Individualized Quality Control Plan ( IQCP) is a method of quality control for total testing process.In January 2016, the United States formally adopted the IQCP instead of the original equivalent quality control.This article will introduce how to establish and implement IQCP in the laboratory , and discuss the common problems in the process of its application .

OBJECTIVE:To study the improving effect of total flavone from Litchi chinensis (TFL) on the hepatocyte injury in rats with liver fibrosis. METHODS:The rats were given dimethylnitrosamine(DMN),ip,once a day in the first 3 d of every week,which lasted for 30 consecutive days to establish hepatocyte injury model. 60 rats were equally randomized into a normal control(isometric normal saline)group,a model(isometric normal saline)group and the groups of high and low-dose TFL(200 and 100 mg/kg). When the model was being established,drugs were administered,ig,once a day for 45 consecutive days except for normal control group. HE staining was performed,and then the rats’hepatocytes were observed under the microscope and path-ological stage (S1-S4) of liver tissue was analyzed. Masson staining and immunohistochemical staining were conducted,and then the rats’hepatocytes were observed under the microscope and calculation was made for the degree of liver fibrosis and the expres-sion of Bcl-2 and Bax. The activities of aspartate aminotransferase(AST)and alanine aminotransferase(ALT)in rats’serum were determined. RESULTS:The pathological stages of liver cell of rats in the model group were mainly stages S3 and S4 and the groups of high and low doses TFL were dominated by stages S1 and S2. Compared to the rats in the normal control group,those in the mod-el group had higher degree of liver fibrosis,expression of Bcl-2 and Bax and activities of AST and ALT in serum. Compared to the rats in the model group,those in the groups of high and low doses TFL had lower degree of liver fibrosis,higher expression of Bcl-2,lower expression of Bax,and lower activities of AST and ALT in serum. There were statistically significance (P<0.05). CONCLUSIONS:TFL can alleviate the hepatocyte injury in rats with liver fibrosis to some degree by a mechanism which may be related to the up-regulation the expression of Bcl-2 and the down-regulation of the expression of Bax.

At present,HbA1c is regarded as the gold standard in of the diagnosis of diabetes mellitus.Point-of-care HbA1c testing is popular used in China,however,the quality assurance of POCT HbA1c lags behind that of central laboratory HbA1c testing.The quality assurance strategy for POCT HbA1c must be taken into consideration.Strategies should include risk management,personnel evaluation,troubleshooting system,quality control,proficiency testing,method validation and calibration.

Since 2005,guidelines for the management of adults with CAP or HAP were updated in United States,Europe and Japan,respectively.In these new CAP guidelines,severity-of-illness scores could be used to decide site of care.Routine diagnostic tests to identify an etiologic diagnosis were optional for outpatients with CAP.Empirical antibiotic therapy regimen,time to first antibiotic dose and duration of antibiotic therapy were all detailed explained.In new HAP guidelines,prevention was still emphasized.In order to prevent VAP,measures should be taken to reduce the risk of aspiration,including subglottic drainage and maintenance of stable optimal endotracheal tube cuff pressure.Cultures of lower respiratory secretions have diagnostic value for VAP.The diagnostic accuracy of blind sampling was similar to that of bronchoscopy-directed methods.Much more attention was paid on multidrug resistant bacteria infections.

Objective To analyze laboratory turnaround time (TAT) and find effective ways to shorten TAT.Methods Data associated with cardiac panel (CK,cTnI and Mb) were collected in 2011 including 19 906 outpatient data and 22 973 inpatient data.The medians and the average medians of the quality indicators on TAT were calculated and the results were transformed to the Six Sigma scale to estimate the degree of control over related process.Processes were considered well controlled when σ ≥4.Based on the results of data analysis,an improvement plan was decided by laboratory quality management meeting and clinical communication meeting.The effect of the improvement plan was evaluated through 2011-2012 satisfaction surveys of outpatients and clinicians.Results The average median of overtime reports for outpatient from specimen collection to reception was 2.78％ (3.5σ),and 17.82％ (2.5σ) for inpatients.The average median of overtime reports for outpatient from specimen reception to result reporting was 3.39％ (3.4σ),and 2.96％ (3.4σ) for inpatients.The average median of overtime reports for outpatient from specimen collection to result reporting was 3.93％ (3.3σ),and 12.18％ (2.7σ) for inpatient.The results of TAT satisfaction surveys for outpatients from 2011 to 2012 were similar,which were 78％ in 2011 and 79％ in 2012; the results for clinicians showed an increase from 80％ in 2011 to 90％ in 2012,including an increase from 75％ to 79％ for very satisfaction choice.Conclusions Outside the laboratory TAT is a key step in sickroom patients delay TAT.The implementation for ten improvement suggestions enabled to shorten TAT effectively.

Objective To study clinical characteristics and diagnostic methods of lymphoma with chest invovement. Methods Twenty-five lymphoma patients with chest involvement were retrospectively analysed, they were all diagnosed in Peking University Third Hospital during 2000 to 2007. The data were collected including clinical manifestations, blood examinations, chest X-ray and CT scan, diagnostic methods and pathologic diagnosis. Results The median age of the 25 patients was 46 years old. Pyrexia(13 cases), weight loss over 10 percent in 6 months(11 cases), cough(10 cases), shortness of breath(9 cases) and painless enlargement of the peripheral lymph nodes(16 cases) were common manifestations. Erythrocyte sedimentation rate and serum lactate dehydrogenase(LDH) level were increased in 72.7% and 81% patients, respectively. The enlargement of mediastinum lymph nodes(16 cases, 64%) was the most common presentation of chest radiography, followed by pulmonary involvement(15 cases, 60%) including infiltration or pulmonary consolidation, mass, multiple nodules, diffuse ground-glass shadow, miliary lesion. There were also presentations of pleural effusion(10 cases, 40%), pericardial effusion(4 cases, 16%), chest wall mass(2 cases, 8%). Eighteen patients(72%) had at least two kinds of these presentations. The appearance of pleural effusion were yellow turbid, bloody or chyliform. Rivaha tests were all positive. The median value of plearal effusion examinations were listed as follows: specific gravity 1.031, total cells 9800×10~6/L, WBC 6.72×10~9/L, lymphocyte 86%, neutrophil 14%, protein 31.4 g/L, LDH 296 U/L,adenosine deaminase (ADA) 67.4 U/L Most patients(16 cases) were diagnosed by surgical biopsy,especialy peripheral lymph nodes biopsy (12 cases). Other patients were diagnosed by ultrasound or CT-guided biopsy (5 cases), video-assisted thoracoscopic pleural biopsy (1 case), video-mediastinoscopic mediastinum lesion biopsy(1 case), bronchial mucosa biopsy through bronchoscope(1 case), bone marrow examination(1 case). All the cases were non-Hodgkin lymphoma except one. Conclusions There was no specific clinical manifestation for lymphoma with chest involvement, but in almost half of patients there were enlargement of not only peripheral but also mediastinum lymph nodes. And there were some characteristics in serum, pleural effusion, chest X-ray and CT scan. Surgical biopsy of peripheral lymph nodes was a simple and convenient method for diagnosis. Micro-invasive biopsy had good diagnostic value for lymphoma with chest involvement, including ultrasound-or CT-guided biopsy for superficial mass, pleura, lung, liver, spleen and deep lymph nodes, video-assisted thoracoseopic and video-mediastinoscopic biopsy for pleura, lung and mediastinum lesions. But bronchial mueosa and lung biopsy during bronchoscopy had a low diagnostic rate for lymphoma.

Objective To establish neuropathic pain models,explore the effects and mechanisms of dexmedetomidine on neuropathic pain.Methods Wistar rats were randomly divided into four groups (n =9):0.9％ sodium chloride solution CCI group (N),dexmedetomidine CCI group (D),ZD7288 CCI group (Z) and sham-operated group (Sham).Sciatic nerve ligation was performed in group N,D and Z.The sciatic nerve in group Sham was exposured without ligation.7 d after surgery,the rats in group D were intraperitoneal injected with dexmedetomidine (40 μg· kg-1),and the rats in group Z were intraperitoneal injected with ZD7288 (10 mg·kg-1)once a day for 3 d.The same volume of 0.9％ sodium chloride solution was given at the same time in group N.The behavioral test was performed before and 7 d after operation,as well as 3 d after injection treatment.Mechanical allodynia was assessed by paw withdrawal mechanical threshold (PWMT) to von Frey filaments.Thermal hyperalgesia was assessed by paw thermal withdrawal latency (TWL) to radiant heat.Dexmedetomidine block of HCN channels in dorsal root ganglion (DRG) neurons were confirmed by whole-cell recording.Results 7 d after surgery,the PWMT and TWL of rats in group N,D and Z were decreased significantly (P ＜ 0.05).The PWMT and TWL in group Sham were no significant difference before and after operation.Dexmedetomidine significantly increased the levers of PWMT and TWL in group D and Z after treatment for 3 d,and group Z was greater than group D (P ＜ 0.05).Dexmedetomidine (0.1,1,10 μmol· L-1) caused a concentration-dependent decrease in the amplitude of Ih in DRG neurons from (-844.43 ± 386.34) to (-215.99 ± 63.90) pA (P ＜ 0.05),and the inhibition rate of Ih was (11.87 ± 1.80) ％,(35.26 ± 3.65) ％ and (52.02 ± 5.56) ％,respectively(P ＜0.05).Dexmedetomidine produced a dose-related shift to the left of the Ih activation,and a negative shift in V1/2 (P ＜ 0.05).V1/2 shifted from (-86.21 ± 1.68) to (-103.54 ± 2.01) mV (P ＜ 0.05).The slope values were not altered by dexmedetomidine.Conclusion Dexmedetomidine produces a dose-dependently analgesic effect on neuropathic pain after peripheral never injury,which is likely due to the inhibition of Ih and reduction of ectopic spontaneous discharge in DRG neurons.

Objective Through statistical analysis of specimen rejection reasons, aimed at finding the ways to reduce the failed specimen, making sure of continuous improvements in laboratory quality. Methods Department of Laboratory, Beijing ChaoYang Hospital, Capital Medical University had analyzed rejections specimen from October 2013 to September 2014 in CAP Q-TRACKS QT3 ( QT3: Laboratory Specimen Acceptability ) , and compared the laboratory rejection reasons with all laboratories of CAP. Results From October 2013 to September 2014, the total number of rejection specimen number was 2 367, in which 225 were incomplete labeled specimen/inadequate filled-out form, accounting for 9.5%.898 samples were rejected because of specimen clotted, accounting for 37.9%.The samples could not meet the requirement of specimen quantity of 254, accounting for 10.7%.Other reasons accounting for above 1%included wrong collection container, specimen hemolysis, lipemia or icteric specimen.After comparing the first five rejection reasons, Department of Laboratory, Beijing ChaoYang Hospital was found to be different with others laboratories of CAP.Conclusion The quality of the specimen is very important for the accuracy and reliability of the test results, and doing some positive statistical analysis and taking corrective measures can effectively reduce the unqualified specimen of the proportion.

In recent years , with the development of error theory and the requirements of the international accreditation bodies , the quality indicators ( QIs) have become one of the important tools in the laboratory quality management .To explore the evolution and origin of QIs , the status and the future of QIs will be helpful for us to understand and to use the QIs .

Objective To investigate the complications of minimally invasive percutaneous nephrolithotomy (PCNL) and their countermeasures.Methods The datum of 265 cases who underwent PCNL in our hospital.Among the 265 cases of PCNL,serious complications occurred in 13 cases.Of the 13 cases,4 cases had massive hemorrhage,2 case had colon perforation,1 case had serious urinary extravasation,6 cases had febricity.Results The incidence of serious complications was 4.91％(13/265),all patients were cured by corresponding treatment and no death in the cases.Conclusions Adequate preoperative preparation in PCNL and strict surgical indications were good for complications reduction.Serious complications should be detected early and treated correspondingly.