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).

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.

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.

ObjectiveTo investigate and analyze the upper and lower limits and their sources of reference intervals in blood gas and acid-base analysis assays.Methods The data of reference intervals were collected, which come from the first run of 2014 External Quality Assessment (EQA) program in blood gas and acid-base analysis assays performed by National Center for Clinical Laboratories (NCCL). All the abnormal values and errors were eliminated. Data statistics was performed by SPSS 13.0 and Excel 2007 referring to upper and lower limits of reference intervals and sources of 7 blood gas and acid-base analysis assays, i.e. pH value, partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), Na+ , K+, Ca2+ and Cl-. Values were further grouped based on instrument system and the difference between each group were analyzed.Results There were 225 laboratories submitting the information on the reference intervals they had been using. The three main sources of reference intervals wereNational Guide to Clinical Laboratory Procedures [37.07% (400/1 079)], instructions of instrument manufactures [31.23% (337/1 079)] and instructions of reagent manufactures [23.26% (251/1 079)]. Approximately 35.1% (79/225) of the laboratories had validated the reference intervals they used. The difference of upper and lower limits in most assays among 7 laboratories was moderate, both minimum and maximum (i.e. the upper limits of pH value was 7.00-7.45, the lower limits of Na+was 130.00-156.00 mmol/L), and mean and median (i.e. the upper limits of K+ was 5.04 mmol/L and 5.10 mmol/L, the upper limits of PCO2 was 45.65 mmHg and 45.00 mmHg, 1 mmHg = 0.133 kPa), as well as the difference in P2.5 and P97.5 between each instrument system group. It was shown by Kruskal-Wallis method that theP values of upper and lower limits of all the parameters were lower than 0.001, expecting the lower limits of Na+ withP value 0.029. It was shown by Mann-Whitney that the statistic differences were found among instrument system groups and between most of two instrument system groups in all assays.Conclusion The difference of reference intervals of blood gas and acid-base analysis assays used in China laboratories is moderate, which is better than other specialties in clinical laboratories.

Quality indicators (QIs)in laboratory medicine can measure how well a clinical laboratory meets the needs and re-quirements of users and the quality of all operational processes.The identification of reliable QIs is a crucial step in enabling users to quantify the quality of laboratory services.Different QIs and terminologies are currently used and,therefore,there is the need to harmonize proposed QIs.A model of quality indicators has been consensually developed by a group of clinical la-boratories according to a project launched by a working group of the International Federation of Clinical Chemistry and La-boratory Medicine.The model includes 57 QIs related to key processes (35 pre-,7 intra-and 15 post-examination phases)and 3 to support processes.The developed a model of quality indicators and the data collected provide evidence of the feasibility of the project to harmonize currently available QIs,but further efforts should be done to involve more clinical laboratories and to collect a more consistent amount of data.

Although the key role of External Quality Assessment schemes ( EQAS ) in the standardization/harmonization process has been clear from the start, it has never been totally implemented, mainly due to the lack of commutable materials, the difficulty target values and acceptable range.EQAS may also improve standardization/harmonization by proposing rules for the post-examination phase.Improvements in standardization and harmonization will really be able to work under the joint efforts of stakeholders.

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.