middle-aged adults (≥18 to <60 years old), and 11 548 (42.72%) were elderly (≥60 years old). The top 3 contents of ME were wrong drug class (5 347 cases, 19.13%), wrong dosage (4 913 cases, 17.58%), and wrong administration frequency (3 429 cases, 12.27%). Among the 27 030 grade B-I MEs, the main person who triggered the event were physicians (18 703 cases, 69.19%) and pharmacists (6 343 cases, 23.47%). These MEs mainly occurred in clinics (11 009 cases, 40.73%), in hospital wards (7 393 cases, 27.35%), and in pharmacies (6 219 cases, 23.27%). The main persons who discovered the MEs were pharmacists (21 021 cases, 74.14%). The top 3 factors causing ME were lack of related pharmacologic knowledge (8 716 cases, 26.49%), tiredness (5 755 cases, 17.49%), and inexperienced skills (4 505 cases, 13.69%). A total of 209 patients were involved in severe MEs (grade E-I), including 133 (63.64%) males and 76 (36.36%) females, aged from 21 months to 94 years, of which 42 (20.10%) were children, 75 (35.88%) were young and middle-aged adults, and 92 (44.02%) were elderly. The top 3 diseases diagnosed in severe MEs were drug poisoning (41 cases, 19.62%), diabetes (34 cases, 16.27%), and hypertension (14 cases, 6.70%); the main person who triggered the MEs were patients and their families (135 cases, 64.59%); the MEs occurred mainly in patients′ houses (116 cases, 55.50%). Drug poisoning was mainly related to accidental ingestion by children, and MEs in patients with diabetes and hypertension were often related to issues on patient compliance. Based on the data of MEs in 2024, it was proposed to establish a better medication safety culture and improve the ME reporting situation in China, pay attention to the risks of misusing external drugs for internal use, children′s accidental ingestion and insulin-related MEs, strengthen the prevention of MEs related to look-alike sound-alike drugs, pay attention to the post administration management and the compliance education of home care for patients with chronic diseases, so as to improve the medication safety of patients in China.

In 2024, a total of 27 309 cases of medication error (ME) from 484 hospitals in 27 provincial administrative regions were collected in the National Monitoring Network for Clinical Safe Medication. Among them, 279 (1.02%) were classified as grade A, 22 081 (80.86%) as grade B, 4 268 (15.63%) as grade C, 472 (1.73%) as grade D, 96 (0.35%) as grade E, 105 (0.38%) as grade F, 6 (0.02%) as grade H, and 2 (<0.01%) as grade I; no MEs of grade G occurred. Among the 27 030 patients involved in MEs of grade B to I, 15 124 (55.95%) were male and 11 906 (44.05%) were female; their ages were from 1 day to 104 years; 3 369 (12.46%) were children (<18 years old), 12 113 (44.81%) were young and middle-aged adults (≥18 to <60 years old), and 11 548 (42.72%) were elderly (≥60 years old). The top 3 contents of ME were wrong drug class (5 347 cases, 19.13%), wrong dosage (4 913 cases, 17.58%), and wrong administration frequency (3 429 cases, 12.27%). Among the 27 030 grade B-I MEs, the main person who triggered the event were physicians (18 703 cases, 69.19%) and pharmacists (6 343 cases, 23.47%). These MEs mainly occurred in clinics (11 009 cases, 40.73%), in hospital wards (7 393 cases, 27.35%), and in pharmacies (6 219 cases, 23.27%). The main persons who discovered the MEs were pharmacists (21 021 cases, 74.14%). The top 3 factors causing ME were lack of related pharmacologic knowledge (8 716 cases, 26.49%), tiredness (5 755 cases, 17.49%), and inexperienced skills (4 505 cases, 13.69%). A total of 209 patients were involved in severe MEs (grade E-I), including 133 (63.64%) males and 76 (36.36%) females, aged from 21 months to 94 years, of which 42 (20.10%) were children, 75 (35.88%) were young and middle-aged adults, and 92 (44.02%) were elderly. The top 3 diseases diagnosed in severe MEs were drug poisoning (41 cases, 19.62%), diabetes (34 cases, 16.27%), and hypertension (14 cases, 6.70%); the main person who triggered the MEs were patients and their families (135 cases, 64.59%); the MEs occurred mainly in patients′ houses (116 cases, 55.50%). Drug poisoning was mainly related to accidental ingestion by children, and MEs in patients with diabetes and hypertension were often related to issues on patient compliance. Based on the data of MEs in 2024, it was proposed to establish a better medication safety culture and improve the ME reporting situation in China, pay attention to the risks of misusing external drugs for internal use, children′s accidental ingestion and insulin-related MEs, strengthen the prevention of MEs related to look-alike sound-alike drugs, pay attention to the post administration management and the compliance education of home care for patients with chronic diseases, so as to improve the medication safety of patients in China.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

Objective:To establish a method for determintation of chlorogenic acid and linarin in Yejuhua granules by HPLC.Methods:We applied HPLC methods. The Kromasil 100-5 C18 column (250 mm×4.6 mm,5 μm) was used, the mobile phase was acetonitrile-0.4%H 3PO 4 solution (gradient elution), the flow rate was 1.0 ml/min, the dection wavelenghth was 334 nm and the column temperture was 32 ℃. Results:Chlorogenic acid and buddleoside had good linearity in the ranges of 0.30-1.50 μg ( r2=0.999 1) and 0.12-0.62 μg ( r2=0.999 8), respectively. The average recoveries were 99.70% and 96.67%, with RSD<2%, respectively. Conclusion:The method is simple, rapid, reliable, efficient, and can be used for determination of chlorogenic acid and buddleoside in Yejuhua Granules.

Objective:To assess the influence of an artificial intelligence (AI) -assisted diagnosis system on the performance of endoscopists in diagnosing gastric cancer by magnifying narrow banding imaging (M-NBI).Methods:M-NBI images of early gastric cancer (EGC) and non-gastric cancer from Renmin Hospital of Wuhan University from March 2017 to January 2020 and public datasets were collected, among which 4 667 images (1 950 images of EGC and 2 717 of non-gastric cancer)were included in the training set and 1 539 images (483 images of EGC and 1 056 of non-gastric cancer) composed a test set. The model was trained using deep learning technique. One hundred M-NBI videos from Beijing Cancer Hospital and Renmin Hospital of Wuhan University between 9 June 2020 and 17 November 2020 were prospectively collected as a video test set, 38 of gastric cancer and 62 of non-gastric cancer. Four endoscopists from four other hospitals participated in the study, diagnosing the video test twice, with and without AI. The influence of the system on endoscopists′ performance was assessed.Results:Without AI assistance, accuracy, sensitivity, and specificity of endoscopists′ diagnosis of gastric cancer were 81.00%±4.30%, 71.05%±9.67%, and 87.10%±10.88%, respectively. With AI assistance, accuracy, sensitivity and specificity of diagnosis were 86.50%±2.06%, 84.87%±11.07%, and 87.50%±4.47%, respectively. Diagnostic accuracy ( P=0.302) and sensitivity ( P=0.180) of endoscopists with AI assistance were improved compared with those without. Accuracy, sensitivity and specificity of AI in identifying gastric cancer in the video test set were 88.00% (88/100), 97.37% (37/38), and 82.26% (51/62), respectively. Sensitivity of AI was higher than that of the average of endoscopists ( P=0.002). Conclusion:AI-assisted diagnosis system is an effective tool to assist diagnosis of gastric cancer in M-NBI, which can improve the diagnostic ability of endoscopists. It can also remind endoscopists of high-risk areas in real time to reduce the probability of missed diagnosis.

Objective:To investigate the expression level of C-type lectin domain family 4 member G ( CLEC4 G) in liver disease tissues and its correlation with the clinicopathological characteristics of hepatocellular carcinoma (HCC) patients. Methods:The cancer tissue and the corresponding adjacent tissues (at least 2 cm from the edge of the cancer tissue), cut in surgeries from January to December in 2019, of 40 HCC patients in Zhuzhou Central Hospital, as well as 10 normal liver tissue samples (seen as far away as possible from the edge of the cancer tissue with naked eyes) and 10 liver cirrhosis samples were analyzed retrospectively. The tumor genome atlas (TCGA) database was used to screen the HCC transcriptome data sets, and bioinformatics methods were used to make expression heat maps and box maps which can help analyze the difference of CLEC4 G in cancer and adjacent tissues. The mRNA expression level of CLEC4 G was detected by conducting real-time fluorescence quantitative PCR (qRT-PCR), and the protein expression level of CLEC4G was detected by immunohistochemistry (IHC). The measurement data were expressed as mean±standard deviation ( Mean± SD). Group t test was used for inter-group comparison. The counting information was expressed as a percentage (%). The χ2 test was adopted to analyze the correlation between CLEC4 G expression level and the clinicopathological features of patients. Results:The expression level of CLEC4 G in cancer tissues was significantly decreased in heat map compared with that in adjacent tissues. In the box figure, the relative expression of CLEC4 G mRNA in the cancer tissues was (82.5±18.9) and (3 354.4±296.2) in paracancer tissues, with statistically significant difference ( P<0.001). Respectively, qRT-PCR and IHC showed that mRNA of CLEC4 G were abundant in normal liver tissues (3 301.3±286.4), while they were very little in liver cancer tissues (63.6±32.9), significantly decreasing in liver cirrhosis (1 742.6±208.7) and paracancer tissues (1 553.2±249.9), with statistically significant difference ( P<0.001). Moreover, low CLEC4 G expression level was associated with tumor vascular metastasis in HCC patients. Conclusions:CLEC4 G is highly expressed in normal liver tissue, but with the progression of malignant liver disease, it is significantly decreased with little expression in HCC tissue. It can be expected to be a good marker for the pathological diagnosis of HCC.

Objective To preliminarily understand the current status of medication safety management of medical institutions in China. Methods Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs (INRUD) and Chinese Pharmacological Society Professional Committee of Drug-induced Diseases jointly established a research group. Basing on the voluntary principle,members (medical institutions)of the group did medication safety self-assessment using the questionnaires of "2011 ISMP Medication Safety Self Assessment? for Hospitals (Chinese version)", which included 10 key elements,20 core indicators,and 270 assessment projects. The questionnaires were handed out on August 17,2018 and needed to be completed and submitted within 2 months. Results As of October 19,2018,67 hospitals of 16 provincial administrative regions in total had submitted their questionnaires,including 61 (91. 0％)3A hospitals and 6 (9％)2A hospitals. The average value of total scores of medication safety self-assessment in the 67 hospitals was 58. 9％ (7. 6％ -90. 0％). None of the 67 hospitals evaluated the key element Ⅵ(medication device acquisition,use,and monitoring). The scores of the other 9 key elements from high to low were 67. 6％,66. 2％,65. 1％,64. 8％,64. 1％,58. 2％, 54. 5％,54. 4％,and 52. 5％ respectively for element Ⅶ (environmental factors,workflow and staffing patterns),element Ⅳ(drug labeling,packaging and nomenclature),element Ⅸ (patient education), element Ⅲ(communication of drug orders and other drug information),element Ⅷ (staff competency and education),element Ⅴ(drug standardization,storage and distribution),element Ⅹ (quality processes and risk management),element Ⅰ (patient information),and element Ⅱ (drug information). Conclusion The data of medication safety from 67 hospitals of 16 provincial administrative regions were obtained through the first national self-assessment questionnaire survey in medical institutions,which initially reflected the current status of medication safety in medical institutions in China.

Objective To preliminarily understand the current status of medication safety management of medical institutions in China. Methods Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs (INRUD) and Chinese Pharmacological Society Professional Committee of Drug-induced Diseases jointly established a research group. Basing on the voluntary principle,members (medical institutions)of the group did medication safety self-assessment using the questionnaires of "2011 ISMP Medication Safety Self Assessment? for Hospitals (Chinese version)", which included 10 key elements,20 core indicators,and 270 assessment projects. The questionnaires were handed out on August 17,2018 and needed to be completed and submitted within 2 months. Results As of October 19,2018,67 hospitals of 16 provincial administrative regions in total had submitted their questionnaires,including 61 (91. 0％)3A hospitals and 6 (9％)2A hospitals. The average value of total scores of medication safety self-assessment in the 67 hospitals was 58. 9％ (7. 6％ -90. 0％). None of the 67 hospitals evaluated the key element Ⅵ(medication device acquisition,use,and monitoring). The scores of the other 9 key elements from high to low were 67. 6％,66. 2％,65. 1％,64. 8％,64. 1％,58. 2％, 54. 5％,54. 4％,and 52. 5％ respectively for element Ⅶ (environmental factors,workflow and staffing patterns),element Ⅳ(drug labeling,packaging and nomenclature),element Ⅸ (patient education), element Ⅲ(communication of drug orders and other drug information),element Ⅷ (staff competency and education),element Ⅴ(drug standardization,storage and distribution),element Ⅹ (quality processes and risk management),element Ⅰ (patient information),and element Ⅱ (drug information). Conclusion The data of medication safety from 67 hospitals of 16 provincial administrative regions were obtained through the first national self-assessment questionnaire survey in medical institutions,which initially reflected the current status of medication safety in medical institutions in China.

Objective To explore the application value and safety of endoscopic submucosal dissection (ESD) and multi-band mucosectomy (EMBM) in the treatment of early esophageal cancer and precancerous lesion.Methods Seventy-two cases of early esophageal cancer and precancerous lesion that underwent endoscopic therapy from January 2010 to April 2016 in the Wuhan Central Hospital were registered for the study.The patients in the ESD group (60 cases) received ESD,while the patients in the EMBM group (12 cases) received EMBM.Retrospective analyses were made on such indicators as surgical time and treatment results,pathological diagnosis,incidence rates of long and short-term complications,and therapeutic efficacy.Results Pathological results indicated that there were 28 cases of low-grade intraepithelial neoplasm (LGIN) precancerous lesion,16 cases of high-grade intraepithelial neoplasm (HGIN) precancerous lesion and 16 cases of early esophageal cancer (EEC).The lengths of the foci were 2-6 cm,with an average length of (3.2 ±0.6)cm and the average surgical time was(82.1 ±7.5)min.Pathological detection showed that in the EMBM group there were 3 cases of LGIN,4 cases of HGIN and 5 cases of EEC.The lengths of the foci were 3-10 cm,with an average length of(4.8 ± 0.8) cm and the average surgical time was (35.0 ± 5.1) min.The rate of retrosternal pain after surgery was 41.7％ (30/72),the rate of hemorrhage was 1.4％ (1/72),and the rates of perforation,esophageal stricture,abdominal pain and fever were respectively 1.4％ (1/72),5.6％ (4/72),11.1％ (8/72) and 11.1％ (8/72).Pathological detection indicated that in the ESD group complete resection in the cases of LGIN was 96.4％ (27/28),complete resection in the cases of HGIN was 93.8％ (15/16) and complete resection in the cases of EEC was 100％ (16/16).Pathological detection after surgery indicated that the incision edges of the foci were all negative.In the ESD group,there were no cases with lesions penetrating into the muscular layer of mucosa and further into the submucous layer,while there were 2 cases in the EMBM group with lesions penetrating into the submucous layer.Examination by gastroscopy in 62 cases 2 months after surgery revealed that the healing rate of the wound surface was 100％ (62/62),and there was only 1 case that had residual incomplete healing.Fifty-eight cases had gastroscopy 6 months after surgery,and detection results indicated that there was only 1 case that had local recurrence,and 56 cases had gastroscopy 12 months after surgery,and detection results revealed that there was no case of local recurrence.16.7％ of the patients(2/72)that had residual foci or local recurrence were all the patients from the EMBM group.Conclusions ESD and EMBM were safe and effective therapeutic methods for the treatment of early esophageal cancer and precancerous lesion.ESD could completely remove foci with just one incision,with the advantages of easy pathological detection,low rates of recurrence and complication,and low injury,while EMBM on the other hand was a more prompt,safe and effective method for the treatment of lesion with broad foci,however it could not provide complete pathologic data.

Objective To explore the application value and safety of endoscopic submucosal dissection (ESD) and multi-band mucosectomy (EMBM) in the treatment of early esophageal cancer and precancerous lesion.Methods Seventy-two cases of early esophageal cancer and precancerous lesion that underwent endoscopic therapy from January 2010 to April 2016 in the Wuhan Central Hospital were registered for the study.The patients in the ESD group (60 cases) received ESD,while the patients in the EMBM group (12 cases) received EMBM.Retrospective analyses were made on such indicators as surgical time and treatment results,pathological diagnosis,incidence rates of long and short-term complications,and therapeutic efficacy.Results Pathological results indicated that there were 28 cases of low-grade intraepithelial neoplasm (LGIN) precancerous lesion,16 cases of high-grade intraepithelial neoplasm (HGIN) precancerous lesion and 16 cases of early esophageal cancer (EEC).The lengths of the foci were 2-6 cm,with an average length of (3.2 ±0.6)cm and the average surgical time was(82.1 ±7.5)min.Pathological detection showed that in the EMBM group there were 3 cases of LGIN,4 cases of HGIN and 5 cases of EEC.The lengths of the foci were 3-10 cm,with an average length of(4.8 ± 0.8) cm and the average surgical time was (35.0 ± 5.1) min.The rate of retrosternal pain after surgery was 41.7％ (30/72),the rate of hemorrhage was 1.4％ (1/72),and the rates of perforation,esophageal stricture,abdominal pain and fever were respectively 1.4％ (1/72),5.6％ (4/72),11.1％ (8/72) and 11.1％ (8/72).Pathological detection indicated that in the ESD group complete resection in the cases of LGIN was 96.4％ (27/28),complete resection in the cases of HGIN was 93.8％ (15/16) and complete resection in the cases of EEC was 100％ (16/16).Pathological detection after surgery indicated that the incision edges of the foci were all negative.In the ESD group,there were no cases with lesions penetrating into the muscular layer of mucosa and further into the submucous layer,while there were 2 cases in the EMBM group with lesions penetrating into the submucous layer.Examination by gastroscopy in 62 cases 2 months after surgery revealed that the healing rate of the wound surface was 100％ (62/62),and there was only 1 case that had residual incomplete healing.Fifty-eight cases had gastroscopy 6 months after surgery,and detection results indicated that there was only 1 case that had local recurrence,and 56 cases had gastroscopy 12 months after surgery,and detection results revealed that there was no case of local recurrence.16.7％ of the patients(2/72)that had residual foci or local recurrence were all the patients from the EMBM group.Conclusions ESD and EMBM were safe and effective therapeutic methods for the treatment of early esophageal cancer and precancerous lesion.ESD could completely remove foci with just one incision,with the advantages of easy pathological detection,low rates of recurrence and complication,and low injury,while EMBM on the other hand was a more prompt,safe and effective method for the treatment of lesion with broad foci,however it could not provide complete pathologic data.