Objective To evaluate our results of external quality assessment (EQA) program of the newborn screening laboratory for 6 years, summarize the problems in the screening measurement and improve the quality of measurement.Methods The phenylalanine (Phe) and thyrotropin (TSH) values in dried blood spot specimens on filter paper distributed by national center were measured by fluorometric method and time -resolved fluorescence im-munoassay ( DELFIA ) respectively.The results sent by national center were analyzed .Results In the 90 specimens of 18 batches, the bias range of Phe and TSH measurement was wide (-62.50%~66.67%and-66.67%~54.31%respectively) and their average values were 8.62%and 10.18% respectively;85 quantitative results of Phe and 84 quantitative results of TSH measurement were in the quality control , accounting for 94.44%and 93.33%respective-ly.The qualitative analysis of 90 Phe and TSH specimens all conformed to the expected results , accounting for 100%.The result of every batch was up to 80%.Conclusion Our neonatal screening laboratory is in control and it is useful to evaluate the measurement competence , find out the problems in the Phe and TSH measurement and re-solve them in time through participated in the national EQA in neonatal screening laboratory , so as to improve the quality of measurement and ensure the accuracy and reliability of results .

Objective To explore the most effective formula to predict the catheterization length of the right internal jugular vein by an-terior approach. Methods Sixty-seven cases performed with right internal jugular vein catheterization from January 2013 to June 2013 were enrolled in this study and 4 formulas were selected to predict the catheterization lengths. Comparing their predicted lengths with the actual lengths defined as the lengths of the internal catheters which terminals were inserted to a accurate position,and analyse their predictive validi-ty. Results The predictive error percentages of the 4 formulas were all less than 15%. Comparing the predicted lengths and the actual lengths, there was no difference between the predicted length of the 1st formula and the actual one(P>0. 05),and the predicted lengths of the other three formulas were significantly less than the actual ones(P<0. 05). Comparing the mean absolute predictive errors of the 4 formu-las in the 3 height groups of 150~159 cm,160~169 cm and 170~179 cm,respectively,those of the 4th formula were all significantly higher than those of the 1st formula in all the 3 groups(P<0. 05);and no differences between those of the 2nd or the 3rd formula and those of the 1st formula were observed(P>0. 05). Conclusion The predictive error of all the 4 formulas is less than 15%, and the 1st formula is simple,practical and associated with a much smaller error,more suitable to estimate the length of the right internal jugular vein catheterization by anterior approach.

Objective To analyse effects of high dietary fiber intervention on gestational diabetes mellitus(GDM ) .Methods 148 GDM hospitalized patients were selected as the research objects and they were divided into two groups randomly .72 patients in the control group controlled their diets by themselves ,while the 76 patients in the treatment group accepted the high dietary fiber inter-vention from the nutritionists based on their different conditions .The fasting plasma glucose(FPG) ,2-hour postprandial blood glu-cose(2hPG) ,hemoglobin A1c(HbA1c) ,triglyceride(TG)and total cholesterol(TC)were recorded in dietary therapy and the out-comes of pregnancy were followed up .Results Under diet control for 12 weeks ,The levels of FPG ,2hPG ,HbA1c ,TG and TC of twe groups reduced obviously(P<0 .05) .The effects of the treatment group was better than the control group(P<0 .05) .The av-erage weight of the patients′infants in the control group was(3 .82 ± 0 .72)kg ,while that in the treatment group was(3 .22 ± 0 .63) kg ,and the difference had statistical significance(P<0 .01) .Also ,the probability of the infant and mom complications in treatment group was obviously lower than that in the control group(P<0 .01) .Conclusion High dietary fiber intervention has great curative effects on patients with GDM ,and the reasonable dietary therapy can reduce the probability of complications .

Objective To investigate the protective effects of ω-3 polyunsaturated fatty acids on severe sepsis patients with myocardial injury.Methods Thirty-one patients with severe sepsis were divided into treatment group (17 cases) and control group (14 cases) by random digits table.All patients received partial enteral nutrition and partial parenteral nutrition with equivalent nitrogen and calorie values for 5 days.The control group was given routine therapy and the treatment group was given routine therapy and ω-3 polyunsaturated fatty acids emulsion.The serum malondialdehyde (MDA),superoxide dismutase (SOD),cardiac troponin Ⅰ(cTnI),N-terminal pro-B urine sodium peptide (NT-proBNP) levels and acute physiology and chronic health evaluation (APACHE) Ⅱ score was compared between two groups before and after treatment.Results There was no difference in indicators before treatment between two groups (P ＞ 0.05).The MDA,cTnI,NT-proBNP and APACHE Ⅱ score in two groups after treatment 5 days was lower than that before treatment 1 day,and the SOD was higher than that before treatment (P ＜ 0.05).The MDA,SOD,cTnI and NT-proBNP after treatment 5 days in treatment group was better than that in control group [(7.50 ±2.06) mmol/L vs.(9.24 ± 1.79) mmol/L,(89.22 ± 16.21) mU/L vs.(76.60 ± 15.13) mU/L,(0.65 ± 0.34)μ g/L vs.(1.03 ± 0.62) μ g/L,(1267.13 ± 279.26) ng/L vs.(1532.47 ± 375.73) ng/L],and there was significant difference between two groups (P ＜ 0.05).The APACHE Ⅱ score was no significant difference between two groups after treatment 5 days.Conclusion ω-3 polyunsaturated fatty acids can reduce the oxidative stress and myocardial injury,decrease cTnI and NT-proBNP levels and improve heart function in the patients with severe sepsis.

Objective To explore the effect of comorbidities on the surgical outcomes of elderly patients with hip fracture. Methods The Age,gender,weight,type of fracture,preoperative comorbidities and surgical outcomes of 117 patients aged 80 yr or over who undergoing hip fracture surgery in our hospital were recorded. Patients were divided into rehabilitation group and postoperative in-hospital death group ac-cording to surgical outcomes. The potential predictors of postoperative in-hospital death were identified by univariate model and were then entered into multiple Logistic regression analysis. Results Twenty three patients(19. 7%)had no comorbidity,94 patients(80. 3%)had one or more comorbidities. Ten patients(8. 5%)died in hospital after the operation. Predictors of postoperative in-hospital death were preoperative respiratory diseases and three or more comorbidities. Conclusion Surgical outcomes of elderly patients with hip fracture may be predicted by analysing preoperative comorbidities. Preoperative preparations must be sufficient in order to ensure successful operation.

Objective The aim of this study is to demonstrate the diagnostic effect of brainstem evoked potential for pancreatic encephalopathy in rats with severe acute pancreatitis. Methods Sixty male Sprague-Dawley (SD) rats were randomly divided into two equal groups: a sham-operated (SO) group and a severe acute pancreatitis (SAP) group. Each group was evaluated at 3, 6, and 12 h during the experiment. To detect the brain stem evoked potential change at different time points. The ultrastructure of brain tissue was observed by transmission electron microscope (TEM). The expressions of the apoptosis-related proteins Bcl-2, Bax and caspase-3 were observed using immunohistochemical and Western Blot technique. Results In SAP group, congestion, edema, inflammatory cell infiltration, mitochondrial swelling and cell apoptosis were apparent. Compared with SO group, the brain stem evoked potential in severe acute pancreatitis group was obviously reduced in SAP group. Compared with SAP group, the expressions of Bcl-2 have increased, whereas the expressions of Bax and caspase-3 have decreased in SO group significantly ( <0.05) . Conclusion Brain stem evoked potential is a sensitive method in detection of rat brain damage. The results showed that the consistency and the damage degree of rats may be important clinical diagnostic index of pancreatic encephalopathy.

Objective To improve the precision of the traditional segmentation of echocardiogram, by suppressing the influence from inherent speckle noises in medical ultrasonic images. Method An automatic segmentation method based on reconstructed morphology was proposed in this paper. First, the opening and closing operations by reconstruction were imposed to the ultrasonic image. Second, the top-hat operation was used to extract the bright and/or dark features and to find out the boundaries corresponding to these features, whereby implemented the automatic segmentation. Result The segmented echocardiogram had less artificial boundaries resulted from speckle noise, and could accurately be extracted the artery and ventricle. Conclusion The presented method can detect both dark and bright objects accurately, and the boundary has a fine continuity. In addition, the algorithm is also applicable to the extraction of sole bright/dark features, accordingly to reduce the complexity and time needed and to improve the accuracy.

Objective To explore the clinicopathologic factors impacting recurrence and survival in rectal cancer patients after radical resection.Methods Clinicopathologic data of 1 166 patients with rectal cancer in Changhai Hospital,were recruited between 2005 and 2010.Kaplan-Meier analysis and the logrank test were used to evaluate the effects of the pathology on patients' survival.Cox regression model was used to assess independent factors associated with clinical prognosis.Results The 1,3,5-year overall survival rates were 94.3％,81.2％ and 76.5％,median survival time was 53 months.328 patients had recurrence and metastases,with a median recurrence time of 18 months.The independent prognostic factors for overall survival time were CEA,CA19-9,tumor distance to dentate line,surgical modality,radical operation,tumor invasion,tumor differentiation,lymph node metastasis and postoperative treatment.Surgical treatment,radical operation or not,tumor invasion and lymph node metastasis were statistically significant associated with tumor recurrence and metastases.Conclusions The important factors inffuencing the prognosis of rectal cancer patients were CEA,CA19-9,tumor distance to dentate line,surgical modality,radial operation,tumor in vasion,tumor differentiation,lymph node metastasis,and post operative treatment.

Objective Mitochondrial DNA depletion syndrome is a rare autosomal recessive disorder characterized by complex genetic and clinical manifestations.This study aimed to investigate the clinical and laboratory features of a boy with mitochondrial encephalomyopathy caused by SUCLG1 mutation.Methods The clinical data and genetic test of a patient with mitochondrial DNA depletion syndrome were retrospectively analyzed.Result The proband presented with limb weakness at the 4th month after birth,and presented dystrophic appearance,muscular hypotonia,psychomotor retardation,failure to thrive,hearing impairment,scoliosis,thoracocyllosis and facial features at 9 months old.Laboratory tests showed blood lactic acid and pymvate increased,liver damage and abnormal myocardial enzymes.Plasma camitine ester profiling showed that amino acids decreased and C4-dicarboxylic-carnitine increased.Urinary organic acid analysis showed increased concentration of methylmalonic acid and its metabolites indicating methyl malonic aciduria.MRI showed bilateral T2 hyperintensities in bilateral caudate nuelei and lenticular and brain atrophy-like changes.Brainstem auditory evoked potential showed severe hearing loss.His development quotient was 35.Genetic sequencing of MUT,,MMAA,MMAB and other classic mitochondrial disease related genes of the proband revealed no mutation.Two heterozygous mutations,c.961C＞G and c.713T＞C,inherited from the phenotype of normal parents were detected in his SUCLG1 gene.The copy number of mitochondrial DNA was 244/cell in peripheral blood leukocytes,equivalent to 68.4％ of that in normal control.Conclusion In this study,an infant with muscular hypotonia,psychomotor retardation,deafness and slightly increased urine methyl malonic acid was diagnosed by genetic test.For patients with unexplained hypotonia,mental retardation,abnormal movements,hearing disorder together with increased blood pyruvic acid and lactic acid,mild methylmalonic acidemia and abnormal acylcarnitine,mitochondrial DNA depletion syndrome should be considered.Gene analysis is important for diagnosis and prenatal diagnosis of the next pregnancy.

Objective:To evaluate the clinical results of miniplates combined with reconstruction plate in treating comminuted posterior wall acetabular fractures.Methods:A retrospective case series study was conducted for 27 patients with comminuted posterior wall acetabular fractures treated in General Hospital of Central Theatre Command of PLA from October 2015 to June 2019. There were 18 males and 9 females, at age of 23-61 years［（45.9±10.9）years］. All patients were treated by using miniplates combined with the reconstruction plate. The operation time, intraoperative blood loss, intraoperative blood transfusion, length of hospital stay and time of fracture healing were recorded. The reduction quality was evaluated according to Matta radiographic standard at 2 days postoperatively. The modified Merle D'Aubigné-Postel score was adopted to evaluate the hip function at 3, 6 months postoperatively and the final follow-up. Postoperative complications were observed, and heterotopic ossification was assessed by Brooker grading standard.Results:All patients were followed up for 12-48 months［36（24, 36）months］. The operation time was 123-242 minutes［（165.4±29.8）minutes］; the intraoperative blood loss was 170-550 ml［（358.3±111.3）ml］; nine patients required intraoperative blood transfusion of 300-500 ml［（377.8±66.7）ml］. The length of hospital stay was 12-29 days［（21.4±4.7）days］. The fracture healing time was 12-24 weeks［（16.3±3.0）weeks］. According to Matta radiographic standard, the reduction quality was excellent in 21 patients, good in 3 and poor in 3 at 2 days postoperatively, with the excellent rate of 89%. The modified Merle D'Aubigné-Postel score was 9-16 points［（13.1±1.9）points］at 3 months postoperatively, was 10-18 points［（15.4±2.0）points］at 6 months postoperatively, and was 12-18 points［（16.9±1.8）points］at last follow-up（ P<0.01）. The modified Merle D'Aubigné-Postel score between 3 months and 6 months was significantly different（ P<0.01）, and the difference between 6 months and the follow-up was statistically significant（ P<0.01）. The modified Merle D'Aubigné-Postel score was graded as excellent in 0 patient, good in 7, fair in 11 and poor in 9 at 3 months postoperatively, with the excellent rate of 26%; graded as excellent in 3 patients, good in 19, fair in 2 and poor in 3 at 6 months postoperatively, with the excellent rate of 81%; graded as excellent in 18 patients, good in 5, fair in 3 and poor in 1 at the last follow-up, with the excellent rate of 85%（ P<0.01）. No iatrogenic sciatic nerve injury, deep vein thrombosis or wound infection occurred after operation. No hardware loosening or loss of reduction occurred during the follow-up. The post-traumatic arthritis was identified in 2 patients. The avascular necrosis of femoral head was observed in 1 patient and thereafter underwent total hip replacement. The heterotopic ossification occurred in 3 patients, among which 2 patients were graded as Brooker class I and 1 as class II, but there was no adverse effect on hip function. Conclusions:Miniplates combined with reconstruction plate in the treatment of comminuted posterior wall acetabular fractures have reliable fixation effect and attain good reduction, high fracture healing rate, less complications and satisfactory functional recovery.