A multi-center research on the establishment and validation of autoverification rules for blood analysis / 中华检验医学杂志

Objective@#To establish a set of rules for autoverification of blood analysis, in order to provide a way to validate autoverification rules for different analytical systems, which can ensure the accuracy of test results as well as shorten turnaround time (TAT) of test reports.@*Methods@#A total of 34 629 EDTA-K2 anticoagulated blood samples were collected from multicenter cooperative units including the First Hospital of Jinlin University during January 2017 to November 2017. These samples included: 3 478 cases in Autoverification Establishment Group, including 288 cases for Delta check rules; 5 362 cases in Autoverification Validation Group, including 2 494 cases for Delta check; 25 789 cases in Clinical Application Trial Group. All these samples were analyzed for blood routine tests using Sysmex XN series automatic blood analyzers.Blood smears, staining and microscopic examination were done for each sample; then the clinical information, instrument parameters, test results and microscopic results were summarized; screening and determination of autoverification conditions including parameters and cutoff values were done using statistical analysis. The autoverification rules were input into Sysmex Laboman software and undergone stage Ⅰ validation using simulated data, and stage Ⅱ validation for post-analytical samples successively. True negative, false negative, true positive, false positive, autoverification pass rate and passing accuracy were calculated. Autoverification rules were applied to autoverification blood routine results and missed detection rates were validated, and also data of autoverification pass rate and TAT were obtained.@*Results@#(1)The selected autoverification conditions and cutoff values included 43 rules involving WBC, RBC, PLT, Delta check and abnormal characteristics. (2)Validation of 3 190 cases in Autoverification Establishment Group showed the false negative rate was 1.94%(62/3 190)(P<0.001), autoverification pass rate was 76.74%, passing accuracy was 97.47%; Validation of 2 868 cases in Autoverification Validation Group, the false negative rate was 3.38%(97/2 868)(P=0.002), autoverification pass rate was 42.26%, passing accuracy was 92.00%; Validation of Delta check on 288 cases in Autoverification Establishment Group and 2 494 cases in Autoverification Validation Group showed the false negative rates were respectively 1.39% and 2.61%(P<0.001). (3)Three hospitals adopted these rules of autoverification for 25 789 blood routine samples, and found that the average TAT of blood routine test reports were shortened by 24min, 32min and 7min respectively, the rate of samples reported within 30min were elevated by 33%, 53% and 7%. The autoverification pass rates were 72%-74%.@*Conclusions@#The application of this set of 43 autoverification rules in blood sample analysis can ensure test quality while shortenTAT and improve work efficiency. It is worth pointing out that for the same analytical systems in this research, validation is necessary before application of this set of rules, and periodic validation is required during application to make necessary adjustment; for different analytical systems, as this research provide a way to establish autoverification rules for blood routine tests.Clinical labs may establish their own suitable autoverification rules on the basis of technological parameters. (Chin J Lab Med, 2018, 41: 601-607)

Value of urine sediment analyzer in the screening of urinary tract infection in cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the value of urine sediment analyzer in the screening of clinically suspected urinary tract infection (UTI) in cancer patients.</p><p><b>METHODS</b>The results of bacterial count of 1 053 midstream urine samples by UF-1000i urine sediment analyzer (UF-1000i urine sediment analyzer, UF-1000i) were compared with the results of bacterial culture. Moreover, the results of distinguishing bacterial species by the bacterial scattergram were compared with the results of bacteria culture. At the same time, the sensitivity, specificity, positive predictive value and negative predictive value of UF-1000i analyzer for UTI screening were evaluated.</p><p><b>RESULTS</b>Of all the 1 053 samples, the top three bacteria were E. coli, Enterococci and P. aeruginosa. The top three malignant tumors of UTI were bladder, lung cancer and cervical cancers. The positive rate of UF-1000i analyzer was 20% (211/1 053), and that of bacteria culture was 17.9% (188/1 053). There was statistically no significant difference in the positive rates between the two methods (χ(2)=1.636, P>0.05), and the two methods had a considerable consistency (Kappa=0.756). Compared with the clinical diagnosis, UTI screening by UF-1000i analyzer showed a sensitivity of 79.6% (160/201), specificity of 95.5% (814/852), positive predictive value of 80.8% (160/198) and negative predictive value of 95.2%(814/855). The distribution of cocci and bacilli acquired by the bacterial scattergram was basically in accordance with the results of bacterial culture.</p><p><b>CONCLUSIONS</b>Bacterial count by UF-1000i analyzer plays an important role in early screening of UTI, and the bacterial scattergram may help to distinguish bacterial species, providing reference for the use of antibiotics in early medication.</p>

Risk factors for Clostridium difficile-associated diarrhea among cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to investigate the prevalence of Clostridium difficile (C. difficile) infection and the risk factors for acquisition of C. difficile-associated diarrhea (CDAD) among cancer patients who received chemotherapy or radiation therapy.</p><p><b>METHODS</b>We analyzed 277 stool samples from cancer patients with diarrhea between Sep 2010 and Dec 2011 in our hospital. Stool C. difficile toxin A/B test, stool culture for C. difficile and routine stool examination were performed. In addition, the risk factors for CDAD were investigated in a set of 41 C. difficile toxin-positive cancer patients and 82 matched C. difficile toxin-negative controls by univariate analysis and multivariate analysis.</p><p><b>RESULTS</b>Out of a total of 277 cancer patients with diarrhea, 41 (14.8%) were C. difficile toxin-positive. Among these 41 cases, 11 (26.8%, 11/41) were C. difficile culture-positive. Univariate analysis showed that antibiotics use (P = 0.853), proton pump inhibitor use (P = 0.718), hypoproteinemia (P = 0.139) and white blood cell count (P = 0.454) did not appear to be associated with acquisition of CDAD in cancer patients. However, receiving chemotherapy (P = 0.023), receiving radiotherapy (P = 0.003), a positive fecal occult blood test result (P = 0.005) and the presence of fecal leukocytes (P = 0.007) showed close association with acquisition of CDAD in cancer patients. Multivariate analysis showed that receiving chemotherapy (OR, 8.308; 95% CI, 1.997-34.572; P = 0.004) and a positive result of fecal occult blood test (OR, 8.475; 95% CI, 1.463-49.109; P = 0.017) were independent risk factors for acquisition of CDAD among cancer patients.</p><p><b>CONCLUSIONS</b>Our results support that receiving chemotherapy and a positive fecal occult blood test result are independent risk factors for acquisition of CDAD among cancer patients. Cancer patients who are at high-risk for CDAD should take stool C. difficile toxin A/B test and stool culture for C. difficile regularly and prevention of CDAD.</p>

Analysis of the efficacy and security of entecavir combined with interferon sequential therapy in the treatment of chronic hepatitis B / 中国基层医药

Objective To discuss the efficacy and security of entecavir and interferon sequential combination therapy on chronic hepatitis B.Methods 108 patients with chronic hepatitis B were randomly divided into the sequential combination therapy group,the entecavir group and the interferon group.Each group had 36 cases.The efficacy and security of different therapy were observed.Results The HBV DNA negative rate of the sequential combination therapy group was 77.78％,and the ALT normalization rate was 91.67％,which were both higher than those of the entecavir group and the interferon group(x2 =14.40,22.12,20.07,18.47,all P ＜ 0.05).The total effective rate of the sequential combination therapy group was 91.67％,which was obviously higher than that of entecavir group and the interferon group(x2 =12.09,6.82,all P ＜ 0.05).The entecavir and interferon sequential combination therapy had a good security.Conclusion Entecavir combined with interferon sequential therapy in the treatment of chronic hepatitis B had a significant clinical efficacy and deserved promotion.

The related factors analysis of hepatitis B liver cirrhosis patients with secondary glucose metabolism disorders / 中国基层医药

Objective To investigate the related factors analysis of hepatitis B liver cirrhosis with secondary glucose metabolism disorders.Methods 184 patients with hepatitis B liver cirrhosis were selected as the research object and were given 75g oral glucose tolerance test( OGTI),then they were divided into three groups[ normal glucose tolerance(NGT) group,impaired glucose tolerance and impaired fasting glucose regulation impairment(IGR) group,diabetic( DM ) group ] according the results.The general information,laboratory examination and viral load of three groups were compared.Results ( 1 ) The difference of age,waist size,weight,body mass index data and hepatitis B virus load in IGR group and DM group compared with NGT group were statistically significant difference ( all P ＜0.05 ),IGR compared with DM group,all index comparative differences were not significant (all P ＞ 0.05 ).(2)As the aggravating of glucose metabolism disorder,the positive rate of HBsAg,HBeAg and former S1 antigen of NGT group,IGR group and DM group were gradually raised ( all P ＜ 0.05 ).Conclusion The body mass index and hepatitis B virus load are relatively independent risk factors of secondary glucose metabolism disorders in patients with hepatitis B liver cirrhosis,and which are positive correlation with it.However,gender,age,blood lipids are not obvious correlation with secondary glucose metabolism disorders.

Influence of therapeutic communication system on depression emotion of postoperative tumor patients undergoing chemotherapy / 中国实用护理杂志

Objective To investigate the effect of therapeutic communication system on alleviation of depression emotion of postoperative tumor patients undergoing chemotherapy.Methods 56 cases of cancer patients undergoing chemotherapy after surgery were randomly divided into the observation group and the control group with 28 cases in each group.The observation group was given therapeutic communication system based on routine care,the control group only received routine care.The self-rating depression scale (SDS),automatic thoughts questionnaire (ATQ) and quality of life evaluation questionnaire (QLQ-C30 3.0) were used for evaluation in two groups before and after intervention.Results The depression mood,negative automatic thoughts and quality of life in the observation group were better than the control group,the difference was statistically significant.Conclusions Application of therapeutic communication system on postoperative tumor patients undergoing chemotherapy can alleviate depression,negative automatic thoughts and quality of life significantly.It implies the effectiveness and feasibility of psychological intervention for postoperative tumor patients undergoing chemotherapy,which is worthy of clinical application.