Objective To explore the differences in antibiotic resistance among pathogenic bacteria isolated from respiratory tract and cerebrospinal fluid specimens in neurosurgery wards .Methods Antibiotic resist-ance tests were performed to analyze the antibiotic sensitivities of pathogenic bacteria isolated from respiratory tract and cerebrospinal fluid specimens in the neurosurgery wards at Beijing tiantan hospital affiliated to cap-ital medical university ,from January 2012 to December 2016 .Statistical analysis was performed using the t test or M-W test to determine the differences between the two independent samples were statistically significant . Results From January 2012 to December 2016 ,6 091 strains isolated from respiratory tract and 1 597 strains isolated from CSF specimens were obtained from patients in the neurosurgery wards of a hospital .Based on the results of the t test ,differences in the antibiotic sensitivities of pathogenic bacteria isolated from these two specimens were statistically significant .Three Gram-negative bacteria ,Pseudomonas aeruginosa ,Klebsiella pneumoniae and Acinetobacter baumannii ,showed statistically significant differences in antibiotic sensitivities between respiratory tract and cerebrospinal fluid specimens (P＜0 .05) ,but this difference was not statistically significant in Staphylococcus aureus (P＞0 .05) .Pathogenic bacteria isolated from two specimens showed sta-tistically significant differences in sensitivity to β-lactam antibiotics ,polymyxin B ,vancomycin and linezolid (P＜0 .05) .Conclusion The sensitivity differences between bacteria isolated from respiratory tract and cere-brospinal fluid specimens are statistically significant .Several reasons ,such as antibiotic-induced antibiotic re-sistance ,horizontal gene transfer are responsible for this result .

Objective To compare and study the two kinds of quality control methodologies related to intelligent quality management system ( iQM) and traditional quality control , and the quality control performance of iQM equivalent to traditional quality control were evaluated , ensuring the accuracy of the results of blood gas testing.Methods Beijing Chaoyang Hospital of Capital Medical University , Beijing Tiantan Hospital of Capital Medical University , Shanghai Longhua Hospital of Shanghai University of Chinese Medicine, and Sichuan Provincial People′s Hospital, these 4 medical institutions were selected to implement this study.During the period from June 2016 to December 2016, in the routine detection of total 3 712 specimen, the iQM and traditional quality control modes were used simultaneously to calculate the mean values of all blood gas parameters quality controls , SD, CV (%) and Sigma values, to evaluate the quality control performance and difference of the two quality control modes .Results During the process of testing blood gas samples from 3 712 specimen in 4 hospitals, iQM process control solution ( PCS) A, B, C ran 1 089, 7 678 and 154 quality control samples respectively , and 732 external quality control samples were run by traditional quality control mode .Considering the most sensitive parameters of blood gas testing pO 2, iQM PCS A, B, C′s Sigma value are higher than 8, however, the traditional quality control′s Sigma value are less than 6; For parameters pCO2, pO2and Na+, there exists significant difference between two quality control methods (P＝0.004 8,P＝0.000 1,P＝0.004 4,P＜0.01), other parameters pH, K+, Ca ++, Glu, Lac and Hct, there exists no significant difference between two quality control methods (P＝0.250 6, P＝0.062 3,P＝0.034 0,P＝0.346 9,P＝0.186 3,P＝0.823 1,P＞0.01).Totally 22 errors detected by iQM, includes 14 micro-clots and 8 interferences samples, which were not detected by traditional quality control .Conclusions The error in blood gas analysis mainly comes from the pre-analytical phase.iQM enhanced specimen inspection capabilities and make up for the inability of traditional quality control to monitor the quality of specimens , enabling full-scale, real-time, and dynamic monitoring of each specimen , powerful error detection capabilities , and automatic error correction capabilities . Besides, automatic documentation saves staff much time.The system can effectively ensure the accuracy of blood gas test results, meet the quality requirements of related laws and regulations and related industry standards , and also can meet the clinical intended use , providing new ideas for POCT quality management and improvement.

Objective To explore the rationality for the examination mode of residents' clinical laboratory clinical skills in the second stage and to provide scientific and reasonable basis for the second stage training. Method Statistical analysis was made on the results of the assessment of the clinical skills of the residents who took the clinical skills examination in inspection division second stage in Beijing from year 2014 to 2016. The differences between the results of the assessment of the base hospitals and non-base hospitals, three level hospitals and non-three level hospitals and different assessment modules were compared between the three groups. SPSS 17.0 statistical software was used to analyze the data. The com-parison between the measured data was done by independent sample t test, and the comparison between the data was analyzed by chi square test. The test level wasα=0.05. Result From the assessment pass rate, three level hospitals were higher than non-three level hospitals (P=0.01), the base hospital was higher than non-base hospital (P=0.01), and physicians' passing rate was higher than technician'. There was statistical significance (P=0.02, P=0.01) in the auxiliary examination of the written test module of three assessment modules in 2014 and 2015. In 2015 and in 2016, there was significance (P=0.02, P=0.01) in the mean scores of case analysis. Conclusion The second stage clinical skills assessment model is more reasonable, and the non-base and non-three level hospitals should strengthen the training and management of the sec-ond stage.

Objective To study on the contribution and cut-off value of coagulase negative staphylococcus (CoNS) in laboratory tests of postoperative infection in neurosurgery and optimize the diagnostic criteria of infection.Methods It made a retrospective study of 650 cerebrospinal fluid (CSF)specimens from neurosurgical patients,who were infected CoNS in Beijing Tiantan Hospital affiliated to Capital Medical University during 2013-2015.The epidemiological data were collected and 8 routine clinical laboratory tests were performed.T test was used to compare the difference among the groups.By making receiver operating characteristic (ROC) curve,the area under the curve (AUC),cut-off value,sensitivity and specificity were obtained.Results A total of 19 756 CSF specimens were collected and 650 CoNS were isolated.The separation rate of CoNS was 3.3％ which was the most frequently isolated bacteria.The differences of cerebrospinal fluid white blood cell count (3 598.6 ± 1 884.3,678.1 ± 629.1,t =2.662,P =0.012),multinucleated cell ratio in cerebrospinal fluid(76.0 ±32.6,46.8 ±29.9,t =9.593,P =0.001),cerebrospinal fluid glucose concentration (5.9 ± 2.12,6.2 ± 1.92,t =-16.296,P =0.001) and cerebrospinal fluid glucose concentration/blood glucose concentration (0.3 ± 0.16,0.63 ± 0.31,t =-11.968,P =0.000) among groups were statistically significant.The AUCs of cerebrospinal fluid white blood cell count,cerebrospinal fluid glucose and cerebrospinal fluid glucose/blood glucose were more than 0.8,and the sensitivities of the three indicators were more than 80.0％.In addition,the specificity of cerebrospinal fluid glucose concentration/blood glucose concentration was more than 0.9.Conclusions CoNS was the main pathogenic bacteria of neurosurgical infections in a hospital.Cerebrospinal fluid white blood cell count,cerebrospinal fluid glucose and the ratio of cerebrospinal fluid glucose and blood glucose could be used for auxiliary diagnosis of CoNS infections in neurosurgical patients.

The cerebrospinal fluid(CSF)is the most closely relatedbody fluidtocentral nervous system(CNS).Compared with other samples, CSF componentsare able to reflect the lesions of CNSmore directly.The detection of CSF pathogen nucleic acid is significantly better than the traditional detection method.Circulating tumor DNA(ctDNA)in CSF is very promising to be a diagnostic and monitoring marker for primary brain tumors and metastatic brain tumors.

Objective To investigate the distribution and antimicrobial resistance of Coagulase-negative staphylococci ( CoNS) isolated from cerebrospinal fluids in neurosurgical patients.Methods CoNS strains isolated from cerebrospinal fluids of neurosurgical patients were collected from Beijing Tiantan Hospital of Capital Medical University during January 2013 and December 2015.CoNS infection was diagnosed according to the standards of US Centers for Disease Control and Prevention, and the distribution and antimicrobial resistance of pathogenic CoNS strains were analyzed. Results A total of 19 756 cerebrospinal fluid specimens were collected and 1 386 bacterial strains were isolated, in which 650 (46.9%) were CoNS.Among 650 CoNS strains, 130 were diagnosed as the pathogen, and the top 4 CoNS species were Staphylococcus epidermidis (77/130, 59.2%), Staphylococcus hominis (18/130, 13.8%), Staphylococcus haemolyticus (11/130, 8.5%) and Staphylococcus capitis (9/130, 6.9%).The rest 520 CoNS strains were contaminating strains.According to antimicrobial susceptibility test, there were 103 strains of methicillin-resistant CoNS (MR-CoNS) accounting for 79.1% (103/130).And among 77 Staphylococcus epidermidis isolates, 67 were MR-CoNS strains (87.0%) .More than 90.0%Staphylococcus epidermidis isolates were sensitive to vancomycin and linezolid, and the rest CoNS strains were also highly sensitive to these two antibacterial agents.Conclusions CoNS plays an important role in post-surgery infection in neurosurgical patients, and Staphylococcus epidermidis is the dominant CoNS species.Most CoNS strains are methicillin-resistant, but are highly sensitive to vancomycin and linezolid.

Objective To discuss the diagnostic value of serum sialic acid for glioma.Methods A retrospective study was conducted.The levels of sialic acid in serum samples of 95 glioma patients, 175 patients with brain benign tumor and 400 normal persons from October 2014 to March 2015 were detected by automatic biochemistry analyzer using enzymic method.The SNK-q test and analysis of variance were used to compare the difference of the groups.By making receiver operating characteristic ( ROC) curve, the cut-off value, sensitivity, specificity, positive predictive value and negative predictive value were calculated to assess the diagnostic value of serum salivary acid.Then the cut-off value was validated by using the serums of 30 glioma patients and 30 normal persons who were out-patients and healthy controls.Results The levels of serum sialic acid in patients with gliomas, patients with brain benign tumor and healthy individuals were (0.66 ±0.14 ) g/L, (0.61 ±0.09 )g/L, (0.54 ±0.07 )g/L.The serum salivary acid of glioma patients were higher than brain benign tumor patients (q=6.74,P<0.05) and normal persons (q=16.42,P<0.05), and there was no significant difference (F=1.67,P>0.05) among the glioma patients of different grades (8 of gradeⅠ,32 of gradeⅡ,24 of grade Ⅲ,31 of grade Ⅳ).There was no significant difference between the low grade patients (gradeⅠandⅡ) and the high grade patients (gradeⅢandⅣ) (t=0.55, P>0.05), but the level of serum sialic acid of high grade group had an increasing trend than the low grade group.The area under the ROC curves was 0.79.The cut-off value of serum salivary acid for diagnosing glioma was 0.61 g/L.The sensitivity was 67.74%, and the specificity was 80.60%.The positive predictive value was 44.68%, and the negative predictive value was 90.76%.Then the cut-off value was used as a diagnostic criteria, and the detected results of 30 glioma patients and 30 normal persons showed that the sensitivity was 63.30% and the specificity was 83.30%.Conclusions The serum sialic acid has good specificity and negative predictive value for diagnosing glioma.It may be a valuable diagnostic marker.

Objective To investigate the immune cell population change during the anesthesia process in patients undergoing craniotomy surgery. Methods A total of 18 patients undergoing craniotomy who had an inhalational general anesthetic were selected as our subjects. Blood samples were collected before anesthesia (T0)and 30 min(T1),45 min(T2),60 min(craniotomy operated,T3),120 min(tumor resected,T4)and 240 min(T5)after anesthesia. Blood cell counts including neutrophils,monocytes and lymphocytes were determined along with lymphocyte subpopulations( T cells,inducer and helper T cells,suppressor and cytotoxic T cells,NK cells,B cells ). Data were analyzed by SPSS 13. 0 software. Results In terms of the immune cell during neuroanesthesia,induction neutrophils,monocytes and lymphocytes decreased significantly from( 4. 50 ± 2. 00 ) × 109/L(,0. 51 ± 0. 22)× 109/L,(1. 90 ± 0. 70)× 109/L to(3. 10 ± 1. 50)× 109/L,(0. 32 ± 0. 17)× 109/L, (1. 10 ± 0. 50)× 109/L at the 30 min after anesthesia,and the differences were significant( P﹤0. 05). It also showed that Ts and NK cells decreased significantly from( 0. 55 ± 0. 29 )× 109/L,( 0. 32 ± 0. 14 )× 109/L to (0. 33 ± 0. 22 )× 109/L,( 0. 10 ± 0. 08 )× 109/L at the 30 min after anesthesia,and the differences were significant( P﹤0. 05 ). Conclusion Special and non special immune system are inhibited during craniotomy, especially at the early anesthesia. Among the inhibited immune cells,neutrophils recover early and followed Ts and NK cells.

OBJECTIVE To study the application value of protein chip technique in detection of Helicobacter pylori(Hp) infection and clinical diagnosis of associated disease. METHODS The antibodies against CagA,Ure and VacA in 300 serum samples were detected by protein chip technique.The biopsy specimens obtained by gastroscopy from 170 patients with digestive system symptom were detected by modified Giemsa staining at the same time.These patients were also accepted with rapid urease test(RUT) and ~(14)C-urease breath test (~(14)C-UBT).Twenty serum samples from Hp infected patients were detected again after treatment. RESULTS The sensitivity of protein chip technique in detection of Hp infection was 92.5%,the specificity was 41.3%,the total consistent rate was 73.5%,the positive predictive value was 72.8%,and the negative one was 76.5%.The disease was serious in CagA~+ Hp.The antibody′s concentration was lower after treatment in patients infected Hp. CONCLUSIONS The method of protein chip for Hp infection detection could be used in judging the type of Hp.It is suitable for guiding of medicine and the monitoring of treatment.

As the advanced technology of proteomics, the surface-enhanced laser desorption/ionization Time-of-Flight Mass Spectrometry(SELDI-TOF-MS)has great potential in clinical application for it′s technological features.Whether it can be applied in clinical trials depends on the quality control and standardization of the technology.In the article, we introduced and discussed the following aspects of the issue.1) quality controlling before sample being analyzed, including the collection and preparation of samples, the selection and conservation of reagents, the calibration and attendance of laboratory apparatus;2) quality controlling during the assay, that is, the validation and analysis of the experimental result;3) the standardization of the continued data handling and analyzing, including the standardization of the analyzed data′s nature, the selection and standardization of the data′s analyzing methods, the system evaluation of the whole SELDI-TOF-MS technological system.