Objective To discuss the value in quality improvement and continuous improvement through the way for determina-tion of target uncertainty in chemical quantitative detection project and regular evaluation of measurement uncertainty in different phase.Methods Based on the biological variability of quality specification and CNAS-TRL-001:CNAS technical report,to compare the five kinds of determination of target uncertainty.Method 1:the fundamental way(calculate the different levels of target impre-cision and bias);Method 2:biological variation of different grades of total allowable error;Method 3:the relative expanded uncer-tainty evaluation value based on target imprecision and bias;Method 4:the target relative expanded uncertainty based on biological variation of different grades;Method 5:the target relative expanded uncertainty based on the quality index of analysis.We used un-certainty evaluate index(UEI)to review the changes of uncertainty in different phase.Results The 14 conventional chemistry tests in 2013 with metrological traceability and participate in the Ministry of health EQA were as the target.There was no significant difference among the 2,3,4 method,the ratio of which reached the ideal value of uncertaninty target were not significantly different. In method 5,9 projects achieved the target of uncertainty requirements,accounted for 64.3%.TP,ALT,BUN,UA,CK,these5 pro-jects′UEI were less than 0,accounted for 35.7%;other 9 projects′UEI were more than 2.0%.Conclusion Method 5:the target relative expanded uncertainty based on the quality index of analysis which is based on WS/T403-2012 can give consideration to the quality standard of repeatability precision and bias in the laboratory at the same time,and is easy to be accepted for laboratory;method 4:the target relative expanded uncertainty based on biological variation of different grades is in the same way with the eval-uation of test results uncertainty,is better than method 2 and 3;method 1 is the fundamental way,can give the specific reasons when the test results cannot get the target uncertainty.Use UEI to assess the changes of uncertainty in different phase is more sensitive to changes of the test results′accuracy and its usefulness needs to be confirmed in practice.

Objective To explore the differences of using different analytic quality requirements in the comparable validation of blood cell analysis multi-system range test comparable schemes for establishing appropriate analysis quality standards for laboratory.Methods According to WS/T 407-2012 Guideline for Comparability Verification of Quantitative Results in Medical Institution,the range test comparable method was established.According to different sources of analytic quality requirements from the WS/T 406-2012 Analysis Quality Requirements of Clinical Hematological Detection Routine Items,the US Clinical Laboratory Improvement Amendment (88),GB/T 20470-2006 Requirements of External Quality Assessment for Clinical Laboratories and biological variations,corresponding analysis quality requirements standard was designed.Results With the standards designed by using WS/T 406-2012,CLIA′-88 and GB/T 20470-2006 as the analysis quality requirements,only the comparison results of low concentration levels in 3 items of HBC,PLT and HCT were not passed,while other results all were passed;all results passed the consistency verification by suitably revising the analytic quality requirements of low value concentrations.With the biological variations as the analysis quality requirement,the comparison results in WBC three concentration levels,and HBG high and low concentration levels were passed,but other results were not passed.Conclusion The biological variations analytical quality requirements are relative demanding.Using WS/T 406-2012 Analysis Quality Requirements of Clinical Hematological Detection Routine Items and GB/T 20470-2006 Requirements of External Quality Assessment for Clinical Laboratories,fully considering the suitability of low concentration quality requirements and formulating appropriate analysis quality standards of laboratory are the important contents of laboratory comparable validation scheme.

Objective To establish quality improvement project through theσ value and quality goal index ,then determine the effect of quality improvement by comparing the changes of uncertainty ,provide the laboratory basis for the effective improving of the quality of clinical laboratory .Methods The quality control data of blood cell analysis items were analyzed ,and the σ values , quality goal index (GQI) and measurement uncertainty [u(Rw)] were calculated and the performance was estimated .The quality improvement project was designed and had run for one year .The effect of quality improvement project was determined according to u(Rw) changes .Results The excellent rate (σvalue >4σ) of process performance evaluation in 2012 was up to 62 .5% ,the items withσvalue>6σamounted to 37 .5% ,about 62 .5% of the items needed to be improved .Comparing the u(Rw) in 2013 with 2012 , the improvement rate was 50% .The laboratory quality had been improved .Conclusion The performance analysis of σvalue ,GQI combined uncertainty evaluation is a good management method to improve the efficiency and reduce the cost .

Liver resection is the most effective treatment for hepatocellular carcinoma (HCC). The Barcelona Clinic Liver Cancer (BCLC) staging system is commonly accepted as a guideline for HCC treatment, but it only recommends liver resection for the patients with HCC at stage 0 to A1. The surgical indications of the BCLC staging system need to be re-evaluated. 120 HCC patients undergoing curative liver resection were retrospectively stratified to the BCLC staging system, and the survival of the patients at stages A, B and C was analyzed. The justification of the BCLC staging system was re-evaluated. Fifty-two patients were classified at stage A, 51 at stage B and 17 at stage C respectively. The hospital mortality of this cohort was zero and the morbidity was 24.1%. The 1-, 2-, 3-year overall survival rate of this cohort was 81.6%, 68.3%, and 57.5% respectively. There was no significant difference in the survival rate between the patients at stage A and B (P>0.05). If the treatment guidelines of BCLC staging system were followed, the majority of the patients at stages A and B (77.7%, 80/103) would not have been treated surgically. Our data suggest that the surgical indications of the BCLC staging system are not justified for HCC treatment. More studies may be needed as for how to further broaden the surgical indications of the BCLC staging system in the future.

Objective To explore the diagnostic value of C‐reactive protein(CRP) for diagnosing chronic obstructive pulmonary disease(COPD) to dig a new marker for COPD diagnosis .Methods A total of 199 cases of COPD ,159 cases of pulmonary malig‐nant tumor and 115 individuals undergoing the physical examination were collected .The whole blood CRP level was detected in 3 groups and the detection results were compared among 3 groups .The receiver operating characteristic(ROC) curve was drawn . Then the sensitivity ,specificity and Youden′s index(YI) were calculated to find the cut‐off value of diagnosis .Results Compared with the individuals undergoing healthy physical examination ,the CRP level in the COPD patients and the patients with pulmonary malignant tumor was significantly increased ,the difference was statistically significant(P<0 .05);the area under ROC curve(AUC) was 0 .768 ,the maximal YI was 0 .418 ,the sensitivity and specificity were 64 .7% and 77 .1% respectively ,the corresponding cut‐off value was 49 .75 mg/L .Conclusion CRP has a certain diagnostic value and can serve as a new index of COPD diagnosis .

Objective: To investigate the role of fibroblast growth factor receptor(FGFR) 1 in endothelial to-mesenchymal transition(EndMT) and epithelial-to-mesenchymal transition(EMT), and to find out a new strategy to study the vascular endothelial function of diabetic renal fibrosis. Methods: Culture media from FRS2 knockdown HMVECs was transferred to HK-2 cells. Western blot and immunofluorescence staining were used to measure EMT markers and key moleculars of transforming growth factor(TGFβ). Results: It was found that the medium from FRS2 siRNA-transfected HMVECs reduced E-cadherin protein levels, increased EMT markers levels, and activated TGFβ signal pathway in HK-2 cells. Conclusion Endothelial FGFR1 deficiency-induced EndMT leads to EMT in neighboring cells in a manner dependent on TGFβ1 signaling. Endothelial cell FGFR1 is an important molecule for maintaining endothelial homeostasis and epithelial homeostasis, and seems to be a key target for anti-diabetic renal fibrosis.

Liver resection is the most effective treatment for hepatocellular carcinoma (HCC).The Barcelona Clinic Liver Cancer (BCLC) staging system is commonly accepted as a guideline for HCC treatment,but it only recommends liver resection for the patients with HCC at stage 0 to A1.The surgical indications of the BCLC staging system need to be re-evaluated.120 HCC patients undergoing curative liver resection were retrospectively stratified to the BCLC staging system,and the survival of the patients at stages A,B and C was analyzed.The justification of the BCLC staging system was re-evaluated.Fifty-two patients were classified at stage A,51 at stage B and 17 at stage C respectively.The hospital mortality of this cohort was zero and the morbidity was 24.1％.The 1-,2-,3-year overall survival rate of this cohort was 81.6％,68.3％,and 57.5％ respectively.There was no significant difference in the survival rate between the patients at stage A and B (P＞0.05).If the treatment guidelines of BCLC staging system were followed,the majority of the patients at stages A and B (77.7％,80/103) would not have been treated surgically.Our data suggest that the surgical indications of the BCLC staging system are not justified for HCC treatment.More studies may be needed as for how to further broaden the surgical indications of the BCLC staging system in the future.

Objective To evaluate he significance of the Neutrophil-Lymphocyte Ratio(NLR)and the red blood cell(erythrocyte)distribution width(RDW)in distinguishing between simple and complex febrile seizures and evaluate the diagnostic values of NLR and RDW in febrile seizures. Methods Totally,100 patients aged between 6 months and 5 years diagnosed with febrile seizure were admitted to the emergency department of the hospital.Complete blood count obtained from the peripheral blood samples collected from the patients at admis-sion were evaluated. Results The average values of NLR for simple and complex seizure groups were 2.16 ± 1.26 and 3.62 ± 1.51 respectively.The average values of RDW for simple and complex seizure groups were 15.04 ± 1.73 and 16.89 ± 1.44,respectively.Using receiver operating characteristic curve(ROC),the sensitivity and specificity were 65.5% and 66.2%,respectively,with the area under the curve[AUC]of 0.670 when the cut-off value was 2.52 for NLR,and they were 62.1% and 59.3%,respectively,with AUC of 0.619 when the cut-off value was 16.47 for RDW. Conclusion NLR and RDW may provide clinicians with an insight into differentiation between simple and complex febrile seizures,however,we need much better diagnostic value to classify the febrile seizures

Intestinal flora can participate in and influence the physiological function and disease process of the organism as part of the host .The symbiotic relationship between intestinal flora and the host is the result of species′evolution over millions of years .Immunity system , which is complex and includes multiple influencing factors , is the necessary defense system that runs through human life .Among them, the intestinal flora plays an important role in maintaining the steady state of human immunity system .In this paper, the relationship between intestinal flora and immune system disease is briefly described , in order to deepen the understanding for medical workers and researchers , and provide references for the prevention , treatment and prognosis of the disease .

Objective To investigate the correlation of serum brain derived neurotrophic factor (BDNF),visceral adipose and cognitive dysfunction in elderly patients with type 2 diabetes.Methods From July 2016 to August 2017,72 patients with type 2 diabetes in our department of inpatient were selected as subjects.According to whether there was cognitive dysfunction,they were divided into 2 groups,type 2 diabetes mellitus combined with cognitive impairment group (A group) and simple type 2 diabetes group (B group).Another 40 healthy persons in the same period were selected as the control group.The indexes of glycolipid metabolism,visceral adipose and BDNF were measured in two groups.The logistic regression analysis was used to analyze the risk factors of cognitive dysfunction,and the relationship between visceral adipose,BDNF and cognitive function was analyzed by Pearson correlation.Results (1) The total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),fasting insulin (FINS),fasting blood glucose (FPG),glycosylated hemoglobin (HbA1c),fasting insulin (FINS),insulin resistance index (HOMA-IR),and visceral fat hormone level of the three groups were from high to low in A group ＞ B group ＞ C group (P ＜ 0.05);while the high density lipoprotein cholesterol (HDL-C),the expression level of BDNF and Montreal Cognitive Assessment (MoCA) score of the three groups were from high to low in C group ＞ B group ＞ A group (P ＜ 0.05);(2) The logistic regression analysis showed that visfatin,HOMA-IR,BDNF for the risk of cognitive impairment factors in elderly patients with type 2 diabetes;(3) Correlation analysis showed that the score and visceral fat MoCA and HOMA-IR were negatively correlated with the MoCA score was positively related to BDNF;HOMA-IR and visfatin was positively correlated,negatively correlated with BDNF.Conclusions The cognitive function of elderly patients with type 2 diabetes is related to serum visfatin and BDNF.Increased visfatin and BDNF may lead to cognitive dysfunction.