Reference materials are one of the major approaches to achieve measurement accuracy and metrological comparability. Different functions of reference materials should also be distinguished when applied to mass spectrometry as an emerging technology in clinical laboratory. Proper reference materials for validation, calibration and quality control of measurement method can ensure the accuracy and comparability of test results. Based on the problems of reference materials in clinical mass spectrometry, the precautions for the use of reference materials are summarized in the aspects of measurement method validation, calibrator usage and quality control.

Objective To investigate the distribution of chronic disease and geriatric syndrome in hospitalized elderly patients with multimorbidity by chronic disease investigation and comprehensive geriatric assessment.Methods A total of 176 patients aged ≥60 years admitted into the geriatric department in our hospital were selected,and demographic factors were collected.Their chronic diseases and geriatric syndrome were recorded.The comprehensive geriatric assessment was consummated,and the biochemical indicators for chronic disease and geriatric syndrome were detected.Results All patients suffered from two or more kinds of chronic diseases.The top three most common diseases were hypertension (112 cases),diabetes (94 cases),and respiratory diseases (73cases).The sum of chronic diseases kinds were ≥3 in 137 patients,≥4 in 78 patients,≥5 in 40 patients.The amount of chronic diseases showed an increased tendency along with ageing.Totally 175 patients had more than one geriatric syndrome,the top three most common types were frailty and prefrailty(133 cases),visual impairment (117 cases),impaired daily activities (107 cases).There were significant differences in the number of geriatric syndrome among different age groups(x2 =16.989,P ＜ 0.001).Spearman analysis showed that the number of patients with geriatric syndrome were positively correlated with age(r =0.307,P＜0.001).Conclusions The prevalence of chronic disease and geriatric syndrome is high in hospitalized elderly patients with multimorbidity,which is increased with aging.We should pay attention to the screening of chronic disease and geriatric syndrome in multimorbid elderly patients

Vitamins are classified as either fat-soluble (vitamins A, D, E, K) or water-soluble (vitamins B and vitamin C). Traditional methods of immunoassay have only been developed for vitamins D,B6, B9 and B12. However, they cannot distinguish between vitamin subtypes such as D2, D3 and associated epi isomers (which has higher leveks in infants),giving false positive or negative results. Mass spectrometry has become a gold standard method for small molecule analysis in biological samples with its advantages in speed,resolution,sensitivity and specificity. It is widely used in clinical research and diagnosis and provides an efficient method for simultaneous detection of multivitamins in one injection using one low volume sample collection.

Objective: To improve the understanding of high calcium risk in patients with diffuse large B-cell lymphoma (DLBCL) during the chemotherapy. Methods: The diagnosis and treatment of high calcium risk in one patient with DLBCL during the chemotherapy in the Second Affiliated Hospital of Anhui Medical University was retrospectively analyzed, and the relevant literatures were reviewed. Results: A 52-year-old man who was diagnosed with DLBCL (non-specific, non-germinal center source; stage Ⅳ group A; International prognosis index score 4 points, high-risk group) in June 2017. Two times R-CHOP chemotherapy was performed before diagnosis. This patient was admitted to the hospital for the third chemotherapy, and the disease assessment showed that the enlarged lymph nodes were not significantly smaller than before, and the tumor burden was still high. Therefore, the chemotherapy regimen was adjusted to R-GDP regimen. However, on the 8th day after the end of rituximab treatment, the patient had head pain, which might be related to the patient's poor sleep and primary invasion of the primary disease (blood calcium: 2.94 mmol/L). And then the ibuprofen and diuresis treatments were given, but the symptoms were still gradually worsening, and vomiting appeared on the 9th day, systemic fatigue with drowsiness and irritability appeared on the 12th day. Review blood calcium: 5.02 mmol/L. Adequate fluid hydration, diuretic, renal replacement treatments were given, and the level of blood calcium gradually returned to normal. Finally, the patient's symptoms were improved significantly, and he successfully completed R-GDP chemotherapy. Conclusion If a DLBCL patient has symptoms such as headache, lethargy, irritability or even coma during the chemotherapy, it is necessary to alert the possibility of hypercalcemia and to timely improve the relevant examination and make symptomatic treatment.

Objective:To construct a multidisciplinary continuing management model for hospitalized elderly patients with multimorbidity and to assess the effectiveness of this model, thus providing insights and suggestions for the management of elderly patients with co-morbidity.Methods:This was a prospective randomized controlled study.Patients with comorbidity admitted to the geriatric ward of our hospital from November 2015 to July 2017 were selected and received comprehensive geriatric assessment(CGA). Patients were randomly divided into the intervention group receiving continuous multidisciplinary medical treatment and the control group receiving conventional medical treatment.The work flow and characteristics of the intervention group were examined, and the effectiveness of the two models(including cost of hospitalization, duration, patient satisfaction, patient functional status, adverse events, and changes in healthy behavior awareness after 6 months of follow-up)were compared between the two groups.Results:A total of 440 patients with comorbidity were included in the study, with an average age of(76.0±8.1)years, including 226 in the intervention group and 214 in the control group.After multidisciplinary continuing medical intervention, patients in the intervention group were associated with a significantly higher level of satisfaction on physician availability(86.3% vs.74.8%, χ2=9.354, P=0.002), medical care(99.6%vs.86.7%, χ2=4.926, P=0.026)and nursing quality(93.4%vs.86.4%, χ2=5.829, P=0.016), compared with the control group.After 6 months of follow-up, the probability of adverse events in the intervention group was lower than that in the control group(61.1%vs.73.5%, χ2=7.436, P=0.006), and drug-related adverse reactions/events in the intervention group(9.0%vs.22.1%, χ2=13.858, P<0.000)were significantly lower than those in the control group.Furthermore, the proportion of patients with improved healthy behavior awareness was markedly higher in the intervention group than that in the control group(30.3%vs.5.4%, χ2=43.979, P<0.001). Conclusions:The multidisciplinary hospital-community continuity management model with CGA at the core can reduce the occurrence of adverse events, improve patient satisfaction and healthy behavior awareness, and is a worthy exploration of a new medical model for elderly comorbid patients.

OBJECTIVE：To systematically evaluate clinical efficacy of L-carnitine in the treatment of male infertility ，and to provide evidence-based reference for clinical treatment of male infertility. METHODS ：Retrieved from CNKI ，Wanfang database ， VIP，CBM，PubMed，Embase and the Cochrane library ，randomized controlled trials （RCTs）about L-carnitine and other chemical drugs in the treatment of male infertility were collected during the inception to Apr. 12th，2020. After data extraction of included literatures and quality evaluation with modified Jadad scale ，Meta-analysis was conducted by using RevMan 5.3 software. RESULTS：A total of 8 RCTs were included ，with 520 patients. The results of Meta-analysis showed that compared with other chemical drugs ，L-carnitine could significantly enhance the semen volume [MD＝0.55，95％CI（0.20，0.91），P＝0.002] and sperm mortality rate [MD＝1.60，95％CI（0.50，2.69），P＝0.004] of male infertility patients ，with statistical significance. There was no statistical significance in sperm count [MD＝4.00，95％ CI（－3.15，11.15），P＝0.27]，the percentage of forward motile sperm [MD＝12.58，95％CI（－3.87，29.03），P＝0.13]，and the percentage of inducing pregnancy rate [OR＝0.85，95％CI（0.47，1.52），P＝ 0.58] of male infertility patients. CONCLUSIONS ：L-carnitine can significantly improve the semen volume and sperm mortality of male infertility patients ，and has the same effects as other drugs on improving sperm count ，percentage of forward motile sperm and percentage of inducing pregnancy rate.