Over the past years efforts have been made by the government to improve the management of clinical laboratories.The government activities such as networking of quality assurance, development and implementation of clinical laboratory standards, and establishment of external quality control mechanisms have facilitated the improvement of clinical laboratory quality.Further definition and integration of clinical laboratory services, introduction of clinical laboratory pathologists and consultation and establishment of a permission mechanism are needed for improving the effectiveness of clinical laboratory services.Government regulations will continue to play an essential role in the clinical improvement process.

Objective To evaluate the advantage of using computer navigation system in the resection of rib tumors.Methods We carried out rib tumor resection in 5 patients using computer navigation system.Preoperative CT of each patient was performed.The preoperation CT-based planning was made for every patient with the navigation system software including confirming the tumor surgical margin and designing resection margin.A C-arm scan was carried out intraoperatively.With image fusion of both data,tumor resection were performed under navigation image guidance.Results The mean time of image fusion was 58 minutes.Four tumor resection specimens showed safe and clear margins.Histological examination of all tumor specimens showed tumor-free margins.One patient who was suspected lung cancer with bone metastases was performed a biopsy under navigation image guidance and obtained a pathology diagnose successfully.Conclusion The computer navigation system helps surgeons determine the surgical margin,implement precision tumor resection and reduce surgical damage.

ObjectiveTo describe upper and lower limits and their sources of reference intervals in routine chemistry assays and to make a comparison between routine and dry chemistry in these aspects.MethodsThe data of reference intervals were collected,which come from the third run of 2010 External Quality Assessment (EQA) programs in routine and dry chemistry performed by National Center for Clinical Laboratories(NCCL).All data from maternal and child care service center,children's hospital and corporations were excluded.Then all the abnormal values and errors (for instance,the lower limit was higher than the upper one or the upper limit was as the same as the lower one,etc.) were eliminated,either.Data statistics was performed by SPSS 13.0 referring to upper and lower limits of reference intervals and sources of 24 routine chemistry assays ( including serum potassium and serum sodium,etc).Comparison was made between routine and dry chemistry in these aspects in 23 assays.Data from adult men were reported when gender difference was present.ResultsThe three main sources of reference intervals were National Guide to Clinical LaboratoryProcedures, instructions of reagent manufacturesanddetermined by their own laboratory.In comparison of reference intervals between routine and dry chemistry,6 assays had statistical significant difference in both upper limits and lower ones while,4 assays in one-sided limits and 13 assays were not statistically significant in both limits.Conclusions The reference intervals of routine chemistry have big differences among institutions and the sources of them are various.Only a few assays have statistical significant difference in routine and dry chemistry among medical institutions,it might be discussed in further study whether the statistical results have clinical values.In order to achieve the result agreement among clinical assays,all the laboratories must share the common reference intervals on the basis of standardization.

ObjectiveTo investigate the effects of oxidized low density lipoprotein (oxLDL) on autophagy and its effect on Akt/mTOR/p70S6K signaling pathway in human umbilical vein endothelial cells (HUVECs).MethodsThe cultured HUVECs were divided into either an oxLDL or a control group, and treated with 100 μg/ml oxLDL and equal volume phosphate buffer solution respectively.The cells were collected after 6 h and 12 h.Transmission electron microscopy was used to observe the autophagosome.Real-time fluorescence quantitative polymerase chain reaction was used to detect expression levels of microtubule associated protein 1 light chain 3 (LC3) and p62 mRNA.Western blot was used to detect the expression levels of LC3, p62, P-Akt/Akt, P-mTOR/mTOR, and p-p70S6K/p70S6K.Results Compared with the control group, the number of intracellular autophagosome increased obviously (P<0.05), LC3 mRNA and protein expression levels increased significantly (all P<0.05), and p62 mRNA and protein expression levels decreased significantly (all P<0.05) in the oxLDL group.In addition, the phosphorylated protein expression levels of Akt, mTOR and p70S6K in the oxLDL group were significantly decreased than those in the control group (all P<0.01).However, total protein levels of Akt, mTOR, and p70S6K were not significantly different between the oxLDL group and the control group.Conclusion oxLDL may induce the autophagy of HUVECs via inhibiting the Akt/mTOR/p70S6K signaling pathway.

OBJECTIVETo observe long-term functional recovery after contralateral C7 transfer.

METHODSFrom August 1986 to July 2000, 224 patients with brachial plexus avulsion injuries were treated with contralateral C7 transfer in our department. Thirty-two patients were followed up for over 2 years for evaluation of the following items: 1 influence on healthy limb function; 2 sensory and motor recovery of the recipient nerves in the affected limb; and 3 coordination between the healthy and affected limbs.

RESULTSThere was no impairment of healthy limb function. Functional recovery of the recipient area reached > or =M3 in 8 patients (8/10, 80%) after musculocutaneous nerve neurotization, > or =M3 in 4 patients (4/6, 66%) after radial nerve neurotization, > or = M3 in 7 patients (7/14, 50%) and > or = M3 in 12 patients (85.7%) after median nerve neurotization, and > or = M3 in 1 patients (1/2, 50%) after thoracodorsal nerve neurotization. Synchronic contraction of the affected limb with the healthy limb occurred within 2-3 years in 12 patients, within 5 years in 13 patients, and over 5 years in 7 patients.

CONCLUSIONContralateral C7 transfer is an ideal procedure for the treatment of brachial plexus root avulsion injury. Selection of the whole root or the posterior division as neurotizer and a staged operation are the major factors influencing treatment outcome.

Adolescent ; Adult ; Brachial Plexus ; injuries ; surgery ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Motor Activity ; Nerve Transfer ; methods

OBJECTIVE: To verify the rationality, reliabilit y and practicability of selective transfer of ipsilateral C(7) nerve root for tr eatment of upper trunk avulsion. METHODS: Selective transfer of ipsilateral C(7) nerve root was ca rried out in 8 patients (7 with upper trunk avulsion, and 1 with left upper trun k avulsion combined with partial injury of the middle trunk) from June 1996 to F ebruary 1997. Selective transfer of the anterior division or the anteriolateral fascicles of the anterior division of ipsilateral C(7) to the anterior division of the upper trunk was performed under general anesthesia. Only 5 cases were fol lowed up. RESULTS: Among these 5 cases, effective recovery was observed o n 4 cases of the transfer of the anteriolateral fascicles of ipsilateral C(7) to the anterior division of the upper trunk. Electromyographic examination showed nerve regeneration could be observed in the 2nd month postoperatively. And detec table elbow flexion by biceps contraction was found in the 4th month postoperati vely. The function of the C(7) innervating muscles was not jeopardized, and the case with combined partial C(7) root injury had a poor result. CONCLUSIONS: Selective transfer of ipsilateral C(7) nerve root leads to a restoration of reinnervating muscle functions without affecting the f unction of the muscles innervated by C(7). It is therefore a practicable new sur gical procedure for treating upper trunk avulsions.

Objective 3D printing has been used in the assistanceof surgical planning and the development of personal-ized prostheses.This study was to determine the feasibility of using a 3D printer for the purpose of producing personalized pros-theses for complex rib fracture fixation .Methods Using data from a high-resolution CT scan of 10 ribs of 3 cases with rib frac-ture, rib moldswere generated with computer software and fabricated with the 3D printer using the fused deposition modeling method.The 3D printing molds were used for custom-designed titanium plate.Results The average length of the 3D models of ribs is 8.45 cm.The mean time of fabricating models was 18.8 minutes and 4.6 gram polylactic acid was consuming on aver-age.The mean error of dimension of 3D models is less than 0.2 mm.Reshaping plates spends 3.3 minutes on average.Radio-logical follow-up for bothcases demonstrated successful fixation at 3 months.Conclusion These cases demonstrate the feasibili-ty of the use of 3D modeling and printing to develop personalizedplates and can ease the difficulty of complex rib fracture .

Objective To investigate the related knowledge and behavior attitude towards 129 pediatric nurses about the family-centered care (FCC). Methods FCC questionnaires were provided among 129 pediatric nurses in Hu′ nan province, teaching training was carried out based on the questionnaires, and twice questionnaires were reopened after teaching training. Cognition and attitude were compared before and after teaching training. Results The rate of concepts, purpose, and characters of FCC had been raised to 100% . Among the trainee, 93. 8% nurses wanted to continue FCC training program, 74. 42% nurses were willing to read the FCC relative information including newspapers, references and books. Conclusions It is very necessary to carry out FCC which can improve knowledge level of FCC and transform the concept of nursing.

Objective:To investigate the current situation of cytomegalovirus (CMV) infection in infants in Lishui, and summarize the related factors of CMV infection, evaluate its influence on the growth and development of infants, and provide evidence for the prevention and control of CMV infection.Methods:In this study, 2 254 cases of infants admitted in pediatric ward in Lishui Maternal and Child Health Hospital, Qingtian County People′s Hospital, Suichang County People′s Hospital, Qingyuan County People′s Hospital from January 1, 2015 to December 31, 2017 with integral clinical data were selected. All the babies were followed up from the time when they were born to 1 year old. The serum CMV antibody and the urine CMV-DNA were screened, the general situation and clinical features of CMV infection were summarized, and the relevant factors of infants CMV infection were analyzed and screened by the single factor and multiple factors analysis. They were followed up to 1 year old to clarify the influence of CMV infection on the growth and development of infants.Results:From 2015 to 2017, the total positive infection rate of CMV-IgM in infants under 1 year old in Lishui was 10.43%(235/2 254), and CMV-IgM positive infection decreased year by year. The positive rate of CMV-IgG did not change significantly with time. The positive rate of CMV-IgM was the highest at 1—3 months, and up to 15.29% (61/399). The positive rate of CMV-IgM decreased with the age of the babies. The positive rate of CMV-IgG increased with the age of the babies. The positive rate of CMV-IgM in infants showed no significant difference in gender ( P>0.05). The positive rate of CMV-IgM was higher in men than that in women [65.43% (810/1 238) vs. 55.51% (564/1 016)], and there was significant difference ( P<0.05). The gestational age of the infected group was lower than that of the non-infected group [(37.41 ± 1.63) weeks vs. (38.97 ± 0.97) weeks], and the breast-feeding rate of the infected group was higher than that of the non-infected group [57.87%(136/235) vs. 40.00%(40/100)], and there were significant differences ( P<0.05). Thrombocytopenia, the increase of transaminase, necrotizing enterocolitis of newborn, and hepatosplenomegaly of infected group is higher that of the non-infected group [18.72%(44/235) vs. 1.00% (1/100), 29.36% (69/235) vs. 13.00% (13/100), 26.81% (63/235) vs. 10.00% (10/100), 9.79% (23/235) vs. 0], and there were significant differences ( P<0.05). Gestational age and breast-feeding were possible risk factors for CMV infection in infants under 1 year old ( P<0.05). There was no significant difference in height, weight, head circumference and intelligence score between the infected group and the non-infected group at the age of 1 year ( P>0.05). The total abnormal rate of hearing development and the abnormal detection rate of B-ultrasound in the infected group were higher than those in the non-infected group [13.62%(64/470) vs. 1.00%(2/200), 6.38%(15/235) vs. 0], and there were significant differences ( P<0.05). Conclusions:The CMV active infection rate of infants under 1 year old in Lishui is relatively high and decreases year by year. It decreases with the prolongation of birth time, and there is no gender difference. Gestational age and breast-feeding are the risk factors for active CMV infection in infants. CMV infection affects the hearing development and the brain development of infants under 1 year old, which is the main cause of hepatitis. It is necessary to pay attention to the prevention of CMV infection, strengthen maternal perinatal health care, and strengthen the screening of CMV infection in high-risk groups.

Objective:To evaluate the diagnostic efficacy of the novel prostate specific membrane antigen (PSMA)-targeted PET imaging agent 18F-AlF-P16-093 in combination with multiparametric MRI (mpMRI) for prostate cancer (PCa), and to explore its application in guiding transperineal puncture biopsy. Methods:A retrospective analysis was conducted on the clinical and pathological data of 36 patients diagnosed as PCa (age: 68-76 years) who underwent 18F-AlF-P16-093 PET/CT and mpMRI examinations at the First Affiliated Hospital of Guangzhou Medical University from August 2023 to March 2024. The entire prostate was divided into 12 regions based on biopsy localization. Imaging evaluations were performed using PET/CT and mpMRI at the lesion level, with biopsy pathology as the gold standard. The correlations between mpMRI scores, PET/CT scores and pathological diagnosis results were evaluated by Phi coefficient analysis. Diagnostic efficacy was assessed by ROC curve analysis. Logistic regression was used to determine the impact of bleeding on image interpretation. Results:18F-AlF-P16-093 PET/CT showed a moderate positive correlation with pathological diagnosis result ( Phi=0.415, P<0.001), which was superior to mpMRI ( Phi=0.338, P<0.001). The diagnostic efficacy of PET single-modality model was superior to mpMRI in all indicators. The combination of 18F-AlF-P16-093 PET/CT with mpMRI significantly improved diagnostic specificity and positive predictive value, with the diagnostic specificity of the PET+ T 2 weighted imaging (WI)+ diffusion WI (DWI) and PET+ T 2WI+ DWI+ apparent diffusion coefficient (ADC) combinations exceeding 90%, and the positive predictive value exceeding 80%. Bleeding did not significantly affect the diagnosis of PCa by mpMRI and PET/CT (odds ratio ( OR): 0.463-0.785, all P>0.05). Conclusion:18F-AlF-P16-093 PET/CT is superior to mpMRI in the detection and diagnostic efficacy of PCa lesions, and the combination of 18F-AlF-P16-093 PET with mpMRI can further improve diagnostic specificity and positive predictive value, which is of guiding significance for targeted prostate biopsy.