ObjectiveTo evaluate creatinine proficiency testing data by robust Z-score analysis.MethodsThe data were collected from three proficiency surveys of routine biochemical test in 2009,to which 1 179,1 169 and 1 168 laboratories participated respectively.Creatinine data were divided into Jaffe group and enzymatic group based on the analytical method used.The results tested by both methods were compared using Mann-Whitney test.The outliers were deleted using the TUKEY fence established by quartile values.The normality of raw data and trimmed data was tested using one-sample Kolmogorov-Smirnov test.The performance of the laboratories was assessed using robust Z-score,whose values were considered satisfactory when ｜ Z-score｜ ≤2,questionable when 2 ＜ ｜ Z-score ｜ ＜ 3 and unsatisfactory when ｜ Z-score ｜ ≥3.Results86.7％ results tested using Jaffe and enzymatic methods were not comparable.The raw data in all research groups were not normally distributed.After deletion of outliers,73.3％ trimmed data in most research groups were normally distributed.For the three proficiency tests in 2009,in Jaffe group,the satisfactory rates were 89.8％( 495/551 ),87.2％( 468/537 ) and 89.5％( 476/532 ) respectively,unsatisfactory rates were 3.3％ ( 18/551 ),6.5％ (35/537) and 4.5％ (24/532) respectively; while in enzymatic group,the satisfactory rates were 88.8％ (558/628),89.3％ (564/632) and 88.1％ (560/636) respectively,unsatisfactory rates were 5.6％( 35/628 ),5.2％ (33/632) and 6.6％(42/636) respectively.Conclusion It is reasonable to choose robust Z-score as a proficiency testing assessment index,because it avoids the influence of the outliers on evaluation results.

Objective To perform calibration verification for the blood glucose test in Hitachi and Olympus automatic biochemistry analyzers and present a method of calibration verification and evaluate the results.Methods The glucose test results were divided into two groups:Hitachi and Olympus groups according to the different analytical instruments.The calibration verification was performed following the current College of American Pathologists strategies.The slope and intercept of the calibration line were tested by one-sample t test and the percentage differences were calculated.The percentage differences were compared with allowable errors.If the slope and intercept had no statistically significant difference from 1 and 0 respectively and the percentage differences were within the limits of allowable errors,the calibration line was evaluated as verified 1 ; if the slope and intercept had no statistically significant difference from 1 and 0 respectively and at least one of the percentage differences exceeded the limits of allowable errors,the calibration line was evaluated as different 1 ; if the slope or intercept had statistically significant difference from 1 and 0 respectively and the percentage differences were within the limits of allowable errors,the calibration line was evaluated as verified 2; if the slope or intercept had statistically significant difference from 1 and 0 respectively and at least one of the percentage differences exceeded the limits of allowable errors,the calibration line was evaluated as different 2.Results In Hitachi group,verified 1,different 1,verified 2 and different 2 were 5.4％ ( 4/74 ),0.0％ ( 0/74 ),68.9％ ( 51/74 ) and 25.7％ ( 19/74 ),respectively.In Olympus group,verified 1,different 1,verified 2 and different 2 were 16.4％ (12/73),0.0％ (0/73),58.9％ (43/73) and 24.7％ ( 18/73 ),respectively.Conclusions The current College of American Pathologist strategies could be performed as a reasonable and feasible method for calibration verification.Most of participating laboratories ( 74.8％,110/147 passed the assessment of calibration verification.

Objective To investigate the linearity on testing creatinine in various assay instntments,in order to evaluate creatinine testing ability of clinical laboratories. Methods Statistically standard linearity and nonlinearity were judged via polynomial regression analysis recommended by EP6-A guideline. The imprecision of analytical data were analyzed and the average deviation of best fitting curve from linearity were determined by Dr. Kroll's EP6-A extended methods. In accordance with the instruments used, the testing data were divided into four groups: Beckman LX (28 Labs), Beckman CX ( 14 Labs), Hitachi (62 Labs)and Olympus (72 Labs) groups. Results This research found that in samples analyzed by Beckman LX,Beckman CX, Hitachi and Olympus instruments, the imprecision ranged from 0. 30%-3.01%, 0.09%-3.46%, 0. 14%-4. 91% and 0. 17% -16. 44%, respectively. The imprecision in one laboratory in Olympus group exceeded the acceptable limit, while the imprecision in the remaining laboratories were precision for linear survey. The average deviations of best fitting curve from linearity ranged from 0%-2. 38%, 0%-2. 51%, 0% -5.46% and 0% -4. 66%, respectively. The linearity with statistical significance were 21.4% (6/28), 35.7% (5/14), 11.3% (7/62) and 18. 1% (13/72), respectively. The linearity with clinical significance were 78.6% (22/28), 64. 3% (9/14), 88. 7% (55/62) and 80. 6% (58/72), respectively.The percentages of laboratories whose creatinine testing met the linearity criteria were 100% (28/28),100% ( 14/14 ), 100% ( 62/62 ) and 98. 6% ( 71/72 ), respectively. Conclusion Majority of the laboratories involved in the linearity survey present good capability for creatinine testing.

Objective To evaluate the advantage of using computer navigation system in the resection of rib tumors.Methods We carried out rib tumor resection in 5 patients using computer navigation system.Preoperative CT of each patient was performed.The preoperation CT-based planning was made for every patient with the navigation system software including confirming the tumor surgical margin and designing resection margin.A C-arm scan was carried out intraoperatively.With image fusion of both data,tumor resection were performed under navigation image guidance.Results The mean time of image fusion was 58 minutes.Four tumor resection specimens showed safe and clear margins.Histological examination of all tumor specimens showed tumor-free margins.One patient who was suspected lung cancer with bone metastases was performed a biopsy under navigation image guidance and obtained a pathology diagnose successfully.Conclusion The computer navigation system helps surgeons determine the surgical margin,implement precision tumor resection and reduce surgical damage.

Objective To estimate the gene mutation and the protein expression of v-Raf murine sarcoma viral oncogene homolog B1 (BRAF) in esophageal cancer.Methods From February 2014 to September 2015,75 patients with esophageal cancer who received operation were enrolled.Tissues of cancer,adjacent to cancer and far from cancer were taken.The mutation and protein expression of BRAF were detected.The relationship between BRAF protein positive expression and clinical characteristics of patients with esophageal cancer was analyzed.The enumeration data was compared by chi-square test.Results The mutation of exon 11 and exon 15 of gene BRAF was not found in the tissues of esophageal cancer.Among 75 esophageal cancer,a base C or T inserted in the exon 11 was found in five Ⅲb TNM stage cases,and the expression of BRAF at protein level was positive in 46 cases (61.3％).Among 57 tissues adjacent to cancer,nine cases (15.8 ％) was BRAF positive at protein level.Among 75 tissues far from cancer,five(6.7％) was BRAF positive at protein level.The difference among three groups was statistically significant (x2 =61.098,P＜0.05).The positive rates of BRAF expression at protein level in patients with esophageal cancer at Ⅰ,Ⅱ and Ⅲ TNM stage were 21.7％ (5/23),70.8％ (17/24) and 85.7 ％ (24/28),respectively.The positive rates of BRAF expression at protein level in patients with and without lymph node metastasis were 81.6％ (31/38) and 40.5％ (15/37).The positive expression of BRAF at protein level was related with TNM stage and lymph node metastasis (x2 =23.136 and 13.313,both P＜0.01),however it was not related with gender,age and the degree of tumor differentiation (all P＞0.05).Conclusions There is base insertion in the exon 11 of gene BRAF in esophageal cancer,but gene mutation is not found.BRAF is highly expressed in esophageal cancer,which is related with TNM stage and lymph node metastasis,and BRAF could be an indicator of assessment of degree of malignancy and prognosis of esophageal cancer.

Objective 3D printing has been used in the assistanceof surgical planning and the development of personal-ized prostheses.This study was to determine the feasibility of using a 3D printer for the purpose of producing personalized pros-theses for complex rib fracture fixation .Methods Using data from a high-resolution CT scan of 10 ribs of 3 cases with rib frac-ture, rib moldswere generated with computer software and fabricated with the 3D printer using the fused deposition modeling method.The 3D printing molds were used for custom-designed titanium plate.Results The average length of the 3D models of ribs is 8.45 cm.The mean time of fabricating models was 18.8 minutes and 4.6 gram polylactic acid was consuming on aver-age.The mean error of dimension of 3D models is less than 0.2 mm.Reshaping plates spends 3.3 minutes on average.Radio-logical follow-up for bothcases demonstrated successful fixation at 3 months.Conclusion These cases demonstrate the feasibili-ty of the use of 3D modeling and printing to develop personalizedplates and can ease the difficulty of complex rib fracture .

Objective To explore the possibility of minimally invasive resection of chest wall tumor by video-assisted tho-racoscopic surgery( VATS) .Methods Retrospective analysis of 24 cases of chest wall tumors with minimally invasive resec-tion by VATS from June 2013 to May 2017, including 13 cases of bone fibrous dysplasia, 7 cases of rib abnormal hyperplasia of fiber, 2 cases of cartilaginous tumor, 1 case of Langerhans histiocytosis and 1 case of extramedullary single plasma cell tumor.3 cases with C arm positioning in operation and 4 cases with computer navigation and positioning .Results 24 cases of rib tumors were successfully removed .No surgical death and serious complications occurred in this group .All patients followed up 1-3 years, there is no recurrence.Conclusion Resection of rib tumors with VATS can bring precise resection and lead to minimally invasive.

Objective: To compare the mutation status of epidermal growth factor receptor (EGFR) between different lesions and clini-cal characteristics of synchronous multiple ground-glass nodules (SMGGNs). Methods: A retrospective analysis was conducted using clinical data from 35 patients with SMGGNs who were admitted to and received surgery at The Fourth Hospital of Hebei Medical Uni-versity Hospital from January 2017 to December 2018. Next generation sequencing (NGS) was performed for all surgical specimens to detect the mutation status of exons 18, 19, 20, and 21 of the EGFR gene to analyze the relationship between the EGFR mutation sta-tus of the lesions and patient gender, age, lesion location, imaging manifestation of nodules, and adenocarcinoma pathological type . Results: The EGFR mutation rate was 65.7% (23/35 patients). Non-smoking patients and females had higher EGFR mutation rates (P=0.015, P<0.001). The EGFR mutation rate of invasive adenocarcinoma nodules was higher than those of atypical adenomatous hyper-plasia, adenocarcinoma in situ, and minimally invasive adenocarcinoma ( P<0.001). Exon 19 deletion and L858R mutation were the most common mutations of the EGFR gene. There was no significant difference between the pathological subtypes of adenocarcino-ma and the EGFR mutant subtype (P=0.707). Among the 27 patients with multiple nodules with detectable EGFR mutations, the EGFR mutation rate was 85.2% (23/27 patients). Conclusions: The EGFR gene mutation status is different in patients with multiple pulmo-nary ground-glass nodules, suggesting that the occurrence and development of each nodule are independent events. EGFR gene muta-tion is closely related to the development of ground-glass nodules, especially in the invasion of tumors.

Positron emission tomography (PET) now plays an important role in the research and development (R&D) of central nervous system (CNS) drugs. PET could characterize the biodistribution, pharmacokinetics, and receptor binding of CNS drugs quantitatively. The present review summarized the quantitative methods of PET used in the pharmacokinetics and receptor occupancy analysis of CNS drugs. Moreover, the present review listed various applications of PET supporting R&D of CNS drugs, which could provide a new direction for the R&D of CNS drugs.