Laboratories are required to develop and put into practice critical value policies by numerous regulatory agencies,such as,the Clinical Laboratory Improvement Amendment of 1988 (CLIA'88),Joint Commission on Accreditation of Healthcare Organizations (JCAHO),College of American Pathologists (CAP),International Standard Organization (ISO EN15189) and National Patient Safety Goals,etc.However,there is little standardization of procedures,which are related with equipment,assay,patient population,recognition and skill of physician.This paper is to describe the proceedings on regulations,critical value items and their limits,critical value identification and reporting,critical value reporting assessment as well as monitoring,etc.Several related factors and the optimum options on critical value reporting are analyzed and discussed.Some suggestions are put forward to be consulted.

The reasonable setting and the understandable duties of position is essential to the management of clinical laboratory.Moreover,the personal quality needed by the position and the training related with the qualification is the basis for the duties of the positions.This paper pays more attention to the polices and the documents of the position and training of clinical laboratory,and analyzes the difference of characteristics of position and training in the clinical laboratories of china and American.Some suggestions are proposed.

Objective To investigate the causes on platelet distribution width (PDW)results not shown in the automatic he-matology analyzer and evaluate the accuracy of the platelet results of these samples with the automatic hematology analyzer. Methods The platelet morphology was observed in microscope for the specimen which PDW were not shown in the auto-matic hematology analyzer.And the platelet results counted in microscope were statistically compared with that in the auto-matic hematology analyzer.Results In the 200 specimens which PDW were not shown in automatic hematology analyzer, there were 104 specimens(52%)in which large platelet was found,36 cases(18%)in which platelet aggregation was visible, 28 cases(14%)in which the microcytes or erythrocyte debris could be seen,32 cases(16%)in which the obvious abnormal was not found.The platelet results counted in microscope for the specimens,in which large platelets,platelet aggregation or microcytes were found,were very different with the results counted with the automatic hematology analyzer(P < 0.05).The PDW of the 200 specimens were rechecked in the automatic hematology analyzer.And 64 cases (32%)PDW results were got,of which 55 cases(85.9%)PDW results were beyond the normal range.Conclusion The main causes for the PDW not shown in automatic hematology analyzer includes large platelets,platelets aggregation and microcytes etc.The platelet re-sults in these specimens by automatic hematology analyzer were different with that counted in microscope.Therefore,the platelet of these specimens should be counted in microscope.

Objective To introduce comet assay and to analyze the DNA damage and repair ability of human fetal lung diploid fibroblasts (2BS) as well as lymphocytes. Methods The mixture of 2BS cells (or lymphocytes) and 1% LMA is put on the gel of 0. 5% NMA. After breakage, electrophoresis and stain, the comet tail distance and comet tail area of 100 cells (per sample) are analyzed with Leica image analysis system. Results There are no obvious comet tail for most of young and senescent 2BS cells as well as lymphocytes from young and senescent donors. The comet tails of 28PD 2BS cells treated with H2O2 are obvious. Moreover, the comet tail distances and tail areas of the cells increase as the concentration of H2O2 increasing. The stastics data of the 28PD 2BS cells exposed to H2O2 are as following. Comet tail distance: s = 1.7 ~3. 5 (?m)、CV = 1. 6% ~ 2. 8% . Comet tail area: s = 1. 5% ~ 2. 3%、CV = 1. 8% ~ 2. 5% . Conclusions The DNA breakage level is low both for young and senescent cell. H2O2 can damage DNA obviously. Comet assay is one of important methods used to comment on DNA damage and DNA repair ability.

To evaluate the measurement uncertainty of 23 items of clinical biochemistry. Internal quality control and external quality assessment were used to determine the uncertainty and standard uncertainty for the 23 items detected by Hitachi 7600 automatic biochemical analyzer. The uncertainties met the requirements of CLIA'88 for allowable error before correction except those of Cl-, P, TCH and TG, and correction made those of P, TCH and TG satisfy the requirements. The top-down method contributes to the understanding of the uncertainty of clinical biochemical items, while further efforts have to be performed for the uncertainty assessment standard.

Platelet function testing is essential for the prevention and treatment of ischemic stroke.Only simple and convenient method of platelet function testing can become the conventional detection method for patients with ischemic stroke and can be used to the prevention and treatment of ischemic stroke in clinical practice.

With the rapid development of medical technology , the precision medicine appears .The accurate analysis of the genetic mutations provides the accuracy of diseasesis prediction diagnosis and targeted therapy.Alzheimer′s disease and Parkinson′s disease are two of the most common neurodegenerative diseases.

In-depth application of the combination of theory and practice is one of the keys to improve the clinical undergraduate teaching quality of clinical laboratory diagnosis.Xuanwu Hospital used ISO15189 standards as a guide to make students fully participate in establishing performance verification and recording registration form,partly participate in the gage calibration,external quality assessment and inter-laboratory comparison etc.It also used the combined form of practice with teaching to make students learn the file writing and the equipment calibration.An orderly teaching model composed of knowledge reserve,file learning,calibration and verification was established,which was a closed-loop system that enabled students to become more deeply and extensively involved in the system and more deeply understand the connotation of clinical laboratory quality.

Objective To study the critical thinking disposition status of senior vocational nursing students in Henan province. Methods CDTI-CV was used for investigation in 506 nursing students and the results underwent analysis. Results The total score of CDTI-CV was low among these nuring students,the score of desire for knowledge,self-confidence and analyzing ability was the lowest.The scofe of the rest 6 dimensions were lower than the other provinces except for the cognition degree.Conclusions we should aim at weak aspects to study critical thinking educational reform,especially construct accelerando clinical didactical model to promote the development of critical thinking ability of nursing students.

Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from surgi-cal patients with infection.Methods Distribution and antimicrobial resistance of 1 208 pathogens isolated from sur-gical patients with infection from January 2013 to January 2014 were analyzed retrospectively.Results Of 1 208 pathogenic isolates,gram-negative bacteria,gram-positive bacteria and fungi accounted for 64.57% (n = 780 ), 24.92%(n = 301 )and 10.51 % (n = 127 )respectively.The main specimens were sputum (44.78%),urine (21 .11 %),blood(11 .51 %),and pus(10.26%).Antimicrobial susceptibility testing results showed that the produ-cing rate of extended-spectrumβ-lactamases (ESBLs)of Escherichia coli and Klebsiella pneumoniae was 62.60%and 33.61 % respectively,resistant rate to imipenem was 0.76% and 15.57%,respectively.The resistant rate of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem was 38.93% and 75.80% respectively.Methi-cillin-resistant Staphylococcus aureus and methicillin-resistant coagulase negative Staphylococcus was 71 .68% and 87.93% respectively.Conclusion The major pathogens isolated from surgical patients with infection are gram-neg-ative bacteria,the main infection sites are respiratory tract and urinary tract in this hospital;multidrug resistance is serious,especially carbapenem resistance,which should be paid attention.