Objective:To explore the effective drug and the best way of administration of the drug in the relief of moderate or severe cancer pain,so as to attain the best effect.Methods:30 patients with moderate or later period cancer orally take 30 mg Morphine tablet every 12 hours. The initial dose was 60 mg,and then it was adjusted according to the effect till the most appropriate dose was reached.Results:After taking Morphine tablet,the rate of complete relief and moderate relief of moderate or severe cancer pain were 70%(21/30),26.7%(8/30),respectively. The total effective rate was 96.7%.Conclusion:Effect of Morphine tablet for cancer pain treatment was sure and reliable,the administration of 30 mg Morphine tablet every 12 hours was safe and effective.

Objective To evaluate the methods and effects of modified surgical treatment for Amold-Chiari Ⅰ malformation complicated with syringomyelia.Methods Twelve patients with ArnoldChiari Ⅰ malformation complicated with syringomyelia,underwent a modified surgical treatment,effects were observed.Results During the first follow-up,sensation and motion function were significantly improved in 10 cases,unchanged in 2 cases.During the second follow-up,2 cases previously unchanged were improved,while the other were with no change.During the first follow-up,lesion showed on MRI disappeared in 5 cases,reduced in 4 cases,no significant change in 3 cases,no case extend,3 cases with hydrocephalus ventricle was significantly reduced.The second follow-up,MRI showed that there was no change compared with the first follow-up.Conclusion The remove of the pia mater of tonsillar hernia + reconstruction the cisterna magna have good effect on surgical therapies for Arnold-Chiari I malformation complicated with syringomyelia.

Objective To explore the assessment of precision, accuracy, and quality control(QC) procedures needed to satisfy the external quality assessment criteria with "operational process specifications" (OPSpecs) derived from an analytical quality-planning model. Methods The routine operating specifications were presented in the form of an OPSpecs chart, which described the operational limits for imprecision and inaccuracy when a desired level of quality assurance was provided by a specific QC procedure. Results OPSpecs charts could be used to compare the operational limits for different QC procedures and to select a QC procedure that was appropriate for the precision and accuracy of a specific measurement procedure. The inaccuracy and imprecision observed for a measurement procedure was plotted on the OPSpecs chart to define the current operating point, which was then compared with the operational limits of candidate QC procedures. Conclusion The general design approach is applicable in all instrument systems.

Objective To discuss the application of allowable total error (Tea) and allowable imprecision derived from biological variation in routine chemistry external quality assessment ( EQA) and internal quality control (IQC) and set up quality specifications of routine chemistry in our country.Methods Data of test items including K,Na,CI,Ca,P,Glu,Urea,UA,Cre,Alb,TP,TC,TG,AST,ALT,Tbil,ALP,AMY,CK,LDH,Fe,Mg,Cu,Zn and GGT was collected and evaluated by a nationwide EQA.At the same time the coefficients of variation (CVs) of these test items during the month were acquired from the IQC reports of each laboratory and then the results were analyzed.Results Percent of pass was different in these test items based on Tea derived from biological variation in EQA results.Except for items of CI,Mg,Cu and Zn,about 80％ of participant laboratories could achieve the minimum performance of biological variation.About 80％ of participant laboratories could achieve the desired performance of biological variation for K,P,Glu,Urea,UA,Cre,TC,TG,ALT,AST,Tbil,AMY,CK,LDH,Fe and GGT.About 80％ of participant laboratories could achieve the optimum performance of biological variation for Urea,UA,TC,TG,ALT,AST,Tbil,C K,and GGT.And the IQC results showed that acceptable percents of different items based on three allowable imprecision were different.More than 80％ of participant laboratories could achieve the minimum allowable imprecision for K,P,Glu,Urea,UA,TC,TG,ALT,AST,Tbil,AMY,CK,LDH,Dbil,Fe,GGT,the desirable imprecision for P,Urea,UA,TG,ALT,AST,Tbil,CK,Dbil,Fe,GGT and the optimum imprecision for TG,ALT,CK,Dbil,Fe.Conclusions The quality specifications derived from biological variation can be as evaluation criteria for EQA and IQC in order to know the detection ability of each laboratory more completely and objectively,set up quality specifications derived from allowable total error and allowable imprecision in routine chemistry and to provide basis for mutual recognition of routine chemistry test results.

Objective To summarize and analyze the results of national external quality assessment (EQA) of maternal serum prenatal screening in second trimester during 2004-2013,in order to provide a assistance for the quality improvement of the prenatal screening testing.Methods Five different concentration samples were distributed to each participated laboratories and were measured at each external quality assessment program during 2004 to 2013.The results reported in a specified time.The testing performance of alpha fetoprotein (AFP),total human chorionic gonadotropin (HCG),total β-human chorionic gonadotropin (β-HCG),free β-human chorionic gonadotropin (free β-HCG),unconjugated estriol (uE3) were evaluated.Results During 2004-2013,the number of laboratory participated increased from 57 to 500.The robust variation coefficient increased from 2.77％ to 18.98％ for AFP,5.6％ to 36.12％ for HCG,4.69％ to 24.38％ for β-HCG,2.66％ to 81.54％ for free β-HCG,and 3.83％ to 26.51％ for uE3.The percentage of passing rate reached 93％ (463/496) for AFP,66％ (35/53)for HCG,85％ (137/ 161) for β-HCG.The percentage of passing of free β-HCG (μg/L) increased from 52 ％ (24/46) to 94％ (248/264),but the passing percentage of free β-HCG (mIU/ml) were 47％ (18/38).The percentage of passing of uE3 reached 84％ (252/299).Conclusions The testing performance of AFP is best in prenatal screening,followed by β-HCG,other item testing have some problems.It is great important to improve the quality of maternal serum prenatal screening by strengthening external quality assessment and building comprehensive quality control system in China.

Objective To investigate the current application status of reference intervals in routine chemistry and compare with the current health industry standards .Methods By using web-based external quality assessmentsoftware system , data were collectedfrom the laboratories which attended 2012 national reference intervals investigation , including the sources of reference intervals , upper and lower limits , subgroups and grouping rules , test methods, instruments and reagents , etc.Microsoft Excell2007 and SPSS 13.0 were used to analyze the trimmed data .Results There were 385 laboratories submitting the reference intervals they had been using .Only a few of laboratories'reference intervalsweregrouped .There are some differences in grouping rulescompared with the currentstandards .Even though some of the laboratories adopt the grouping rules as the same as the standards , there are still significantstatistical differences in reference intervals between the laboratories and the health industry standards (P <0.01).Conclusions The reference intervals of routine chemistry items suggested by the health industry standards have quite big differences from thoseused in current clinical laboratories dailywork ,that might be related from the population they served and many internal influence factors. If the health industry standards are used , the evaluation and validation of reference intervals should be done first.

Objective To describe the reference intervals and their sources of tumor markers in clinical laboratories all over China.And make a comparison of difference between different testing systems.Methods The questionnaires about reference intervals of tumor markers testing were distributed to participants.The information was collected by external quality assessment software system based on website, which including upper and lower limits, sources, validation information and testing systems.The analytes were AFP, CEA, total-PSA, CA125, CA153, CA199, ferritin and free-PSA. The participants were classified according to the testing systems they used.The mean, median, maximum and minimum of each group were calculated using Microsoft Excel 2007.The difference of reference intervals between different testing systems were compared by Kruskal-Wallis test.Results The main source of reference intervals was instructions of testing system manufactures ( 83.1% for mean of 8 ratios ) .The next in sequence were instructions of reagent manufactures(8.4% for mean), National Guide to Clinical Laboratory Procedures (4.6%for mean), determined by their own laboratory(2.0% for mean) and the rest (1.9% for mean). There were 48.0% ( 1 906/3 967 ) of analytes whose reference intervals had been validated.Difference of reference intervals which was with P value of Kruskal-Wallis test with <0.05 was found between different testing system groups except the upper limit of free prostate specific antigen ( PSA ) .Conclusions Most clinical laboratories establish the reference intervals of tumor markers on the basis of instructions of testing system manufactures.The reference intervals among different testing systems have statistically significance.

Objective To study the effctiveness and safety of arsenic trioxide(As2O3)combined with Homoharringtoninum in the chronic myelocytic leukmia-chonic phase(CML-CP).Methods Seven patients were treated with As2O3 10mg per day for 2~3 week and with Homoharringtoninum 3~4mg per day for 1~2.Results All patients were clinic remission,of which there were 4 complete remission who were all initial therapy,and 3 partial remission,2 of who were initial therapy and 1 was resume threapy.4 patients of CR were treated with second strengthen therapy and continued hematologic CR.The main side effects were grade 3 hematologic toxicity and light liver damage,and no significant nausea,emesis,diarrhea or mucositis.Conclusion As2O3 combined with Homoharringtonium in the CML-CP is a safe and effctive regimen.

Objective To investigate and analyze the current situation of reference intervals and decision limits of reticulocyte count in China.Methods The information related to upper/lower limits,decision limits,data resources,method principles, instruments and reagents of reticulocyte count in 2014 was collected via the external quality assessment software system based on website.The participants were divided according to their methods and instruments.The SPSS 1 9.0 was used for conducting the data analysis and statistics of results for each group.Results There were 276 laboratories submitting the val-id results.The major resources for reference intervals came from national guide to clinical laboratory procedures (53.99%), instructions of instrument manufacturers (16.30%),textbook (9.78%),instructions of reagents manufacturers (9.06%) and others.The major resources for decision limits were national guide to clinical laboratory procedures (56.06%),instruc-tions of instrument manufacturers (16.67%),textbook (7.58),instructions of reagents manufacturers (7.58%)and others. The medians and averages of upper/lower limits and decision limits among subgroups were close,whereas the P2.5 and P97.5 were significant discrepancies.Only 45.65% and 48.48% of participant laboratories had verified reference intervals and deci-sion limits before clinic use.The lower limits and decision limits among subgroups had nostatistical difference (P>0.05), where as the upper limits of different instrument groups had significant differences (P<0.001).Conclusion The current situation of reference intervals and decision limits of reticulocyte count is unsatisfactory.It is certain to establish a uniformed reference interval and decision limits for reticulocyte count,which provides a reference for the standardization of reticulocyte count testing.

Objective Discussthe reference intervals and their sources of lymphocyte subsets by flow cytometry tests by all Chinese clinical laboratories at 2014 with a comparison of difference between different test systems.Methods Questionnaires about reference intervals were distributed to 212 clinical laboratories participating in October 2014 national external quality assessment scheme of lymphocyte subsets by flow cytometry tests of National Center for Clinical Laboratory.Relevant information about reference intervals of 5 relative counting items CD3 + (％),CD3 + CD4 + (％),CD3 + CD8 + (％),CD3-CD16 + CD56 + (％) and CD3-CD19 + (％) was collected by a internet-based external quality assessment software systems.Microsoft Excel 2010 and SPSS 19.0 were used to sort out raw data,eliminate unreasonable or incorrect data,and only analyze source distribution,arithmetic average,median,minimum value,maximum value and percentiles (P2.5 and P97.5) of upper and lower limits about healthy adults' reference intervals.Laboratories derived from the highest percentage of source distribution whose reagent and instrument were matching with each other were grouped according to the test systems used and the differences of reference intervals between different systems were compared with Mann-Whitney test.Results For five items collected,in the clinical laboratories who accepted statistical analysis,respectively 39.32％ (81/ 206),37.44％ (79/211),37.68％ (78/207),37.11％ (72/194),36.98％ (71/192) of them had verified the reference intervals they used.The top three sources of reference intervals were instructions of reagent and instrument manufactures (49.70％-52.54％),calculations by laboratories themselves (18.64％-20.00％),and calculations by other laboratories (14.12％-15.43％).The arithmetic averages and medians of upper and lower limits about every item were relatively close.But the minimum and maximum values of upper and lower limits of certain items had moderate differences.As Mann-Whitney test later showed,all items with the P values of upper and lower limits between different test systems,except for the lower limit of CD3 + CD4 + (％) (P value is 0.052) and the upper limit of CD3-CD19 + (％) (P value is 0.117),were lower than 0.05 which meant an existing statistical difference.Conclusions The sources of lymphocyte subsets by flow cytometry tests in all Chinese clinical laboratories were different and the instructions of reagent and instrument had the highest percentage,but the reference intervals among differenttest systems had statistically significance.