Objective:To compare the diagnostic efficacy of 22 G fine needle aspiration (FNA) needles and 22 G end-cutting fine needle biopsy (FNB) needles for solid pancreatic lesion using both cytological and histological examination.Methods:Clinical data of 116 patients who underwent endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNA/FNB) at the Digestive Endoscopy Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from June 2022 to March 2023 were retrospectively analyzed. Sixty-three patients sampled with 22 G FNA needles were the FNA group, and 53 sampled with 22 G FNB needles were the FNB group. The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and cytological and histological diagnostic yield of FNA needles and FNB needles for solid pancreatic lesions were compared.Results:There were no significant differences in age, gender, lesion location, lesion size, or the number of passes between the FNA group and the FNB group ( P>0.05). There were no significant differences in the diagnostic accuracy [93.7% (59/63) VS 90.6% (48/53), P=0.730], sensitivity [93.0% (53/57) VS 90.2% (46/51), P=0.732], specificity [100.0% (6/6) VS 100.0% (2/2), P=1.000], positive predictive value [100.0% (53/53) VS 100.0% (46/46), P=1.000] and negative predictive value [60.0% (6/10) VS 28.6% (2/7), P=0.335] of combined cytology and histology in distinguishing benign and malignant lesions between the two groups. In the FNA group, the diagnostic accuracy of combined cytology and histology was higher than cytology alone [93.7% (59/63) VS 81.0% (51/63), P=0.008], and was higher than histology alone without statistical significance [93.7% (59/63) VS 87.3% (55/63), P=0.125]. In the FNB group, the diagnostic accuracy of combined cytology and histology was higher than cytology alone [90.6% (48/53) VS 69.8% (37/53), P=0.001], but not than histology alone [90.6% (48/53) VS 90.6% (48/53)， P=1.000]. For solid masses located in pancreatic body/tail, the diagnostic accuracy for malignancy by histology using FNB needles tended to be higher than that of FNA needles [100.0% (17/17) VS 81.3% (26/32), P=0.080]. Conclusion:Both FNA needles and FNB needles exhibit adequate diagnostic yield for solid pancreatic masses when combining cytology and histology. FNB needles may offer a higher histological diagnostic yield.

Objective:To explore the risks of medication errors of insulin degludec (IDeg) in clinical application using failure mode and effect analysis (FMEA).Methods:A research group on the risk points of medication errors was established in the First Affiliated Hospital of Shandong First Medical University. The risk points of medication errors were collected through questionnaire survey, literature research, and on-the-spot investigation. The severity, frequency of occurrence, and likelihood of detection were scored to determine the risk priority number (RPN) and formulate corresponding preventive measures.Results:After comprehensive evaluation, 32 risk points were found in the 4 links of physician prescription, pharmacist dispensing, nurse administration, and patient medication. The RPN was ranked from high to low, and 10 key risk points (RPN>70 points) were selected. (1) The pharmacist did not give the patients guidance on the use of IDeg; (2) Patients did not know that they should actively report to the physicians about the use feeling and adverse reactions of the drug; (3) Patients did not clear about the content of medication monitoring; (4) Patients did not master how to use the drug; (5) Pharmacists did not conduct medication feedback survey on patients; (6) Patients did not attach importance or thought it was unnecessary to receive medication guidance from pharmacists; (7) Physician′s prescription was wrong, resulting in overdose; (8) Doctors and patients did not communicate well, and patients did not know what medicine they were using; (9) Pharmacists did not fully understand drug information such as drug properties, prohibited population, interaction, medication time, etc.; (10) Pharmacists ignored the commonly used dose of the drug, applicable population, and other information in the process of reviewing the prescription. According to above-mentioned risk points, the risk intervention suggestions of IDeg were put forward, including the maintenance of basic drug information, the prescription of doctors, the dispensing of pharmacists, the patient medication link, the nurse administration link, the collection of medication error reports, and the strengthening of personnel training.Conclusion:The FMEA method can be used to effectively find out the risk points of medication errors in the clinical application of IDeg, the priority of IDeg risk management can be determined through quantitative evaluation, and corresponding preventive measures can be formulated.

Objective:To compare the efficacy and safety of insulin degludec and insulin glargine U100 in patients with type 2 diabetes mellitus.Methods:This study was a retrospective cohort study. The subjects were patients with type 2 diabetes mellitus who were hospitalized in 13 3A-level general hospitals in Shandong Province from September 2018 to December 2021. According to the type of basal insulin used, the patients were divided into insulin degludec group and insulin glargine U100 group. The basic information and laboratory test results in patients in the 2 groups were collected, the differences of fasting blood glucose level and incidence of hypoglycemia between the 2 groups were compared. The patients with complete blood glucose monitoring data in the 2 groups were selected and their blood glucose fluctuations were compared.Results:A total of 1 152 patients were entered in the study, including 552 patients in the insulin degludec group and 600 patients in the insulin glargine U100 group. The difference in the basic conditions in patients in the 2 groups was not statistically significant (all P>0.05). After treatment, the fasting blood glucose levels in patients in the 2 groups were lower than those before treatment, with statistically significant differences [10.2 (8.8, 12.5) mmol/L vs. 7.5 (6.6, 8.7) mmol/L, Z=-19.443, P<0.001; 10.0 (8.6, 11.7) mmol/L vs. 7.8 (6.6, 9.0) mmol/L, Z=-15.449, P<0.001], but the difference in fasting blood glucose levels between the 2 groups after treatment was not statistically significant ( Z=-1.427, P>0.05). The incidence of hypoglycemia in the insulin degludec group was lower than that in the insulin glargine U100 group [1.09% (6/552) vs. 2.83% (17/600), Z=4.481, P=0.032]. The intraday blood glucose standard deviation, maximum blood glucose fluctuation range, postprandial blood glucose fluctuation range, and average blood glucose fluctuation range in patients with complete blood glucose monitoring data in the insulin degludec group were significantly lower than those in the insulin glargine U100 group [(1.7±0.6) mmol/L vs. (2.4±1.0) mmol/L, (4.5±1.6) mmol/L vs. (6.7±2.9) mmol/L, (1.8±1.0) mmol/L vs. (3.3±1.2) mmol/L, (2.9±1.3) mmol/L vs. (4.6±2.1) mmol/L; all P<0.001]. Conclusion:The efficacy of insulin degludec in the treatment of type 2 diabetes mellitus is equivalent to that of insulin glargine U100, but the risk of hypoglycemia and blood glucose fluctuation is lower.

Objective:To explore the risks of medication errors of insulin degludec (IDeg) in clinical application using failure mode and effect analysis (FMEA).Methods:A research group on the risk points of medication errors was established in the First Affiliated Hospital of Shandong First Medical University. The risk points of medication errors were collected through questionnaire survey, literature research, and on-the-spot investigation. The severity, frequency of occurrence, and likelihood of detection were scored to determine the risk priority number (RPN) and formulate corresponding preventive measures.Results:After comprehensive evaluation, 32 risk points were found in the 4 links of physician prescription, pharmacist dispensing, nurse administration, and patient medication. The RPN was ranked from high to low, and 10 key risk points (RPN>70 points) were selected. (1) The pharmacist did not give the patients guidance on the use of IDeg; (2) Patients did not know that they should actively report to the physicians about the use feeling and adverse reactions of the drug; (3) Patients did not clear about the content of medication monitoring; (4) Patients did not master how to use the drug; (5) Pharmacists did not conduct medication feedback survey on patients; (6) Patients did not attach importance or thought it was unnecessary to receive medication guidance from pharmacists; (7) Physician′s prescription was wrong, resulting in overdose; (8) Doctors and patients did not communicate well, and patients did not know what medicine they were using; (9) Pharmacists did not fully understand drug information such as drug properties, prohibited population, interaction, medication time, etc.; (10) Pharmacists ignored the commonly used dose of the drug, applicable population, and other information in the process of reviewing the prescription. According to above-mentioned risk points, the risk intervention suggestions of IDeg were put forward, including the maintenance of basic drug information, the prescription of doctors, the dispensing of pharmacists, the patient medication link, the nurse administration link, the collection of medication error reports, and the strengthening of personnel training.Conclusion:The FMEA method can be used to effectively find out the risk points of medication errors in the clinical application of IDeg, the priority of IDeg risk management can be determined through quantitative evaluation, and corresponding preventive measures can be formulated.

Objective:To compare the efficacy and safety of insulin degludec and insulin glargine U100 in patients with type 2 diabetes mellitus.Methods:This study was a retrospective cohort study. The subjects were patients with type 2 diabetes mellitus who were hospitalized in 13 3A-level general hospitals in Shandong Province from September 2018 to December 2021. According to the type of basal insulin used, the patients were divided into insulin degludec group and insulin glargine U100 group. The basic information and laboratory test results in patients in the 2 groups were collected, the differences of fasting blood glucose level and incidence of hypoglycemia between the 2 groups were compared. The patients with complete blood glucose monitoring data in the 2 groups were selected and their blood glucose fluctuations were compared.Results:A total of 1 152 patients were entered in the study, including 552 patients in the insulin degludec group and 600 patients in the insulin glargine U100 group. The difference in the basic conditions in patients in the 2 groups was not statistically significant (all P>0.05). After treatment, the fasting blood glucose levels in patients in the 2 groups were lower than those before treatment, with statistically significant differences [10.2 (8.8, 12.5) mmol/L vs. 7.5 (6.6, 8.7) mmol/L, Z=-19.443, P<0.001; 10.0 (8.6, 11.7) mmol/L vs. 7.8 (6.6, 9.0) mmol/L, Z=-15.449, P<0.001], but the difference in fasting blood glucose levels between the 2 groups after treatment was not statistically significant ( Z=-1.427, P>0.05). The incidence of hypoglycemia in the insulin degludec group was lower than that in the insulin glargine U100 group [1.09% (6/552) vs. 2.83% (17/600), Z=4.481, P=0.032]. The intraday blood glucose standard deviation, maximum blood glucose fluctuation range, postprandial blood glucose fluctuation range, and average blood glucose fluctuation range in patients with complete blood glucose monitoring data in the insulin degludec group were significantly lower than those in the insulin glargine U100 group [(1.7±0.6) mmol/L vs. (2.4±1.0) mmol/L, (4.5±1.6) mmol/L vs. (6.7±2.9) mmol/L, (1.8±1.0) mmol/L vs. (3.3±1.2) mmol/L, (2.9±1.3) mmol/L vs. (4.6±2.1) mmol/L; all P<0.001]. Conclusion:The efficacy of insulin degludec in the treatment of type 2 diabetes mellitus is equivalent to that of insulin glargine U100, but the risk of hypoglycemia and blood glucose fluctuation is lower.

Objective:To investigate the prognostic value of infarct size (IS) in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI).Methods:A total of 104 patients with acute STEMI who underwent primary PCI treatment in Shengjing Hospital of China Medical University from February 2017 to November 2018 were included in the present study. All patients underwent cardiovascular magnetic resonance (CMR) within one week after primary PCI treatment. The subjects were followed up for two years. Major adverse cardiac events (MACE) included new onset congestive heart failure and/or recurrent nonfatal myocardial infarction and/orcardiac death. The optimal IS cutoff value for MACE was determined by receiver operating character (ROC) curve. Based on the IS cutoff value, the patients were divided into the high IS group and the low IS group. Clinical characteristics between the two groups were compared. A cox regression model was used to analyze the prognostic value of IS in acute STEMI patients treated with primary PCI for the adverse events.Results:The IS cutoff value determined by ROC curve was 13.55%. 50 patients were in the high IS group (IS≥13.55%) and 54 patients were in the low IS group (IS<13.55%). More female patients [14 cases (28.0%) vs. 6 cases (11.1%)] were in the IS group, and a higher proportion of patients in the high IS group had anterior myocardial infarction [27 cases (54.0%) vs. 16 cases (29.6%)] or microvascular obstruction [32 cases (64.0%) vs. 16 cases (29.6%)]. White blood cell counts [11.25(8.90, 13.38) ×10 9/L vs. 9.25(7.58, 11.00) ×10 9/L], troponin I levels [50.63(16.56, 76.30)μg/L vs. 16.58(2.66, 38.42)μg/L] and brain natriuretic peptide levels [178.10(79.70, 281.95)μg/L vs. 79.60(42.83, 183.90)μg/L] in the high IS group were higher than those in the low IS group ( P<0.05), and left ventricular ejection fraction [(45.15±10.65)% vs. (51.95±12.91)%] in the high IS group was lower than that in the low IS group ( P<0.05). Multivariate Cox regression analyses showed that IS was independently associated with the risk of cardiac death in patients with acute STEMI two years after primary PCI( P=0.033, HR=1.075, 95% CI1.006-1.148). Every 1% increase in IS was associated with a 7.5% increase in cardiac death. Conclusions:Infarct size, measured by CMR within one week after primary PCI, is strongly associated with cardiac death in patients with acute STEMI two years after primary PCI. IS could be used as an index for the prognosis of patients with acute STEMI.

Objective:To investigate the characteristics of short-term prognostic factors in very elderly patients with acute coronary syndrome (ACS).Methods:A total of 2 912 ACS patients admitted to Shengjing Hospital of China Medical University from January 1, 2010 to October 31, 2014 and treated with percutaneous coronary intervention (PCI) were enrolled and divided into two groups according to age: very elderly group (≥75 years, 480 cases) and control group (< 75 years, 2 432 cases). The clinical data and coronary artery lesions of the included patients were detected. Major cardiovascular adverse events (MACE) occurred within 30 d after discharge were followed up and recorded. The short-term prognostic factors in very elderly patients with ACS were analyzed by Logistic regression.Results:Compared with control group, the percentage of hypertension, global registry of acute coronary events (GRACE) score, high density lipoprotein cholesterol, N-terminal pro-brain natriuretic peptide, the left main lesion ratio and Gensini score in very elderly group were higher, while the percentage of men, number of smoking, hyperlipidemia proportion, red blood cell count, white blood cell count, blood platelet count, albumin, and long term oral administration of aspirin, clopidogrel, statins, angiotensin receptor inhibitor after discharge were lower, and the differences were statistically significant ( P<0.01 or<0.05). During the follow-up period, the all-cause mortality in very elderly group was higher than that in control group: 2.5%(12/480) vs. 0.9% (21/2 432), and the difference was statistically significant ( P<0.01). Multivariate analysis showed that oral angiotensin converting enzyme inhibitor was a protective factor for elderly ACS patients after discharge ( OR = 0.046, 95% CI 0.006 to 0.383, P = 0.004). The receiver operating characteristic curve analysis showed that Gensini score ≥ 87.75 scores was a threshold value for all-cause mortality. The all-cause mortality ratio in high Gensini score (≥ 87.75 scores) group was higher than that in low Gensini score (<87.75 scores) group: 6.6% (9/137) vs. 0.9% (3/343), and the difference was statistically significant ( P<0.01). Conclusions:Very elderly patients with ACS have their own characteristics from both clinical history and prognostic factors. Patients with Gensini score of ≥ 87.75 scores should be closely observed, and drug treatment during hospitalization should be intensified if necessary. Follow-up should be strengthened for such patients, and oral drug treatment should be continued after discharge.

The widespread application of next generation sequencing (NGS) in clinical settings has enabled testing, diagnosis, treatment and prevention of genetic diseases. However, many issues have arisen in the meanwhile. One of the most pressing issues is the lack of standards for reporting genetic test results across different service providers. The First Forum on Standards and Specifications for Clinical Genetic Testing was held to address the issue in Shenzhen, China, on October 28, 2017. Participants, including geneticists, clinicians, and representatives of genetic testing service providers, discussed problems of clinical genetic testing services across in China and shared opinions on principles, challenges, and standards for reporting clinical genetic test results. Here we summarize expert opinions presented at the seminar and report the consensus, which will serve as a basis for the development of standards and guidelines for reporting of clinical genetic testing results, in order to promote the standardization and regulation of genetic testing services in China.

Objective:To analyze PD-L2 expression on monocytes of peripheral blood cells in systemic lupus erythematosus ( SLE) and it′s correlation with the degree of disease activity .Methods:Peripheral blood of 26 cases of SLE patiens and 38 cases of healthy controls were collected .Peripheral blood mononuclear cells ( PBMC) were isolated and realtime PCR was carried on to analyze the PD-L2 gene expression.At the same time flow cytometry was performed to analyze the CD 14 and PD-L2 expression.Results:PD-L2 was significantly up-regulated on monocytes in RA patients than in healthy controls and had correlation with the disease activity and the SLEAI score.Conclusion:These findings help to clarify the function of PD-L2,including its potential role as a biomarker for SLE .

Objective To evaluate efficacy of healthy canteen based-nutritional health promotion so as to provide evidence for popularization and application.Methods A total of 429 college professors and administrative staffs with a healthy canteen were selected as the intervention group in 2012 in Changzhou,and another 947 counterparts without a healthy canteen were selected as the control group.Those of the intervention group was further assigned to the ≥2 times/week and＜2 times/week subgroups.Blood pressure,fatty liver,serum triglycerides,blood glucose,total cholesterol,uric acid,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol and body mass index(BMI)were tested before and after the intervention.Results After the intervention,the mean serum glucose[(5.06±0.62)mmol/L],uric acid[(310.57 ± 71.79)μmol/L],total cholesterol[(4.88 ± 0.86)mmol/L],triglycerides[(1.39 ± 0.67)mmol/L]and low-density lipoprotein cholesterol[(2.51 ±0.62)mmol/L]of the intervention group were significantly decreased(t values were 7.513,2.126,2.062,3.731 and 8.891,respectively; all P＜0.05),and mean high-density lipoprotein cholesterol[(1.43±0.34)mmol/L]were significantly increased(t=-2.309,P＜0.05).After the intervention,mean serum glucose and uric acid of the control group were significantly increased(t values were-3.491 and-7.703,respectively; both P＜0.05),although there was no statistically significant difference of mean serum triglycerides,total cholesterol,low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in the control group before and after the intervention(all P＞0.05).The abnormality rates of serum glucose,uric acid,total cholesterol,triglycerides,low-density lipoprotein cholesterol and BMI as well as the incidence of hypertension of the intervention group were significantly decreased after the intervention(x2 values were 4.202,3.940,4.031,7.305,59.422,4.273 and 7.385,respectively; P＜0.05).In the control group,although the abnormality rate of serum uric acid and the incidence of fatty liver were significantly inclined after the intervention(x2 values were 23.740 and 7.408,respectively; both P＜0.05),there were no significant difference of abnormal serum triglycerides,glucose,total cholesterol,low-density lipoprotein cholesterol and BMI as well as the incidence of hypertension before and after the intervention(all P＞0.05).Mean serum triglycerides[(1.15 ±0.68)mmol/L]and low-density lipoprotein cholesterol[(2.4 1±0.60)mmol/L]in the ≥2 times/ week subgroup were significantly lower than those of the＜2 times/week subgroup(t values were-4.884 and-2.513,respectively; both P＜0.05),and mean high-density lipoprotein cholesterol[(1.46±0.33)mmo]/L]of the ≥2 times/week subgroup was significantly higher than that of the＜2 times/week subgroup(t=2.032,P＜0.05).The abnormality rates of serum total cholesterol,triglyceride and low-density lipoprotein cholesterol in the ≥ 2 times/week subgroup were significantly lower than those in the＜2 times/week subgroup(x2 values were 3.963,9.947 and 4.589,respectively; all P＜0.05).Conclusion Healthy canteen based-nutritional health promotion model may provide an effective method to prevent and control the development of noncommunicable chronic diseases.