Objective:To establish auto verification rules for the routine coagulation assays,and to provide reference for clinical laboratories to improve the quality and efficiency of results verification.Methods:A total of 24,510 specimens of sodium citrate anticoagulation routine coagulation test from the laboratory departments of eight hospitals including the First Medical Center,Chinese PLA General Hospital during January to March 2020 were collected and randomly divided into a rule establishment group and a rule verification group,with 6,670 specimens in the rule establishment group,including 2,056 Delta checks,and 17,840 specimens in the rule validation group,including 3,210 Delta checks.The activities of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),thrombin time(TT),D-dimer(DD)and/or antithrombin(AT)were detected by Stago STA R Max automatic coagulation analyzer and supporting reagents.Taking the manual verification results as the standard,the auto verification and manual false negative rate(invalid verification),false positive rate(invalid interception),pass rate,positive coincidence rate,negative coincidence rate,verification consistency rate and specimen turnaround time(TAT)of the two groups were calculated.Results:The auto verification rules and the application process were preliminarily established,including internal quality control,alarm information,auto verification scope,critical value and deviation value inspection.In the rule establishment group,the single item pass rate was 82.6%-92.4%,and the overall pass rate was 73.8%.The consistency rate between auto verification and manual verification was 98.2%,and the positive coincidence rate and negative coincidence rate were 24.4%and 73.8%,respectively.In the rule verification group,the single item pass rate was 86.4%-91.5%,and the overall review pass rate was 71.5%.By simulating the application of auto verification rules,the average TAT of two hospitals among the eight hospitals was shortened by 1.5 hours and 2.1 hours,respectively.Conclusion:The application of auto verification rules can reduce workload of manual verification,and significantly shorten the TAT,and improve the report efficiency of the laboratory.

Background: Inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR), serve as valuable prognostic indicators in various cancers. This multicenter, retrospective cohort study assessed the treatment outcomes of lenvatinib in 71 patients with radioactive iodine (RAI)-refractory thyroid cancer, considering the baseline inflammatory biomarkers. Methods: This study retrospectively included patients from five tertiary hospitals in Korea whose complete blood counts were available before lenvatinib treatment. Progression-free survival (PFS) and overall survival (OS) were evaluated based on the median value of inflammatory biomarkers. Results: No significant differences in baseline characteristics were observed among patients grouped according to the inflammatory biomarkers, except for older patients with a higher-than-median NLR (≥2) compared to their counterparts with a lower NLR (P= 0.01). Patients with a higher-than-median NLR had significantly shorter PFS (P=0.02) and OS (P=0.017) than those with a lower NLR. In multivariate analysis, a higher-than-median NLR was significantly associated with poor OS (hazard ratio, 3.0; 95% confidence interval, 1.24 to 7.29; P=0.015). However, neither the LMR nor the PLR was associated with PFS. A higher-than-median LMR (≥3.9) was significantly associated with prolonged OS compared to a lower LMR (P=0.036). In contrast, a higher-than-median PLR (≥142.1) was associated with shorter OS compared to a lower PLR (P=0.039). Conclusion Baseline inflammatory biomarkers can serve as predictive indicators of PFS and OS in patients with RAI-refractory thyroid cancer treated with lenvatinib.

Objective:To explore the effectiveness of PDCA (plan, do, check, action) cycle management method in improving the completion rate of after-department examination in pediatric professional base.Methods:Through the residency management system platform, the completion rate of after-department examination from February 2019 to March 2019 differed greatly. Referring to the PDCA cycle management methods, according to the analysis of fishbone diagram, relevant reasons were obtained and a series of rectification measures were implemented including the formulation of relevant programs from the four aspects such as department, resident, rules and regulations and tools. The rectification courses were taken for 5 months. SPSS 17.0 was used for Chi-square test.Results:April to August 2019 was the main rectification execution stage, during which the monthly completion rate of after-department examination increased, but fluctuated (66.70%-89.70%).Compared with the rectification courses before (in February), the completion rate of after-department examination was significantly increased after rectification (in October) [(96.00%) vs. (42.11%)], with statistical significance ( P < 0.01). Conclusion:PDCA cycle management method can effectively improve the completion rate of after-department examination in pediatric professional base, which should be further widely promoted.

Background: Immunoglobulin G4 (IgG4)-related disease is an entity that can involve the thyroid gland. The spectrum of IgG4-related thyroid disease (IgG4-RTD) includes Hashimoto thyroiditis (HT) and its fibrotic variant, Riedel thyroiditis, as well as Graves’ disease. The early diagnosis of IgG4-RTD is important because it is a medically treatable disease, and a delay in the diagnosis might result in unnecessary surgery. We present a case series of IgG4-RTD with a review of the literature. Methods: We retrospectively reviewed the clinical presentation and the radiological and pathological findings of patients diagnosed with IgG4-RTD between 2017 and 2021 at a tertiary medical center in Korea. We also conducted a literature review of IgG4-RTD. Results: Five patients were diagnosed with IgG4-RTD during the study period. The patients’ age ranged from 31 to 76 years, and three patients were men. Most patients visited the clinic for a neck mass, and hypoechogenic nodular lesions were observed on neck ultrasonography. Three patients had IgG4 HT, and two patients had IgG4 Riedel thyroiditis. All patients developed hypothyroidism that necessitated L-thyroxine replacement. The diagnosis of IgG4-RTD was confirmed after a pathological examination of the surgical specimen in the first two cases. However, the early diagnosis was possible after a core needle biopsy in three clinically suspected patients. Conclusion The diagnosis of IgG4-RTD requires clinical suspicion combined with serology and histological analyses using IgG4 immunostaining. The early diagnosis of IgG4-RTD is difficult; thus, biopsy with IgG4 immunostaining and serum IgG4 measurements will help diagnose patients suspected of having IgG4-RTD.

Objective: To learn the epidemiological characteristics of coronavirus disease 2019（COVID-19）in Huzhou,so as to provide reference for prevention and control of COVID-19. Methods: All the confirmed cases of COVID-19 in Huzhou,diagnosed according to the COVID-19 Diagnosis and Treatment Plan（Sixth Version Trial）and reported from January 25 to February 7,2020,were recruited. The process of diagnosis and treatment,clinical manifestation,exposure history and close contacts were collected to analyze the epidemiological characteristics. Results: On January 25,the first confirmed cases of COVID-19 in Huzhou was reported. By February 7,totally 10 confirmed cases were reported and no asymptomatic infection was found. They were all imported,including three Wuhan residents,two with a trip to Wuhan,three with a trip to Suizhou,one with a trip to Hangzhou and one with a trip to Thailand（two Wuhan passengers on the same flight）. The ratio of male to female cases was 1∶1. The median age was 32 years old. Seven cases were found when they went to a doctor by themselves,and three cases were found during the quarantine. The main clinical manifestations were fever,dry cough and fatigue. The median time from onset to diagnosis was 3 days. By March 3,all the cases were discharged,with median course of 24 days. There were 312 close contacts,and all of them were released after 14 days of quarantine. Conclusions To prevent imported cases from outside and stop spread inside taken by Huzhou government was proved to be effective. All the COVID-19 cases in Huzhou were imported,mostly from Wuhan. No local cases were reported.

Colon interposition is a surgical procedure used for maintenance of luminal conduit after esophagectomy. Although epithelial neoplasia, such as adenoma and adenocarcinoma, may develop in the interposed colon, there are only few case reports on the condition. Due to the rarity of this condition, there is no definite consensus on recommending screening endoscopy for the early detection of neoplasia in the interposed colons. Here, we report a case of intramucosal adenocarcinoma in an interposed colon. Initial endoscopic resection for this tumor failed to accomplish complete resection. A subsequent endoscopic resection was performed 1 month later and complete resection was achieved. Based on our experience and recommendation on screening endoscopy for gastric cancer in Korea, we suggest that regular screening esophagogastroduodenoscopies should be performed following esophagectomy to detect early neoplasia in the stomach and interposed colon and avoid adverse results induced by delayed detection.
Adenocarcinoma ; Adenoma ; Colon ; Consensus ; Endoscopy ; Endoscopy, Digestive System ; Esophagectomy ; Korea ; Mass Screening ; Phenobarbital ; Stomach ; Stomach Neoplasms

Diabetic mellitus induced erectile dysfunction (DIED) is a common complication of type 2 diabetes mellitus (T2DM), which seriously affects the physical and mental health of male T2DM patients. The occurrence of DIED involves a variety of pathophysiological changes such as vascular tissue, nerve, endocrine and so on. But the traditional treatment of erectile dysfunction is not ideal for DIED. Glucagon like peptide (GLP)- 1 receptor agonist has been widely used as a new drug for the treatment of diabetes, and the representative drugs are exenatide and liraglutide. Existing research shows that it can improve endothelial cell function, neuropathy and sex hormone secretion, reduce body weight and insulin resistance. Therefore, these drugs may be a new choice for patients with DIED.

Objective: To describe the distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015 to provide reference for empirical anti-infection treatment. Methods: Pathogens were from hematology department of 26 tertiary hospitals in Jiangsu Province from 2014 to 2015. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or agar dilution method. Collection of drug susceptibility results and corresponding patient data were analyzed. Results: The separated pathogens amounted to 4 306. Gram-negative bacteria accounted for 64.26%, while the proportions of gram-positive bacteria and funguses were 26.99% and 8.75% respectively. Common gram-negative bacteria were Escherichia coli (20.48%) , Klebsiella pneumonia (15.40%) , Pseudomonas aeruginosa (8.50%) , Acinetobacter baumannii (5.04%) and Stenotropho-monas maltophilia (3.41%) respectively. CRE amounted to 123 (6.68%) . Common gram-positive bacteria were Staphylococcus aureus (4.92%) , Staphylococcus hominis (4.88%) and Staphylococcus epidermidis (4.71%) respectively. Candida albicans were the main fungus which accounted for 5.43%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were 3.5%-6.1% and 5.0%-6.3% respectively. The rates of Pseudomonas aeruginosa resistant to tobramycin and amikacin were 3.2% and 3.3% respectively. The resistant rates of Acinetobacter baumannii towards tobramycin and cefoperazone/sulbactam were both 19.2%. The rates of Stenotrophomonas maltophilia resistant to minocycline and sulfamethoxazole were 3.5% and 9.3% respectively. The rates of Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis resistant wards vancomycin were 0, 6.4% and 1.4% respectively; also, the rates of them resistant to linezolid were 1.2%, 0 and 1.6% respectively; in addition, the rates of them resistant to teicoplanin were 2.8%, 14.3% and 8.0% respectively. Furthermore, MRSA accounted for 39.15% (83/212) . Conclusions Pathogens were mainly gram-negative bacteria. CRE accounted for 6.68%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were lower compared with other antibacterial agents. The rates of gram-positive bacteria resistant to vancomycin, linezolid and teicoplanin were still low. MRSA accounted for 39.15%.

Objective: To investigate the association between serum vitamin A levels and clinical factors in preterm infants. Methods: A retrospective study was conducted on neonates admitted to Peking University Third Hospital from May 2013 to May 2014. Totally, 89 preterm neonates were recruited (preterm group). Fifty term babies with hyperbilirubinemia were selected as hyperbilirubinemia group and 50 healthy term babies were chosen as control group. High-performance liquid chromatography (HPLC) was used to examine the serum vitamin A concentrations for preterm babies at the age of 2, 7, 14 and 28 days, while those for babies in hyperbilirubinemia group was measured on one week old. Umbilical cord blood serum vitamin A concentrations were determined in control group. t-test, univariate analysis of variance or multiple linear regression was used for statistical analysis. Results: (1) In the preterm group, the mean serum vitamin A levels at the age of 2, 7, 14 and 28 days were (0.136±0.060), (0.141±0.047), (0.122±0.053) and (0.134±0.073) mg/L, respectively, while (0.168±0.109) and (0.159±0.049) mg/L in hyperbilirubinemia and the control group. The proportions of vitamin A deficiency (lower than 0.20 mg/L) in preterm babies were 91.2% (62/68), 92.1% (58/63), 91.3% (42/46) and 84% (21/25) at the age of 2, 7, 14 and 28 days respectively. There was no significant difference in serum vitamin A levels between the age of 2 days and the rest in preterms (P>0.05). However, the vitamin A levels in preterm babies at the age of 2 and 7 days were lower than that of control and hyperbilirubinemia group, respectively (t=-2.068 and -1.790, both P<0.05). (2) Vitamin A levels showed no significant difference among different gestational age ( ≤ 32 weeks vs 33 to 36 weeks) or different birth weight groups (<1 500 g vs 1 500-2 000 g) at the age of 2, 7, 14 and 28 days ( all P>0.05). (3) Multiple factor analysis showed that respiratory distress syndrome, neonatal pneumonia, small for gestational age and maternal hypertensive diserders of pregnancy were associated with serum vitamin A level in early life of newborns (all P<0.05). Conclusion Preterm infants might require sufficient vitamin A supplementation due to low vitamin A level in their first month of life. Small for gestational age, maternal hypertensive disorders of pregnancy, respiratory distress syndrome and neonatal pneumonia are associated with serum vitamin A level in preterm infants.

Objective To investigate the effects of Tangshen Formula on liver oxidative stress in diabetic rats, and their mechanisms thereof.Methods Rat model of type 2 diabetes mellitus and nonalcoholic fatty liver disease was estab?lished by intraperitoneally injecting small dose of chain urea with cephalosporins (STZ) and feeding high fat fodder . The model rats were randomly divided into control group, model group, Tangshen Formula group and metformin group.The se?rum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride (TG), cholesterol (CHO), low density lipoprotein-cholesterol(LDL-C), and superoxide dismutase (SOD), catalase(CAT), vitamin E(VE), nitric oxide (NO) and nitric oxide synthase (NOS) in liver were compared between four groups. Changes of pathological morphology were ob?served under light microscopy. Results There were significantly decrease in serum levels of ALT, AST, TG, CHO, LDL-C in Tangshen Formula group and metformin group compared with those of model group. There were significantly higher levels of SOD, CAT and VE, and lower levels of NO and NOS of liver homogenate in Tangshen Formula group than those of model group. There were higher levels of SOD and CAT, and lower levels of NO and NOS in liver homogenate in metformin group than those of model group. HE staining showed that liver fatty degeneration was significantly reduced in metformin group and Tangshen Formula group compared with that of model group. Conclusion The fatty liver in type 2 diabetic rats is signifi?cantly improved by Tangshen Formula treatment, which is probably associated with the regulation of the response level to oxi?dative stress in liver.