Based on the analysis of the problems of traditional medical literature retrieval teaching,taking North Sichuan Medical College as an example,the paper discusses the reform practice of medical literature retrieval course teaching from the aspects of enriching teaching contents,constructing literature retrieval excellent resource shared course,online practice and examination platform and controlling teaching quality strictly,etc.

External quality assessment (EQA)as an effective tool for quality control can help clinical laboratories to discover quality problems during testing process and prompt clinical laboratories to improve their testing quality.Samples used for traditional EQA frequently have matrix effects which assign the target value by grouping.Ideal samples for EQA are com-mutable which have the same numeric relationship between different measurement procedures as that expected for patients’ samples.And they can assess accuracy against a reference measurement procedure or a designated comparison method.When analyzing,robust statistical method can be used to reflect the variability of testing results between laboratories more truly. And the evaluation standards should be desirable.If unsatisfactory results appear,we should investigate every aspect of tes-ting process,find the root cause,and take corrective action.On condition that no official EQA scheme is launched for some analytes,it is necessary for us to evaluate the performance of analytes by alternative evaluation procedures.

Objective To study the internal quality control(IQC)designing procedure of the quantitative immunoassay testing i-tem to provide the most suitable IQC rule for the clinical laboratory immunoassay.Methods 3 quantitative detection items of thy-roxine,cortisol and thyroid stimulating hormone were taken for examples.The coefficient of variation(CV)of the method was ob-tained by the repeatability test for evaluating the methodological imprecision.Inaccuracy(bias)was obtained by the methods com-parison.The accuracy of the method was evaluated.Then the most suitable IQC rule for each quantitative detection item was select-ed by plotting the location of the operating point on the normalized operational process specifications(OPSpecs)chart according to CV and bias.Results Two multirule methods of 1 3s/(2of3)2s/R4s/3 1s/6 x and 1 3s/(2of3)2s/R4s/3 1s were identified when the oper-ating point was plotted on the normalized OPSpecs chart for N =6 and 90% analytical quality assurance(AQA)at the thyroxine de-cisive level of 0.064 4 mmol/L.When the cortisol decisive level was 0.735 μmol/L,the normalized OPSpecs chart for N =3 with 90%AQA showed the three solutions of 1 3s/(2of3)2s/R4s/3 1s ,1 2 .5s ,and 1 3s/(2of3)2s/R4s as for thyroid stimulating hormone,3 1s/2 2s/R4s/41s multirole procedure was the best choice for N =4,50%AQA at the upper control level,and the N =2 chart with 50%AQA showed a multirole procedure with 1 3s/2 2s/R4s at the lower control level.Conclusion The suitable internal quality control de-signing procedure of the quantitative immunoassay testing item can be selected by using the OPSpecs chart.

Objective To study the management of enterostomy in children.Methods The clinical data of 425 cases of enterostomy in children were analyzed retrospectively.Results The primary diseases of 425 cases underwent enterostomy included:intestinal perforation(119 cases),intestinal necrosis(36 cases),necrotizing enterocolitis(45 cases),congenital megacolon(61 cases),congenital anal atresia with rectourethral fistula(86 cases),and congenital anal atresia with rectovaginal fistula(78 cases).Among the 425 cases,159 cases underwent small bowel enterostomy and 266 cases had colostomy;single-stoma enterostomy was done in 225 cases,and double-stoma enterostomy in 197 cases.Follow-up was acquired in 389 patients,and all the stomas were closed successfully.The closure time of small bovvel enterostomy was 1-3 month(ayerage 1.87 months)later,and of colostomy was 3-12 month(averag 4.95 months)later.Conclusions When an enterostomy is to be adopted in pediatric surgery,a suitable time and enterostomal location should be chosen according to the state of illness.The timing of enterostomy closure is also very important.

对拐杖支脚垫进行检验分析 ,提出了设计方案改进 ,并投产使用 ,取得较好效果。

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.

Key factors for interpreting proficiency testing (PT)/external quality assessment (EQA) results are knowledge of the commutability of the samples used and the process used for target value assignment.A commutable PT/EQA sample,which would be seen as patients' samples,has the agreement of results among different measurement procedures and demonstrates the same numeric relationship.The value assignment for the sample can be done by using of a reference measurement procedure.Its results can be used to assess the accuracy against a reference measurement procedure or a designated comparison method.Noncommutable PT/EQA samples frequently have a matrix-related bias of unknown magnitude,and can't give meaningful information about the relationship of results for patients' samples among different measurement procedures.Its results must be compared to the peer group mean or the median of results from participants who use measurement procedures that are expected to have the same or very similar matrixrelated bias.

This study was aimed to establish a separation method for neochlorogenic acid reference substances from Lonicera japonica. Refined neochlorogenic acid inL. japonica water extract was separated and concentrated by HPD200A macroporous resin, which was isolated and purified by medium-low-pressure preparative chromatography and determined by HPLC. The structure was identified by various spectroscopic data including ESI-MS,1H-NMR and13C-NMR. The results showed that the optimal purification technology conditions were as follows: washed with 5BV of water, collected elution, concentration, drying; neochlorogenic acid crude products were eluted with acetonitrile-0.5% formic acid solution (10:90) with the flow rate of 20 mL·min-1; and the detection wavelength was 326 nm. The contents of the prepared neochlorogenic acid reached to 98.86% and the yield was 89.1%. It was concluded that the method was effective for the preparation of neochlorogenic acid with high purity. It can be used to prepare the reference substances for quantitative analysis and content determination of Chinese materia medica.

Objective To explore the effect of low tidal volume ventilation on the treatment of children with acute respiratory distress syndrome (ARDS).Methods Forty-four hospitalized children with ARDS from Jan 2008 to Dec 2011 at Kunming Children's Hospital were enrolled in this study.The observation group included 24 patients who received the treatment of low tidal volume ventilation (6 ～ 8 ml/kg),while the other 20 patients were in the control group who were given traditional volume ventilation (10 ～ 12 ml/kg).Oxygenation situations and blood gas analysis at 24,48,72 h after ventilation、mechanical ventilation complications,and the mortality in the first 28 days were observed.Results The ratios of PaO2/FiO2 were 104 ±23.6 in observation group and 112 ±34.7 in control group (P ＞0.05).However,after 24,48 and 72 h of ventilation,the ratios of PaO2/FiO2 showed statistical significance (t ≥2.01,P ＜0.05 ; t ≥2.74,P ＜ 0.01).Barotrauma in observation group was significantly lower than that in control group (x2 =6.97,P ＜ 0.01).The mortality (16.7％) of the observation group was significantly lower than that (50％) of the control group (x2 =5.58,P ＜ 0.05).Conclusions Low tidal volume ventilation can reduce complications and improve oxygenation of ARDS patients,and reduce the mortality in ARDS children.The improved rescue technology should be applied for the treatment of children with ARDS.

Objective To observe the expression of FGF19 (fibroblast growth factor 19) and PEDF (pigment epithelium-derived factor) in the serum of type 2 diabetic retinopathy (DR) patients and discuss their significance.Methods Total 89 patients with type 2 diabetes were selected and divided into two groups according to whether they were combined with diabetic retinopathy:45 patients with type 2 diabetes alone (DM group) and 44 patients with type 2 diabetes mellitus combined with retinopathy (DR group).At the same time,40 healthy people were selected as the control group (NDM group).The serum levels of FGF19 and PEDF and their biochemical indexes were detected and compared in each group.The correlation between the indexes and the relationship between FGF19,PEDF and DR were analyzed.Results Compared with NDM group,serum FGF19 level in DM group and DR group decreased,while C-reactive protein (CRP) and PEDF level in DM group and DR group increased (P ＜ 0.05);serum FGF19 level in DR group was lower than that inDMgroup,while serum PEDF level was higher than that in DM group (P ＜0.05).The levels of fasting blood glucose (FBG),fasting insulin levels (FINS),glycosylated hemoglobin (HbA1c),total cholesterol (TC),high density lipoprotein (HDL) and low density lipoprotein (LDL) in DM and DR groups were higher than those in NDM group (P ＜ 0.05),but there was no significant difference between DM group and DR group (P ＞ 0.05);the levels of Hcy,triacylglycerol (TG) and CRP in DR group were higher than those in DM and NDM group (P ＜ 0.05),and the levels of VLDL were lower than those in DM and NDM group (P ＜ 0.05).The level of serum FGF19 was positively correlated with HDL and CRP in patients with DR (r =0.341,0.623,P ＜ 0.05),and negatively correlated with fasting blood glucose(r =-0.428,P ＜0.05);The level of serum PEDF in patients with DR were negatively correlated with FINS (r =-0.343,P ＜0.05).When the serum level of PEDF ＞ 12.76 mg/L,the sensitivity and specificity of PEDF dignosing DR were 80.9％ and 56.7％ respectively.Conclusions In patients with DR,serum FGF19 level decreased and serum PEDF levels increased.The level of both changes is closely related to DR and may be involved in the development of DR.