Table of Content

30 April 2016, Volume 31 Issue 4

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Orginal Article

Serum procalcitonin in diagnosing prognosis of infective endocarditis

ZHANG Haixia, DU Gang, XU Haifeng, YANG Guiying, LIU Yajun, PENG Jing, YU Chong, PENG Qiongying

2016, 31(4):  243-246.  DOI: 10.3969/j.issn.1673-8640.2016.04.001

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Objective To analyze the significance of serum procalcitonin （PCT） for the prognosis of infective endocarditis（IE）. Methods A total of 80 patients with IE were enrolled. IE patients with poor prognosis （severe complications or death） were as poor prognosis group,and IE patients without complications were as no complication group. Serum PCT of the 2 groups were determined by enzyme-linked fluorescence analysis,and C-reactive protein（CRP） was analyzed by nephelometry immunoassay. The levels of PCT and CRP were compared between the 2 groups. The sensitivities, specificities,positive predictive values and negative predictive values of PCT and CRP for judging IE poor prognosis were compared. Results PCT and CRP in poor prognosis group had higher levels and positive rates than those in no complication group（P<0.05）. The sensitivity, specificity, positive predictive value and negative predictive value of PCT for IE poor prognosis diagnosis had no statistical significance compared with CRP （P>0.05）. Conclusions Monitoring serum PCT is of important significance for the prognosis diagnosis of IE,which should be combined with CRP determination when available.

Setting the gray zones of domestic anti-hepatitis C virus antibody detection kits

LU Yinhua, ZHU Yuqing, XU Chong, ZHAO Xiaojun, CAO Danru, ZHU Lingfeng, GU Zhidong

2016, 31(4):  247-252.  DOI: 10.3969/j.issn.1673-8640.2016.04.002

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Objective To set the gray zones of 4 commonly-used domestic anti-hepatitis C virus（HCV）antibody detection kits in clinical laboratories of Shanghai. Methods A total of 656 cases diagnosed as anti-HCV antibody positive initially were collected,and 4 domestic anti-HCV antibody detection kits,Rongsheng,Xinbo,Kehua and Kemei,were used for review. The review rates of different initial detection signal-to-cut off（S/CO）ratio were calculated,respectively. A total of 338 weakly-positive samples with inconsistent initial and review results were chosen. Recombinant immunoblot assay（RIBA）was used for validation test,and for samples showing uncertain,fluorescence quantitation polymerase chain reaction（PCR）was used for the detection of HCV RNA. The results of RIBA and HCV RNA were as gold standard,and receiver operating characteristic （ROC） curve was used to discuss optimal S/CO ratio. With 95% true positive and 95% true negative S/CO ratios,the negative and positive gray zones for 4 domestic anti-HCV antibody detection kits were identified. Results The 4 domestic anti-HCV antibody detection kits′ negative review rates were > 90%,S/CO ratios were >12.01,and their positive review rates were > 95%. The optimal S/CO ratios for Rongsheng,Xinbo,Kehua and Kemei were 1.31,2.48,3.22 and 4.32,respectively. With 95% true positive rates and 95% true negative rates for determining 4 domestic anti-HCV antibody detection kits′positive and negative cut-off values,the gray zones for optimal S/CO ratios were 0.6-1.3, 0.7-2.5,0.7-4.0 and 0.7-4.3,respectively. Conclusions The 4 commonly-used domestic anti-HCV antibody detection kits′optimal S/CO ratios are confirmed. It provides 4 kinds of gray zones for anti-HCV antibody detection kits in clinic.

Significance of C-reactive protein in the diagnosis and disease monitoring among cancer patients with infection

HU Haoyun, ZHOU Lei, GAO Xiang, LU Renquan, GUO Lin

2016, 31(4):  253-257.  DOI: 10.3969/j.issn.1673-8640.2016.04.003

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Objective To evaluate the change of C-reactive protein（CRP） in cancer patients with infection,and to observe the relationships of CRP with neutrophil count and procalcitonin（PCT）. Methods The levels of CRP in 206 cancer patients with fever were determined,and the results of neutrophil count and infection status were analyzed. Among them,57 patients were followed up,and the change of CRP was evaluated,and the relationship with infection was analyzed. Results Among 206 cancer patients with fever,CRP level [median（quartile） ] in increased neutrophil count group was 119.95 （57.22,182.62） mg/L,which was higher than that in normal neutrophil count group [64.55（26.92,119.25） mg/L] and decreased neutrophil count group [80.45（42.00,123.35）mg/L]（P<0.05）. Among cancer patients with various kinds of fever,CRP levels in infection group and late-phase group were significantly higher than those in postoperative group,drug reaction group and other groups. For therapeutic effect assessment,CRP level in invalid treatment group was 101.00（69.50,143.00）mg/L,which was significantly higher than that in valid treatment group [10.00（4.00,27.00）mg/L]（P<0.05）. For disease monitoring,the change of CRP was similar to that of PCT. Conclusions CRP can be used as a diagnosis parameter for cancer patients with infection,and it is also an independent indicator for prognosis.

Antibiotic susceptibility of isolates in intensive care unit of children's hospital

HUANG Weichun, WANG Xing, ZHOU Qirui, LI Huaiyuan

2016, 31(4):  258-265.  DOI: 10.3969/j.issn.1673-8640.2016.04.004

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Objective To investigate the kinds and antibiotic susceptibility of isolates in intensive care unit（ICU）of Shanghai Children's Medical Center. Methods VITEK 2 automatic microbial analysis system was used to identify isolates, and antibiotic susceptibility was determined by E-test,Kirby-Bauer（K-B） method and automatic systems. The data were analyzed by WHONET 5.6 software,according to the document of the Clinical and Laboratory Standards Institute （CLSI）2014. Results A total of 5133 non-duplicate isolates were collected in ICU from January 2012 to December 2014. The isolates were mainly isolated from respiratory tract samples （66.8%）,blood（15.2%） and urine（11.8%）. The primary microorganisms were Klebsiella pneumoniae（16.9%）,coagulase-negative Staphylococcus（15.0%）,Escherichia coli（14.5%）,Acinetobacter baumannii （12.7%）and Staphylococcus aureus（10.1%）. The primary microorganisms of multidrug-resistant isolate was extended-spectrum beta-lactamases-producingEnterobacteriaceae（61.0%）,and carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Enterobacteriaceae had an increasing tendency. Conclusions The drug resistance of isolates is high in ICU,which should be paid more attention.

Group B Streptococcus screen in prevention and control of maternal and neonatal infection

CHEN Xiaoping, WANG Huijiao, YU Beiwei, XU Jiaojun, XU Qiulian, ZHAO Lan, XU Xiaobao, DING Mingxing

2016, 31(4):  266-269.  DOI: 10.3969/j.issn.1673-8640.2016.04.005

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Objective To establish a screen method for group B Streptococcus（GBS） in prenatal period,to investigate the significance of GBS screen among pregnant women in late pregnancy,to take interventions to GBS carriers,and to observe prevention and control of maternal and neonatal infection. Methods A total of 1 000 cases with more than 35-week pregnancy for prenatal care and delivery were enrolled,and their samples from vaginal orifice 1/3 and perianal secretions were collected for GBS screen. GBS was detected by bacterial culture method. GBS-positive subjects were classified into intervention and non-intervention groups according to subjects' wishes. Intervention group was treated with prophylactic antibiotics in delivery or rupture of membranes,and non-intervention group was not treated. Maternal pregnancy outcomes were compared. Results A total of 97 cases had GBS infection,and the infection rate was 9.7%. Compared with GBS-negative group,premature rupture of membranes,premature delivery,intrauterine infection,fetal distress,neonatal low quality,Apgar score and infection incidence in intervention group had no statistical significance（P>0.05）. The difference of Apgar score in intervention group had no statistical significance compared with non-intervention group（P>0.05）,and other indices had statistical significance（P<0.05）. Conclusions The screen method for GBS in pregnant women's vaginal and perianal secretions is rapid,sensitive and specific. It is important to carry out GBS screen among pregnant women in late pregnancy. It can effectively reduce the incidence of adverse maternal and neonatal pregnancy outcomes and infection.

Expression and procoagulant property of tissue factor-positive microparticles generated in vitro

SHAO Yanyan, DING Qiulan, DAI Jing, LU Yeling, XU Guanqun, ZHANG Liwei, SHEN Yun, WANG Hongli, WANG Xuefeng

2016, 31(4):  270-274.  DOI: 10.3969/j.issn.1673-8640.2016.04.006

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Objective To study the procoagulant property of tissue factor-positive microparticles（TF⁺MP） generated in vitro through the culture and stimulation of cell line. Methods Human acute monocytic leukemia cell line（THP-1） was stimulated by different concentrations of lipopolysaccharide（LPS）. Microparticle（MP）was separated by gradient centrifugation. Thrombin generation abilities of tissue factor（TF） and phosphatidylserine（PS） were determined by thrombin generation test by adding MP into MP-depleted plasma. ZYMUPHEN MP-TF kit was performed to determine TF procoagulant property. The 0.45 and 0.65 μm filters were selected to determine MP procoagulant properties（< 0.45 and < 0.65 μm）. Results Both thrombin generation test and chromogenic substrate test demonstrated a procoagulant property of MP generated in vitro. Thrombin generation test further showed that the procoagulant property of MP increased by the addition of LPS in a concentration-dependent manner. MP > 0.65 μm had a strong procoagulant property. Conclusions MP generated in vitro through the culture and stimulation of THP-1 demonstrates certain procoagulant property.

Genetic diagnosis and phenotype analysis for 9 patients with hereditary coagulation factor Ⅶ deficiency

LU Yiyi, DING Qiulan, DAI Jing, WANG Jianbiao, CAI Xiaohong, WANG Xuefeng

2016, 31(4):  275-281.  DOI: 10.3969/j.issn.1673-8640.2016.04.007

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Objective To investigate the gene mutations of coagulation factor Ⅶ（FⅦ） and the clinical characteristics in 9 patients with hereditary FⅦ deficiency. Methods FⅦ activity（FⅦ：C） and FⅦ antigen （FⅦ：Ag） were determined by one-stage clotting test and double-antibody sandwich enzyme-linked immunosorbent assay （ELISA）,respectively. Genomic DNA was extracted from peripheral blood. All the exons and flank sequences of FⅦ gene were amplified by polymerase chain reaction （PCR）,and gene analysis was performed by direct sequencing. Results A total of 10 different mutations were identified in 9 patients with hereditary FⅦ deficiency,including 3 splice site mutations and 7 miss sense mutations. One patient had p.Tyr128（68）Cys homozygous mutation,FⅦ：C was 0.8%,FⅦ：Ag was 2.5%,and the clinical characteristic was severe bleeding. Five patients had double heterozygous mutations,p.Thr241（181）Asn with p.Gly406（346）Asn,IVS1a+5G>A with p.His408（348）Gln,IVS5-1G>A with p.His408（348）Gln,c.*64G>A with p.Ile213（153）Asn and p.Cys389（329）Gly with p.His408（348）Gln,and FⅦ：C were 1.2%,4.4%,1.0%,0.5% and 1.2%,respectively. The clinical bleeding symptoms had various severities. Three patients had mono-heterozygous mutations,p.Cys389（329）Gly,p.His408（348）Gln and p.Thr419（359）Met,and FⅦ：C were 0.5%,8.3% and 9.4%,respectively. The first patient had a history of bleeding,and the other 2 patients had no significant bleeding. Conclusions A total of 10 types of gene mutations are identified in 9 patients with hereditary FⅦ deficiency. p.Gly406（346）Asn,c.*64G>A and p.Ile213（153）Asn are found newly,and p.His408（348）Gln is a common mutation,and FⅦ：C has no correlation with clinical phenotypes.

Eliminating matrix effect in the determination of plasma free hemoglobin by o-methyl benzidine method

TU Yongtao, LIU Qinglin, XU Minmin, WANG Ying

2016, 31(4):  282-285.  DOI: 10.3969/j.issn.1673-8640.2016.04.008

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Objective To study the matrix effect of o-methyl benzidine method （classic method）in determining plasma free hemoglobin （Hb）and the eliminating methods. Methods Hb storage solution diluted 1 000 times by normal saline （concentration was 103.1g/L）was used as standard,while the standard diluted by Hb-free plasma 500,1 000,2 000 and 4 000 times（theoretical concentrations were 206.20,103.10,51.55 and 25.78 mg/L）was determined by classic method for plasma free Hb. The results were compared with theoretical values. Hb storage solution diluted 1 000 times by normal saline（classic method）, Hb-free plasma（eliminating method 1） and mixed plasma（eliminating method 2）was used as standard. The equation of classic method and eliminating method 1 was plasma free Hb（mg/L）=test tube absorbance（A）× concentration of standard ÷ standard tube A. The equation of eliminating method 2 was plasma free Hb（mg/L）= test tube A×concentration of standard ÷ （standard tube A× mixed plasma A）. The equation of eliminating method 3 was plasma free Hb（mg/L）= test tube A× concentration of standard ×2.35÷standard tube A. A total of 40 specimens were determined,and the results of different eliminating methods were compared. Hb of 206.20, 103.10 and 51.55 mg/L were added into plasma,and the recovery rate of each method was determined. Adding 0.5 mL of 1.031 g/L standard,in 4.5 mL of vitamin C solution of 6.25,12.50,25.00 and 50.00 μg/L, the recovery rate was determined by classic method. Results The theoretical values of plasma free Hb were 87.85, 43.16, 21.90 and 10.99 mg/L for standard diluted by Hb-free plasma 500,1 000,2 000 and 4 000 times. As to 40 specimens,plasma free Hb concentrations of classic method, eliminating method 1,eliminating method 2 and eliminating method 3 were（7.99±4.90）,（18.61±11.42）,（19.18±11.77） and（18.77±11.52）mg/L,the results of eliminating method 1,eliminating method 2 and eliminating method 3 were higher than that of classic method（P<0.01）,and there was no statistical significance among the 3 eliminating methods（P>0.05）. The average recovery rates of classic method, eliminating method 1 ,eliminating method 2 and eliminating method 3 were 42.54%, 98.33%, 100.98% and 97.56%. The recovery rates of vitamin C solution of 6.25,12.50,25.00 and 50.00 μg/L were 98.57%,98.17%,97.17% and 95.16%. Conclusions There is matrix effect of o-methyl benzidine method in determining plasma free Hb, and the 3 eliminating methods are effective.

Consistency of 2 HBsAg quantitation determination systems in different HBV infection phases and different genotypes

LIU Yang, PENG Daorong, MA Yueyun, CHENG Xiaodong, ZHANG Tao, WANG Jing, HAO Xiaoke

2016, 31(4):  288-292.  DOI: 10.3969/j.issn.1673-8640.2016.04.010

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Objective To analyze the consistency of Roche MODULAR E170 electrochemiluminescence immunoassay system（Roche E170）and Abbott i2000 chemiluminescence microparticle immunoassay system（Abbott i2000）for hepatitis B surface antigen（HBsAg） quantitation determination in different hepatitis B virus（HBV）infection phases and different genotypes. Methods A total of 125 serum samples were collected from chronic hepatitis B patients without antiviral treatment,and they were classified into 4 different phases according to the Guideline of Prevention and Treatment for Chronic Hepatitis B,including immune tolerant phase,immune clearance phase,low replicative phase and hepatitis B e antigen（HBeAg）-negative hepatitis phase. Simultaneously,they were classified according to genotypes（B/C）and different HBsAg levels（HBsAg≤1 000 IU/mL / HBsAg>1 000 IU/mL）as well. All the samples were determined by the 2 systems,and the consistency was analyzed. Results The correlation and consistency of the 2 systems were good（r=0.989,P<0.001）. The correlations of the 4 different HBV infection phases were good （r=0.977-0.993,P<0.001）. The consistencies of the 2 systems during immune clearance phase,low replicative phase and HBeAg-negative hepatitis phase were good. However,during immune tolerant phase,the results of Roche E170 were higher than those of Abbott i2000,and the bias was 0.114 log IU/mL. For B and C genotypes,the correlation and consistency were good（r >0.95,P<0.001）. The 2 systems' r was 0.959 in high HBsAg level group,and the bias between Roche E170 and Abbott i2000 was 0.076 log IU/mL. Even though the correlation was poor,it was falling in professional acceptable range. Conclusions The consistencies of the 2 systems for different HBV infection phases and different genotypes are good,but during immune tolerant phase and in high HBsAg level samples,the same system should be used to evaluate the efficacy of antiviral therapy,in order to avoid differences.

Comparison on the performances of 5 rapid systems for the determination of C-reactive protein

JIANG Lingli, TANG Dahai, ZHANG Jian, ZHANG Fan, GE Danhong, XIAO Yanqun, ZHU Lingfeng

2016, 31(4):  293-298.  DOI: 10.3969/j.issn.1673-8640.2016.04.011

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Objective To evaluate the performances of 5 common systems for C-reactive protein（CRP） determination. Methods The imprecision [coefficient of variation（CV）],accuracy,linearity and anti-interference ability of 5 systems for CRP determination were evaluated. The 5 systems included Uppergold U2 gold spot method system,NEPHSTAR specific protein analyzer,ABX Micros CRP200 automatic blood analyzer,i-CHROMA Reader immune fluorescence analyzer and QuikRead 101 detecting system. Their original reagents were used. The 5 systems were labelled as A,B,C,D and E in turn. The reference range was validated. The results were compared with those of Dade Behring BN ProSpec automatic system （DADE）. Results The within-run and between-run precisions of the 5 systems were 1.01%-16.91%,which met the requirements from manufacturers,but they were lower than those of DADE. Passing-Bablok regression analysis showed that the regression equation slopes between DADE and the 5 systems were 0.88-1.73. The correlations were good between DADE and A,B,C systems,but the correlations were poor between DADE and D,E systems. For 50 mg/L CRP as cut-off value,the consistency of the 5 systems for CRP determination with DADE was 92.4%-100%. The linear range of 4 systems was 5-160 mg/L,and the linear range of 1 system was 5-100 mg/L. The interference rates of 1 500 FTU chyle,0.2 mg/L free bilirubin（FBil）,0.2 mg/L conjugated bilirubin（CBil）and 5 g/L hemoglobin（Hb） were <10%. The reference value met the requirements from manufacturers. Conclusions The performances of the 5 systems are good. However,there is a bias between the 5 systems and DADE system,which should be considered in clinic.

Capillary electrophoresis for glycated hemoglobin A_1c determination in patients with iron deficiency anemia

XU Anping, JI Ling, CHEN Weidong, XIA Yong, YU Jing, ZHOU Yu, LI Lu

2016, 31(4):  299-303.  DOI: 10.3969/j.issn.1673-8640.2016.04.012

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Objective To investigate the influence of iron deficiency anemia （IDA） on glycated hemoglobin A_1c （HbA_1c）determination and the application of capillary electrophoresis in the determination of hemoglobin A₂（HbA₂）for the diagnosis of IDA. Methods A total of 79 patients with IDA were enrolled,and 79 subjects with normal blood routine test results and ferritin were enrolled as control group. Fasting blood glucose, glycated serum protein,ferritin, HbA_1c and HbA₂ were determined. Using 2 plans,the influence of IDA on HbA_1c determination was evaluated.（1）The influence of IDA on the results of HbA_1c determination was evaluated.（2）HbA₂ was determined by capillary electrophoresis, and the differences of hemoglobin（Hb）,mean corpuscular volume（MCV）,mean corpuscular hemoglobin（MCH）,ferritin, HbA_1c and HbA₂ before and after treatment were compared. The HbA₂ results in control and IDA groups by capillary electrophoresis were analyzed. The cut-off values of HbA₂ by capillary electrophoresis for IDA were assessed by receiver operating characteristic （ROC） curve. Results Fasting blood glucose and glycated serum protein showed no statistical significance between control and IDA groups（P>0.05）. Ferritin and HbA_1c showed statistical significance between control and IDA groups（P<0.05）. In IDA group,Hb,MCV,MCH,ferritin,HbA_1c and HbA₂ had statistical significance between before and after treatment（P<0.01）. When the cut-off value of HbA₂ by capillary electrophoresis for IDA screen was 2.25%,the sensitivity was 93.4%,and the specificity was 92.1%. Conclusions IDA has certain effect on HbA_1c determination. Capillary electrophoresis can determine HbA_1c and HbA₂ simultaneously,which can be used into IDA screen.

Improvement and assessment of a homemade semiautomatic blood slide maker

ZHANG Shihua, LU Qinhong, CHEN Yi

2016, 31(4):  304-308.  DOI: 10.3969/j.issn.1673-8640.2016.04.013

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Objective To improve a homemade semiautomatic blood slide maker which has been used in pre-clinical test and teaching, to determine its main parameters, and to further assess efficiency. Methods According to the feedbacks of preliminary application,the instrument's software program and a part of mechanical structure were adjusted,and then the intrinsic relationship of working speed,hematocrit （Hct） and slide stage dropping time was determined using blood samples with different Hct values. After improvement,a certain number of blood smears were made by hand and the blood slide maker,and these blood smears' appearance,blood film length,the single layer length of erythrocytes and the degree of erythrocyte dispersion under microscope were compared and analyzed. Results The working speed of blood slide maker was inversely proportional to Hct and slide stage dropping time,and the latter 2 parameters were proportional. Compared with the previous instrument,the efficiency had been significantly improved. The blood smears made by the blood slide maker showed good appearance and appropriate thickness,and the blood film length was longer than that made by hand （P < 0.05）. The single layer length of erythrocytes also showed a significant increase compared with handmade blood smears （P < 0.01）. Under microscope,blood smears made by the blood slide maker also showed uniform dispersion of erythrocytes. In addition,the improved instrument can also produce satisfactory thin blood films for malaria inspection. Conclusions After improvement,the performance was improved by the blood slide maker,and initially versatile advantages were displayed,and thus it is suitable for application.

Analysis of AmpC beta-lactamase and outer membrane porin OprD₂ gene deletion in Pseudomonas aeruginosa

XU Weihong, XU Bin, YAO Yiting, HUANG Mingmin, ZHANG Jun, ZHAO Hu

2016, 31(4):  309-313.  DOI: 10.3969/j.issn.1673-8640.2016.04.014

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Objective To understand AmpC beta-lactamase（AmpC） and outer membrane porin OprD₂ gene deletion in Pseudomonas aeruginosa. Methods The three-dimensional test was used to determine AmpC . Polymerase chain reaction（PCR） was used to determine outer membrane porin OprD₂ gene and ampC gene. The data were analyzed statistically. Results The 63 isolates of Pseudomonas aeruginosa were collected,of which 14 isolates（22.22%） produced AmpC,OprD₂ gene was positive in 22 isolates（OprD₂ gene deletion rate 65.08%） ,and ampC gene was positive in 62 isolates（93.94%）. The resistance rates to ampicillin,ampicillin / sulbactam,cefotetan and ceftriaxone and cefazolin were 100.00%. The resistance rates of AmpC-producing isolates to imipenem, gentamicin and cefepime were 42.85%,64.29% and 57.14%,respectively. The resistance rates of non-AmpC-producing isolates were 30.61%,6.12% and 14.29%,respectively. The resistance rates of Pseudomonas aeruginosa to gentamicin and cefepime had statistical significance between AmpC-producing and non-AmpC-producing isolates（P<0.01）,but there was no statistical significance for imipenem（P>0.05）. A total of 6 isolates of Pseudomonas aeruginosa had OprD₂ gene deletion,and the resistance rates to imipenem,ceftazidime and cefepime were 100.00%,66.67% and 55.56%. The resistance rates of 8 isolates of Pseudomonas aeruginosa with normal OprD₂ gene expression and AmpC-producing isolates were 0.00%,25.00% and 37.50%. Conclusions Multi-drug resistant Pseudomonas aeruginosa might be caused by a variety of mechanisms. Enzyme production and molecular epidemiological studies for Pseudomonas aeruginosa should be strengthened.

Investigation on 5 item reference intervals of thyroid function among 490 clinical laboratories in China

FEI Yang, WANG Wei, WANG Zhiguo

2016, 31(4):  314-318.  DOI: 10.3969/j.issn.1673-8640.2016.04.015

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Objective To investigate the current situation of 5 item reference intervals of thyroid function among 490 clinical laboratories in China,and to provide a reference data for promoting harmonization Methods The data of 5 item reference intervals of thyroid function were collected from the National Center for Clinical Laboratories by endocrine reference interval investigation external quality assessment program 2014 based on website（490 clinical laboratories）,which included sources,classification,upper and lower limits of reference intervals,methods,instruments,reagents and calibrators. Microsoft Excel 2007 and SPSS 19.0 were used to obtain mean,median and percentiles（P_2.5 and P_97.5） of upper and lower limits of reference interval for all groups. The box plot of each group for each analyte was drawn. Results The primary source of reference intervals was instructions of reagent manufacturers（90.34%）,followed by the National Guide to Clinical Laboratory Procedures（3.75%）,being determined by their own laboratories（3.57%） and others （2.34%）. Only a few laboratories had considered different age and sex groups when establishing reference intervals. There were differences for the reference intervals of different test systems,and the reference intervals of laboratories using the same test system also varied widely. Conclusions The current situation of 5 item reference intervals of thyroid function among clinical laboratories in China is not good. Most clinical laboratories have not established their own reference intervals of thyroid function for specific population. Therefore,national standards are needed for the reference intervals of thyroid function in China.

Quality control rule softwares for datum analysis in external quality assessment of quantitative assays

ZHAO Haijian, ZHANG Chuanbao, WANG Jing, DU Zhongli, WANG Zhiguo

2016, 31(4):  319-323.  DOI: 10.3969/j.issn.1673-8640.2016.04.016

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External quality assessment plays an important role in quality evaluation and improvement,but most laboratories often focus on the unsatisfied data only. With appropriate quality control rules, laboratories can detect not only the error sources of unsatisfied data but also the potential error sources of satisfied data. The article mainly analyzes developed quality control rule softwares, which can be used to analyze external quality assessment data, evaluate the performance of assay and detect error sources.

Progress on the correlation between integrons and bacterial drug resistance

LI Qingcao, WEI Quhao, LU Wenjun, ZHAO Yujie

2016, 31(4):  324-328.  DOI: 10.3969/j.issn.1673-8640.2016.04.017

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Integron is a mobile gene element being found recently. It could recognize drug resistance gene from outside. It can also recombine exogenous gene and express by site-specific recombination. In addition,integron is located at transposon or plasmid,and by being a part of it transmitting drug resistance gene. Researches on integron are attracting many interests for its importance in the generation of drug resistance and transmission.

GWAS for susceptibility genes of primary open-angle glaucoma

TANG Binghua, CAO Wenjun

2016, 31(4):  329-333.  DOI: 10.3969/j.issn.1673-8640.2016.04.018

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Primary open-angle glaucoma（POAG） is a kind of complex diseases caused by interaction between multiple genes and environmental factors,and genetic factors play important roles in POAG development. Genome-wide association study（GWAS） is widely applied into genetic research for POAG,and it has obtained a series of research results. This method can analyze candidate susceptibility genes in POAG patients,and quantitatively analyze related genes of endophenotypes. Vertical cup-disc ratio（VCDR）,intraocular pressure（IOP）,central corneal thickness（CCT） and optic disc area（ODA）can also be analyzed. These abnormal phenotype-related genes are crucial in the development of POAG. This article reviews the findings of GWAS for POAG.

Cerebral spinal fluid determination in the diagnosis of central nervous system infections

GUO Lichao, LI Jiao, WEI Xiaolong

2016, 31(4):  334-337.  DOI: 10.3969/j.issn.1673-8640.2016.04.019

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Central nervous system infections are common in clinic,which can cause severe systemic complications and sequel of nervous system if untreated, and they have high mortality and disability rate. In recent years, researchers investigate constantly the parameters of cerebral spinal fluid determination for the early diagnosis and treatment. This article mainly reviews the progress of these determination parameters.