Objective To discuss the value in quality improvement and continuous improvement through the way for determina-tion of target uncertainty in chemical quantitative detection project and regular evaluation of measurement uncertainty in different phase.Methods Based on the biological variability of quality specification and CNAS-TRL-001:CNAS technical report,to compare the five kinds of determination of target uncertainty.Method 1:the fundamental way(calculate the different levels of target impre-cision and bias);Method 2:biological variation of different grades of total allowable error;Method 3:the relative expanded uncer-tainty evaluation value based on target imprecision and bias;Method 4:the target relative expanded uncertainty based on biological variation of different grades;Method 5:the target relative expanded uncertainty based on the quality index of analysis.We used un-certainty evaluate index(UEI)to review the changes of uncertainty in different phase.Results The 14 conventional chemistry tests in 2013 with metrological traceability and participate in the Ministry of health EQA were as the target.There was no significant difference among the 2,3,4 method,the ratio of which reached the ideal value of uncertaninty target were not significantly different. In method 5,9 projects achieved the target of uncertainty requirements,accounted for 64.3%.TP,ALT,BUN,UA,CK,these5 pro-jects′UEI were less than 0,accounted for 35.7%;other 9 projects′UEI were more than 2.0%.Conclusion Method 5:the target relative expanded uncertainty based on the quality index of analysis which is based on WS/T403-2012 can give consideration to the quality standard of repeatability precision and bias in the laboratory at the same time,and is easy to be accepted for laboratory;method 4:the target relative expanded uncertainty based on biological variation of different grades is in the same way with the eval-uation of test results uncertainty,is better than method 2 and 3;method 1 is the fundamental way,can give the specific reasons when the test results cannot get the target uncertainty.Use UEI to assess the changes of uncertainty in different phase is more sensitive to changes of the test results′accuracy and its usefulness needs to be confirmed in practice.

Objective To establish quality improvement project through theσ value and quality goal index ,then determine the effect of quality improvement by comparing the changes of uncertainty ,provide the laboratory basis for the effective improving of the quality of clinical laboratory .Methods The quality control data of blood cell analysis items were analyzed ,and the σ values , quality goal index (GQI) and measurement uncertainty [u(Rw)] were calculated and the performance was estimated .The quality improvement project was designed and had run for one year .The effect of quality improvement project was determined according to u(Rw) changes .Results The excellent rate (σvalue >4σ) of process performance evaluation in 2012 was up to 62 .5% ,the items withσvalue>6σamounted to 37 .5% ,about 62 .5% of the items needed to be improved .Comparing the u(Rw) in 2013 with 2012 , the improvement rate was 50% .The laboratory quality had been improved .Conclusion The performance analysis of σvalue ,GQI combined uncertainty evaluation is a good management method to improve the efficiency and reduce the cost .

Objective To establish a high performance liquid chromatography (HPLC) method for the determination of baicalin and naringin inQinbei mixture.Methods The HPLC system consisted of the Fortis-C18(4.6 mm × 250 mm, 5μm) column, and the mobile phase consisted of MeOH:0.4% H3PO4 (42:58), and the flow rate was 1.0 ml/min, and the UV detector was set at 280 nm, and the column temperature was 30℃.Results The linear response range of baicalin was 0.062-0.930μg. The linear response range of naringin was 0.033-0.492μg. The average recovery of baicalin was 98.11% (RSD=1.62%). The average recovery of naringin was 96.78% (RSD=1.74%).Conclusions The method is simple, rapid, accurate and repeatable. It can be applied in determination of baicalin and naringin inQinbei mixture.

Objective To explore the diagnostic value of C‐reactive protein(CRP) for diagnosing chronic obstructive pulmonary disease(COPD) to dig a new marker for COPD diagnosis .Methods A total of 199 cases of COPD ,159 cases of pulmonary malig‐nant tumor and 115 individuals undergoing the physical examination were collected .The whole blood CRP level was detected in 3 groups and the detection results were compared among 3 groups .The receiver operating characteristic(ROC) curve was drawn . Then the sensitivity ,specificity and Youden′s index(YI) were calculated to find the cut‐off value of diagnosis .Results Compared with the individuals undergoing healthy physical examination ,the CRP level in the COPD patients and the patients with pulmonary malignant tumor was significantly increased ,the difference was statistically significant(P<0 .05);the area under ROC curve(AUC) was 0 .768 ,the maximal YI was 0 .418 ,the sensitivity and specificity were 64 .7% and 77 .1% respectively ,the corresponding cut‐off value was 49 .75 mg/L .Conclusion CRP has a certain diagnostic value and can serve as a new index of COPD diagnosis .

A sensitive and convenient method based on accelerated solvent extraction ( ASE )-liquid chromatography tandem mass spectrometry (LC-MS / MS) was established for the simultaneous determination of 11 phthalic acid esters(PAEs) in soil. The optimized conditions were as follows: By using n-hexane as the extraction solvent, spiked sample was extracted by ASE at 160 ℃ for 4 times, 12 min for each time. The extract was concentrated by evaporation. Qualitative and quantitative analysis was carried out by the multiple reaction monitoring mode after the chromatographic separation with atmospheric pressure chemical ionization (APCI), using acetonitrile -0. 1% formic acid water as mobile phase. The limits of detection(LODs) for 11 PAEs were between 0. 03 - 13. 0 μg / kg. The recoveries and relative standard deviations were 72. 8% -101. 8% and 1. 7-6. 7% , respectively. This method is rapid, sensitive and suitable for the determination of PAEs in soil.

Objective Plasma circulating DNA can be em-ployed in place of bone marrow examination for the auxiliary diagnosis of leukemia.This study aimed to explore the clinical application of the plasma DNA level in evaluating the effect of chemotherapy on chronic leukemia. Methods We collected blood samples from 52 patients with chronic myelogenous leukemia (CML) (33 in the chronic phase, 7 in the acceleration phase, and 12 in the blast phase) , 85 with chron-ic lymphocytic leukemia (CLL) (28 with complete remission, 27 with partial remission, and 30 with no remission), 4 patients with hairy cell leukemia (HCL), and 80 healthy subjects.We simultaneously obtained plasma DNA and recombinant plasmid DNA using the BI-LATEST DNA Kit and examined the human β-actin gene and the level of plasmid DNA by real-time quantitative PCR. Results Before chemotherapy, the median value of plasma DNA was 149.46(30.63-496.91)ng/ml in the CML and 101.54(69.10-258.14) ng/ml in the CLL patients, both significantly higher than in the healthy controls (19.05[12.67-25.92]ng/ml) (P<0.01).After chemotherapy, the plasma DNA level of the CML patients was remarkably decreased, but still higher than that of the controls ( P<0.01).The CML patients in the chronic phase showed a markedly higher level of plasma DNA (302.89[93.33-541.52]ng/ml) than those in the blast phase (43.19[23.54-70.03]ng/ml) and acceleration phase (28.11[16.21-92.07]ng/ml) (P<0.05).The CLL patients with CR exhibited a significantly lower level of plasma DNA (24.29[14.64-30.74]ng/ml) than those with PR (106.88 [96.23-143.25]ng/ml) and NR (460.73[284.57-653.38〗ng/ml) (P<0.01), but all dramatically higher than that of the healthy controls (P<0.01) Conclusion The quantification of plasma DNA has a clinical application value in evaluating the effect of chemo-therapy on chronic leukemia.

Chronic hepatitis B (CHB) is a major global public health issue, and although direct-acting antiviral agents can control hepatitis B virus (HBV) replication, it is difficult to achieve the cure of CHB. Host adaptive immune response plays a key role in eliminating HBV, and it is expected to achieve the functional cure of CHB by rebuilding the patient’s adaptive immunity. Great progress has been made in therapeutic vaccines, cellular immunotherapy, immune checkpoint blockade, T cell metabolic reprogramming, and strategies of neutralizing antibody targeting adaptive immunity for the treatment of hepatitis B. This article summarizes the above-mentioned therapies for hepatitis B in recent years.

Intestinal flora can participate in and influence the physiological function and disease process of the organism as part of the host .The symbiotic relationship between intestinal flora and the host is the result of species′evolution over millions of years .Immunity system , which is complex and includes multiple influencing factors , is the necessary defense system that runs through human life .Among them, the intestinal flora plays an important role in maintaining the steady state of human immunity system .In this paper, the relationship between intestinal flora and immune system disease is briefly described , in order to deepen the understanding for medical workers and researchers , and provide references for the prevention , treatment and prognosis of the disease .

Objective To investigate the diagnostic value of B7-H3 and carcinoembryonic antigen (CEA) on diagnosis of malignant pleural effusion (MPE).Methods We collected and analysed the expression of B7-H3 and CEA in 40 MPE cases and 22 cases of benign pleural effusion (BPE) using enzyme-linked immunosorbent assay (ELISA).Receiver operator characteristic curves (ROC) were drawn according to the expression of B7-H3 and CEA, calculated diagnosis sensitivity, specificity and the area under curve (AUC).Results The diagnosis sensitivity of B7-H3 was 62.5％, specificity 81.0％, with the AUC of 0.777;similarly, The diagnosis sensitivity of CEA was 72.5％, specificity 81.0％, with the AUC of 0.850.Higher AUC of 0.910 was gained in combination ROC, with sensitivity and specificity of 72.5％, 81.0％, respectively.Conclusion B7-H3 and CEA could be available diagnosing markers for MPE.Combined applications of B7-H3 and CEA have higher AUC.They may be widely applied in future clinical practice.

Objective To evaluate he significance of the Neutrophil-Lymphocyte Ratio(NLR)and the red blood cell(erythrocyte)distribution width(RDW)in distinguishing between simple and complex febrile seizures and evaluate the diagnostic values of NLR and RDW in febrile seizures. Methods Totally,100 patients aged between 6 months and 5 years diagnosed with febrile seizure were admitted to the emergency department of the hospital.Complete blood count obtained from the peripheral blood samples collected from the patients at admis-sion were evaluated. Results The average values of NLR for simple and complex seizure groups were 2.16 ± 1.26 and 3.62 ± 1.51 respectively.The average values of RDW for simple and complex seizure groups were 15.04 ± 1.73 and 16.89 ± 1.44,respectively.Using receiver operating characteristic curve(ROC),the sensitivity and specificity were 65.5% and 66.2%,respectively,with the area under the curve[AUC]of 0.670 when the cut-off value was 2.52 for NLR,and they were 62.1% and 59.3%,respectively,with AUC of 0.619 when the cut-off value was 16.47 for RDW. Conclusion NLR and RDW may provide clinicians with an insight into differentiation between simple and complex febrile seizures,however,we need much better diagnostic value to classify the febrile seizures