Objective To analyze the status of quality indicators(QI) on specimen acceptability and establish preliminary qual ity specification.Methods Web based External Quality Assessment system was used to collect data of laboratories partici pated in "Medical quality control indicators in clinical laboratory" from 2015 to 2017,including once in 2015 and 2017 and twice in 2016.Rate and sigma scales were used to evaluate incorrect sample type,incorrect sample container,incorrect fill level and anticoagulant sample clotted.The 25th percentile (P25) and 75th percentile (P75) of the distribution of each QI were employed to establish the high,medium and low specification.Results 5 346,7 593,5 950 and 6 874 laboratories sub mitted the survey results respectively.The P50 of biochemistry (except incorrect fill level),immunology and microbiology reach to 6σ.The P50 of clinical laboratory is 4 to 6σ except for incorrect sample container.There is no significant change of the continuous survey results.Based on results in 2017 to establish the quality specification,the P25 and P75 of the four QIs is 0 and 0.084 4 ％,0 and 0.047 6 ％,0 and 0.114 2 ％,0 and 0.078 4 ％,respectively.Conclusion According to the results of the survey,most laboratories had a faire performance in biochemistry,immunology and microbiology,and clinical laboratory needs to be strengthened.Laboratories should strengthen the laboratory information system construction to ensure the actual and reliable data collection,and make a long time monitoring to achieve a better quality.

Objective To observe the effect of thumb pressing at Yangming Meridian on the function rehabilitation after total knee arthroplasty (TKA) for knee osteoarthritis (KOA).Method Sixty KOA patients after TKA were randomized into a treatment group (thumb pressing at Yangming Meridian plus conventional rehabilitation) and a control group (single conventional rehabilitation),30 cases each.The treatment group was intervened by thumb pressing and kneading manipulation at the acupoints of Foot Yangming Meridian and Foot Taiyin Meridian plus rehabilitation training of passive flexion and extension by CPM machine,while the control group was intervened by rehabilitation training of passive flexion and extension by CPM machine.The American Hospital for Special Surgery (HSS) for knee joint,the American Knee Society score (KSS) and the Western Ontario and the McMaster Universities Osteoarthritis Index (WOMAC) of KOA were used to evaluate the function.Result After the treatment,the HSS,KSS and WOMAC scores were changed significantly in both groups (P＜0.05).The improvements of HSS,KSS and WOMAC scores in the treatment group were superior to those in the control group,and the differences were statistically significant (P＜0.05).Conclusion The efficacy of thumb pressing at Yangming Meridian plus conventional rehabilitation for post-TKA KOA is superior to single conventional rehabilitation.

Objective To develop europium (Ⅲ) [Eu (Ⅲ)] chelated microparticles for homogeneous immunoassay.Methods Anti-human PCT antibodies were labeled with Eu (Ⅲ) chelated nanoscale microparticles as the detection antibody,and another anti-human PCT antibody was labeled with biotin as the solid-phase antibody.Magnetic microspheres labeled with streptavidin were used to separate the complexes of Eu-IgM-PCT-IgM-Biotin.Results In the homogeneous immunoassay,the standard curve fit was not linear.The quadratic curve was Y =19170.12 + 75493.74X-26.00X2(r =0.9986).According to the standard curve,the limit of detection for PCT was 0.04 ng/ml.Conclusion The homogeneous immunoassay which uses Eu (Ⅲ) chelated microparticles is highly sensitive for detection of PCT recombinant antigens and may serve as a promising method to measure serum PCT levels in the future.

Objective:To investigate the technique and efficacy of PTES for treatment of L5/S1 disc herniation.Methods:PTES was performed on 52 cases of L5/S1 herniations without spinal instability and central spinal canal stenosis,including 24 cases of high iliac crest,from November 2012 to April 2013.The operation duration,frequency of intraoperative fluoroscopy,blood loss and hospitalization days were recorded.Leg pain was evaluated by using the visual analog scale(VAS)Preoperatively and immediately,1 week,1 month,2 months,3 months,6 months,1 year and 2 years after surgery.The results were determined to be excellent,good,fair,or poor according to the Macnab classification,and complications were observed at 2-year follow-up.Objective:The mean operation duration was(56.3 ±11.5)min per segment.The median frequency of intraoperatively fluoroscopy was 5(3-14)times.The median blood loss was 5(2-20)mL.The median hospital stay was 3(2-4)days.The average postoperative follow-up was(26.2±2.0)months.The median preoperative VAS score of leg pain was 9(6-10),1(0-3)immediately after the operation and 0(0-3)2 years after operation,and the differences were statistically significant(P<0.001).There were 3 cases of lower limb rebound pain 1 week after operation,which were relieved within 2 months after operation.The rate of excellent and good curative effect was 98.1％(51/52)2 years after operation.No complications such as nerve injury,infection,abdominal organ damage and rupture of large vessels occurred.No recurrence occurred.Conclusions:PTES for L5/S1 disc herniation including the cases with high iliac crest is an easy,effective and safe technique.The method has the advantages of simple positioning,easy puncture,simple steps and less fluoroscopy,and the learning curve is not steep for surgeons.

Objective To explore the regularity of time-dependent changes in morphology and biomechanical properties of brain tissues in pigs,and value the feasibility of deducing the postmortem interval (PMI).Methods Brain tissues were taken from 42 pigs and kept in an artificial climate chamber with the temperature of 25 ℃ and humidity of 75％.The samples were collected from telencephalon at sequential time intervals (0,12,24,36,48,60 h;n =6) according to the principle of predefined time,position,direction,ratio,quantity and shape.The samples fixed with formaldehyde were then immediately tested by mechanical testing machine to obtain their biomechanical parameters and the histological sections were prepared.Results With the extension of PMI (0-60 h),brain tissues gradually became discolored,weak,mudding and liquefied under the influence of autolysis and putrefaction.Both clearance area of the white matter and its integrated optical density (IOD) significantly increased during 0-48 h.Biomechanical properties of brain tissues including the limit load,average force,elastic modulus and fracture energy all presented a declining tendency at the interval of 12-60 h.The limit load was considered highly statistically significant,and statistical differences were found in average force,elastic modulus and fracture energy.Conclusions There exists a significantly negative structure-activity relationship between the morphology of brain tissues and biomechanical properties.The limit load of postmortem brain tissues in 60 h is the optimum in the window period,which can be used as a new method for estimating PMI.

Background Surgery is regarded as the most effective treatment to relieve pain and reduce complications in chronic pancreatitis (CP).Two major strategies exist:duodenum-preserving pancreatic head resection (DPPHR) and pancreatoduodenectomy (PD).Many studies suggest that DPPHR offers advantages during surgery and in the short-term; however,the long-term effects have not been thoroughly investigated.We analyzed the long-term outcomes of DPPHR and PD,over follow-up times of at least 1 year,to determine the optimal surgical treatment for CP.Methods We systemically reviewed all CP surgical treatment reports,and only included randomized controlled trials (RCT) comparing DPPHR and PD,excluding unqualified studies using several pre-specified criteria.When multiple publications of a single trial were found,the most comprehensive current data were selected.Characteristics of the study populations and long-term postoperative outcome parameters were collected.The quality of the studies and data was analyzed using RevMan 4.2 software.Results Five trials were qualified for meta-analysis,with 261 participants in total (114 in the DPPHR group and 147 in the PD group).There were no significant differences in the age,gender,or indications for surgery of each group.At the mean of 5.7-year (1-14 years) follow-up examination,DPPHR and PD resulted in equally effective pain relief,exocrine and endocrine function,and similar mortality rates (P ＞0.05); however,DPPHR patients had improved global quality of life and weight gain,and reduced diarrhea and fatigue (P ＜0.05).Conclusion DPPHR and PD result in equal pain relief,mortality,and pancreatic function; however,DPPHR provides superior long-term outcomes.

Objective To investigate wingless-type MMTV integration site family,member 10A (WNT10A) expression in human dental pulp tissues and human dental pulp cells (HDPC).Methods Human premolars or wisdom teeth were obtained fron healthy individuals extracted for orthodontic purpose.The expression of WNT10A and the molecules of Wnt signaling pathway in human dental pulp tissues were analyzed by immunohistochemistry and semi-quantitative reverse transcription-PCR(RT-PCR).HDPC were primarily cultured from pulp tissues of healthy premolars or wisdom teeth and passaged cells.Their growth patterns were observed by microscopy.The expression levels of Wnt molecules and odontoblast-specific biomarkers during different cell passage were determined by semi-quantitative and real-time quantitative RT-PCR.Results The immunohistochemical analysis showed WNT10A was located in the cytoplasms of odontoblasts.WNT10A,axis inhibition protein 2(AXIN2),Dickkopf(DKK1),lymphoid enhancer factors 1 (LEF1),low density lipoprotein receptor-related protein 4 (LRP4),dentin sialophoshoprotein (DSPP),alkaline phosphatase(ALP) and osteocacin were detected in the pulp tissues by RT-PCR.HDPC reached confluence in 15 days.The 4th passage of HDPC proliferated actively,with clear cytoplasms and uniformly stretches.The 9th passage of HDPC tended to die.The Wnt signaling pathway downstream molecules were expressed in HDPC throughout the subculture.DSPP expression at mRNA level was detected peaking in the 4th passage(0.4178 ±0.0076).The expression levels of WNT10A in the 5th and the 9th passage(4.97 ±2.83,4.70 ±4.06) were significantly higher than in the 2th and the 4th passage (0.84 ± 0.66,0.70 ±0.45) (P ＜ 0.05).Conclusions Wnt signaling pathway mediated by WNT1 0A was activated in pulp tissues and HDPC,indicating that WNT10A could be involved in differentitation of odontoblasts and dentin formation.

Background Hypoxia is a crucial factor of neovascularization.Many researches found that stromal cell-derived factor-1 (SDF-1) and integrin-linked kinase (ILK) play an important role in the neovascular disease.However,effect of SDF-1 and ILK in eye neovascular disease is below understood.Objective The aim of this study was to investigate the effect of hypoxia on the expressions of SDF-1 and ILK in cultured retinal pigment epithelium(RPE) cells in vitro.Methods RPE tissue was isolated from 4-week-old C57BL/6 mouse and was digested and cultured in DMEM/F12 with 10％ fetal bovine serum (FBS).The cells with 80％ confluence were collected and passaged.The third generation of cells were identified with cytokeratin 18 (CK18) antibody by immunochemistry.The cells were inoculated at the density of 5×104 cells/ml to free-serum DMEM/F12 for 24 hours and then were cultured in regular medium in the normoxic control group.RPE cells were cultured for 1 hour and 3,6,12,24,48,72 hours with 200 μmol/L CoCl2 in the hypoxia group.Reverse transcription-PCR(RT-PCR) was used to evaluate the expressing change of SDF-1 mRNA and ILK mRNA in RPE cells,and Western blot was used to assay the expressing change of SDF-1 protein and ILK protein in RPE cells in different time points.The detected outcomes were represented as the ratio of target gene A value/β-actin A value.Results Cultured cells showed the polygon in shape with the black pigment granules in cytoplasm.Over 90％ cells were positive response for CK18.Expressions of the SDF-1 mRNA and ILK mRNA were increased in different time points after CoCl2 co-cultured(SDF-1 mRNA:F=281.875,P=0.000 ;ILK mRNA: F=187.566,P=0.000),with the highest expressing value in hypoxia at 12 hours.No significant change in the expression of SDF-1 mRNA and protein was found 1 hour after CoCl2 co-cultured,but expressions of SDF-1 mRNA and ILK mRNA were significantly higher in 3,6,12,24,48 and 72 hours than the normoxic control group(P＜0.01).The expressions of SDF-1 protein and ILK protein were gradually ascended with the time increase of CoCl2 co-culture,showing a significant difference among different time points(SDF-1: F=44.719,P =0.000 ; ILK: F =144.481,P =0.000),and the up-regulation of SDF-1 protein and ILK protein expression was seen mainly in 3,6,12,24,48 and 72 hours after CoCl2 co-cultured in comparison with the normoxic control group (P＜0.01).Conclusions SDF-1 and ILK are involved in the hypoxic response of RPE cells and may play a potential role in ischemic/hypoxic retinopathy.

Objective To investigate the role of antigen-processing machinery (APM) component defects in HLA class Ⅰ antigen down-regulation in laryngeal squamous cell carcinoma (SCC) and to assess the clinical significance of these defects. Methods Fifty-one formalin-fixed,paraffin-embedded SCC specimens were examined for the expressions of APM component transporter associated with antigen processing (TAP1) and low molecular weight polypeptide (LMP-7) and HLA class Ⅰ antigen by immunohistochemistry.Results HLA class Ⅰ antigens,TAP-1 and LMP-7 expressions were downregulated in 56.9％ (29/51),39.2 ％ (20/51) and 45.1％ (23/51) of the tested specimens respectively,whereas HLA class Ⅰ antigens,TAP-1 and LMP-7 expressions lost in 21.6 ％ ( 11/51 ),33.3％ ( 17/51 )and 27.5 ％ ( 14/51 ) of the tested specimens respectively.TAP-1 and LMP-7 expressions were significantly correlated with HLA class Ⅰ antigen expression (r =0.460,P < 0.05 and r =0.685,P < 0.05,respectively).HLA class Ⅰ antigens down-regulation was significantly correlated with T stage( x2 =8.61,P ＜ 0.05).Both TAP-1 and LMP-7 down-regulations were significantly correlated with T stage ( x2 valueswere 9.72 and 8.97 respectively,P ＜ 0.05 ) and TNM stage( x2 values were 9.18 and 7.70 respectively,P ＜0.05 ).TAP-1,LMP-7 and HLA class Ⅰ antigen down-regulations were significantly associated with reduced patients' overall survival ( P ＜ 0.05 ) and disease-free survival ( P ＜ 0.05 ).Multivariate analysis showed lymph node metastasis,recurrence and HLA class I antigen down-regulation were unfavorable prognostic factors(P ＜ 0.05).Conclusions Down-regulated expressions of HLA class Ⅰ antigen and APM component TAP-1 and LMP-7 occur frequently in laryngeal squamouss cell carcinoma,by which cancer cells could avoid immune surveillance,while HLA class Ⅰ antigen down-regulation is a major contributing factor to tumour progression and mortality.

Objective To explore the correlations of biochemical factors as gamma-aminobutyric acid (GABA) level with amino acid metabolism level in the blood, levels of intestinal immunoglobulin A (IgA)+complement factor 3 (C3), feeding intolerance and fatiguability in children with hypotonia cerebral palsy. Methods Ninety-six children with hypotonia cerebral palsy,admitted to our hospital from January 2009 to January 2012,were chosen in our study; questionnaire was used to understand the clinical symptoms of the children; the blood ammonia level,hepatic function and IgA+C3 level were obtained from routine blood chemistry testing, and amino acid metabolism was detected by blood tandem mass spectrometry; the correlations of GABA level with amino acid metabolism level in the blood, levels of IgA+C3, feeding intolerance and fatiguability were statistically analyzed. Results In all the 96 children with hypotonia cerebral palsy,63 (65.63％) had low arginine; 52 had both decreased arginine and elevated blood ammonia levels, enjoying negative correlation (r=-0.776,P=0.000); 42 had decreased arginine and reduced levels of IgA+C3 enjoying positive correlation (r=0.351,P=0.000); both decreased arginine level and feeding intolerance were noted in 47 with positive correlation (r=0.372,P=0.000).In these 96 children,30 (31.25％) had carnitine metabolism abnormality,including decreased propionyl carnitine/free carnitine or propionyl carnitine/acetylcarnitine levels in 21 (21.88％),increased hydroxyl palmitoyl carnitine/hydroxyl Palm enoyl carnitine level in 9 (9.37％),and decreased cysteine content in 3 (3.12％). Conclusion Metabolic abnormalities of arginine,carnitine and cysteine are noted in children with hypotonia cerebral palsy; a lot of exercise will consume arginine,carnitine and cysteine,which causes fatigue; children with low blood arginine content might also have increased blood ammonia level,reduced IgA+C3 level,trends of vomiting,susceptibility to infection and feeding difficulties,and therefore,children's mental state,immune function and exercise tolerance ability are affected.