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 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 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.

Objective To identify proteomic biomarkers in serum samples and to construct a pro-teomic model for diagnosis of anti-SSA and anti-SSB negative primary Sj?gren′s syndrome ( pSS) .Methods Serum proteomic spectra were generated by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) in combination with weak cation exchange (WCX) magnetic beads. The proteomic data were analyzed by Ciphergen ProteinChip and BioMarker Wizard software .The protein peaks were further analyzed by Biomarker Patterns Software to screen the representative proteomic biomark -ers, which were to be used to construct a decision tree model for the diagnosis of anti -SSA and anti-SSB neg-ative pSS.Results Ten mass-to-charge (m/z) peaks with significant difference were identified among sub-jects with antibody-negative pSS and antibody-positive pSS (P<0.05).Among them, the protein peaks with the m/z value of 6625 .004 and 27993 .280 were selected as potential biomarkers to construct the diag-nostic decision tree model .The sensitivity and specificity of the model were 77.8%and 90.9%respectively as indicated by a double blind study .Conclusion The potential protein biomarkers for seronegative pSS could be identified by MALDI-TOF-MS in combination with WCX magnetic beads .A proteomic model for the diagnosis of seronegative pSS was successfully constructed with an advantage of good sensibility and specifici -ty based on the protein peaks with m/z value of 6625 .004 and 27993 .280 .

Objective To investigate the clinical significance of soluble Mer receptor tyrosine kinase (sMerTK) in patients of systemic lupus erythematosus.Methods sMerTK was detected in the serum of 101 SLE patients,96 disease controls and 62 healthy controls (HC) by sandwich enzyme-linked immunosorbent assay (ELISA).The relationships between the serum levels of sMerTK and clinical manifestations,laboratory parameters,disease activity were investigated in SLE patients.Comparisons between groups were tested by t-test and x2 test,Correlation of parameters were analyzed by Spearman method.Results sMerTK levels in SLE patients [(10.6±6.0) ng/ml] was significantly higher than disease controls [(4.4±2.0) ng/ml] (t=9.704,P＜0.01) and healthy controls [(2.8±2.5) ng/ml] (t=11.505,P＜0.01).The concentrations in SLE patients were independent of gender,age and disease duration.The levels of sMerTK were negatively correlated with white blood cell (r=-0.236,P=0.017),hemaglobin(r=-0.354,P＜0.01),platelet values (r=-0.310,P=0.002).Compared with the patients without lupus nephritis (LN)[(9±6) ng/ml],patients with LN had higher concentrations in serum [(11±6) ng/ml],and the difference was statistically significant (t =2.071,P=0.041).In addition,sMerTK levels were also correlated with 24 h-urinary protein level (r=0.293,P=0.013),serum creatinine (r=0.250,P=0.035) and e-GFR (r=-0.201,P=0.045).Furthermore this study indicated that sMerTK was negatively correlated with C3 (r=-0.447,P＜0.01) and C4 (r=-0.357,P＜0.01)level,but positively correlated with anti-dsDNA antibody titers (r=0.360,P＜0.01),anti nucleosome antibody (AnuA) (r=0.264,P=0.016) and SLEDAI (r=0.473,P＜0.01).Conclusion sMerTK level is increased in SLE patients.The concentration may associate with hematology changes and lupus nephritis.It may be an indicator of disease activity.

Objective To establish new classification criteria for early rheumatoid arthritis (E-RA) based on large samples of early inflammatory arthritis patients and to evaluate the value of this criteria in China.Methods Patients who had arthritic complaints with disease duration less than one year were enrolled.They were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists.The clinical and laboratory parameters were analyzed and those with high sensitivity or specificity were selected as the new classification criteria.Statistical analysis was carried out by using t test,x2 test and Logistic regression.Results ① A total of 803 patients with early inflammatory arthritis were included in this study.Five hundreds and fourteen patients were diagnosed as early RA and 251 were diagnosed as other rheumatic diseases,and the diagnosis of 38 patients remained unestablished by the end of follow-up.② New E-RA classification criteria were established based on the parameters with high sensitivity and/or specificity.The sensitivity of the new E-RA criteria was 84.4％,which was higher than 1987 ACR criteria (58.0％),while the corresponding specificities were similar,which were 87.4％ and 93.6％ respectively.③ Compared with the complex scoring system of 2010 ACR/EULAR criteria,the E-RA criteria was more simple and practical.The diagnostic sensitivity and specificity of E-RA criteria were higher than those of 2010 ACR/EULAR criteria reported in the literatures.④ New classification criteria based on scoring system using Logistic regression analysis was established.The sensitivity of this criteria was 86.4％,which was higher than 1987 ACR criteria (58.0％).Conclusion The diagnostic value of the E-RA criteria developed in this study for early RA is better than 1987 ACR criteria,and is more simple than 2010 ACR/EULAR criteria.It may be used as a new classification criteria for early RA diagnosis.

Objective To evaluate the clinical significance of the level of [gG4 in the bronchoalveolar lavage fluid (BALF) of patients with rheumatic disease related interstitial lung disease (RD-ILD).Methods Eighteen patients with RD-ILD,14 patients with pulmonary infection and 12 patients without ILD or pulmonary infection,were recruited consecutively from the in-patient ward of Peking University People's Hospital.Clinical features and laboratory data were extracted from the medical record database of Peking University People's Hospital.The level of IgG4 was determined by ELISA.The statistical analysis of data using t test,and the correlation between the two variables were analyzed using linear regression analysis.Results The level of IgG4 was significantly higher in BALF of patients with RD-ILD than patients' without ILD or pulmonary infection,whereas there was no difference compared to patients with pulmonary infection.The level of IgG4 in BALF of patients with RD-ILD was positively correlated with the percentage of lymphocytes (r=0.53,P=0.03),and significantly negatively correlated with the percentage of macrophages (r=-0.65,P=0.005).Conclusion The level of IgG4 is significantly elevated in BALF of patients with RD-ILD,which is probably secreted from the lymphocyte of the lung.