To provide an effective approach to select, develop, interpret and apply well-designed quality indicators. Then to promote the continual improvement of laboratory quality and to assure patient safety. We focused on the quality cycle of selecting, development, implementation and processing for quality indicators. And some examples for essential activities in the development and use of quality indicators were shown. Through the presentation of process and examples, we put forward an organized approach that provides the laboratory with a plan to structure its development of quality indicators to gather useful information. Quality indicators are important. However, they should be integrated with internal review plan, External Quality Assessment (EQA) and the process of activities in plan. Only then can we really promote the continual improvement of quality.

Objective: To assess the effect of preoperative carbohydrate fluid intake on immediate postoperative insulin resistance. Methods: 32 patients for elective colorectal cancer resection were recruited to this randomized controlled study. These patients were randomly assigned to control group and test group. Control group were fasted before surgery, while test group were given oral carbohydrate 3 h before surgery. Patient's wellbeing scores on a visual analogue scale(VAS) were recorded at 3 PM the day before operation and 2 h after consuming carbohydrate fluid respectively. Blood sample were collected to measure the level of blood glucose and the serum concentrations of insulin 4 h before surgery and immediately after surgery, respectively. Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance (HOMA-IR), basic function of pancreatic ? cell (HOMA-? cell) and insulin sensitivity index (ISI). Results: Patients consumed carbohydrate-rich beverage before surgery reduced thirst, hunger and anxiety compared with fasting before surgery. Whole body insulin sensitivity decreased by 33% in the test group vs. 38% in the control group(P

Acquired growth hormone resistance(AGHR) in critical illness may be defined as the combination of a raised serum growth hormone concentration,low serum insulin-like growth factor-1 concentration and a reduced anabolic response to exogenous GH.GH given to reverse catabolism in critical illness increased mortality.Therefore,it has the theoretical significance and clinical value for better understanding of the mechanism of AGHR.The mechanism of AGHR and its prevention and cure are reviewed.

It was pointed out in this paper that the nature of values was invisible knowledge by analyzing the rela-tion between values and invisible knowledge,and the measures were put forward for constructing the values in medi-cal staff in view of their value construction process and its influencing factors.

Objective To promote worldwide standardization of methods to determine creatinine by tracing to reference measurement for achieving universal accuracy measurement of creatinine.Methods The results of external laboratory assessment (EQA) survey in China and CAP were compared and analyzed. Results There was significant difference among different measurement methods and assay systems.Conclusion It should promote worldwide standardization of determine creatinine, which makes it trace to reference measurement liquid chromatography-isotope dilution mass spectrometry (LC-IDMS).

ObjectiveTo investigate the early diagnosis and treatment of pleuropulmonary blastoma in children. Meth-ods The progress of pleuropulmonary blastoma from type 1 to type 3 was retrospectively analyzed.Results The male infant had no obvious abnormality in chest X-ray at 18 days. At one year old, X-ray iflm of the chest showed cystic lesions near hilum of the left lung (about 5 cm × 4 cm × 4 cm). The congenital cystic adenomatoid malformation was considered and an operation resection was suggested. However, it had been rejected by his parents. At 3 years and 2 months old, chest X-ray and CT showed left lung had a solid cystic lesion, the volume was signiifcantly enlarged, the back side was solid and the upper part had a large gas cavity. Two months later, the patient had asthmatic suffocation. The chest CT showed the tumor was completely solid. Pleuropulmonary blastoma type 3 was considered. The patient received the conventional chemotherapy after operation excision, and was followed up for 1 year. No recurrence was observed after the treatment.Conclusions Type 1 pleuropulmonary blastoma and congenital cystic adenomatoid malformation are hard to be differentially diagnosed. Early diagnosis and treatment of type 1 pleuropulmo-nary blastoma can improve the prognosis.

It was proved that Phenolic alkaloids from Menisphermum dauricum (PAMD) has extensive pharmacological effects, manifested as affecting electrophysiology of the heart, resisting cardiac arrhythmia, inhibiting myocardial infarction, protecting nverves in cerebral ischemia, exerting resisting action in thrombogenesis, dementia, and tumor, and improving learning disorder, and so on. We made an overall sum up of researching progress on PAMD pharmaceutical actions in this article.

FISH technology has become a routine technique in many clinical laboratories.It can be used for the examination of genetic aberrations that are too small to visualize by conventional cytogenetic assays,but too large to detect by standard DNA sequencing.Today,FISH applications are used not only in medical genetics,but also in many other disciplines including neuroscience,evolutionary biology,microbiology,pathology,toxicology,and reproductive genetics.As FISH technology keep developing,the requirement of the results of FISH is increasingly high.This paper described the quality management for FISH detailedly,aimed at improving the accuracy and reliability of the result of FISH,satisfying the requirements of clini-cians and patients and improving the healthcare quality and outcome of patients,hoping for providing some references for la-boratories who develop FISH technology.

Objective To evaluate the difference of two sources of allowable total errors provided by National Health Industry Standard (WS/T 403-2012,analytical quality specification for routine analytes in clinical biochemistry)and National Stand-ard (GB/T 20470-2006,requirements of external quality assessment for clinical laboratories)in assessing the analytical qual-ity byσmetrics,and selecting quality control procedures using operational process specifications graphs.Methods Selected one of the laboratories participating in the internal quality control activity of routine chemistry of February,2014 and the first time external quality assessment activity of routine chemistry in 2014 organized by National Center for Clinical Labora-tories for its coefficient of variation and the bias of nineteen clinical chemistry tests.With the CV% and Bia%,σmetrics of controls at two analyte concentrations were calculated using two different allowable total errors targets (National Health In-dustry Standard (WS/T 403-2012)and National Standard (GB/T 20470-2006).Could obtain a operational process specifica-tions graph by which Could select quality control procedures using the Quality control computer simulat software developed by National Center for Clinical Laboratories and the company zhongchuangyida.Results The σ metrics under National Health Industry Standard (WS/T 403-2012)were from 0 to 7.Most of the values (86% and 76.2%)under National Stand-ard (GB/T 20470-2006)were from 3 to 15.On the normalized method decision chart,the assay quality using the allowable total errors targets of National Standard (GB/T 20470-2006)was at least one hierarchy more than one using National Health Industry Standard (WS/T 403-2012).The quality control rules under National Health Industry Standard (WS/T
403-2012)were obviously more strict than that under National Standard (GB/T 20470-2006).Among the control procedures using National Health Industry Standard (WS/T 403-2012),multirule (n=4):ALB,ALP,Ca,Cl,TC,Crea,Glu,LDH,K, Na,TP,TG and Urea;13s (n=4):Mg;12.5s (n=2):CK,AMY ang Fe;13s (n=2):TBIL;13.5s (n=2):ALT,AST and UA.Conclusion The allowable total errors provided by National Health Industry Standard (WS/T 403-2012)are more stringent than that from National Standard (GB/T 20470-2006).So Laboratories need to improve the analytical quality of their tests furthermore.

Objective To investigate the status of report appropriateness in Clinical Hematology and to identify its potential influence factors to improve the quality of laboratory reports.Methods 1 120 National External Quality Assessment ( EQA ) participants laboratories were enrolled in this study.The questionnaires were assigned to all the participants in both electronic and printed form.The participants were asked to retrospectively count the total reports and the affected reports while the following quality indicators occurred in 2012:report delay, inconformity of data between instrument and LIS as well as between report and request erroneous report transportation, report recall, and report modification.All quality indicators were evaluated in two ways:percentage and sigma (σ) scale.Mann-Whitney Test and Kruskal-Wallis Test were used to analyze the potential impacts of report appropriateness.Results Totally 609 (54.38%)laboratories submitted the survey results .The sigma metrics of six quality indicators on report appropriateness were more than 4.The main reason for report delay was equipment failure.Group comparison suggested that the report appropriateness of laboratories in tertiary-A hospitals and accredited by ISO 15189 werebetter.Report appropriateness with electronic request, electronic form and electronic transmission were superior than that inother ways. Conclusions Report appropriateness in China differs from laboratory to laboratory. Laboratories should develop emergency action plan in case the instrument breaks down and strengthen information technology .Long-term internal quality control and external quality assessment scheme are very meaningful to identify the insufficient performance and improve laboratory quality .(Chin J Lab Med, 2015,38:632-636)