Predictive value of monocyte to HDL-C ratio for coronary artery lesions and intravenous immunoglobulin resistance in Kawasaki disease.

We aimed to investigate the predictive validity of monocyte to high-density lipoprotein cholesterol ratio (MHR) for coronary artery lesions (CALs) and intravenous immunoglobulin (IVIG) resistance in complete Kawasaki disease (KD). MHR values of a total of 207 complete KD patients were calculated and analyzed with regard to their clinical characteristics and outcomes. We compared the differences in clinical data and laboratory parameters between CAL+ group and CAL- group as well as between IVIG-resistant group and IVIG-responsive group. Spearman's correlation analysis was applied to evaluate the correlation between C-reactive protein (CRP) and MHR. Multivariate logistic regression was used to identify risk factors of CALs and IVIG resistance. Receiver operating characteristic (ROC) curve analysis was chosen to determine the optimal cut-off value of MHR and its validity in predicting CALs and IVIG resistance. The MHR level was significantly higher in the CAL+ group, with cut-off value of 1.30 g/L, yielding a sensitivity of 0.753 and specificity of 0.805, as well as in IVIG-resistant group, with cut-off value of 1.03 g/L, yielding a sensitivity of 0.97 and specificity of 0.485. Multivariate logistic regression showed that MHR was an independent risk factor for CALs but not for IVIG resistance. According to the Spearman's correlation analysis, CRP was positively correlated with the MHR. CONCLUSIONS: As a practical, cost-effective inflammatory biomarker, MHR has a significantly predictive value in complete KD children complicated with CALs and IVIG-resistance. Paying more attention to the changes of MHR in KD children may contribute to better understanding of KD development and prognosis in clinical practice. WHAT IS KNOWN: • CALs are the most prevalent serious sequela of KD, and approximately 10%~20% of patients do not respond to IVIG therapy. • MHR could be a convenient biomarker to predict the development and progression of CVDs. It has been reported that the MHR is a new prognostic biomarker in several CVDs. WHAT IS NEW: • MHR has a significantly predictive value in KD children complicated with CALs and IVIG-resistance. • Compared with the molecular and immunological biomarkers that have been reported, MHR has the characteristics of practical, cost-effective, higher sensitivity and specificity, which can be used as a predictive indicator in complete KD patients.

Coefficient of variation of heart rate and blood pressure in rapid identification of children with suspected orthostatic intolerance / 中华儿科杂志

Objective: To investigate the clinical value of coefficient of variation of heart rate and blood pressure in rapid identification of children with suspected orthostatic intolerance(OI). Methods: This was a retrospective study. The medical records of 379 children with OI were collected, who were admitted to the Department of Pediatrics of Qilu Hospital of Shandong University from January 2015 to January 2020. Another 20 out-patient children without syncope or syncope aura were selected as control. According to the results of standing test and head-up tilt test (HUTT), all the patients with OI were divided into the following 4 groups: vasovagal syncope (VVS) group, postural tachycardia syndrome (POTS) group, POTS combined with VVS (POTS+VVS) group and HUTT negative group. Then, coefficient of variation of systolic pressure (SBPCV), coefficient of variation of diastolic pressure (DBPCV) and coefficient of variation of heart rate (HRCV) in standing test and HUTT were calculated. Kruskal-Wallis test was used for comparison among the five groups, and Dunnett's T3 method for comparison between two groups. Paired t test was used to compare the coefficient of variation between supine and erect position and tilt position in each group. The predictive values of HRCV,SBPCV and DBPCV for negative HUTT were evaluated by receiver operating characteristic (ROC) curve. Results: Among the 379 children, there were 79 in HUTT negative group, 208 in VVS group, 52 in POTS group, and 40 in POTS+VVS group. The SBPCV of supine-erect position of the control group, HUTT negative group, VVS group, POTS group, POTS+VVS group were (3.8±1.0)%, (5.3±2.2)%, (6.6±3.4)%, (5.9±3.6)%, (6.9±2.8)%, respectively. Similarly, the SBPCV of supine, erect and head-up tilt position were (4.5±0.8)%, (6.0±1.9)%, (7.1±2.6)%, (6.0±2.1)%, (7.3±2.5)%; the DBPCV of supine-erect position were (7.3±1.2)%, (9.1±3.7)%, (9.1±4.9)%, (9.1±4.8)%, (11.6±4.6)%; the DBPCV of supine, erect and tilt position were (7.4±1.1)%, (9.4±2.9)%, (10.1±3.8)%, (9.2±3.3)%, (11.0±4.7)%; the HRCV of supine-erect position were (7.6±2.6)%, (12.9±3.7)%, (16.2±4.3)%, (21.2±5.9)%, (24.9±5.3)%; and the HRCV of supine, erect and tilt position were (8.1±1.6)%, (10.1±2.7)%, (14.1±4.3)%, (15.6±3.7)%, (18.9±4.0)%, respectively. All the indexes showed significant differences among the five groups (χ2=21.91, 25.47, 19.82, 14.65, 104.52, 92.51, all P<0.05). ROC curve analysis showed that when the SBPCV and HRCV of supine-erect position reached 4.4% and 10.5%, the area under the curve of ROC were 0.713 and 0.877, the sensitivity of predicting negative HUTT were 58.2% and 78.5%, and the specificity were 80.0% and 95.0%, respectively. Conclusions: Coefficient of variation of heart rate and blood pressure may serve as potential diagnostic indexes in evaluating autonomic function of OI patients. SBPCV ≥ 4.4% or HRCV ≥ 10.5% of supine-erect position could be an indication of HUTT.

Paeonol suppresses fibroblast synovitis by increasing MANF expression / 中国药理学通报

Aim To investigate the possible mechanism of paeonol inhibiting the inflammatory response of fibroblast synovial cells (RA-FLSS) in rheumatoid arthritis. Methods CCK-8 assay was used to detect Paeonol's inhibitory level on the abnormal proliferation of arthritis human fibroblast synovial cells (RA-FLSs). The levels of endoplasmic reticulum stress-related proteins MANF and ATF6 were detected by Western blot. Cell localization of transcription factor p65 and Mesencephalic Astrocyte Derived Neurotrophic Factor (MANF) was detected by immunofluorescence. RT-qPCR detected the changes of p65 target genes. Results Paeonol could significantly inhibit the abnormal proliferation of RA-FLSS cells. Paeonol activates ATF6 and increases the expression of MANF. Paeonol promoted the nuclear transfer of MANF protein and inhibited the transcriptional activity of p65. Conclusion Paeonol promotes the expression of MANF and nuclear transfer through the endoplasmic reticulum stress pathway and affects the progression of RA by inhibiting the transcriptional activity of p65.

[Short and medium term follow-up study on the changes of spine pelvic parameters in patients with hip-spine syndrome after total hip arthroplasty].

OBJECTIVE: To investigate the influence of total hip arthroplasty on the changes of spine pelvic parameters in patients with hip spine syndrome. METHODS: From January 2013 to October 2014, 22 patients (26 hips) with hip spine syndrome accompanied by necrosis of femoral head, hip osteoarthritis and congenital dysplasia of hip were treated with total hip arthroplasty. There were 12 males and 10 females with an average age of 58.4 years (range, 45 to 76 years). The course of disease was 1.5 to 25 years with an average of 12.8 years. Before and after the operation, the anteroposterior, full length radiographs of both lower limbs, thoracolumbar spine and pelvis in standing position were routinely taken. The balance parameters of spine pelvis coronal plane and sagittal plane before and after the replacement were measured. Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Harris score were performed before and after the operation. RESULTS: All cases were followed up for 21 to 52 (32±8) months. No infection, prosthesis subsidence, loosening, prosthesis dislocation were found in the last follow up. After total hip arthroplasty, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic tilt (PT) were significantly reduced(P<0.05), sacral slope(SS) was significantly increased(P<0.05), there was no significant difference in pelvic incidence(PI)(P>0.05); PT and scoliosis (coronal position) were significantly decreased after operation(P<0.05); VAS score of waist, VAS score of hip joint and ODI score of waist were significantly decreased before and after operation (P<0.05). Harris score of hip joint increased significantly after operation, and thedifference was statistically significant (P<0.05). CONCLUSION: After total hip arthroplasty, the coronal and historical balance parameters of spine and pelvis are significantly improved, and the short term and medium-term effects are satisfactory.

[Strategy of acetabular anteversion in total hip arthroplasty with lumbar degenerative kyphosis].

OBJECTIVE: To investigate how to place the anteversion of acetabular prosthesis more reasonably in patients with lumbar degenerative kyphosis. METHODS: A total of 122 patients with degenerative kyphosis of lumbar spine who underwent total hip arthroplasty from December 2017 to October 2019 were included and divided into experimental group and control group, 61 cases in each group. In experimental group, there were 25 males and 36 females, with a median age of 67.0 years;the median course of disease was 46.0 months;the functional pelvic plane with acetabular anteversion was set according to different types of pelvic anterior plane bracket. In control group, there were 27 males and 34 females, with a median age of 67.0 years;the median course was 42.0 months;in control group, the anteversion was set by the traditional method. The patients were followed up for 3 months. The operation time and blood loss were recorded. The incidence of infection and dislocation within 3 months was counted. Harris score before and 3 months after operation was recorded. Functional anteversion angle of standing position was measured 3 months after operation. RESULTS: Compared with control group, there was no difference in operation time and blood loss between the two groups (P=0.918, 0.381);there was no infection between two groups within 3 months after operation;there was 1 case of hip joint dislocation in the control group and no dislocation in experimental group. There was no significant difference in Harris score before and after operation. Three months later, reexamination of pelvic standing radiographs showed that the number of patients with functional anteversion of acetabular prosthesis outside the safe area was less in experimental group thanin control group (P=0.048), and the functional anteversion angle of acetabular prosthesis was more concentrated in the range of 15 ° to 20 ° in experimental group (P<0.001). CONCLUSION: According to the preoperative evaluation and classification of patients, better functional anteversion of acetabular prosthesis can be obtained with the help of pelvic anterior plane reference bracket in hip arthroplasty with lumbar degenerative kyphosis.

Mechanism of miRNA-based Aconitum leucostomum Worosch. Monomer inhibition of bone marrow-derived dendritic cell maturation.

Delvestidine (DLTD) is a monomeric compound isolated from Aconitum leucostomum Worosch, a widely used medicine for local treatment of rheumatoid arthritis (RA). Studies have shown that Aconitum leucostomum Worosch. can inhibit maturation of bone marrow-derived dendritic cells (BMDCs). Further, microRNAs (miRNAs) have regulatory effects on DC maturity and function. However, the mechanism underlying DLTD effects on DC maturity and RA remains to be elucidated. This study investigated whether DLTD-mediated inhibition of DC maturation is regulated by miRNAs. LPS-induced mature BMDCs were treated with DLTD for 48 h. CD80 and CD86 expression on BMDCs was detected by flow cytometry, and levels of inflammatory factors IL-6, IL-23, IL-1ß, and TNF-α were detected by ELISA and PCR. Further, gene expression and miRNA expression profiles were investigated by bioinformatics analysis and verified by PCR. DLTD was found to inhibit CD80 and CD86 expression on the surface of BMDCs and secretion of inflammatory factors IL-6, IL-23, IL-1ß, and TNF-α. In total, 54 differentially expressed miRNAs were detected, including 29 up-regulated and 25 down-regulated miRNAs after DLTD treatment. Analysis of biological information revealed that the differentially expressed target genes mainly regulated biological processes, including cell differentiation, cell cycle, and protein kinase complexes. Additionally, miR-511-3p downstream targets Calcr, Fzd10, and Eps8, were closely related to BMDCs maturation. DLTD may induce BMDCs maturity through regulation of miRNAs that affect Calcr, Fzd10, and Eps8 gene signals.

Extraintestinal Clostridioides difficile infection.

Clostridioides (Clostridium) difficile is the major cause of healthcare antibiotic-associated diarrhoea. However, extra-intestinal manifestations of Clostridioides (Clostridium) difficile infection (CDI) (including bacteremia and tissue infection) are extremely rare. We report a case of extraintestinal CDI after surgery. The isolate of C. difficile was not the PCR ribotype 027. However, this isolate produced toxins A and B. The patient underwent a follow-up examination 30 days after discharge, which showed complete recovery. This case report adds to existing knowledge of CDI.

Strategy of acetabular anteversion in total hip arthroplasty with lumbar degenerative kyphosis / 中国骨伤

OBJECTIVE@#To investigate how to place the anteversion of acetabular prosthesis more reasonably in patients with lumbar degenerative kyphosis.@*METHODS@#A total of 122 patients with degenerative kyphosis of lumbar spine who underwent total hip arthroplasty from December 2017 to October 2019 were included and divided into experimental group and control group, 61 cases in each group. In experimental group, there were 25 males and 36 females, with a median age of 67.0 years;the median course of disease was 46.0 months;the functional pelvic plane with acetabular anteversion was set according to different types of pelvic anterior plane bracket. In control group, there were 27 males and 34 females, with a median age of 67.0 years;the median course was 42.0 months;in control group, the anteversion was set by the traditional method. The patients were followed up for 3 months. The operation time and blood loss were recorded. The incidence of infection and dislocation within 3 months was counted. Harris score before and 3 months after operation was recorded. Functional anteversion angle of standing position was measured 3 months after operation.@*RESULTS@#Compared with control group, there was no difference in operation time and blood loss between the two groups (P=0.918, 0.381);there was no infection between two groups within 3 months after operation;there was 1 case of hip joint dislocation in the control group and no dislocation in experimental group. There was no significant difference in Harris score before and after operation. Three months later, reexamination of pelvic standing radiographs showed that the number of patients with functional anteversion of acetabular prosthesis outside the safe area was less in experimental group thanin control group (@*CONCLUSION@#According to the preoperative evaluation and classification of patients, better functional anteversion of acetabular prosthesis can be obtained with the help of pelvic anterior plane reference bracket in hip arthroplasty with lumbar degenerative kyphosis.

Short and medium term follow-up study on the changes of spine pelvic parameters in patients with hip-spine syndrome after total hip arthroplasty / 中国骨伤

OBJECTIVE@#To investigate the influence of total hip arthroplasty on the changes of spine pelvic parameters in patients with hip spine syndrome.@*METHODS@#From January 2013 to October 2014, 22 patients (26 hips) with hip spine syndrome accompanied by necrosis of femoral head, hip osteoarthritis and congenital dysplasia of hip were treated with total hip arthroplasty. There were 12 males and 10 females with an average age of 58.4 years (range, 45 to 76 years). The course of disease was 1.5 to 25 years with an average of 12.8 years. Before and after the operation, the anteroposterior, full length radiographs of both lower limbs, thoracolumbar spine and pelvis in standing position were routinely taken. The balance parameters of spine pelvis coronal plane and sagittal plane before and after the replacement were measured. Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Harris score were performed before and after the operation.@*RESULTS@#All cases were followed up for 21 to 52 (32±8) months. No infection, prosthesis subsidence, loosening, prosthesis dislocation were found in the last follow up. After total hip arthroplasty, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic tilt (PT) were significantly reduced(@*CONCLUSION@#After total hip arthroplasty, the coronal and historical balance parameters of spine and pelvis are significantly improved, and the short term and medium-term effects are satisfactory.

China′s strategy and experience in preventing and controlling the local spreading and epidemic of COVID-19 / 上海预防医学

After implementing a series of prevention and control strategies of Corona Virus Disease 19(COVID-19), China′s local epidemic situation has been basically blocked.While China has achieved a periodic success, global pandemic situation is still serious.Together with the timeline of China′s epidemic prevention and control this study reviewed the main strategies and measures in response to COVID-19 epidemic from Dec.2019 to Mar.23, 2020, and summarized China′s prevention and control plans and experiences.We hope all countries could fully understand the importance of non-pharmaceutical public health interventions, make positive and effective adjustments to the measures and strategies of prevention and control based on their own national conditions.

The IGF2/IGF1R/Nanog Signaling Pathway Regulates the Proliferation of Acute Myeloid Leukemia Stem Cells.

Acute myeloid leukemia is an aggressive disease characterized by clonal proliferation and differentiation into immature hematopoietic cells of dysfunctional myeloid precursors. Accumulating evidence shows that CD34+CD38- leukemia stem cells (LSCs) are responsible for drug resistance, metastasis, and relapse of leukemia. In this study, we found that Nanog, a transcription factor in stem cells, is significantly overexpressed in CD34+ populations from patients with acute myeloid leukemia and in LSCs from leukemia cell lines. Our data demonstrate that the knockdown of Nanog inhibited proliferation and induced cell cycle arrest and cell apoptosis. Moreover, Nanog silencing suppressed the leukemogenesis of LSCs in mice. In addition, we found that these functions of Nanog were regulated by the insulin-like growth factor receptor (IGF1R) signaling pathway. Nanog overexpression rescued the colony formation ability of LSCs treated with picropodophyllin (PPP), an IGF1R inhibitor. By contrast, knockdown of Nanog abolished the effects of IGF2 on the colony formation ability of these LSCs. These findings suggest that the IGF2/IGF1R/Nanog signaling pathway plays a critical role in LSC proliferation.

Use of immune modulation by human adipose-derived mesenchymal stem cells to treat experimental arthritis in mice.

Rheumatoid arthritis is a chronic and systemic autoimmune disease characterized by inflammatory cell infiltration and joint erosion. Human adipose-derived mesenchymal stem cells (hASCs) have shown the capacity of suppressing effector T cell activation and inflammatory cytokine expression. We investigated whether hASCs play a therapeutic role in collagen-induced arthritis (CIA) by administering a single dose of hASCs in mice with established CIA. In vivo, a beneficial effect was observed following hASC infusion as shown by a marked decrease in the severity of arthritis. Human ASCs were detectable in the joints, and reduced levels of pro-inflammatory cytokines and increased levels of anti-inflammatory cytokines were observed in the sera of the hASC-treated mice. Furthermore, hASC treatment induced the expansion of regulatory T cells (Tregs) both in the peripheral blood and in the spleen tissues. In vitro, hASCs downregulated the production of proinflammatory cytokines TNF-α, IL-1ß, and IL-6 in mouse macrophages stimulated with lipopolysaccharide and inhibited the proliferation of human primary T cells in response to mitogens. Thus hASCs represent a novel and effective therapeutic strategy for RA.

ETS-related gene is a novel prognostic factor in childhood acute lymphoblastic leukemia.

The ETS-related gene (ERG) has been demonstrated to be associated with overall survival in cytogenetically normal acute myeloid leukemia and acute T cell-lymphoblastic leukemia (T-ALL) in adult patients. However, there are no data available regarding the impact of ERG expression on childhood ALL. In the present study, ERG expression levels were analyzed in bone marrow samples from 119 ALL pediatric patients. ALL patients demonstrated higher ERG expression compared with the controls (P<0.0001). In addition, low ERG expression identified a group of patients with higher white blood cell counts (P=0.011), higher percentages of T-ALL immunophenotype (P=0.027), and higher relapse rates (P=0.009). Survival analyses demonstrated that low ERG expression was associated with inferior relapse-free survival (RFS) in childhood ALL (P=0.036) and was an independent prognostic factor in multivariable analyses for RFS. In conclusion, low ERG expression is associated with poor outcomes and may be used to serve as a molecular prognostic marker to identify patients with a high risk of relapse in childhood ALL.

Quality Requirements for Reference Intervals and Decision Limits in Clinical Laboratory / 现代检验医学杂志

Reference intervals and decision limits are critical parts of the clinical laboratory report.The evaluation ot their correct use represents a tool to verify the post analytical quality.Four elements are identified as indicators:① The use of decision limits for lipids and glycated hemoglobin.② The use of common reference values.③The presence of gender-related reference intervals for at least the following common serum measurands (besides obviously the fertility relate hormones):alkaline phosphatase (ALP),alanine aminotransferase (ALT),creatine kinase (CK),creatinine,gamma-glutamyl transferase (GGT),IgM,ferritin,iron,transferrin,urate,red blood cells (RBC),hemoglobin (Hb) and hematocrit (HCT).④) The presence of age-related reference intervals.The problem of specific reference intervals for elderly people is discussed,but their use is not recommended.On the contrary it is necessary the presence of pediatric age-related reference intervals at least for the following common serum measurands:ALP,amylase,creatinine,inorganic phosphate,lactate dehydrogenase,aspartate aminotransferase,urate,insulin like growth factor 1,white blood cells,RBC,Hb,HCT,alfafetoprotein and fertility related hormones.The lack of such reference intervals may imply significant risks for the patients.

Interpretation of External Quality Assessment Results in Clinical Laboratories and Suggested Approach on Investigating Unacceptable Results / 现代检验医学杂志

Important objectives of external quality assessment (EQA) is to detect analytical errors and urge laboratories to take corresponding corrective actions.The paper described knowledge required to interpret EQA results and present a structured approach on how to handle unacceptable EQA results.The interpretation of EQA results depends on five key points:the control material,the target value,the number of replicates,the acceptance limits and between lot variations in reagents.When there are unacceptable EQA results,these factors may be the sources of errors.The ideal EQA sample has two important properties:having no matrix effects;having a target value established with a reference method.If either of these two criteria is not entirely fulfilled,results not related to the performance of the laboratory may arise.To help and guide the laboratories in handling an unacceptable EQA result,National Center for Clinical Laboratories has developed a preliminary investigation on the sources of errors and corrective actions for nonconforming EQA results in fifteen EQA schemes.Then a flow chart with additional comments was developed based on the investigation and the document of QMS24 to help laboratories improve quality by use of EQA results.

Investigation on reasons of unacceptable external quality assessment results for blood gas and acid-base analysis in China / 临床检验杂志

Objective To investigate the reasons of unacceptable results and corrective measures adopted in external quality assessment (EQA)for blood gas and acid-base analysis.Methods The reasons of unacceptable results and corrective measures for three EQA testing events of blood gas and acid-base analysis in 2016 were reported through EQA system based on web which was developed by National Central for Clinical Laboratories.The responses were divided into seven major groups,including EQA samples,errors in reporting results,methodology,equipments,techniques,EQA evaluations and unexplainable results after survey.Results The disqualified rates of EQA survey on blood gas and acid-base analysis were ranged from 0.5％ to 13.1％ and reporting rates of disqualification causes were ranged from 45.8％ to 69.0％ (except for the groups less than 20 laboratories).In the reasons for unacceptable results technological defects (35.9％ to 37.0％)were mainly associated with inappropriate specimen handling and/or storing,reagents and calibration problems.The defects of equipments (24.4％ to 27.9％) included mainly the malfunction and failure to adhere to scheduled instrument maintenance procedures.The errors in reporting results (12.2％ to 19.7％) were mostly transcription errors and reporting wrong codes.The unexplainable results after survey account for 8.7％ to 9.6％.The methodological defects (8.1％ to 11.8％) were largely attributed to inadequate training and quality control method.The defects of EQA evaluations (0.8％ to 3.3％)were all due to inappropriate grouping.The categorizations of the problems in the three EQA testing events were similar.The most corrective measures were appropriate,in which re-education and training for staff and improvement in instruments,reagents,internal quality control,calibration and process of reporting results were included.Conclusion The analysis and classification for reasons of unacceptable EQA results should be helpful for laboratories in identifying opportunities for improvement and adopting corrective measures in time.

Arthroscopic treatment with canulated screw fixation through very high-posteromedial portal approach versus double bundle suture fixation for avulsion fracture of tibial attachment of posterior cruciate ligament / 中国组织工程研究

BACKGROUND: This team modified the arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach to perform direct compression. Thus, the pressure of the fracture block is evenly distributed on the healing line, and the operation is convenient and fixed firmly, but its clinical effect remains to be further confirmed. OBJECTIVE: To compare the clinical outcome of arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach and double bundle suture fixation for avulsion fracture of the tibial attachment of posterior cruciate ligament. METHODS: From January 2011 to May 2017, 60 cases of the avulsion fracture of posterior cruciate ligament (transverse diameter of fracture block > 10 mm) were treated operatively at the Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, China. According to different modes of operation in different periods, patients were assigned to two groups. In the canulated screw group (n=31), patients were treated with canulated screw through very high-posteromedial portal approach. In the suture group (n=29), patients were treated with double bundle suture fixation through posteromedial portal approach. General conditions were compared between the two groups. Knee function was assessed with the Intemational Knee Documentation Committee and Lysholm scores. Knee stability was evaluated with KT-2000 and posterior drawer test. RESULTS AND CONCLUSION: (1) All the patients were followed up (range 6-12 months). (2) The average operation time was (63.49±3.97) minutes in the canulated screw group and (87.28±3.46) minutes in the suture group (P < 0.05). At 3 months after surgery, all the patients were healed. (3) At the final follow-up, in the canulated screw group, the negative rate of posterior drawer test was 90%. Lysholm scores were 94.89±4.75. IKDC scores were 94.01±3.25. In the suture group, the negative rate of posterior drawer test was 90%. Lysholm scores were 95.56±3.63. IKDC scores were 95.52±4.72. No significant difference was determined between the two groups (P > 0.05). (4) KT-2000 measurement results revealed that there were no significant differences between the surgical knee and the normal knee in both groups (canulated screw group:(2.53±1.02)mm versus(2.12±0.83)mm;suture group:(2.65±0.82)mm versus(2.19±0.63)mm (P > 0.05). Moreover, no significant difference was detected in the affected knee of KT-2000 results between the two groups. (5) Both arthroscopic reduction with canulated screw through very high-posteromedial portal approach and double bundle suture fixation can achieve satisfactory clinical outcomes, but arthroscopic reduction with canulated screw through very high-posteromedial portal approach in patients with fracture block diameter > 10 mm can result in shorter operation time, more reliable fixation, and thus permit an early postoperative functional exercise.

Pragmatic Approach of Verification of Examination Procedures in Clinical Laboratory for Imprecision,Trueness and Diagnostic Accuracy / 现代检验医学杂志

Objective To propose a practice model for implementing procedures employed for the verification of validated ex-amination procedures already used for at least 2 years in their laboratory,in agreement with the ISO 15189 requirement at the Section 5.5.1.2.Methods In order to identify the operative procedure to be used,approved documents were identified, together with the definition of performance characteristics to be evaluated for the different methods;the examination proce-dures used in laboratory were analyzed and checked for performance specifications reported by manufacturers.Then,opera-tive flow charts were identified to compare the laboratory performance characteristics with those declared by manufacturers. Results The choice of performance characteristics for verification was based on approved documents used as guidance,and the specific purpose tests undertaken,a consideration being made of:imprecision and trueness for quantitative methods;diag-nostic accuracy for qualitative methods;imprecision together with diagnostic accuracy for semi-quantitative methods.Conclu-sion The described approach,balancing technological possibilities,risks and costs and assuring the compliance of the funda-mental component of result accuracy,appears promising as an easily applicable and flexible procedure helping laboratories to comply with the ISO 15189 requirements.

Analysis of Reference Intervals of 18 Routine Biochemistry in 56 Mutual Recognition Laboratories in Beijing-Tianjing-Hebei Region / 现代检验医学杂志

Objective To evaluate reference intervals consistency of 18 routine biochemistry among mutual recognition labora-tories by analyzing the information of reference intervals of these laboratories in Beijing-Tianjing-Hebei region.Methods Laboratories submitted the data of reference intervals via interval quality assessment(EQA)software which was based on WEB,then the background of the software save the data as Microsoft Excel 2007 document.Finally,the mutual recognition routine biochemical projects,including Kalium(K),Sodium(Na),Chlorinum(Cl),Calcium(Ca),Phosphorus(P),Total protein(TP),Albumin(ALB),Total cholesterol(TC),Triglyceride(TG),Creatinine(CRE),Urea(URE),Uric acid (UA),Glucose(GLU),Alanine amino transaminase(ALT),Aspartate aminotransferase(AST),γ-glutamyltranspeptidase (GGT),Lactate dehydrogenase(LDH)and Creatine kinase(CK)of 56 mutual recognition laboratories were chosen,and perform analysis on upper and lower limits of reference intervals and their sources.Results The sources of reference inter-vals differ among different laboratories.As for projects owning hygiene professional standards(including K,Na,Cl,Ca,P, TP,ALB,CRE,URE,ALT,AST,GGT,LDH,CK),the primary sources were hygiene professional standards(23.1%~48.1%),manufacturer instructions of reagents/instrument(17.3%~41.8%)and National Clinical Laboratory Procedures (18.9% ~37.0%),as for projects which didn't have professional standards(including TC,TG,UA and GLU),the main sources were manufacturer instructions of reagents/instrument(>41.1%)and National Clinical Laboratory Procedures(>45.3%).Moreover,more than half of laboratories(50.9%~58.9%)had verified the reference intervals.There were little difference among laboratories in the upper and lower limits of Cl,Ca,P,K and GLU,but bigger difference for other projects. Conclusion The upper and lower limits of reference intervals werenot consistent among laboratories.In order to ensure the comparability of the test results in beijing-tianjin-hebei region,laboratories should use reference intervals based on the popu-lation of beijing-tianjin-hebei region or China.