Objective To explore the application value of the Plan-Do-Check-Act(PDCA)cycle in the refined whole-process management of low-value medical consumables.Methods Using the PDCA cycle as a framework,the Plan phase in-volved analyzing the causes of traceability difficulties for low-value medical consumables.The Do phase implemented multiple im-provement measures,including establishing standardized management systems,strengthening personnel supervision,creating a split-item tertiary inventory,and introducing the Unique Device Identification(UDI)system.The Check phase evaluated man-agement effectiveness by comparing data from June to December 2023 and June to December 2024.The Act phase refined institu-tional norms and operational processes through a closed-loop feedback mechanism.Results After PDCA management,the appli-cation time for low-value medical consumables[(6.16±1.47)min]and the collection time[(15.08±1.89)min]were signif-icantly shorter than before implementation(P＜0.001).The acceptance qualification rate increased from 92.96％to 99.11％.The application of the split-item tertiary inventory ensured synchronization between inventory deduction and billing data.Conclu-sion The PDCA cycle improves the traceability of low-value medical consumables through systematic quality improvement.Its dynamic feedback mechanism supports continuous improvement,providing an effective pathway for hospitals to achieve refined management and cost control.

Objective To explore the application value of the Plan-Do-Check-Act(PDCA)cycle in the refined whole-process management of low-value medical consumables.Methods Using the PDCA cycle as a framework,the Plan phase in-volved analyzing the causes of traceability difficulties for low-value medical consumables.The Do phase implemented multiple im-provement measures,including establishing standardized management systems,strengthening personnel supervision,creating a split-item tertiary inventory,and introducing the Unique Device Identification(UDI)system.The Check phase evaluated man-agement effectiveness by comparing data from June to December 2023 and June to December 2024.The Act phase refined institu-tional norms and operational processes through a closed-loop feedback mechanism.Results After PDCA management,the appli-cation time for low-value medical consumables[(6.16±1.47)min]and the collection time[(15.08±1.89)min]were signif-icantly shorter than before implementation(P＜0.001).The acceptance qualification rate increased from 92.96％to 99.11％.The application of the split-item tertiary inventory ensured synchronization between inventory deduction and billing data.Conclu-sion The PDCA cycle improves the traceability of low-value medical consumables through systematic quality improvement.Its dynamic feedback mechanism supports continuous improvement,providing an effective pathway for hospitals to achieve refined management and cost control.

With the world aging aggravation,the prevalence of neurodegenerative diseases has risen year by year,which brings a huge burden on society and family.However,the effective treatment drugs are still scarce,there is an urgent need to discover new therapeutic targets and develop new therapeutic strategies.Recent studies have found that the the mitochondrial calcium uniporter(MCU)has an important function in many neurodegenerative diseases,the imbalance of mitochondrial calcium homeostasis caused by its abnormal expression or function is one of the important mechanisms of neurodegenerative diseases.Inhibiting the MCU function can play the good neuroprotective role,the specific inhibitors of MCU have shown the good prospect in treating various neurodegenerative diseases.This paper sketched the structure,function,regulatory mecha-nism and specific inhibitors of MCU,and focused on analyzing the role of MCU in the occurrence and develop-ment of different neurodegenerative diseases in order to provide reference for further exploration of MCU as a new therapeutic target for neurodegenerative diseases.

To evaluate the effects of abdominal belts in colonoscopy for patients with low body mass index (BMI) (BMI<18.5 kg/m2) or a history of abdominal surgery, a prospective, randomized, single-blind study was conducted on colonoscopy outpatients. Patients with low BMI or a history of abdominal surgery who underwent colonoscopy at the Second Affiliated Hospital of Soochow University from January 2018 to January 2022 were enrolled. The patients were divided into the abdominal belts group and non-abdominal belts group according to whether they used abdominal belts. Differences between the two groups were compared in terms of cecal intubation time, length of colonoscope intubation into the cecum, patient repositioning, abdominal pressure, and degree of abdominal distension. A total of 296 patients (98 low BMI patients and 198 patients with a history of abdominal surgery) were enrolled, 148 in each group. The results showed that cecal intubation time (4.35±1.85 min VS 7.99±3.86 min, t=35.624, P<0.001) and length of colonoscope intubation into the cecum (72.03±10.35 cm VS 86.42±17.71 cm, t=38.442, P<0.001) were lower in the abdominal belts group, compared with those of the non-abdominal belts group. The percentage of patients requiring repositioning [18.9% (28/148) VS 71.6% (106/148), χ2=82.959, P<0.001] and abdominal pressure [6.1% (9/148) VS 52.7% (78/148), χ2=77.504, P<0.001] in the abdominal belts group were significantly lower than those in the non-abdominal belts group. There were significant differences in the degree of abdominal distension during and after colonoscopy ( P<0.001). In conclusion, the use of abdominal belts significantly improves the efficiency and effects of colonoscope intubation in difficult colonoscopy patients with low BMI and a history of abdominal surgery.

Brain metastasis is a common and serious complication of breast cancer, which is commonly associated with poor survival and prognosis. In particular, the treatment of brain metastasis from triple-negative breast cancer (BM-TNBC) has to face the distinct therapeutic challenges from tumor heterogeneity, circulating tumor cells (CTCs), blood-brain barrier (BBB) and blood-tumor barrier (BTB), which is in unmet clinical needs. Herein, combining with the advantages of synthetic and natural targeting moieties, we develop a "Y-shaped" peptide pVAP-decorated platelet-hybrid liposome drug delivery system to address the all-stage targeted drug delivery for the whole progression of BM-TNBC. Inherited from the activated platelet, the hybrid liposomes still retain the native affinity toward CTCs. Further, the peptide-mediated targeting to breast cancer cells and transport across BBB/BTB are demonstrated in vitro and in vivo. The resultant delivery platform significantly improves the drug accumulation both in orthotopic breast tumors and brain metastatic lesions, and eventually exhibits an outperformance in the inhibition of BM-TNBC compared with the free drug. Overall, this work provides a promising prospect for the comprehensive treatment of BM-TNBC, which could be generalized to other cell types or used in imaging platforms in the future.

Objective:To explore the clinical utility of liquid chromatography tandem mass spectrometry forprimary aldosteronism screening.Methods:From January to October 2019, 413 inpatients diagnosed hypertension from Fuwai Hospital of Chinese Academy of Medical Sciences were enrolled, including 60 Primary aldosteronism(PA)patients and 353 primary hypertension patients. The plasma aldosterone concentration (PAC) and renin concentration (DRC) were measured after 2 h of standing. The 24 h urine samples were collected for measurement of aldosterone using LC-MS/MS. The performance of urine aldosterone and urine aldosterone/renin ratio (UADRR) in PA screening was evaluated by ROC, and compared with PAC/DRC ratio (ADRR). Meanwhile, the efficiency of urine aldosterone in elderly patients or patients with low blood potassium or 24 h urine sodium over 200 mmol was investigated.Results:Area under the curve (AUC)of urine aldosterone was 0.725 (95 %CI 0.679-0.767), and the best cut-off was 7.13 μg/24 h, which was lower than AUC of ADRR (0.958, 95 %CI 0.934-0.975). The AUC of UADRR was 0.947 (95 %CI 0.920-0.966), the best cut-off was 1.11 (μg/24 h)/(μIU/ml), the sensitivity and specificity were 91.7% and 89.0%, respectively. There is no significant differences found with ADRR. In patients with 24 h urine sodium over 200 mmol, AUC of aldosterone was 0.834 (95 %CI 0.730-0.910) and the best cut-off was 9.31 μg/24 h. The sensitivity and specificity were 90.9% and 68.7%, respectively. For the elderly patients over 60 years old, the AUC of urinary aldosterone was 0.860 (95 %CI 0.770-0.925), and the best cut-off was 6.91 μg/24 h. The sensitivity and specificity were 84.6% and 81.3%, respectively. When admission blood potassium was less than 3.50 mmol/L, AUC of urinary aldosterone was 0.822 (95 %CI 0.684-0.917), and the best cut-off was 10.63 μg/24 h. The sensitivity and specificity were 85.7% and 66.7%, respectively. Conclusion:The detection of aldosterone in urine by LC-MS/MS can provide clinical information for PA screening, and the screening performance is better in patients with 24-hour urine sodium over 200 mmol, elderly patients or patients with low blood potassium. If combined with renin, screening efficiency was the same as that in ADRR.

Objective To investigate the role of endoscopic ultrasonography (EUS) in diagnosis and treatment of colorectal submucosal lesions. Methods EUS were applied in 74 patients with suspected colorectal submucosal lesions. According to the origin of submucosal lesion, the patients had received biopsy, endoscopic ultrasonography-fine needle aspiration (EUS-FNA) and endoscopic treatment or surgery. The correlation between EUS and clinical pathology is analyzed retrospectively. Results In the diagnosis based on EUS, there were 28 cases of neuroendocrine tumors (occurred in the rectum), 15 lipomas (4 cases occurred in ileocecal, 1 in transverse colon, 8 in ascending colon, 2 in sigmoid colon), 2 rectal gastrointestinal stromal tumor (1 in muscularis propria and the other in muscularis mucosa), 14 external pressure changes (9 ovarian tumor, 2 lymph nodes, 3 pelvic tumor), 5 cyst (4 in transverse colon, 1 in ascending colon), 1 gas cyst, 3 sigmoid colon endometriosis, 4 rectum malignant tumor invasion, 2 intestinal lymphoma. All the patients had received biopsy, EUS-FNA, endoscopic treatment or surgery. Compared with pathology, a total coincidence rate of 91.9% (68/74) was achieved by EUS, and 2 cases were pathologically diagnosed as leiomyoma, which is considered as rectal carcinoma by EUS at first, 1 case of intestinal lymphoma instead of lipoma, 2 inflammatory mass instead of malignant tumor around the rectum, and 1 rectal carcinoma instead of endometriosis. Conclusion The digestive tract structure could be showed clearly with EUS, and the size of the colon and rectal submucosal lesions, the layer of origin and the structural relationship of adjacent tissues could also be detected. Then, the appropriate treatment against the colon and rectal submucosal lesions would be adopted after the accurate judgment of lesions with EUS.

Objective To find the related factors of the unsuccessful unsedated colonoscopy. Methods Clinical data of 1 726 consecutive subjects who underwent colonoscopy without sedation from April 2014 to January 2015 at the second affiliated hospital of Soochow university were analyzed. Data included characteristics of the patients (age, gender, body mass index, degree of education, the bowel-cleaning drugs, previous colonoscopy experience, bowel habits, history of chronic disease, history of sport, history of abdominal or pelvic surgery, the indication of colonoscopy, mood, quality of bowel preparation, and presence/absence of colonic diverticulum), the characteristics of the physicians (procedure experience, the instrument handling method). These factors were analyzed to evaluate their impact on result of unsedated colonoscopy. Results This study included 1 726 patients (male/female: 927/799). These patients' average age was 50.04 years old, the cecal intubation rate was 91.6%, and the average intubation time was 10.27 minutes. The multiple regression analysis showed the elderly patient, lower BMI, irritability, consti﹣pation, poor bowel preparation were associated with the lower cecal intubation rate. Conclusions The elderly patient, lower BMI, irritability, constipation and poor bowel preparation were associated with the failure of unsedated colonoscopy. In clinical practice, quality improvement programs are needed to improve the rate of total colonoscopy.

OBJECTIVETo investigate the clinical features and AGL gene mutations in a family with glycogen storage disease type IIIa (GSD IIIa).

METHODSClinical data for diagnosis, treatment and follow-up of a sick child with GSD III was collected and analyzed. Genomic DNA was extracted from the peripheral blood samples from the patient and his parents. Polymerase chain reaction and direct DNA sequencing were utilized to analyze all of the exons of the AGL gene.

RESULTSThe genotype of the child was found to be c.3710_3711delTA/IVS14+1G>T. The former was a maternally-inherited mutation, which has not been reported previously. The latter was an abnormal splice-site mutation inherited from the father.

CONCLUSIONBased on its clinical and molecular evidences, the patient was diagnosed as GSD IIIa in conjunction with retrobular optic neuritis.

Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Child, Preschool ; China ; Female ; Glycogen Debranching Enzyme System ; genetics ; metabolism ; Glycogen Storage Disease Type III ; enzymology ; genetics ; Humans ; Male ; Molecular Sequence Data ; Pedigree ; Point Mutation

Objective:To study B cells proliferation and activation induced by tumor derived-autophagosomes ( TDA). Methods:Splenocytes of mice were incubated with 10μg/ml TDAs in vitro ( with the 10μg/ml whole cell lysate as the control).At the 3rd day,the expression of MHCⅠ,Ⅱand co-stimulate molecules including CD86,CD40 were detected by flow cytometry,and B cells proliferation was detected at the 5th day.B cells were selected from spleen of mice using anti-CD43 dynabeads,and incubated with 10μg/ml TDA in vitro ( with the same concentrated whole tumor cell lysate as the control).At the 7th day,IgM in the supernatant were tested by ELISA.Results:When compared with whole cell lysate stimulated B cells,TDA efficently stimulated B cells division in vitro ( TDA group:28.6%, Whole cell lysate group:4.4%) , and significantly up-regulated the expression of MHC class Ⅰ,Ⅱ and co-stimulatory molecules (CD86 and CD40) on B cells,and enhanced the levels of total IgM secretion in vitro.Conclusion:Tumor-derived autophagosomes ( TDA) ,as a vacuole antigen vector, could stimulate B cells proliferation, activation, and increased IgM secretion in vitro.