In present,clinical laboratory is required to continuously improve the quality management system for providing almost perfect reports and services.The new conception and methodology of quality management in clinical laboratory should be constantly updated in order to ensure the patient safety.The article focuses on the integration of risk management and six sigma,into the quality management system for clinical laboratory.

Objective To compare the anesthesia effect and adverse effect of subarachnoid block anesthesia with different doses of sufentanil combined with bupivacaine 7.5 mg in aged patients,and explore the suitable dosage of sufentanil.Methods Eighty aged patients with ASA grade Ⅰ-Ⅲ undergoing elective lower limb surgery were divided into 4 groups by random digits table and each group was in 20 cases:group Ⅰ received bupivacaine 7.5 mg,group Ⅱ received bupivacaine 7.5 mg+sufentanil 2.5 μg,group Ⅲ received bupivacaine 7.5 mg+ sufentanil 5.0 μg,group Ⅳ received bupivacaine 7.5 mg+ sufentanil 7.5 μg.The vital signs,degree of motor and sensory nerve blockade and adverse effect were observed.Results Compared with base blood pressure,systolic blood pressure(SBP)and diastolic blood pressure(DBP)in group Ⅰ was significantly decreased after intrathecal injecton 15,30,45,60 minutes(P ＜0.05).There were no significant differences in the degree of motor nerve blockade in four groups(P ＞ 0.05).The time of sensory nerve blockade in group Ⅰ[(194 ± 58)min]was significantly shorter than that in group Ⅱ,Ⅲ,Ⅳ[(255 ±44),(242 ±58),(308 ± 123)min](P ＜0.05).The time of sensory nerve blockade in group Ⅳ was significantly longer compared with group Ⅱ and Ⅲ(P ＜ 0.05).The number of pruritus in group Ⅳ(10 cases)was significantly more than that in group Ⅰ and Ⅱ(0,4 cases)(P＜0.05).Conclusion Subarachnoid block anesthesia with sufentanil 2.5 or 5.0 μg combined with bupivacaine 7.5 mg in aged patients is safe and effective.

Severe acute pancreatitis( SAP),especially with secondary infection of pancreatic necrotic tissue,is clinically a very severe and critical condition. The mortality rate can be as high as 40% . Intestinal barrier dysfunction and translocation of enteric bacteria contribute to the infection of pancreatic necrotic tissue and peripancreatic accumulated fluid,promote systemic inflammatory response syndrome( SIRS)and multiple organ dysfunction syndrome( MODS). Because there is no specific and objective assessment criteria for intestinal function and the function is diversity,intestinal dysfunction is not included in the modified Marshall organ dysfunction scoring system in 2012 revision of the Atlanta International Consensus on Classification and Definitions of Acute Pancreatitis. Paying emphasis to prevention and treatment of intestinal dysfunction may reduce the infection of pancreatic necrotic tissue,preventing the progress of MODS and reducing the mortality rate of SAP. This article reviewed the pathogenic mechanism as well as prevention and treatment of intestinal dysfunction in SAP.

Objective To study the ultrasonographic changes and blood flow characteristic ofthromboangiitis obliterans (TAO) by two-dimensional ultrasound and color Doppler imaging MethodForty-seven vessels of 40 patients with clinically suspected TAO vascular detected with two-dimensionalultrasound and color Doppler,and comparison with CT imagmg.Results Color Doppler imaging couldvisualize the arterial wall and blood flow echo filling case,and the spectrum showed the hemodynamicchanges.Conclusions Color Doppler is the first choice for the secondary check to the noninvasivethromboangiitis obliterans,close to the result by an angiography that is usually regarded as a sensitive,accurate and convenient diagnostic method.

The incidence rate of erectile dysfunction (ED) is reportedly as high as 30-90% after radical prostatectomy for prostate cancer, which seriously affects the patients' quality of life. Penile rehabilitation is defined as the use of any drug or device at or after radical prostatectomy to maximize erectile function recovery. A variety of treatment options are available for post-prostatectomy ED patients, including oral phosphodiesterase 5 inhibitors (PDE5I) , intracorporal injections, vacuum erection device, and penile prosthesis. This article presents an overview of the currently used methods for the drug treatment and penile rehabilitation of the ED patients after radical prostatectomy. It seems proper to recommend daily use of a vacuum erection device plus oral PDE5I in the early postoperative period. For those who fail to respond to this therapy, intraurethral alprostadil, intracorporal injections, or a penile prosthesis could be considered.
Alprostadil ; administration & dosage ; Combined Modality Therapy ; Erectile Dysfunction ; etiology ; therapy ; Humans ; Male ; Penile Erection ; Penile Prosthesis ; Phosphodiesterase 5 Inhibitors ; administration & dosage ; Prostatectomy ; adverse effects ; Quality of Life ; Recovery of Function ; Vacuum

Objective:To determinate the substances with high molecular weight in porcine anterior pituitary and adrenal cortex extracts injection. Methods:The HPLC analysis was performed on a TSK-GEL G2000SWXL(7. 8 mm × 300 mm,5 μm) column with the mobile phase of trifluoroacetic acid-acetonitrile-water(0. 05:35:65). The flow rate was 0. 5 ml·min-1, and the detection wave-length was 214 nm. Results:The substances with high molecular weight in porcine anterior pituitary and adrenal cortex extracts injec-tion was below 1%. Conclusion:The method is simple and repeatable, which can be used for the control of the substances with high molecular weight in porcine anterior pituitary and adrenal cortex extracts injection.

BACKGROUND:There was a variety of surgery treatment method in senile patients with unstable intertrochanteric fractures, such as hip replacement and internal fixation, but there was a great deal of controversy about advantages and disadvantages of different methods.
OBJECTIVE:To evaluate clinical effect and safety of total hip replacement, hemiarthroplasty and proximal femoral nail in senile patients with unstable intertrochanteric fractures.
METHODS:103 senile patients with unstable intertrochanteric fractures were selected, including 43 males and 60 females at the age of 62 to 80 years old. There were 28 cases of total hip replacement, 34 cases of hemiarthroplasty and 41 cases of proximal femoral nail. Perioperative complications and recovery of hip function after repair were compared among three groups.
RESULTS AND CONCLUSION:(1) The incidence of postoperative complications of internal medicine was higher in the proximal femoral nail group than in the total hip replacement and hemiarthroplasty groups (P < 0.05). No significant difference in the incidence of complications was found between the hemiarthroplasty and total hip replacement groups. (2) The incidence of prosthesis complications was lower in the total hip replacement group than in the hemiarthroplasty and proximal femoral nail groups (P < 0.05). No significant difference in the incidence of prosthesis complications was detectable between the total hip replacement and hemiarthroplasty groups. (3) The recovery of hip function was better in the total hip replacement and hemiarthroplasty groups than in the proximal femoral nail group during 12-month folow-up (P < 0.05), and no significant difference in the recovery of hip function was found between the total hip replacement and hemiarthroplasty groups. These results showed that total hip replacement and hemiarthroplasty had good curative effect on unstable intertrochanteric fractures in senile patients, and could effectively restore the hip function and reduce complications.

BACKGROUND:It wil provide a new insight into the future application of bone marrow mesenchymal stem cels in the treatment of spinal cord injury and tissue engineering by studying the effect of activation of Wnt signaling pathway in the neuronal differentiation of bone marrow mesenchymal stem cels.
OBJECTIVE: To detect the expression of related genes by gene chip technology during the neuronal differentiation of bone marrow mesenchymal stem cels.
METHODS:Human bone marrow mesenchymal stem cels were isolated and purified, and passage 5 cels were obtained. GatewayTM technology was used to build lentiviral vectors that was used to transfect Wnt-1 into human bone marrow mesenchymal stem cels. Control, non-transduction and transduction groups were set in this study. Human bone marrow mesenchymal stem cels were then induced to differentiate into neurons. Cel morphology was observed under inverted phase contrast microscope. Gene chip was used to detect the regulation changes and the differential expression of related genes in the Wnt signaling pathway.
RESULTS AND CONCLUSION: Under the scanning electron microscope, the transfected cels were found to have the similar morphology of neuron-like cels. Analysis by the gene chip hybridization technique showed that 3 287 genes were up-regulated and 4 215 genes were down-regulated in the signal pathway. In the Wnt signaling pathway, genes related to the nervous system development and differentiation were up- or down-regulated. It is verified that the Wnt signal pathway is activated via Wnt-1 transduction, and the downstream genes appear to have genetic transcription so as to promote the neuronal differentiation of human bone marrow mesenchymal stem cels.

Objective To investigate the relationship between PSMA expression and histologic grading of prostatic carcinoma. Methods Different prostatic tissues and non-prostatic tumors (PCa 70,prostate intraepithelial tumor 21,BPH 20,nonprostatic malignancies 30) were analysed for the expression of PSMA by using PSMA mono-clonal antibody and ABC immunohistochemical staining. Results All prostatic tissues but 2 cases of prostatic carcinoma and 4 cases of benign prostate hyperplasia were stained positively,while all of the non-prostatic tumors were stained negatively.There was a negative correlation between PSMA expression and histologic grading of prostatic adenocarcinoma. Conclusions PSMA was prostatic organic specific and could be a prognostic marker of prostate adenocarcinoma.

Objective To study the character of transformation of H.pylori into coccoid form under oxidative stress, and the changes in the biological charasteristics after transformation. Methods The coccoid form of H.pylori was studied with bacteriological, enymological, and genetical methods to identify its differences from the original form. Animal experiment was conducted to determine its implantation capacity. Results Morphological transformation from spiral to coccoid form occurred with the prolongation of culture under oxygen stress. The metabolic activity was reduced gradually, finally maintained at a lower level. The activities of urease, alkaline phosphatase and acid phosphatase were decreased markedly. The mRNA levels of main virulence factors were declined. Both mRNA and activities of enzyme of Sod B and Kat retained high levels. A part of the coccoid forms showed reversion to helical form, and colonization in mice stomach could be found after being inoculated to mice. Conclusions The metabolism and virulence of H.pylori were all lowered under oxidative stress, but a part of the coccoid form may be viable. Sod B and Kat may play an important role in the oxygen metabolism of H.pylori.