Objective:To compare the diagnostic rates of disseminated intravascular coagulation(DIC)in ca-ses of postpartum hemorrhage,utilizing the obstetric standard of the Chinese DIC scoring system(CDSS)and the International Society on thrombosis and hemostasis(ISTH),and the differences in DIC diagnosis between the two diagnostic criteria.Methods:The cases with postpartum hemorrhage(blood loss＞1500 ml)from January 1,2016,to December 31,2020,in Beijing Obstetrics and Gynecology Hospital,Capital Medical University,were retro-spectively collected.Data included hemoglobin(Hb),platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),international normalized ratio(INR),D-dimer(D-D),general patient information,transfusion records,comorbidities,and complications.Statistical analyses comprised comparative a-nalysis of coagulation profiles between diagnostic groups and ROC curve analysis to determine optimal diagnostic thresholds.Results:A total of 500 women with postpartum hemorrhage(blood loss＞1500 ml))were included in our study,88 cases(17.6％)met CDSS obstetric criteria for DIC,369 cases(73.8％)met ISTH,Poor diagnostic agreement,the Kappa value was 0.117.There were differences in blood loss volume,Hb,PLT,FIB,PT,APTT,prothrombin ratio(PTR),and D-D between the two diagnostic criteria for DIC(P＜0.01).FIB＜1.0g/L in 47 cases(9.4％),PT＜14 s in 368 cases(73.6％),D-D＜5mg/L in 93 cases(18.6％).Correlation analysis demonstrated CDSS scores showed correlation with PT(r=0.449)and PTR(r=0.441),ISTH scores with PT(r=0.574)and PTR(r=0.578).ROC analysis showed that when CDSS,ISTH and the two obstetric criteria were met,the area under the ROC curve(AUC)of PLT was 0.926,0.769 and 0.982,and FIB was 0.896,1.000 and 1.000,respective-ly.ROC analysis for CDSS criteria showed for FIB(cutoff 1.87g/L,sensitivity 85.4％,specificity 84.1％),that AUC values were 0.851 for PT(cutoff 14.05 s,sensitivity 73.9％,specificity 85.4％),for D-D(cutoff 24.03 mg/L,sensitiv-ity 77.3％,specificity 83.3％).Conclusions:The two DIC diagnostic scores differ in diagnosing DIC in patients with postpartum hemorrhage.PLT and FIB are more effective.The ISTH obstetrics standard,including only coagu-lation indices,can't distinguish DIC from dilution coagulation caused by postpartum hemorrhage.The scoring of FIB and PT according to the CDSS obstetric criteria may result in missed diagnoses,while the scoring of D-D may contribute to an increased false-positive rate.The scores for coagulation indices in obstetric DIC require further verification and adjustment.

Objective:To compare the diagnostic rates of disseminated intravascular coagulation(DIC)in ca-ses of postpartum hemorrhage,utilizing the obstetric standard of the Chinese DIC scoring system(CDSS)and the International Society on thrombosis and hemostasis(ISTH),and the differences in DIC diagnosis between the two diagnostic criteria.Methods:The cases with postpartum hemorrhage(blood loss＞1500 ml)from January 1,2016,to December 31,2020,in Beijing Obstetrics and Gynecology Hospital,Capital Medical University,were retro-spectively collected.Data included hemoglobin(Hb),platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),international normalized ratio(INR),D-dimer(D-D),general patient information,transfusion records,comorbidities,and complications.Statistical analyses comprised comparative a-nalysis of coagulation profiles between diagnostic groups and ROC curve analysis to determine optimal diagnostic thresholds.Results:A total of 500 women with postpartum hemorrhage(blood loss＞1500 ml))were included in our study,88 cases(17.6％)met CDSS obstetric criteria for DIC,369 cases(73.8％)met ISTH,Poor diagnostic agreement,the Kappa value was 0.117.There were differences in blood loss volume,Hb,PLT,FIB,PT,APTT,prothrombin ratio(PTR),and D-D between the two diagnostic criteria for DIC(P＜0.01).FIB＜1.0g/L in 47 cases(9.4％),PT＜14 s in 368 cases(73.6％),D-D＜5mg/L in 93 cases(18.6％).Correlation analysis demonstrated CDSS scores showed correlation with PT(r=0.449)and PTR(r=0.441),ISTH scores with PT(r=0.574)and PTR(r=0.578).ROC analysis showed that when CDSS,ISTH and the two obstetric criteria were met,the area under the ROC curve(AUC)of PLT was 0.926,0.769 and 0.982,and FIB was 0.896,1.000 and 1.000,respective-ly.ROC analysis for CDSS criteria showed for FIB(cutoff 1.87g/L,sensitivity 85.4％,specificity 84.1％),that AUC values were 0.851 for PT(cutoff 14.05 s,sensitivity 73.9％,specificity 85.4％),for D-D(cutoff 24.03 mg/L,sensitiv-ity 77.3％,specificity 83.3％).Conclusions:The two DIC diagnostic scores differ in diagnosing DIC in patients with postpartum hemorrhage.PLT and FIB are more effective.The ISTH obstetrics standard,including only coagu-lation indices,can't distinguish DIC from dilution coagulation caused by postpartum hemorrhage.The scoring of FIB and PT according to the CDSS obstetric criteria may result in missed diagnoses,while the scoring of D-D may contribute to an increased false-positive rate.The scores for coagulation indices in obstetric DIC require further verification and adjustment.

With the progress of society and the continuous improvement of people′s living standards in China, the public′s demand for medical services is becoming increasingly diversified. How to move hospital services forward and improve medical services centered on patients has become a key consideration for hospitals to enhance patients′ sense of medical satisfaction. A certain hospital has established a one-stop patient service hotline, integrating functions such as number inquiry, medical consultation, appointment registration, appointment examination, praise and suggestions, complaint follow-up, etc., injecting a complaint handling management mode, and responding to and solving patient feedback problems in a timely manner. Since the launch of the patient service hotline, it has effectively solved the problems that patients encountered during their visits, effectively reduced the hospital′s complaint rate, and initially formed a service closed-loop management. From March to October 2023, the demand ratio of the 12345 hotline in the hospital has continuously decreased, and was significantly lower than the average level of 22 municipal hospitals in Beijing. In the future, we should further improve the communication skills between doctors and patients, focus on managing appeals and services, and continue to strengthen proactive governance.

Objective To investigate the prevalence of high-risk HPV subtypes in different pathological types of cervical cancer, and analyze the attribution of carcinogenic HPV subtypes in different pathological types. Methods A total of 1 541 patients with cervical cancer were treated between February 2009 and October 2016 in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The median age at diagnosis was 49 years (ranged 20-82 years old). The numbers of patients with cervical cancer from North China, Northeast China, East China, Central China and other regions (including Northwest, Southwest and South China) were 961, 244, 175, 87 and 74 cases, respectively. Pathological types: 1 337 cases of squamous cell carcinoma (SCC), 87 usual adenocarcinoma (ADC), 23 adenosquamous carcinoma (ASC), 20 mucinous carcinoma (MC), 19 clear cell carcinoma (CCC), 12 endometrioid carcinoma (EC), 25 neuroendocrine carcinoma (NEC), 9 serous carcinoma (SC), 5 villous adenocarcinoma (VADC) and 4 minimal deviation adenocarcinoma (MDAC). The prevalence of high-risk HPV in different regions, age groups at diagnosis and pathological types in cervical cancer were analyzed. The attribution of 13 high-risk HPV subtypes in different pathological types of cervical cancer based on proportional attribution method, and the attribution of high-risk HPV subtypes prevented by 9-valent HPV vaccine in SCC and ADC were calculated. Results (1) The prevalence of high-risk HPV in 1 541 patients with cervical cancer was 86.6% (1 335/1 541). The multiple high-risk HPV infection rate in patients with SCC ≥60 years old (23.0%, 37/161) was significantly higher than those in patients aged 45-59 years old and≤44 years old [11.4% (85/747) vs 11.7% (50/429), P<0.01], and the high-risk HPV infection rates of patients with cervical cancer in North China, Northeast China, East China, Central China and other regions were respectively 86.8% (834/961), 87.7% (214/244), 83.4% (146/175), 83.9% (73/87) and 91.9% (68/74). SCC (86.8%, 1 337/1 541) and ADC (5.6%, 87/1 541) were the most common pathological types in cervical cancer. The high-risk HPV prevalence of SCC, ADC, ASC, MC, NEC and VADC were 90.1% (1 205/1 337), 74.7% (65/87), 87.0% (20/23), 65.0% (13/20), 72.0% (18/25) and 5/5 respectively. The high-risk HPV infection rates of SC, EC, CCC and MDAC were 4/9, 3/12, 2/19 and 0/4 respectively. (2) According to proportional attribution, HPV 16 (69.5%), HPV 18 (5.6%), HPV 58 (2.2%), HPV 31 (1.9%), HPV 52 (1.4%) and HPV 33 (1.3%) were the six common high-risk HPV subtypes in SCC. While, HPV 18 (44.1%), HPV 16 (20.5%), HPV 52 (2.3%), HPV 58 (1.2%) and HPV 51 (1.2%) were the main carcinogenic subtypes in ADC. The main carcinogenic high-risk HPV subtypes of ASC, NEC and MC were HPV 18 and HPV 16. The total attribution of HPV 16, 18, 31, 33, 45, 52 and 58 prevented by 9-valent HPV vaccine in SCC and ADC were 82.6% and 68.1% respectively; the attribution of HPV 45 in SCC and ADC were only 0.8% and 0. Conclusions SCC and ADC are the main pathological types in cervical cancer. SCC, ADC, ASC, MC, NEC and VADC are closely related to high-risk HPV infection. HPV 16 is the main carcinogenic genotypes of SCC. HPV 18 maybe play an important role in the pathogenesis of ADC.