Objective:To establish auto verification rules for the routine coagulation assays,and to provide reference for clinical laboratories to improve the quality and efficiency of results verification.Methods:A total of 24,510 specimens of sodium citrate anticoagulation routine coagulation test from the laboratory departments of eight hospitals including the First Medical Center,Chinese PLA General Hospital during January to March 2020 were collected and randomly divided into a rule establishment group and a rule verification group,with 6,670 specimens in the rule establishment group,including 2,056 Delta checks,and 17,840 specimens in the rule validation group,including 3,210 Delta checks.The activities of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),thrombin time(TT),D-dimer(DD)and/or antithrombin(AT)were detected by Stago STA R Max automatic coagulation analyzer and supporting reagents.Taking the manual verification results as the standard,the auto verification and manual false negative rate(invalid verification),false positive rate(invalid interception),pass rate,positive coincidence rate,negative coincidence rate,verification consistency rate and specimen turnaround time(TAT)of the two groups were calculated.Results:The auto verification rules and the application process were preliminarily established,including internal quality control,alarm information,auto verification scope,critical value and deviation value inspection.In the rule establishment group,the single item pass rate was 82.6%-92.4%,and the overall pass rate was 73.8%.The consistency rate between auto verification and manual verification was 98.2%,and the positive coincidence rate and negative coincidence rate were 24.4%and 73.8%,respectively.In the rule verification group,the single item pass rate was 86.4%-91.5%,and the overall review pass rate was 71.5%.By simulating the application of auto verification rules,the average TAT of two hospitals among the eight hospitals was shortened by 1.5 hours and 2.1 hours,respectively.Conclusion:The application of auto verification rules can reduce workload of manual verification,and significantly shorten the TAT,and improve the report efficiency of the laboratory.

Abstract: To investigate the differential expression of lncRNA SH3BP5-AS1 in hepatocellular carcinoma and the possible mechanism of promoting hepatocarcinogenesis. Methods: The expression of SH3BP5-AS1 in hepatocellular carcinoma tissue/paraneoplastic tissue(n=91) was detected by qRT-PCR. TCGA database visualization software UALCAN analyzed SH3BP5-AS1 expression in a large sample of hepatocellular carcinoma tissues(n= 371). The expression of SH3BP5-AS1 was detected by qRT-PCR in normal hepatocytes THLE-2 and hepatoma cell lines Huh 7, BEL-7405, SNU-387, Hep 3 B. After silencing SH3BP5-AS1 expression by siRNA technology, the effects of silencing SH3BP5-AS1 on the proliferation of Hep 3 B cells were detected by CCK-8 assay, cell clone formation assay and Edu assay, and the effects of silencing SH3BP5-AS1 on apoptosis and cycle of Hep 3 B cells were detected by flow-through assay. Based on the expression of SH3BP5-AS1 and TM6 SF2 in hepatocellular carcinoma tissues, the expression correlation was counted and analyzed. Results: SH3BP5-AS1 was highly expressed in hepatocellular carcinoma tissues. SH3BP5-AS1 was highly expressed in a large sample of hepatocellular carcinoma tissues from the TCGA database SH3BP5-AS1 was highly expressed in different hepatocellular carcinoma cell lines Huh 7, BEL-7405, SNU-387 and Hep 3 B to a different extent. Silencing of SH3BP5-AS1 by siRNA inhibited the proliferation ability of Hep 3 B cells, promoted apoptosis ability, affected the cell cycle and increased the number of G1 phase cells. SH3BP5-AS1 and TM6 SF2 expression were negatively correlated in hepatocellular carcinoma tissues. Conclusion SH3BP5-AS1 is an important oncogenic non-coding RNA that can provide a theoretical basis for tumour-targeted therapy in patients with hepatocellular carcinoma.

Objective:To investigate the nutritional status of elderly inpatients in China, and to assess its relationship with clinical outcomes.Methods:A prospective, multicenter, parallel investigation was organized and conducted by the Chinese Medical Association's Group of Geriatric Nutrition Support.Patients aged ≥65 years from 30 major hospitals of 14 cities in China were evaluated by the Nutritional Risk Screening 2002(NRS2002)and the Mini-Nutritional Assessment-Short Form(MNA-SF), in order to understand the nutritional status and nutritional risk of elderly inpatients in China.The indicators of clinical outcomes were summarized, and the correlation between nutritional status and clinical outcomes was analyzed.Results:A total of 10 184 elderly patients who met the inclusion criteria were enrolled in this study, aged 65-112(74.81±7.01)years, with a body mass index(BMI)of 17.80-35.50(23.32±3.83)kg/m 2.Grip strength of the dominant hand was(16.95±18.42)kg, upper arm circumference was(25.68±3.70)cm, and calf circumference was(32.07±3.89)cm.BMI, grip strength, upper arm circumference and calf circumference decreased significantly with age( F=13.74, 97.47, 28.31 and 88.68, all P<0.001). NRS2002 was conducted on 10 182 patients.Of them, 10.14%(895/10 182)suffered malnutrition(BMI≤18.5 kg/m 2), and 46.42%(4 726/10 182)were at nutritional risk(NRS2002 score≥3). Nutrition deficiency and nutritional risk showed upward trends with age( F=43.41 and 177.05, both P<0.001). A total of 9 755 patients(95.79%, 9 755/10 182)completed the MNA-SF.Of them, 14.67%(1 431/9 755)had malnutrition, 35.04%(3 418/9 755)were at risk of malnutrition, and 50.29%(4 906/9 755)had normal nutritional status.The incidence of malnutrition and the risk of malnutrition significantly increased with age( F=172.79, 12.10 and 152.42, all P<0.05). Nutritional risk(NRS2002 score≥3)was related to age, BMI, mortality, infectious complications, length of hospital stay and total hospital cost(all P<0.05). Conclusions:The incidence of malnutrition and the risk of malnutrition are high in elderly inpatients in China.Nutritional risk is an influencing factor for adverse clinical outcomes.

Objective:To evaluate the medium and long-term clinical efficacy of the treatment of lumbar degenerative diseases in Dynesys dynamic internal fixation combined with decompression.Methods:From March 2008 to March 2015, 145 patients (84 males and 61 females, mean age 55.9±7.1 years old) with symptoms of lumbar degenerative diseases (69 lumbar disc herniation, 53 lumbar spinal stenosis and 23 I grade lumbar degenerative spondylolisthesis) were treated by the lumbar discectomy using Dynesys dynamic internal fixation combined with decompression. The clinical symptoms before and after surgery were assessed by visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI). Lumbar lateral radiographs were used to measure the height of intervertebral space between the surgical segment and the adjacent segment. The range of motion (ROM) between the surgical segment and the adjacent segment was measured by lumbar dynamic position X-ray. Surgical and adjacent segments degenerative were classified according to the Pfirrmann grade classification.Results:The VAS score, ODI and JOA score of lower back and lower limbs in patients with lumbar disc herniation were improved from 6.6±1.7, 7.1±1.4, 63.1%±10.2%, 12.5±2.4 preoperatively to 2.6±1.0, 2.8±0.9, 30.9%±9.8%, 22.4±2.1 at the latest follow-up. The differences were statistically significant. The VAS score, ODI score and JOA score of lower back and lower limbs in patients with lumbar spinal stenosis were improved from 6.3±2.2, 6.9±1.3, 63.4%±8.5%, 12.8±2.7 preoperatively to 2.4±1.2, 2.8±1.0, 35.1%±12.0%, 22.2±2.2 at the latest follow-up. The differences were statistically significant. The VAS score, ODI score and JOA score of lower back and lower limbs in patients with I degree lumbar degenerative spondylolisthesis were improved from 5.7±2.3, 6.7±0.9, 65.7%±10.0%, 12.5±2.7 preoperatively to 2.2±1.2, 2.7±1.1, 37.0%±11.8%, 22.4±2.6 at the latest follow-up. The differences were statistically significant. Comparing to preoperational value, the height of the operative segment and caudal intervertebral space were decreased at the 1 year postoperatively and last follow-up. But the difference was not significant. As for cranial adjacent segment, the height of intervertebral space preoperatively was decreased from 12.1±1.9 mm preoperatively to 11.7±1.6 mm at 1 year postoperatively, and to 11.3±1.8 mm at the latest follow-up. The difference between them was statistically significant ( F=6.46, P=0.001). The ROM of surgical segments was decreased from 7.6°±2.2° preoperatively to 5.5°±1.6° at 1 year postoperatively, and to 2.9°±1.4° at the latest follow-up. The difference between them was statistically significant ( F=267.9, P<0.001). Conversely, the ROM of cranial and caudal segments was increased from 8.2°±2.4°, 6.5°±1.6° preoperatively to 9.1°±2.1°, 7.1°±1.9° at 1 year postoperatively, and to 10.6°±2.5°, 7.2°±1.8° at the latest follow-up. The difference between them was statistically significant ( F=38.66, 3.81, P<0.001, 0.023). At the latest follow-up, 120 (51.9%) adjacent segments were to be defined adjacent segment degeneration which includes 103 radiological adjacent segment degeneration and 17 symptomatic adjacent segment degenerations. Conclusion:Dynesys dynamic internal fixation combined with decompression could achieve satisfying mid- and long-term therapeutic effect in the treatment of lumbar degenerative diseases. The ROM of surgical segments decreased with time, although part of the ROM was still retained at the latest follow-up. However, it does not seem to avoid the degeneration of adjacent segment.

Targeting the poor powder characteristics of the contents in Hewei Jiangni Capsules, this study characterized the powder properties of the contents and employed particle design technique for improving the content quality. The content composite particles of Hewei Jiangni Capsules prepared by the particle design technique were evaluated by scanning electron microscopy(SEM), followed by infrared ray(IR), content uniformity, and in vitro dissolution detection. It was found that there was a good correlation between the crushed particle size of slices and the crushing time, and the calcined Haematitum was responsible for the poor content uniformity. After the fine powder of calcined Haematitum was super-finely ground for 8.5 min and those of the other contents in the capsule for 1 min, they were prepared into the composite particles, whose property characterizations were compared with those of the physical mixtures. The content uniformity of the prepared composite particles was significantly improved, and the preparation process was stable and reliable. The adoption of particle design technology to correct the poor uniformity of the physical mixture, solve the pharmaceutical defects of Hewei Jiangni Capsules, and improve the quality of prescriptions has provided important reference for the clinical application and development of Chinese medicinal preparations.
Capsules ; Microscopy, Electron, Scanning ; Particle Size ; Powders

Based on the defects in powder properties of the contents of Ziyin Yiwei Capsules, this study screened out the main medicinal slice powders causing the poor powdery properties, and introduced the powder modification process to improve the powdery properties of these slice powders, the pharmaceutical properties of the capsule contents, and the content uniformity of Ziyin Yiwei Capsules, so as to provide a demonstration for the application of powder modification technology to the preparation of Chinese medicinal solid preparations. Through the investigation on the powder properties of the contents of Ziyin Yiwei Capsules, it was clarified that the pulverized particle size of the capsule contents had a good correlation with the pulverization time. According to the measurement results of the powder fluidity and wettability, the quality defects of the capsule contents were caused by the fine powders of Taraxaci Herba and Lungwortlike Herba. "Core-shell" composite particles were prepared from medicinal excipients magnesium stearate and fine powders of Taraxaci Herba and Lungwortlike Herba slices after ultra-fine pulverization to improve the powder properties of the problematic fine powders. Powder characterization data including fluidity and wettability were measured, followed by scanning electron microscopy(SEM) and infrared ray(IR) detection. It was determined that the optimal dosage of magnesium stearate was 2%, and the compositing time was 3 min. The composite particles were then used as content components of the Ziyin Yiwei Capsules. The powder characteristics between the original capsule and the modified composite capsule including the particle size, fluidity, wettability, uniformity of bulk density, and uniformity of chromatism as well as the content uniformity and in vitro dissolution were compared. The results showed that the powder characteristics and content uniformity of the prepared composite capsule were significantly improved, while the material basis of the preparation was not changed before and after modification. The preparation process was proved to be stable and feasible. The powder modification technology solved the pharmaceutical defects that were easy to appear in the preparation of traditional capsules, which has provided experimental evidence for the use of powder modification technology for improving the quality of Chinese medicinal solid preparations and promoting the secondary development and upgrading of traditional Chinese medicinal dosage forms such as capsules.
Capsules ; Excipients ; Particle Size ; Powders ; Wettability

Objective:To evaluate the feasibility of C 2 laminar screw fixation with double holes, and to explore a new method to judge the safe position of screws during operation. Methods:There were 22 axial specimens, 11 males and 11 females, aged from 26-69 years (mean 47.2 years). The Dicom format of Cervical spine specimens were obtained by CT scanning. It was transferred into the Mimics software for reconstructing the three-dimensional cervical spine model. The central horizontal plane of the axial lamina was cut off as the measuring plane by using the segmentation function. The cortical bone of the start and end lamina was removed naming hole 1 and 2. The distances of D1 and D2 are measured at the trajectory positions of maximum safe ventral inclination, parallel, or maximum safe dorsal inclination, with each entry point (A, M, P). A paired comparison was performed for each group.Results:Forty-four groups of parallel, introversion and extroversion screw path parameters were obtained from 22 axial specimens, and there was no significant difference between the left D1 and D2 groups in each group A, M, P [group A: 3.72±0.95 mm, 3.37±1.24 mm; group M: 2.29±0.72 mm, 1.94±0.58 mm; group P: 1.17±0.44 mm, 0.86±0.69 mm] ( t=1.051, 1.776, 1.777; P>0.05), while the right D1 and D2 had statistical significance[group A: 4.44±1.20 mm, 3.36±1.37 mm; group M: 3.01±0.76 mm, 1.97±0.90 mm; group P: 2.06±0.73 mm, 1.00±0.87 mm]( t=2.781, 4.141, 4.378; P<0.05). In introversion, there was no significant difference in left D1 and D2 in group M [3.11±0.92 mm, 3.79±1.36 mm] ( t=1.942, P=0.058), and was no significant difference in right D1 and D2 in group M [3.79±1.20 mm, 3.69±1.55 mm] ( t=0.239, P=0.812). In group P, the left D1 and D2 were compared, and the results had statistically differences [2.67±0.77 mm, 4.25±1.39 mm] ( t=4.644, P=0.000). In group P, the right D1 and D2 were compared, and the results were statistically different [2.57±1.14 mm, 3.94±1.53 mm] ( t=3.368, P=0.001). In extroversion, the left D1 and D2 in group A and M were compared, and the results had statistically differences [group A: 3.44±1.05 mm, 1.22±0.71 mm; group M: 2.26±0.73 mm, 0.90±0.75 mm] ( t=8.215, 6.095; P<0.05); the results of group A and group M were statistically different between groups of D1 and D2 on the right side[group A: 4.56±1.51 mm, 1.48±0.97 mm; group M: 2.96±1.12 mm, 1.06±0.75 mm] ( t=8.049, 6.611; P<0.05). Conclusion:The double hole screw technique of the C 2 lamina can judge the safe position of the screw in the operation without additional fluoroscopy.

Objective:To assess the antibody persistence 3-5 years following vaccination of measles and rubella combined live-attenuated vaccine (MR) at 8 months of age and measles, mumps and rubella combined attenuated live vaccine (MMR) at 18 months of age.Methods:In 2016, 18-month-old children who were vaccinated with one dose of MR vaccine at the age of 8 months were recruited in Hebei Province as group 1; 4-, 5- and 6-year-old children who were vaccinated with one dose of MR vaccine at the age of 8 months and one dose of MMR vaccine at 18 months of age were recruited in Shanxi, Inner Mongolia and Beijing as group 2, group 3 and group 4, respectively. Serum samples were collected to detect IgG antibodies against measles, mumps and rubella by ELISA. Geometric mean concentrations (GMCs) of measles, mumps, and rubella antibodies were compared among groups by analysis of variance or non-parametric test. Seropositive rates were compared among groups by Chi-square test or Fisher′s exact test. Results:A total of 650 children were included in this study. Seropositive rates of measles, mumps and rubella antibodies 30 d after vaccination of 150 18-month-old children with one dose of MMR vaccine were 100%, 91.33% and 100%, respectively, and the GMCs were 1 846.87 mIU/ml, 299.91 IU/ml and 111.33 IU/ml, respectively. Seropositive rates of measles, mumps and rubella antibodies 3-5 years after vaccination one dose of MR vaccine at 8 months of age and one dose of MMR vaccine at 18 months of age were above 94%, 79% and 71%, respectively, and the GMCs were above 830 mIU/ml, 240 IU/ml and 31 IU/ml. No significant difference in the seropositive rates of the three antibodies was observed among groups 2, 3 and 4 ( P>0.05). There was no significant difference in the GMCs of measles or mumps antibodies among the three groups ( P>0.05), but the differences in the GMCs of rubella antibodies were statistically significant ( P=0.034). Conclusions:Measles, mumps and rubella antibodies persisted for 3-5 years without significant decrease after vaccination one dose of MR vaccine at 8 months of age and one dose of MMR vaccine at 18 months of age.

Objective To investigate the clinical efficacy of posterior lumbar interbody fusion and internal fixation for the treatment of lumbar spinal stenosis with redundant nerve roots (RNRs).Methods A retrospective case series study was performed on the clinical data of 23 cases of lumbar spinal stenosis with RNRs from January 2009 to December 2014.This study involved 10 males and 13 females,with an average age of 48.4 years(range,38-58 years).The course of disease averaged 28.1 months(range,2 months-7 years).There were seven patients with single segment of stenosis,12 patients with two segments of stenosis,and four patients with three segments of stenosis.RNRs diagnostic criteria:in the sagittal section of the MRIT2 image of lumbar spine,the cauda equina nerve root in the dural sac was circular,tortuous and twining.MRI information was collected and analyzed by three double-blind radiologists,respectively.RNRs were determined based on the unanimous consent of all the three doctors.All patients underwent posterior discectomy,spinal canal decompression,interbody fusion,and internal fixation after admission.The operation time,intraoperative blood loss,and postoperative complications were recorded.The visual analogue scale (VAS),Oswestry disability index (ODI),and Japanese Orthopedic Association (JOA) score were used to evaluate the back pain and leg pain before operation and 3 months after operation.Fischgrund standard was used for the overall efficacy evaluation.Results All patients were followed up for 12-30 months (mean,23.3 months).The operation time was (130.0 ± 23.2) minutes,and the intraoperative blood loss was (513.0 ± 165.0) ml.MRI was reviewed 1 week after operation,and the result showed that redundancy of cauda equina disappeared.Preoperatively,the scores of back pain VAS,leg pain VAS,ODI and JOA were (6.3± 0.8) points,(6.8 ±0.9)points,(46.7±2.5)points and (10.3 ±2.8)points,respectively.At 3 months postoperatively,the scores were (1.4 ± 0.5) points,(1.8 ± 0.7) points,(11.9 ± 2.1) points,and (25.3 ± 1.8) points,respectively (P ＜ 0.05).In terms of the efficacy,17 cases were excellent,four good,and two fair,with an excellent and good rate of 91％.At 12 months after operation,the CT scan showed no screw rupture or cage dislocation,with bony union seen between the vertebrae.Conclusion Posterior lumbar interbody fusion and internal fixation can help relieve the back and leg pain and eliminate redundant nerve roots in patients with lumbar spinal stenosis with RNRs.

Objective To investigate the distribution of age at onset and its influence on clinical characteristics in synovitis,acne,pustulosis,hyperostosis,and osteitis (SAPHO) syndrome.Methods We recruited 164 patients with SAPHO syndrome who presented to Peking Union Medical College Hospital from Jan 2004 to Mar 2015.All the patients were assessed for medical history,laboratory tests and imaging presentations.The distribution of age at onset was analyzed using Shapiro-Wilknormality test and Kolmogorov-Smimov test for mixed normal distribution.The influence of age at onset on clinical features was analyzed using Mann-Whitney U test and x2 test.Results A double-peak mixed normal distribution of age at onset of skin lesions was found in female patients with SAPHO syndrome,with means and standard deviations of (30±6) years (early-onset) and (51 ±7) years (late-onset) for each mixed normal distribution.The cut-off point was determined to be 42 years old.Nonetheless,a typical single-peak normal distribution of age at onset of skin lesions was observed in male patients.A significantly higher frequency of thoracic region pain [14/36 (38.9％) vs 6/70 (8.6％),x2=14.28,P＜0.01,spinal lesions revealed by bone scintigraphy [23/35 (65.7％) vs 23/66(34.8％),x2=8.79,P=0.003],and peripheral skeletal lesions revealed by bone scintigraphy [17/35 (48.6％) vs 17/66(25.8％),x2=5.33,P=0.021] were found in late-onset female patients compared with early-onset ones.Moreover,female patients with late onset had significantly higher hs-CRP level [(12±12) mg/L vs (9±11) mg/L;U=911.5,P=-0.042)],pain VAS (4.8±1.8 vs 4.0±2.1;U=948,P=0.036),and BASFI (3.0±2.2 vs 1.8±2.0;U=822.5,P=0.003) at baseline than those with early onset.Conclusion Female patients with SAPHO syndrome have a double-peak distribution of age at onset of skin lesions.Female patients with early and late onset of skin lesions exhibit distinct clinical characteristics.