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AIM: To quantify early changes of macular capillary parameters in type 2 diabetic patients using optical coherence tomography angiography(OCTA).METHODS: Retrospective case study. A total of 49 healthy subjects, 52 diabetic patients without retinopathy(noDR)patients, and 43 mild nonproliferative diabetic retinopathy(mNPDR)patients were recruited. Capillary perfusion density, vessel length density(VLD), and average vessel diameter(AVD)were calculated from macular OCTA images(3 mm×3 mm)of the superficial capillary plexus after segmenting large vessels and the deep capillary plexus. Parameters were compared among control subjects, noDR, and mNPDR patients. The area under the receiver operating characteristic curve estimated the abilities of these parameters to detect early changes of retinal microvascular networks.RESULTS: Significant differences were found in the VLD and AVD among the three groups(P<0.001). Compared with the control group, the noDR group had significantly higher AVD(P<0.05). VLD of both layers in patients of mNPDR group was significant decreased compared with that of noDR group(all P<0.01). Deep AVD had a higher area under the curve(AUC)of 0.796 than other parameters to discriminate the noDR group from the healthy group. Deep AVD had the highest AUC of 0.920, followed by that of the deep VLD(AUC=0.899)to discriminate the mNPDR group from the healthy group.CONCLUSIONS: NoDR patients had wider AVD than healthy individuals and longer VLD than mNPDR patients in both layers. When compared with healthy individuals, deep AVD had a stronger ability than other parameters to detect early retinal capillary impairments in noDR patients.
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Objective To investigate the relationship between hypoxia and insulin resistance in males with metabolic syndrome ( MS ). Methods Parameters at physical, hematological, glucose metabolism, lipid metabolism, and insulin resistance were measured in 295 middle-aged men who took health examination. The trends of laboratory indexes grouped by hemoglobin quartile and MS components were compared. The correlation between hypoxia and insulin resistance was analyzed. Results With the increase of hemoglobin, the occurrence rates of MS, TG, INS, and HOMA-IR were also significantly increased ( P < 0. 05 ), while HDL-C and HOMA-IS reduced remarkably(P<0. 05). With the increase of MS components, hematological parameters(RBC, Hb, Hct), INS, and HOMA-IR were significantly increased( P<0. 05) while HOMA-IS were significantly decreased( P<0. 05). Blood lactate and HIF-1αwere significantly increased with the increase of hemoglobin as well as MS components(P<0. 05);Hematological parameters were positively correlated with blood lactate and HIF-1α, and Hypoxia related indicators including hematological parameters, Lac, HIF-1α showed a positive correlation with HOMA-IR and a negative correlation with HOMA-IS( P < 0. 05). Conclusion Chronic hypoxia does exist in metabolic syndrome, and the degree of hypoxia is associated with insulin resistance. Hematological parameters are also significantly correlated with insulin resistance which could be as a result of chronic hypoxia.
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Objective To observe the clinical characteristics of gestational diabetic retinopathy (DR)of 13 pregnants with vitreous hemorrhage.Methods The clinical data of 26 eyes retinopathy with 13 cases of gestational diabetes were retrospectively analyzed.After bilateral eyes were mydriatic by Pyrazole MAO amine compound,ophthal-mologist used fundus camera to check bilateral fundus.B ultrasonic was used to examine vitreous hemorrhage and the surfaces of vitreous and retinal.Results In 13 cases,26 eyes vision were between hand motion-0.6.Sudden vitre-ous hemorrhage in 13 eyes,accounted for 50.0%(13/26).Among them,the classⅠvitreous hemorrhage in 10 eyes, 76.9%(10/13).Ⅱ,Ⅲ grade vitreous hemorrhage in 2 eyes,15.4%(2/13).LevelⅣvitreous hemorrhage in 1 eye, accounted for 7.7%(1/13).26 eyes were diagnosed with stage IV(early or fiber hyperplasia period)DR.The fundus photography:the size,number of retinal neovascularization were found in 13 eyes without vitreous hemorrhage.Ultra-sound confirmed that the 13 eyes vitreous hemorrhage were fresh bleeding,and found 4 eyes with fiber membrane, accounted for 30.8%(4/13).The eyes without vitreous hemorrhage were timely treated by laser,and the eyes with vitreous hemorrhage were treated by stage laser treatment according to the condition of vitreous hemorrhage absorp-tion.Followed up for 4 to 6 months,in a stable condition.Conclusion Obstetrics and gynecology doctors and oph-thalmologists should pay attention to pregnancy DR with vitreous hemorrhage.Because they are all early or fiber hyper-plasia period.Timely and reasonable laser treatment can prevent permanent damage of visual function.
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Objective To establish and apply the procedure of survey on quality indicator in clinical laboratory and to analyze the status in quo of the 15 quality indicators in Zhejiang province .Methods A network platform for the survey on quality indicator in clinical laboratory was designed and developed by our center.The online questionnaires that should be reported back within one month were assigned to 473 laboratories.The developed software and SPSS 13.0 were used for statistical analysis .13 indicators expressed in rate were further evaluated with sigma scales .The 25th percentile, 50th percentile, and 75th percentile of the distribution of each quality indicator were regarded as the minimum , appropriate and optimum quality specifications, respectively.Results Totally 444 laboratories submitted the survey results.The overall sigma levels of 10/13 indicators were all >3, of which the inappropriate CV of internal quality control and unacceptable performances in EQA were still less than 3σin 15.8%and 9.2%of the laboratories.The rates of quality indicators in different scales of laboratories and diverse disciplines were significantly different .Pre-analytical TAT in routine examination for clinical chemistry and immunology was 50 min, on average.And the time for routine examination of blood , urine and stool was 30 min.Pre-analytical TAT in emergency examination for all four disciplines were all between 10 and 15 min. Intra-analytical TAT for clinical immunology was the longest , which was 154 min for routine examination and 40 min for emergency examination, respectively.The optimum quality specifications for 8 indicators were 6σ, while the minimum quality specifications were less than 1σfor 4 indicators.Conclusions According to the results of our survey, the pre-analytical quality indicator perform better than that of Intra-analytical and post-analytical phase.The laboratory should strengthen the laboratory information system technology construction to ensure the reliable data collection and long-time monitoring.
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Objective To investigate the differences and harmonization of immunoassay systems in detecting CA19-9 and to assess the possibility of mutual recognition in different laboratories.Methods Data were collected and analyzed from External Quality Assessments (EQA) of NCCL(Lots:200811-201215) and ZJCCL(Lots:080309-120211).120 fresh serum with different concentrations of CA19-9 were collected.The CA19-9 results of healthy people were also collected from September 2010 to March 2012.Four kinds of stable immunoassay systems were involved in our research,including Abbott Architect i2000,Beckman UniCel DxI 800,Roche E170 and Siemens ADVIA Centaur XP.The differences among four system groups were calculated with the EQA data.The fresh serum comparisons were also performed following the guideline of CLSI EP9-A2 The 95％ confidence interval of each immunoassay system was calculated.Comparisons were made by scatter diagrams and weighted regression.Results Both EQA of NCCL and ZJCCL showed better correlation coefficients and larger bias (bw ranged from 1.340 to 4.683) than in fresh serum comparisons.Although the correlation coefficients were all unsatisfactory,the bw were all close to 1 in fresh serum comparisons.When the recommended serum concentration of 27 U/ml was used,the biases were Abbott-Roche-6.41％,Beckman-Roche-5.07％,Siemens-Roche 13.15％,Beckman-Abbott 2.46％,Siemens-Abbott 22.52％ and Siemens-Beckman 39.66％,respectively.Differences of 95％ confidence intervals were statistically significant among parts of the immunoassay systems.Conclusions Only in the lower concentration can CA19-9 results be mutual recognized among four different immunoassay systems,there will be larger differences and risks in the higher concentration.
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Objective To investigate the synergistic efficacy of different antibiotic combinations against KPC-2 carbapenemase producing Klebsiella pneumoniae strains in vitro and search for effective antibiotic combination.Methods During 2008 - 2009,a total of 24 strains of K.pneumoniae producing KPC-2 carbapenemase were collected from 8 hospitals in the First Affiliated Hospital of Medical School of Zhejiang University,Ningbo LiHuiLi Hospital,Zhejiang People's Hospital,Hangzhou Third Hospital,the Second Hospital of Shaoxing,Hangzhou First Hospital,Fudan University Huashan Hospital,General Hospital of Nanjing Military Region.MLST technique was used for epidemiological analysis.The MIC of antibiotics,such as amikacin,minocycline,imipenem,amoxicillin/clavulanic-acid,ceftazidime,meropenem,gentamicin,cefoxitin,cefepime,rifampicin,polymyxinB,ciprofloxacin were determined by an agar dilution method,the MIC of tigecycline and piperacillin/tazobactain were determined by Etest.The antibacterial activities of cefepime in combination with amoxicillin/clavulanic-acid,amikacin,or ciprofloxacin,amikacin with ciprofloxacin,imipenem with amikacin,ciprofloxacin,polymyxinB,or minocycline,polymyxin B with rifampicin,ceftazidime with amoxicillin/clavulanic-acid were assessed by chequerboard synergy agar dilution tests against all the isolates.Results MLST showed 5 STs among 24 strains of KPC-2 carbapenemase producing K.pneumoniae,and the most prevalent clone was ST11 (15 strains).All isolates were susceptible to polymyxin B and tigecycline,and the resistance rate of minocycline was 4.2％.The synergetic effects were observed in cefepime-amoxicillin/clavulanic acid,imipenem-amikacin,ceftazidime-amoxicillin/clavulanic acid combinations as 19 isolates,13 isolates,and 13 isolates,respectively.Conclusions KPC-2 carbapenemase producing K.pneumoniae is sensitive to polymyxin B,tigecycline and minocycline.The synergetic effect is predominant in cefepime-amoxicillin/clavulanic acid,imipenem-amikacin ceftazidime-amoxicillin/clavulanic acid combinations in vitro,their clinical efficacy are worthy of further observation.
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Objective To have a general picture the history and existing problems of independent clinical labs in China, for the purpose of building a supervision mechanism for such novel clinical institutions-clinical labs. Methods By way of the nationwide network of clinical labs, ICLs in China were surveyed with written questionnaires and field check. Results ICLs have grown into a greater and diversified scale thanks to the development of China's economy and laboratory technology. However,such vulnerabilities as unbalanced staff ratio, full-range quality control bugs, cutthroat competition,asymmetrical information disclosure, and bio-safety have loomed large in the meantime. Conclsion It is time to formulate a stricter industry access system and appropriate regulatory modes; ICLs should take a good care of the "Four relations" in their development, and health regulators should play a tighter role in the "Four supervisions". All these aim at better sharing medical resources, and building a win-win environment for the people, hospitals and ICLs.
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Objective To establish an external quality assessment (EQA) scheme for cell morphological interpretation of bone marrow smears and investigate its application value.Methods The Laboratories taking part in the assessment were periodically provided with diagnosed bone marrow smears,clinical data and other examination results for cell morphological interpretation of EQA.Results The coincidence rate was improved year after year from 50% in 1988 up to 85.8% in 2005 (P