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.

Gastroesophageal reflux disease(GERD)is a chronic and recurrent disease with a wide variety of symptoms,often overlapping with functional gastrointestinal disorders,having different response to proton pump inhibitor (PPI)therapy,and facing various challenging for diagnosis and treatment. It is important for improving the diagnosis via knowing well the clinical manifestations of GERD and related diseases,rational using PPI test,upper gastrointestinal endoscopy and ambulatory esophageal pH/impedance monitoring,and understanding the relationship between the symptoms and reflux events. Different strategies of maintenance therapy should be chosen in accordance with patient's condition for decreasing recurrence. Aggressive acid suppressive therapy,inhibiting gastroesophageal reflux and modulating esophageal hypersensitivity are the main treatment methods for patients with poor response to PPI after ruling out the non-GERD causes.

Irritable bowel syndrome(IBS)is a common functional intestinal disease,and its etiology and pathogenesis are not completely clear. The pathogenesis of IBS involves disturbed gastrointestinal motility,gut hypersensitivity,intestinal inflammation,immune dysfunction and brain-gut axis abnormality. Cathepsin S(CTSS)is a proteolytic enzyme widely distributed in various cell lysosomes,and participates in a variety of pathophysiological processes. Recent studies have shown that CTSS may be involved in the pathogenesis of IBS. This article reviewed the advances in study on role of CTSS in IBS.

AIM To establish an HPLC method for the simultaneous content determination of seven constituents in Gnaphalium affine D.Don.METHODS The analysis of 80％ methanol of G.affine was performed on a 30 ℃ Atlantis (C) T3 column (4.6 mm× 250 mm,5 μm),with the mobile phase comprising of acetonitrile-formic acid flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelength was set at 288 nm.RESULTS Seven constituents showed good linear relationships within their own ranges (R2 ≥0.999 8),whose average recoveries were 98.58％-103.8％ with the RSDs of 0.88％-1.74％.CONCLUSION This accurate,stable and reproducible method can be used for the quality control of G.affine.

Objective To establish a method for extracting DNA from old bones by AutoMate ExpressTM system.Methods Bones were grinded into powder by freeze-mill.After extraction by AutoMate ExpressTM,DNA were amplified and genotyped by Identifiler(R) Plus and MinFilerTM kits.Results DNA were extracted from 10 old bone samples,which kept in different environments with the postmortem interval from 10 to 20 years,in 3 hours by AutoMate ExpressTM system.Complete STR typing results were obtained from 8 samples.Conclusion AutoMate ExpressTM system can quickly and efficiently extract DNA from old bones,which can be applied in forensic practice.

Objective To investigate the long-term effects of non-surgical treatment on clinical and hematologic states of patients with generalized aggressive periodontitis (GAgP).Methods Patients with GAgP(n =25) and healthy controls (n =28) were recruited.The clinical parameters,including probing depth(PD),bleeding index(BI),attachment loss(AL) were examined and recorded.Blood cell variables,including white blood cells (WBC),leukocyte,neutrophil,and lymphocyte counts,as well as serum triglycerides,fasting glucose and protein parameters,including total protein,albumin,globulin,and albumin/globulin ratio(A/G),were analyzed.Twenty-five GAgP patients received non-surgical treatment and the clinical and blood parameters 3 to 7 years after treatment were re-evaluated.Clinical and hematological parameters of the two groups were compared.Comparisons of clinical and hematologic parameters pre-and post-treatment in GAgP group were performed through one-way ANOVA and paired-t test.Results Elevated white blood cells,neutrophil numbers and serum total protein,globulin levels were observed in patients with GAgP compared to controls [(6.3 ± 2.0) × 109cell/L vs.(5.4 ± 1.0) ×109cell/L,(4.1 ±1.8) × 109 cell/L vs.(3.0 ±0.9) × 109 cell/L,(78.2 ±4.4) g/L vs.(75.6 ±4.6) g/L and (29.3 ±3.8) g/L vs.(26.5 ±3.9) g/L respectively,P ＜0.05].A/G ratio was lower in the GAgP group than in the control group (1.7 ±0.2 vs.1.9 ±0.3,P ＜0.01).Three to seven years after periodontal treatment,the reduction of PD and BI was observed in GAgP group (P ＜ 0.05).There were significant decreases of WBC count,neutrophil count,serum total protein and globulin level,and significant increases of albumin level and A/G at 3 to 7 years after treatment (P ＜ 0.05).Conclusions Non-surgical treatment may have long-term beneficial effect on the periodontal clinical status and hematologic parameters of generalized aggressive periodontitis.

Objective To explore the ability and mechanism of insulin-like growth factor l (IGF-1) induced bone mesenchymal stem cells ( BMSCs) differentiation into cardiomyocyte-like cells ( CLCs).Methods BMSCs were isolated and purified in vitro.BMSCs were treated with control medium and 15 ng/ml IGF-I for 3,7, 14 and 21 d, respectively. The expression of Troponin-T ( TNT), Troponin-I (TNI) and pIGF-1R were c~etected by immunocytochemistry and Westem blot.In another experimental setting,BMSCs were treated with control medium and 15 ng/ml IGF-l,ICF-1 antaS;onist I-Ome AG538 (300 nmol/L) and 300 nmol/L I-Ome AG538 + 15 ng/ml IGF-1 for 3 t0 48 h,respectively.Phosphorylation status of ERKl/2 and AKT,the two downstream mediators of mitogen-activated protein kinase ( MAPK) kinase and phosphatidylinositol 3-kinase ( PBK) pathways,were detected by immunocytochemistry and Yvestem blot.Results After 3 t0 21 d exposrue to IGF-1, the expression of pIGF1R,TNT and TNI were significandy higher in 'IGF-1 group than those in control group,pIGF-IR peaked 14 d (all P ＜0.05).After 3 and 6 h treatment,the ratio of pAKT/AKT(0.17 ± 0.03)and pERK1/2/ERK1/2(0.06 ± 0.03)were significantly downregulated in I-Ome AG538 group compared to control group (1.00 ±0.05) (all P ＜ 0.05).The ratio of pAKT/AKT(1.00 ± 0.07) and pERK1/2/ERK1/2 (1.00 ± 0.09) were significantly upregulated in IGF-1 group compared to control group (0.72 ± 0.05) (all P ＜ 0.05),but the ratio of pAKT/AKT(0.31 ± 0.10)and pERK1/2/ERK1/2 (0.39 ±0.04) were significantly downregulated in I-Ome AG538 group compared to control group (0.63 ± 0.05) (all P ＜ 0.05),the value of gray scale of TNT (195.06 ± 5.98) and TNI (198.32 ± 3.46) in I-Ome AG538 + IGF-1 group were significantly upregnlated than that in IGF-1 group for TNT (188.70 ± 5.35) and TNI (176.10 ± 4.96) (all P ＜ 0.05).Conclusions IGF-1 could induce BMSCs differentiation into CLCs in vitro by activating MAPK and PI3K signaling pathways.

Purpose To compare coronary plaque burden,composition,distribution and the degree of coronary artery stenosis in invasive coronary angiography (ICA) diagnosed coronary artery disease (CAD)patients with or without metabolic syndrome (MetS).Methods From January 2008 to June 2011,consecutive patients underwent both coronary computed tomography angiography (CCTA) and ICA within three months were enrolled.Patients with history of previous percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) were excluded.Plaque characteristics and maximal luminal diameter stenosis were analyzed on a 16-segment basis as suggested by the American Heart Association classification.Results The study population consisted of 872 patients [age (60.2 ± 10.0) years,72.70％ males] including 377 patients with MetS and 495 patients without MetS.The median coronary artery calcium score (CACS) was higher in MetS patients than in non-MetS patients [102(10,410) vs.58(0,274),P ＜ 0.01].Percentage of patients with no coronary artery calcium was significantly lower in MetS group than in non-MetS group [19.63％ (74/377) vs.30.71％ (152/495),P ＜ 0.01],while percentage of patients with severe coronary calcium (CACS ≥ 1000) were significantly higher in MetS than non-MetS group [8.22％ (31/377) vs.4.65％ (23/495),P =0.03].The proportion of patients with 1-vessel disease was lower [23.61％ (89/377) vs.36.77％ (182/495),P ＜ 0.01],2-vessel [29.71 ％ (112/377) vs.22.83 ％ (113/ 495),P ＜ 0.05] and 3-vessel disease [35.54％ (134/377) vs.24.44％ (121/495),P ＜ 0.01] were higher in MetS group than in non-NetS group.Calcified plaque of LM and the middle and distal coronary artery were significantly higher in MetS group than in non-MetS group(all P ＜ 0.05).Conclusions CAD patients with MetS are associated with severer coronary artery calcium deposition and higher percentage of calcified plaque in the middle and distal coronary arteries and severer obstructive coronary vessels.

Background The incidence of brain metastases in patients with breast cancer is approximately 10％-16％,and survival after diagnosis of brain metastases is usually short.This study was designed to evaluate the risk factors associated with brain metastases in advanced breast cancer patients,with a view to help predict patient groups with high risk of brain metastases.Methods In total,295 patients with advanced breast cancer were evaluated.All patients were pathologically confirmed and metastatic lesions were confirmed pathologically or by imaging.All patients were examined at least once every 6 months with head CT or MRI.Patients showing symptoms underwent immediate inspection,and brain metastatic lesions were confirmed by head CT and/or MRI.Results At a median follow-up of 12 months from the occurrence of metastases,brain metastases had occurred in 49 patients (16.6％).In our univariate analysis,variables significantly related to increased risk of brain metastases were hormone receptor-negative tumors,epidermal growth factor receptor 2 (HER2)-positive tumors,and multiple distant metastases.Patients with dominant tumor sites in soft tissue,or defined as Luminal A subtype,tended to have a lower risk of brain metastases than patients with visceral metastases,Luminal B subtype,triple-negative subtype or HER2-enriched subtype tumors.Conclusions Our results strongly suggest that factors such as Luminal B,triple-negative,and HER2-enriched subtypes are high risk factors for brain metastases.These data,therefore,provide pivotal clinical evidence towards a comprehensive understanding of the risk factors of brain metastases in advanced breast cancer patients.

ObjectiveTo investigate current iodine nutritional status of different groups of people in Harbin city, and to provide the basis for development of salt iodization standard and scientific iodine supplementation.MethodsThree urban districts and three surrounding counties were chosen in Harbin,2011.In each chosen urban district and county,one district office (township) was selected,and one residents committee (village) was chosen in each of the district office(township),and 30 households were selected by systematic sampling.Iodized salt,water iodine and iodine intake per capita were investigated.In each of the residents committee (village),20 adults aged 18 - 45,30 pregnant women or lactating women,and 100 school children aged 8 - 10 were selected.Urine samples were collected and urinary iodine level were tested.Salt iodine was determined by direct titration,water and urinary iodine by arsenic cerium catalytic spectrophotometry.Iodine uptake and iodine nutritional status of different populations in Harbin urban and rural areas were compared.ResultsThe edible rate of qunlified iodized salt were 93.3％(84/90) and 96.3％(156/162) in Harbin urban and rural residents,respectively,which were all greater than 90％,and the highest value of salt iodine were 38.3,46.0 mg/kg,respectively,in urban and rural areas,which all did not exceed the upper limit(50 mg/kg) of qualified iodized salt,but there were some samples of salt iodine content below the national standard(20 mg/kg).Water iodine value in urban and rural areas,even the highest value(9.40,8.40 μg/L),was failed to meet the national standard 10 μg/L; salt eaten by rural people perperson a day(8.33 g) was significantly higher than that of the urban people(7.03 g,Z=- 2.750,P ＜ 0.01); in addition to rural children aged 8 - 10,whose urinary iodine value(228.6 μg/L) was higher,the values in urban and rural adults ( 111.3,195.6 μg/L),pregnant women ( 193.0,172.9 μg/L),lactating women ( 128.4,173.7 μg/L)and urban children ( 186.8 μg/L ) were all in appropriate level.The urinary iodine medians ( 195.6,228.6 μg/L )of adults and children in rural were significantly higher than that of urban adults and children(111.3,186.8 μg/L,Z =- 2.294,- 5.434,P ＜ 0.05 or ＜ 0.01,respectively).Population composition of iodine deficiency in both urban and rural adults,lactating and pregnant women[46.7％(28/60),21.6％(13/60) ; 21.1％(19/90),21.3％ (18/89) ; 27.8％ ( 25/90 ),42.2％ (38/90) ] were significantly higher than that of the population composition with iodine excess[4.6％(4/60),5.0％(3/60) ; 16.7％(15/90),16.9％(15/89) ; 4.4％(4/90),0.0％(0/90)],but proportion of iodine excessive population in rural children [26.3％(79/300)] was significantly higher than proportion of iodine deficiency[5.6％(17/300)].ConclusionsThe natural environment of Harbin city is still in the iodinedeficient state.In addition to children in rural areas,the iodine intake and iodine nutrition level is basically appropriate; the risk of disease caused by iodine deficiency in adults,lactating and pregnant women is higher than by iodine excess,but the situation of children in rural is on the opposite.Therefore,we should strengthen the monitoring of different populations,and supplement iodine scientifically based on their need.