Objective Analyze the historical data of critical values lists,providing scientific evidence for continuous improvement of critical value systems.Methods Screen out critical value lists data of 2006 from laboratory information system,after pretreatment and transformation of data,calculate the percentage of critical value,and its daily distribution,weekly distribution and department distribution, evaluate the range and turnaround time for critical value.Results The rate of critical value was 1.67%.It was mainly concentrated from 8 to 13 O'clock.Monday and Thursday have more critical value than other days.From the perspective of department,the majority critical value was from hematology department and transplantation department.After the evaluation of distribution diagram of critical value range,the lower critical value limit of blood potassium was adjusted from 3.0 mmol/L to 2.8 mmol/L,the blood platelet and leukocyte counts for parlents with hematology disease were a(Ijusted from 20×109/L,1.5×109/L to 10×1O9/L,1.0×109/L respectively.The laboratory turnaround time for 76.2% critical value was less than 1 hour.Conclusion Review and analyze critical value lists data regularly can improve the work efficiency and quality for the laboratory and clinic department and better meet patients' safety needs.

Objective To study the variation characteristics of peripheral blood β-catenin and DKK1 levels in patients with rheumatoid arthritis (RA) and the correlation with bone and joint damage.Methods One hundred and eight patients with RA (observation group) and 110 healthy individuals (control group) were selected.The bone mineral density(B MD) in the femur (femur neck,Ward area,greater trochanter,total femur area) and lumbar spine (L2,3,4) were measured by dual-energy X-ray absorptiometry instrument.X-ray for two hands were evaluated according to the Sharp score.The peripheral blood β-catenin and DKK1 levels were detected by enzyme-linked immunosorbent assay (ELISA).Multiple analysis was completed by multiple linear regression and Logistic regression.Results The peripheral blood DKK1 level in observation group was significantly higher than that in control group [(8.2 ±5.0) mg/L vs.(6.1 ±4.2)mg/L],there was statistical difference (t =2.452,P =0.025),but there was no statistical difference in β-catenin level between the 2 groups (t =15.947,P =0.142).Compared to control group,patients with RA had lower BMD at femur and lumbar spine (P ＜ 0.01).The incidence of osteoporosis in observation group was significantly higher than that in control group [31.5％ (34/108) vs.15.5％ (17/110)],there was statistical difference (x2 =9.289,P =0.005).The correlation analysis results showed that the peripheral blood DKK1 was positive correlation with erythrocyte sedimentation rate (ESR),28-jonit disease activity score (DAS28),alkaline phosphatase (AKP) and two hands X-ray joint narrowing space score in patient with RA (P ＜ 0.01 or ＜ 0.05) ;the peripheral blood β-catenin level was positively correlated with ESR and AKP (P ＜ 0.01 or ＜ 0.05).The multiple linear regression results showed that the disease duration,health assessment questionnaires (HAQ),DKK1 influenced two hands X-ray joint narrowing space score; but the age,disease duration,HAQ influenced two hands X-ray bony erosion score.The multiple Logistic regression results showed that the two hands X-ray Sharp score was the risk factor of osteoporosis at femur in patients with RA; but the age was the risk factor of osteoporosis at lumbar in patients with RA.Conclusions Peripheral blood DKK1 level in patients with RA increases significantly,while there is no apparent alteration in β-catenin level.Peripheral blood DKK1 level is correlated with disease activity and joint space narrow score.

Objective To investigate the clinical application of VCS parameters of leukocyte in the detection of blood bacterial infection, Methods The subjects consisted of 120 patients with blood bacterial infection,69 non-infectious fever patients and 67 health controls.The VCS parameters of neutrophil and lymphocyte were examined with Coulter LH 750 hematology analyzer.The parameters examined including mean channel of neutrophil volume(MNV),neutrophil volume distribution width (NDW) ,mean channel of neutrophil conductivity (MNC),mean channel of neutrophil scatter (MNS),mean channel of lymphocyte volme(MLV),lymphocyte volume distfibufion width (LDW),mean channel of lymphocyte conductivity (MLC) and mean channel of lymphocyte scatter (MLS).Additionally,120 blood bacterial infection patients were grouped according to WBC count(WBC≤10×109/L group and WBC＞10×109/L group),neutrophii rate(≥85%group and＜85%group)and bacterial stain(Gram positive bacteria group and Gram negative bacteria group).VCS parameters among these groups were compared.Results The results of blood infection group were as follows:MNV 156±15,NDW 23.31±3.72,MNS 137±7,MLV 87±12,LDW 17.50±3.38.MLC 110±5 and MLS 69±12.The results of non-infectious fever group were as follows:MNV 151±8,NDW 21.33 ±2.62,MNS 132±10,MLV 91±4.LDW 15.78±1.96.MLC 117±4 and MLS 62±6.The results of control group were as follows:MNV145 ±5.NDW 18.43±0.93.MNS 143 ±4,MLV 84±2,LDW 13.30±0.76.MLC 108±1 and MLS 62±2.There were significant diffierences among these three groups (F value were 19.295,26.272,32.767,6.226,31.016,23.739 and 12.662 respectively,P＜0.05 or P＜0.01).In the infection group.the MNV and NDW were 152 ±16 and 22.19±3.45 respectively for WBC≤10×109/L group.159±12 and 25.29±3.43 respectively for WBC＞10×109/L group.They were both significantly different compared with control group (F valRe were 21.575 and 40.856 respectively,P＜0.01).Also in the infection group.the MNV and NDW were 159±12 and 24.88 ±3.74 respectively for neutrophil rate≥85%group.151±16 and 21.68±2.29 respectively for neutrophil rate＜85%group.They were both significantly different compared with control group(F value were 23.76 and 43.22 respectively,P＜0.01).The MNV and NDW were 157±15 and 24.25±3.39 respectively in those cases with gram-negative bacteremia,153±14 and 21.51±3.78 respectively in those cases with gram-positive bacteremia.They were both signifieanfly difierent compared with control group (F value were 18.74 and 37.47 respectively,P＜0.01).With a cut-off value of 20.50 for the NDW,a sensitivity of 76.7%and specificity of 98.3% were achieyed in diagnosing blood hacterial infection.Conclusion The VCS parameters can reflect the morphologic change of leukocyte in blood bacterial infection.Additionally.the NDW can detect blood bacterial infection more sensitively and specifically.

Objective To compare the characteristics of connective tissue disease-associated interstitial lung disease (CTD-ILD) and idiopathic pulmonary fibrosis(IPF). Methods Patients with a diagnosis of ILD from June 2014 to December 2015 were selected in this study and patients with known other causes of ILD were excluded. The clinical manifestation, autoantibody, high resolution chest computed tomography (CT) and blood gas analysis were retrospectively analyzed. Results Six hundred and twenty-eight patients were included in this study. The prevalence of CTD-ILD and IPF were 459 (73.09%) and 169(26.91%) respectively. The age in IPF group was higher than that in CTD-ILD group:(67.10 ± 13.13) years vs. (52.10 ± 14.23) years, and there was significant difference (t =-10.092, P =0.000). The rate of male in IPF group was higher than that in CTD-ILD group: 75.15%(127/169) vs. 28.32%(130/459), and there was significant difference (P=0.000). Autoantibodies were commonly seen in CTD-ILD group and only antinuclear antibody, and anti-SSA antibody and anti-Ro-52 antibody were seen in IPF group. The most common chest images were honeycombing, bullae of lung and pneumonectasis in CTD-ILD group, while the presence of consolidation and small nodular shadow were more common in IPF group. The concurrence of respiratory failure was higher in IPF group compared with that in CTD-ILD group:49.11%(83/169) vs. 13.07%(60/459), and there was significant difference (P<0.01). Conclusions Patients with CTD-ILD and IPF possess distinct characteristics. Overall assessment of clinical manifestation, autoantibody serology, high resolution chest CT and other indicator will be conducive to the differential diagnosis and treatment of ILD.

Objective To prospectively evaluate the efficacy and safety of Computed Tomography (CT)-guided microcoil localization for pulmonary small solid nodules and ground-glass opacity prior to thoracoscopic resection.And to investigate the indication for CT-guided microcoil localization for small solid pulmonary nodules and ground-glass opacity.Methods From December 2012 to February 2014,85 enrolled patients with pulmonary solid nodules and ground-glass opacity underwent CT guided microcoil localization prior to video assisted thoracoscopic surgery.The procedures of localization were performed by trailing method or routine method under CT guided percutaneous pneumocentesis.For Trailing method,the microcoil was placed with the distal part coiled adjacent to the lesion and the proximal end coiled beyond the parietal pleura.By routine method,the entire microcoil was injected adjacent to the lesion.Results CT-guided microcoil placements were successful in all ninety-one lesions,including 15 solid nodules,15 mixed ground glass opacity,and 61 pure ground glass opacity,with an average diameter of 8.75mm(5-26 mm).The Complication rate of the localization procedure was 23.5％ (20/91),with 13 cases of asymptomatic pneumothorax,and 7 cases of pulmonary hematoma.None patient required surgical intervention,nor severe Complication occurred.All patients underwent video assisted thorascopic surgery on the same day or the next few days after microcoil localization.VATS removal of the pulmonary lesions was successful in all patients.However,two of 91 microcoils were found displaced during VATS resection.The success rate of microcoil marking VATS resection for pulmonary small solid nodules and ground-glass opacity was 97.8％.Microcoil marking was required for 84.6 percent of all the resected lesions.Conclusion Preoperatively CT-guided microcoil localization for pulmonary small solid nodules and ground-glass opacity is a feasible safe and effective marking technique for video assisted thoracoscopic resection.The indication for microcoil localization in our study meet the requirement of VATS resection.

Objective To analysis the clinical radiologic features of intrapulmonary lymph nodes,and to improve the diagnostic rate of intrapulmonary lymph nodes.Methods From May 2008 to September 2011,16 cases of pulmonary nodules were proved pathologically as intrapulmonary lymph nodes,including 9 males and 7 females,with an average age of 58.2 years (39-73 years).All patients accepted chest X-ray and HR CT scan prior to operation,identified of 11 solitary nodules,3 multiple nodules,and other 2 cases of multiple nodules with synchronous ipsilateral lung cancer.We retrospectively review the data as follows:the population and clinical characters,the subjective imaging diagnosis,the imaging characters of the nodule location,size,texture,shape,border,distance from the nearest pleural surface,and the appearance of the surrounding pulmonary parenchyma et al.Results Clinically,six of all the 16 patients are or were cigarette smokers or had an exposure history of inhaled particles,three patients else were all from a same oilfield area although they denied having the Aforementioned history of smoke or exposure.Lung cancer,metastatic tumor,lung cancer intrapulmonary metastasis were the common subjective imaging diagnosis,with a misdiagnosis rate of 56.3％.Radiologically,these intrapulmonary nodules could be seen in the chest X-ray in half of the 16 patients,with a discovery rate of 50％ in chest X- ray screening.The median size of the intrapulmonary lymph nodes was 7.1 mm (4 - 11 mm),all nodules located below the level of the carina,87.5％ ( 14/16 cases) were solid nodules,68.75％ ( 11/16 cases) were round or ovate in shape with a sharp border.87.5％ ( 14/16 cases) were attached to the pleura or within 1 cm from the nearest pleural surface,87.5％ ( 14/16 cases) appeared linear densities extending from the intrapulmonary lymph nodes.The linear denshy referred to the CT imaging feature that a linear soft-tissue density extended from the intrapulmonary lymph nodes,distinct from the normal lung marking like interlobular septa and bronchovascular bundles,with a diameter less than 5 mm; spiculation were detected in only 2 of the 16 patients ; no calcification and mediestinal lymphadenopathy was detect in all the nodules.Pathologically,All nodules contained anthracotic pigment,and follicular hyperplasia were seen in 8 cases.Conclusion Intrapulmonary lymph nodes are rare benign pulmonary nodules possessing certain clinical and radiologic features.Intrapulmonary lymph nodes should be suspected for small subpleural nodules below the level of the carina.

Objective To observe the effect of the chitosan tube combined with basic fibroblast growth factor(bFGF) on inducing nerve axon regeneration of rats with peripherial nerve injury.MethodsA novel chitosan tube combined with bFGF was developed and used to suture the 10 milimeter long right sciatic nerve gap of 10 rats,single injury group(10 rats) were the control with sciatic nerve injury alone,and other 10 rats were assigned to sham group.Immunohistochemistry and electrophysiology study had been done to observe the effect of repairing.Results3 months after operations,the sciatic nerve gap were repaired by the regeneration nerve in the experiment group.And there was no evident inflammation in the defects.ConclusionThe chitosan tube combined with bFGF can induce the sciatic nerve to regenerate.

Objective To explore the degeneration of motor end plates (MEP) by observing the expression of calcitonin gene-relative peptide (CGRP) and acetylcholine esterase (AChE) in the MEP after different types of spinal cord injury. Methods 60 adult female Wistar rats were randomly assigned to 3 groups: sham group, completely transection group and contusion group. The content of AChE in the MEP was detected with Karnovsky-Roots staining and the expression of CGRP was then determined with immunohistochemistry. Results The content of both AChE and CGRP significantly decreased after either type of spinal cord injury. However, their activity gradually recovered to the normal level in the contusion group, but not in the transection group. Moreover, the changes of CGRP occurred earlier than those of AChE. Conclusion The motor end plate degenerates differently after different kinds of spinal cord injury in adult rat, CGRP and AChE are related to the degeneration of MEP.

Objective To explore the restoration of motor function and the expression of calcitonin gene-related peptide(CGRP)and acetylcholine esterase(AChE)in the anterior horn motoneurons after different types of spinal cord injury.Methods 60 adult female Wistar rats were randomly assigned to 3 groups:sham group,completely transection group and contusion group.Average combined scores(ACOS)were applied to assess the motor function at various time after the surgery.The content of AChE in the anterior horn of L2-L4 was detected with Karnovsky-Roots staining and the expression of CGRP was then determined with immunohistochemistry.Results The scores of ACOS were much higher in the contusion group than in the transection group at each time point examined.The content of both AChE and CGRP significantly decreased after either type of spinal cord injury.However,their activity gradually recovered to the normal level in the contusion group,but not in the transection group.Moreover,the changes of CGRP occurred earlier than those of AChE.Conclusion There is strong relationship between the motor function recovery and the functional state of anterior horn cells.CGRP or AChE may play an important role in the functional recovery of locomotion after spinal cord injury in rats.

Objective To evaluate a rapid biochip system for the determination of muhidrugresistant tuberculosis (MDR-TB) in Mycobacterium tuberculosis isolates. MethodsA total of 1 186 clinical strains, including 800 rifampin (RFP) resistant isolates, 797 isoniozid (INH)resistant isolates, 791 MDR-TB and 380 susceptible strains, were selected from Beijing Chest Hospital, Shanghai Pulmonary Hospital and Guangzhou Chest Hospital respectively using stratified sampling method. Biochips were used to detect loci of rpoB 511 (T→C), 513 (A→C, C→A), 516 (G→T, A→T, A→G) , 526 (C→T, C→G, A→T, A→G), 531 (C→T, C→G), 533 (T→C), katG 315 ( G→C, G→A) and inhA -15 (C→T). Absolute concentration drug susceptibility test of RFP and INH were performed to serve as the gold standard to calculate susceptibility, specificity and overall concordance of biochip test. All polymerase chain reaction (PCR) products were sequenced to confirm the mutations. ResultsThe concordances between the biochip system and absolute concentration drug susceptibility test were 93.7％ ( 1 108/1 183 ) for RFP, 83. 8％(994/1 186) for INH and 82.4％ (975/1 183) for MDR-TB. Compared with absolute concentration drug susceptibility test, the biochip method displayed a sensitivity of 92. 0％ (733/797) and 77. 4％ (617/797)and a specificity of 97. 2％ (375/386) and 96. 9％ (377/389) for RIF and INH, respectively. For MDR-TB, the biochip system reached a sensitivity of 74. 6％ ( 588/788 ) and a specificity of 98.0％ ( 387/395 ).Among rpoB mutants, mutations were mostly detected at codon 531[64. 5％ (480/744)]. In stains with mutations in katG or inhA, 77.4％ ( 487/629 ) had mutation at codon 315 ( TCG ) of katG only. The sequencing results had a high concordance with that of the biochip method. There were slight differences in 5 strains, among which one strain was detected by biochip as katG 315(G→C) mutant, but was identified by sequencing as wild type, and mutation types other than those detected by the biochip were confirmed in the other 4 strains by sequencing. Conclusion This biochip system is adapted for extensive application in clinical diagnosis, as it allows fast and reliable detection of resistance to isoniazid and rifampin in tuberculosis clinical isolates.