Objective:To construct a quality control indicator system for the performance of extracorporeal membrane oxygenation(ECMO)equipment during clinical use,and to improve scientific evaluation ability for the reliability of clinical application of ECMO products,so as to provide guarantees for ECMO technical specifications and its reliability in clinical application.Methods:The ECMO industry standard specifications,relative research literature and ECMO equipment operation manuals were retrieved,and the quality control indicators of ECMO performance parameters were summarized and organized.The items of indicators were analyzed through individual interviews and group discussions.Three rounds of expert inquiries were conducted using the Delphi method to construct indicator library of ECMO performance parameters.And then,a key performance indicator system of clinical quality control for ECMO equipment was constructed through analyzed the weight of each indicator.Results:The key performance indicator system of clinical quality control for ECMO equipment included 3 key components(primary indicators)(centrifugal pump,air oxygen mixer,and water tank of variable temperature),6 performance parameters(secondary indicators)(flow rate of blood pump,blood pump speed,oxygen concentration,temperature,pressure pre operating pump,and pressure post operating pump),and 6 performance testing ranges(tertiary indicators),all of which were indicators of quality control for ECMO performance.Conclusion:This research organized an indicator system of clinical quality control for ECMO equipment through analyzed the key performance indicators of ECMO equipment,and constructed quality control template for ECMO in clinical application,and conducted beneficial explorations for the management of quality control for ECMO equipment in clinical application.

OBJECTIVE To optimize the prescription pre-review system in our hospital and evaluate its application effects. METHODS Aiming at the problems of imperfect rule base and high false positive rate in the early operation of the system， optimization measures were taken， including improving the content of the rule base， adjusting the interception level and prompt mode， refining the working model of prescription review pharmacists， and strengthening clinical communication. A retrospective cohort study was conducted， with prescription data from June to December 2023 （before optimization） as the control group and June to December 2024 （after optimization） as the observation group. Through inter group comparative analysis， the actual effect of optimizing the prescription pre-approval system was evaluated. RESULTS The prescription qualified rate increased from （82.51± 4.04）% before optimization to （90.98±1.55）% after optimization； the false positive rate decreased from （20.87±1.64）% before optimization to （7.41±2.04）% after optimization. The monthly range of prescription qualified rate narrowed from 10.24% to 4.11%， and the coefficient of variation decreased from 4.92% to 1.73%. The monthly range of false positive rate slightly increased from 4.40% to 5.34%， the coefficient of variation rose from 8.32% to 26.18%. CONCLUSIONS Through multi-dimensional optimizations of the prescription pre-review system in our hospital， its prescription review efficiency has been significantly enhanced， the quality of prescriptions has steadily improved， and the accuracy of reviews has notably improved.

Objective:To construct a quality control indicator system for the performance of extracorporeal membrane oxygenation(ECMO)equipment during clinical use,and to improve scientific evaluation ability for the reliability of clinical application of ECMO products,so as to provide guarantees for ECMO technical specifications and its reliability in clinical application.Methods:The ECMO industry standard specifications,relative research literature and ECMO equipment operation manuals were retrieved,and the quality control indicators of ECMO performance parameters were summarized and organized.The items of indicators were analyzed through individual interviews and group discussions.Three rounds of expert inquiries were conducted using the Delphi method to construct indicator library of ECMO performance parameters.And then,a key performance indicator system of clinical quality control for ECMO equipment was constructed through analyzed the weight of each indicator.Results:The key performance indicator system of clinical quality control for ECMO equipment included 3 key components(primary indicators)(centrifugal pump,air oxygen mixer,and water tank of variable temperature),6 performance parameters(secondary indicators)(flow rate of blood pump,blood pump speed,oxygen concentration,temperature,pressure pre operating pump,and pressure post operating pump),and 6 performance testing ranges(tertiary indicators),all of which were indicators of quality control for ECMO performance.Conclusion:This research organized an indicator system of clinical quality control for ECMO equipment through analyzed the key performance indicators of ECMO equipment,and constructed quality control template for ECMO in clinical application,and conducted beneficial explorations for the management of quality control for ECMO equipment in clinical application.

Objective:To investigate the current situation and organizational management policies of government procurement in public hospitals,and to improve the level of standardized management of government procurement.Methods:An electronic questionnaire survey was conducted to investigate the current status of organization and administration of government procurement in different types and levels of public hospitals across the country.The current situation of the organizational structure,management system,working mode,supervision and evaluation,budget establishment,bidding and procurement,contract signing,acceptance process,payment management,and other aspects of government procurement management in public hospitals were analyzed.Results:A total of 216 valid questionnaires were collected from 216 public hospitals in 28 provinces,municipalities and autonomous regions across the country,including 165 general hospitals,37 specialized hospitals and 13 traditional Chinese medicine hospitals,accounting for 76.39％,17.13％and 6.02％respectively;among the hospital levels,there were 202 tertiary hospitals(accounting for 93.52％).Among the surveyed government procurement management institutions of public hospitals,there were 112,103,110 and 112 organizations at the four levels of procurement management committee,procurement management office,procurement center and business and administrative logistics department,accounting for 51.85％,47.69％,50.93％and 51.85％respectively.The quota standards for public bidding for government procurement in all hospitals were in line with the requirements of national laws and regulations.The approval of funds payment must conditions of each hospital complied with relevant requirements.In terms of management effects of risk prevention and control,the hospitals with very good,good,average and inadequate were 48,125,34 and 9 respectively,accounting for 22.22％,57.87％,15.74％and 4.17％.Conclusion:The organizational framework and management system of government procurement in public hospitals are becoming increasingly standardized,and there are certain differences in the work mode and process of government procurement in different hospitals,and the supervision and evaluation are relatively weak,which is worthy of attention and strengthened administration.

BACKGROUND: Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia. METHODS: In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared. RESULTS: A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94-0.99), 0.93 (95% CI: 0.85-0.98), and 0.94 (95% CI: 0.87-0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63-0.83), 0.72 (95% CI: 0.62-0.82), and 0.73 (95% CI: 0.62-0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers' interpretation and clinical factor model ( P <0.05). CONCLUSIONS The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.
Humans ; Retrospective Studies ; Pneumonia/diagnostic imaging* ; Analysis of Variance ; Tomography, X-Ray Computed ; Lymphoma/diagnostic imaging*

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

To investigate the safety and feasibility of indocyanine green ( ICG ) fluorescence staining guided by laparoscopic ultrasound guiding portal branch puncture approach in anatomical segmentectomy of the liver . Methods The clinical data of 22 patients with malignant liver diseases underwent anatomical segmentectomy between February 2018 and M ay 2018 were retrospectively analyzed . ICG 0 .125～0 .250 mg was directly injected into the portal branches supplying blood flow to the tumor‐bearing hepatic segment , after puncturing of the target portal branch under intraoperative laparoscopic ultrasound guidance in all patients . T he fluorescence imaging system ( Pinpoint) was used for the resection procedure . Observation indicators :intraoperative conditions ( tumor diameter ,success rate of portal branches puncture ,success rate of staining the target hepatic segment ,intraoperative complications , time of operation ,volume of intraoperative blood loss , blood transfusion , and transit of laparotomy ) . Postoperative conditions :postoperative complications ,and length of hospital stay . Results Twenty‐two patients with liver tumors were all performed anatomical hepatectomy assisted by laparoscopic ultrasound guiding ICG injection for liver segment staining . All the liver tumors were hepatocellular carcinoma . ①Intraoperative conditions : T he portal branches puncture successful rate was 100% ( 22/22 ) . Eighteen patients achieved expected effect of ICG fluorescence staining ,with a satisfaction rate of 81 .8% (18/22) and 4 failed to get expected effect ,including 2 with uneven dying ,and 2 with adjacent hepatic segmental staining induced to unclear boundary . No complication such as allergy occurred in all patients after ICG injection . T he mean operation time was ( 209 ± 89 ) min ( range :97 ～ 325 min) and the target portal branches ICG puncture injection time under intraoperative laparoscopic ultrasound guidance was ( 11 ± 5) min ( range 3－25 min) . T here was no intraoperative blood transfusion or transit of laparotomy .Average tumor diameter was ( 3 .9 ± 1 .3) cm( range :2 .2－7 .0 cm ) . ②Postoperative conditions of 22 patients ,4 with grade Ⅰ － Ⅱ of Clavien‐Dindo classification were improved by drug treatments ( 1 with deep venous thrombosis of the lower extremities and 3 with pleural effusion ) , no patient had grade Ⅲ and above complications , and no perioperative death occurred . Average duration of hospital stay was ( 7 ± 2 ) days in 22 patients ( range :5 .0－14 .0 days) . Conclusions ICG fluorescence staining guided by laparoscopic ultrasound guiding portal branch puncture ,obtains accurate and lasting fluorescence markers on the liver surface and inside the parenchyma . ICG staining guides the selection of liver section in the operation of liver in real time ,and helps surgeons to perform laparoscopic anatomical segmentectomy of the liver .

Objective To compare the etiology of vertigo patients between flying personnel group and ordinary group and to provide evidence for the accurate diagnosis of vertigo or dizziness and the aeromedical assessment. Methods One thousand and sixteen ordinary vertigo patients,who were diagnosed by the Vertigo Center of Former Air Force General Hospital of PLA in the period from January 2017 to April 2018,were assigned to ordinary group.One hundred and fifty-three vertigo inpatients and outpatients of flying personnel,who were diagnosed by the hospital in the period from September 1984 to Augut 2018,were selected as flying personnel group.The etiological stratification analysis was conducted upon the gender and age in ordinary group.The disease spectrum was analyzed in flying personnel group.The etiological characteristics were compared between two groups. Results①In ordinary group,1 265 etiological factors were found in 1 016 vertigo patients (some of them had 2 or more etiologies).The top 7 etiological factors of the vertigo patients in ordinary group were benign paroxysmal positional vertigo (BPPV)that took 32.73 % (414/1 2 6 5 ),vestibular migraine (VM),31.46% (398/1 265 ),hypertension 12.96% (164/1 265 ),diabetes 4.03% (51/1 265 ), Meniere,s disease(MD)3.87%(49/1 265),vestibular neuritis(VN)3.87%(49/1 265),and cerebral infarction 3.24%(41/1 265).1.43%(1 7/1 265)cases were unable to categorize clearly.②The patients of ordinary group,aged from 8 to 89 yrs,were categorized to <21 yrs,21-40 yrs,41-60 yrs and >60 yrs subgroups.The top 4 etiological factors for <21 yrs group were VM (43.37%),BPPV (15.79%),VN(10.53%),and sudden deafness with vertigo(10.53%);for 21-40 yrs group were VM (46.86%),BPPV(29.7 1 %),VN (5 .86%),and hypertension (4.60%);for 41-60 yrs group were BPPV(35 .1 7%),VM(3 1 .54%),hypertension(12.30%),and MD(4.73%);and for >60 yrs group were BPPV (3 1 .28%),VM (20.5 9%),hypertension (20.05%),and cerebral infraction (6.68%). Detection rate of the top 7 etiological factors had significant difference in different age groups except VN and MD (χ2=1 3 .45-5 3 .1 6 ,P<0.0 1 ).③The etiological stratification by gender showed that the ratio of male to female was 1.00︰1.57.Detection rate of VM in female was higher than that in male. Detection rate of hypertension,MD and VN in male was higher than that in female,the difference was satistically significant (χ2=3.87-8.93,P<0.05).④In flying personnel group,184 etiological factors were found in 153 vertigo patients (some of them had 2 or more etiologies).Top 3 etiological factors were motion sickness(MS)that took 1 1 .41%(21/184),VN that took 10.32%(1 9/184)and MD that took 9.78% (18/184 ).The dizziness or vertigo with no accurate etiology took 57.61 % (106/184 ).⑤The BPPV and VM detection rate in flying personnel group were less than those in ordinary group (χ2=78.34,78.7 7 ,P<0.0 1 ).The dizziness or vertigo cases with no accurate etiology and MS,MD, VN and alternobaric vertigo cetection rate in flying personnel group were higher than those in ordinary group (χ2=6 .02-645 .5 9 ,P<0.05 ). Conclusions The causes of vertigo/dizziness are complex and diverse and patients may have more than one etiology.The etiological stratification analysis for patients is conducive to accurate diagnosis and treatment.Studying the difference of etiology between flying personnel and ordinary people will contribute to exploring the pathogenesis and prevention measures in flight environment and providing proof for aeromedical assessment.

Objective To compare the etiology of vertigo patients between flying personnel group and ordinary group and to provide evidence for the accurate diagnosis of vertigo or dizziness and the aeromedical assessment. Methods One thousand and sixteen ordinary vertigo patients,who were diagnosed by the Vertigo Center of Former Air Force General Hospital of PLA in the period from January 2017 to April 2018,were assigned to ordinary group.One hundred and fifty-three vertigo inpatients and outpatients of flying personnel,who were diagnosed by the hospital in the period from September 1984 to Augut 2018,were selected as flying personnel group.The etiological stratification analysis was conducted upon the gender and age in ordinary group.The disease spectrum was analyzed in flying personnel group.The etiological characteristics were compared between two groups. Results①In ordinary group,1 265 etiological factors were found in 1 016 vertigo patients (some of them had 2 or more etiologies).The top 7 etiological factors of the vertigo patients in ordinary group were benign paroxysmal positional vertigo (BPPV)that took 32.73 % (414/1 2 6 5 ),vestibular migraine (VM),31.46% (398/1 265 ),hypertension 12.96% (164/1 265 ),diabetes 4.03% (51/1 265 ), Meniere,s disease(MD)3.87%(49/1 265),vestibular neuritis(VN)3.87%(49/1 265),and cerebral infarction 3.24%(41/1 265).1.43%(1 7/1 265)cases were unable to categorize clearly.②The patients of ordinary group,aged from 8 to 89 yrs,were categorized to <21 yrs,21-40 yrs,41-60 yrs and >60 yrs subgroups.The top 4 etiological factors for <21 yrs group were VM (43.37%),BPPV (15.79%),VN(10.53%),and sudden deafness with vertigo(10.53%);for 21-40 yrs group were VM (46.86%),BPPV(29.7 1 %),VN (5 .86%),and hypertension (4.60%);for 41-60 yrs group were BPPV(35 .1 7%),VM(3 1 .54%),hypertension(12.30%),and MD(4.73%);and for >60 yrs group were BPPV (3 1 .28%),VM (20.5 9%),hypertension (20.05%),and cerebral infraction (6.68%). Detection rate of the top 7 etiological factors had significant difference in different age groups except VN and MD (χ2=1 3 .45-5 3 .1 6 ,P<0.0 1 ).③The etiological stratification by gender showed that the ratio of male to female was 1.00︰1.57.Detection rate of VM in female was higher than that in male. Detection rate of hypertension,MD and VN in male was higher than that in female,the difference was satistically significant (χ2=3.87-8.93,P<0.05).④In flying personnel group,184 etiological factors were found in 153 vertigo patients (some of them had 2 or more etiologies).Top 3 etiological factors were motion sickness(MS)that took 1 1 .41%(21/184),VN that took 10.32%(1 9/184)and MD that took 9.78% (18/184 ).The dizziness or vertigo with no accurate etiology took 57.61 % (106/184 ).⑤The BPPV and VM detection rate in flying personnel group were less than those in ordinary group (χ2=78.34,78.7 7 ,P<0.0 1 ).The dizziness or vertigo cases with no accurate etiology and MS,MD, VN and alternobaric vertigo cetection rate in flying personnel group were higher than those in ordinary group (χ2=6 .02-645 .5 9 ,P<0.05 ). Conclusions The causes of vertigo/dizziness are complex and diverse and patients may have more than one etiology.The etiological stratification analysis for patients is conducive to accurate diagnosis and treatment.Studying the difference of etiology between flying personnel and ordinary people will contribute to exploring the pathogenesis and prevention measures in flight environment and providing proof for aeromedical assessment.

Objective To investigate the significance of plasma protein S and growth-arrest specific protein 6 (Gas6) in systemic lupus erythematosus (SLE).Methods Sandwich enzyme-linked immunosorbent assay (ELISA) was used to measure the protein S and Gas6 in the plasma of 103 SLE patients and 40 healthy controls.Mann-Whitney U-test,x2-test and Spearman's rank correlation were used for statistical analysis.Results The plasma concentrations of protein S and Gas6 were both significantly [protein S:30.6 (27.2,33.6) μg/ml,37.8(35.4,46.7) μg/ml,Z=6.04,P＜0.01; Gas6:402.6(239.2,757.8) pg/ml,913.6(765.0,1 290.6) pg/ml,Z=4.26,P＜0.01] decreased in plasma of SLE patients than that in healthy controls.There was a positive correlation between levels of protein S and Gas6 (r=0.312,P=0.001).The level of protein S in SLE patients was positively correlated with hemoglobin (Hb),WBC,platelet blood platelet (PLT),C3 and C4 (r=0.209,0.264,0.264,0.362,0.280,P＜0.01 or P＜0.05).Plasma protein S level was also found to be negatively correlated with auto-antibodies such as anti-double strand DNA (anti-dsDNA) antibody,anticardiolipin (ACL),anti-nucleosome antibody (AnuA) or IgG (r=-0.197,-0.264,-0.226,-0.229,P＜0.01or P＜0.05).The plasma Gas6 level was positively associated with age,disease duration and C-reaction protein (CRP) (r=0.229,0.198,0.263,P＜0.01 or P＜0.05).Patients with decreased Gas6 level showed higher incidence of fever,rash and serositis.Patients with decreased WBC or positive for proteinuria also showed decreased Gas6 (P＜0.05).Conclusion Protein S levels are significantly decreased in plasma of SLE patients and is associated with a series of severe disease manifestations such as hematological involvement,decreased complements and the presence of auto-antibodies.Decreased Gas6 levels in SLE patients are observed and they are correlated with age,disease duration and certain clinical characteristics such as rash,renal involvement and inflammatory response.