Objective:To construct a scoring system for the main examination report of health examination and evaluate its effect.Methods:A historical control study design was used in this study. By sorting out the problems in 321 main examination reports from December 2023 by equal proportion random sampling method, the quality control plan of main examination report of 2024 was formulated and the "Quality Control Rating Table of Checkup Summary Report" was constructed, which included the principle of conclusion words, classification, sorting, dynamic comparison, disease analysis, health guidance, consistency, completeness, language expression, timeliness and physician. Each principle had its corresponding scoring standard, with a total score of 100 points, 91-100 classified as grade A, 61-90 classified as grade B, and≤60 classified as grade C. According to the "Quality Control Rating Table of Checkup Summary Report", 1 691 main examin reports from January to June 2024 were selected for analysis. In addition, the differences of those reports were analyzed according to categories of primary examination physicians in internal medicine and subspecialties.Results:Compared with December 2023, the proportion of grade A report in June 2024 increased by 111.3% ( χ2=133.38, P<0.001), while the proportion of grade B and C reports decreased by 84.7% ( χ2=61.82, P<0.001) and 97.6% ( χ2=42.36, P<0.001), respectively. In terms of scoring principles, compared with December 2023, the error rates of conclusion words, disease analysis, health guidance and consistency in June 2024 were improved by 54.9%, 46.7%, 62.9% and 100.0%, respectively ( χ2=27.68, 13.41, 48.34 and 7.84, all P<0.001). Additionally, compared with 2023, the total scores of the checkup summary reports of internal medicine and subspecialties in 2024 were increased by 6.8% ( t=-6.843, P<0.001) and 12.6% ( t=-5.321, P<0.001), respectively. Conclusion:The scoring system constructed through the"Quality Control Rating Table of Checkup Summary Report"is scientific, reasonable and practical, which can effectively improve the quality of the main examination report and has strong operability.

Objective:To explore the application effect of double-check standard process for ultrasound reports in health examinations.Method:A historical control study design was used in this study. A total of 11 909 health examination ultrasound reports from the Health Center of the First Affiliated Hospital of Zhengzhou University from February to April in 2021 were selected by systematic sampling method, the double-check standard process was adopted in those reports. The existing problems were categorized, organized and analyzed, and relevant measures for continuous quality improvement were formulated. Then, 13 939 and 15 833 health examination ultrasound reports from February to April in 2022 and 2023 respectively were selected for effect analysis.Results:Compared with those in February to April in 2021, the overall (double-check), initial check and secondary check ultrasound report accuracy rates in February to April in 2023 increased by 5.73%, 3.07% and 1.99%, respectively ( χ2=132.58, 46.80, 127.44, all P<0.001). In terms of trend changes, from February to April 2021 to February to April 2023, the error rates of the following five issues all showed a declining trend: misspellings, inconsistencies between descriptions and conclusion, need for doctor′s signature on the report, missing images, and errors in thyroid/breast color Doppler grading ( χ2=98.93, 30.13/14.59, 3.98, 14.6, all P<0.05). The error rate of ultrasound reports after continuous quality improvement was significantly lower than before. Conclusion:The double-check standard process for ultrasound reports in health examinations can effectively improve the quality of health examination ultrasound reports.

Objective:To construct a scoring system for the main examination report of health examination and evaluate its effect.Methods:A historical control study design was used in this study. By sorting out the problems in 321 main examination reports from December 2023 by equal proportion random sampling method, the quality control plan of main examination report of 2024 was formulated and the "Quality Control Rating Table of Checkup Summary Report" was constructed, which included the principle of conclusion words, classification, sorting, dynamic comparison, disease analysis, health guidance, consistency, completeness, language expression, timeliness and physician. Each principle had its corresponding scoring standard, with a total score of 100 points, 91-100 classified as grade A, 61-90 classified as grade B, and≤60 classified as grade C. According to the "Quality Control Rating Table of Checkup Summary Report", 1 691 main examin reports from January to June 2024 were selected for analysis. In addition, the differences of those reports were analyzed according to categories of primary examination physicians in internal medicine and subspecialties.Results:Compared with December 2023, the proportion of grade A report in June 2024 increased by 111.3% ( χ2=133.38, P<0.001), while the proportion of grade B and C reports decreased by 84.7% ( χ2=61.82, P<0.001) and 97.6% ( χ2=42.36, P<0.001), respectively. In terms of scoring principles, compared with December 2023, the error rates of conclusion words, disease analysis, health guidance and consistency in June 2024 were improved by 54.9%, 46.7%, 62.9% and 100.0%, respectively ( χ2=27.68, 13.41, 48.34 and 7.84, all P<0.001). Additionally, compared with 2023, the total scores of the checkup summary reports of internal medicine and subspecialties in 2024 were increased by 6.8% ( t=-6.843, P<0.001) and 12.6% ( t=-5.321, P<0.001), respectively. Conclusion:The scoring system constructed through the"Quality Control Rating Table of Checkup Summary Report"is scientific, reasonable and practical, which can effectively improve the quality of the main examination report and has strong operability.

Objective:To explore the application effect of double-check standard process for ultrasound reports in health examinations.Method:A historical control study design was used in this study. A total of 11 909 health examination ultrasound reports from the Health Center of the First Affiliated Hospital of Zhengzhou University from February to April in 2021 were selected by systematic sampling method, the double-check standard process was adopted in those reports. The existing problems were categorized, organized and analyzed, and relevant measures for continuous quality improvement were formulated. Then, 13 939 and 15 833 health examination ultrasound reports from February to April in 2022 and 2023 respectively were selected for effect analysis.Results:Compared with those in February to April in 2021, the overall (double-check), initial check and secondary check ultrasound report accuracy rates in February to April in 2023 increased by 5.73%, 3.07% and 1.99%, respectively ( χ2=132.58, 46.80, 127.44, all P<0.001). In terms of trend changes, from February to April 2021 to February to April 2023, the error rates of the following five issues all showed a declining trend: misspellings, inconsistencies between descriptions and conclusion, need for doctor′s signature on the report, missing images, and errors in thyroid/breast color Doppler grading ( χ2=98.93, 30.13/14.59, 3.98, 14.6, all P<0.05). The error rate of ultrasound reports after continuous quality improvement was significantly lower than before. Conclusion:The double-check standard process for ultrasound reports in health examinations can effectively improve the quality of health examination ultrasound reports.

Objective:To explore the association between glutamyl transpeptidase (GGT) trajectories and new-onset metabolic syndrome to provide insights for the prevention and treatment of metabolic syndrome.Methods:A total of 3 209 subjects who met the inclusion criteria were enrolled in the study cohort of physical examination population. The GGT levels before follow-up were classified by R LCTMtools program into 3 GGT trajectory groups: low-stable group, medium-stable group and high-stable group. Cox proportional hazards regression model was used to analyze the correlation between different GGT trajectories and new-onset metabolic syndrome.Results:At the end of follow-up in 2020, the cumulative incidence of metabolic syndrome was 7.0%, and the incidence of metabolic syndrome in the low-stable group, medium-stable group and high-stable group were 3.9%, 11.4%, and 15.0%, respectively, showing a growth trend ( P<0.001). After adjusting for multiple confounding factors by Cox proportional hazards regression model, the risk of metabolic syndrome in medium-stable group and high-stable group increased in the total population. The hazard ratios (95% CI)for the high stable group in males and the medium-stable group in females were 1.67(1.07-2.60) and 3.29(1.14-9.53), respectively, compared with their respective low-stable group. Conclusion:Elevated longitudinal trajectory of GGT is a risk factor for new-onset metabolic syndrome, the risk of metabolic syndrome in the total population increased with the increase of long-term GGT level. It is recommended to maintain the long-term level of GGT at about 28 U/L in males and 14 U/L in females, respectively, to achieve the goal of early prevention of metabolic syndrome.

Objective:To investigate the correlation between the trajectory of triglyceride-glucose index multiplied by body mass index (TyG×BMI) and the incidence of new-onset non-alcoholic fatty liver disease (NAFLD).Methods:It was a retrospective cohort study. A total of 2 304 subjects who underwent health examinations at the Health Management Center of the First Affiliated Hospital of Zhengzhou University from 2017 to 2019 were included as the study population. Based on the TyG×BMI values from the health examinations, a latent class modeling approach was used to determine four distinct TyG×BMI trajectory groups: low-stable, moderate-stable, high-stable, and extremely high-stable group. The incidence of NAFLD was followed-up during the 2020 and 2021 health examinations for each group. The differences in NAFLD incidence among different TyG×BMI trajectory groups were compared using the log-rank test, and the correlation between different TyG×BMI trajectories and the incidence of new-onset NAFLD was analyzed using Cox proportional hazards regression models.Results:The incidence of NAFLD increased with the elevation of TyG×BMI trajectories. The cumulative incidence rates of NAFLD for the low-stable, moderate-stable, high-stable, and extremely high-stable groups was 13.00%, 16.70%, 20.10% and 26.60%, respectively, with statistically significant differences ( χ2=35.155, P<0.01). Compared with the low-stable group, the high-stable and extremely high-stable groups had higher risks of NAFLD (HRs for high-stable group was 1.564, 1.428, 1.426, 1.289, respectively; HRs for extremely high-stable group was 2.121, 1.670, 1.659, 1.607, respectively; all P<0.05). After adjusting for various confounding factors such as gender, waist circumference, BMI, blood glucose, blood lipids and liver function in model 4, the risks of NAFLD for the high-stable and extremely high-stable groups were still 1.389 and 1.607 times higher than that in the low-stable group (95% CIs: 1.035-1.864, 1.207-2.140). Conclusion:The risk of NAFLD increases with the elevation of TyG×BMI trajectories, suggesting that TyG×BMI can serve as a predictive index for NAFLD.

Objective:To investigate the mediation effect of triglyceride glucose index(TyG) on the relation between thyroid nodules and visceral fat area.Methods:A total of 9 324 individuals at the Health Management Center of the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2021 were selected, and the basic information, biochemical indicators, color ultrasound of thyroid were also collected. According to the cut-off value of visceral fat area(VFA) of 100 cm 2 and body mass index(BMI) of 24 kg/m 2, they were divided into four groups: VFA(-)BMI(-), VFA(-)BMI(+ ), VFA(+ )BMI(-), and VFA(+ )BMI(+ ). Chi-square test was used to compare the incidence rate among the four groups, and multivariate logistic regression analysis to indentify influencing factors. TyG and VFA were quartiled, and multivariate logistic regression analysis was used to explore the effects of TyG and VFA on thyroid nodules. The regression coefficient test was used to analyze whether TyG mediated the association between VFA and thyroid nodules. Results:Multivariate logistic regression analysis revealed that compared with VFA(-)BMI(-) group, the VFA(+ )BMI(-) group had the highest risk of thyroid nodules( OR=1.283, 95% CI 1.064-1.546, P=0.009), followed by VFA(+ )BMI(+ ) group( OR=1.245, 95% CI 1.028-1.508, P=0.025). When using TyG and VFA Q1 group as reference, the Q4 group showed an increased risk of thyroid nodule by 1.584 times(95% CI 1.208-2.077, P=0.001) and 1.573 times(95% CI 1.249-1.982, P<0.001), respectively. Mediation analysis indicated that VFA had a direct impact on the incidence rate of thyroid nodules( β=0.162, 95% CI 0.140-0.186, P<0.001). TyG partially mediated the effect of VFA on the incidence rate of thyroid nodules( β=0.103, 95% CI 0.087-0.121, P<0.001), accounting for 38.87% of the total effect. Conclusions:VFA is an independent risk factor for thyroid nodules regardless of BMI. Among individuals with visceral obesity but normal BMI, the incidence rate of thyroid nodules was the highest. In addition, TyG partially mediates the risk of thyroid nodules in patients with visceral obesity. The evaluation of visceral obesity might be of great significance in the early screening and prevention of thyroid nodules.

Objective: To explore the association between urinary metals and lung function among college students, and to provide a theoretical basis for related research on metal exposure and lung function injury. Methods: A total of 45 healthy college students were recruited from North China University of Science and Technology in Caofeidian between 2017-2018. During the four seasons, information was obtained from questionnaires and physical examinations, lung function parameters were assessed, including FVC, FEV1, PEF, FEV1/FVC and FEF 25-75 , and morning urine samples were collected simultaneously. The urinary levels of 15 metals were measured by inductively coupled plasma mass spectrometry (ICP/MS); a Kruskal Wallis H test was used to compare differences in urinary metals during the four seasons; and a mixed effect model was used to assess correlations between urinary metals and lung function. Results: There were significant differences in the levels of urinary chromium, iron, nickel, copper, zinc, arsenic, selenium, selenium, molybdenum, cadmium, antimony and lead from 15 metals over the four seasons ( H =9.79- 20.61 , P <0.05). The differences observed in five lung function parameters over the four seasons were statistically significant ( F =61.72, 45.30, 47.61, 25.47, 35.13, P <0.05). The linear mixed effect model analysis showed that urinary concentrations of vanadium, manganese, iron, cobalt, nickel and antimony were negatively correlated with FEV1( B =0.202, 0.192, 0.181, 0.154, 0.131 , 0.283); urinary concentrations of aluminum, vanadium, manganese, iron, cobalt, nickel, zinc, cadmium, and antimony were negatively correlated with FVC ( B =0.252, 0.290, 0.292, 0.271, 0.201, 0.180, 0.171, 0.163, 0.381); urinary concentrations of manganese and antimony were negatively correlated with PEF ( B =0.291, 0.354)( P <0.05). Conclusion The increase of multiple metal concentrations among college students was related to lung function decline, the long term metal exposure might lead to lung function damage. So environmental metal pollution should be controlled.

Objective:To investigate the correlation between fasting plasma glucose (FPG) and new-onset carotid plaque through latent class trajectory models.Methods:A total of 953 observation objects came from the first affiliated hospital of Zhengzhou University in accordance with the inclusion criteria. According to the FPG values of the observed subjects during the annual physical examination from January 2017 to December 2019, the following four different FPG trajectories groups were determined by latent class trajectory modelling tools: the low-stable group, the medium stable group, the medium-high stable group, and the high stable group. Carotid plaque incidence in each group was followed up in 2020 to compare the differences of the cumulative incidences of the four groups. The Cox proportional risk regression model was used to analyze the correlation between different FPG trajectories and new-onset carotid plaque.Results:The incidence of carotid plaque increased with the increase of FPG trajectories by 11.13%, 19.70%, 23.44%, 23.81%, respectively, with significance ( P<0.001). After adjusting gender, age, BMI and other confounding factors with the cox proportional risk regression model, the risk of carotid plaque in the FPG medium stable group, medium and high stable group, high-stable group was still 1.895 (95% CI: 1.296-2.769), 2.273 (95% CI: 1.241-4.161), 2.527 (95% CI: 1.219-5.241) times of the low stable group (all P<0.05). Conclusion:The long-term high FPG levels are independent risk factors for the incidence of carotid plaque, and controlling FPG at a low level steadily can reduce the risk of carotid plaque.

Objective:To explore the clinical characteristics of dabigatran etexilate-related serious adverse events(AE).Methods:Databases of CNKI, WanFang, PubMed, and Embase were searched as of October 31, 2020 and case reports on serious AE related to dabigatran etexilate were collected. Relevant information in patients (nationality, gender, age, weight, application of dabigatran etexilate, co-existing diseases and combined drugs, the occurrence, treatment and outcome of AE, etc.) was extracted and analyzed descriptively.Results:A total of 77 literature were included, involving 101 patients from 20 countries. There were 64 males (63.4%) and 37 females (36.6%), aged 56-94 years with the body weight of 38-193 kg. In terms of the reasons for medication, 87 were for prevention of stroke caused by atrial fibrillation, 12 were for the treatment of venous thromboembolism or for prevention of the possible venous thromboembolism, and the other 2 were not described. Co-existing diseases or past medical history were described in 88 patients, including hypertension, renal insufficiency, and type 2 diabetes mellitus, etc. Combined medication was described in 67 patients, of which drugs that might increase the risk of bleeding (non-steroidal anti-inflammatory drugs, clopidogrel, P-glycoprotein inhibitors, etc.) were used in 35 patients. Other combined drugs were antihypertensive drugs and hypoglycemic drugs, etc. Serious AE occurred from 2 minutes to 5 years after medication and 33 cases occurred within 1 month after the start of medication. Serious AE associated with dabigatran etexilate were bleeding in 81 patients (including gastrointestinal bleeding, intracerebral hemorrhage, coagulation disorder, etc.), kidney injury/renal failure in 8 patients, esophageal ulcer in 4 patients, liver injury in 2 patients, and thrombocytopenia, leukocyte fragmentation vasculitis, and severe cough with dyspnea in 1 patient respectively. The main measure taken after AE occurence was drug withdrawal. Those who were not improved after drug withdrawal were given symptomatic treatment, and hemodialysis were performed on those who fail to respond to the treatment. A total of 29 patients died and all of them had bleeding events. Among the 101 patients, 43 had medication errors, of which 33 had overdose, 6 had contraindications, and 4 had wrong administration methods.Conclusions:Serious AE related to dabigatran etexilate manifest mostly as bleeding in clinic and can occur from 2 minutes to 5 years after medication, which can lead to death in severe cases. Medication error is one of the important causes of serious AE related to dabigatran etexilate, so the label should be strictly followed when prescribing the drug and medi-cation guidance should be given to patients.