Table of Content

30 January 2020, Volume 35 Issue 1

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Correlation between biochemical parameters and apolipoprotein E genotypes among inpatients with late-onset Alzheimer’s disease in Beijing

HONG Ping, WANG Peichang

2020, 35(1):  1-5.  DOI: 10.3969/j.issn.1673-8640.2020.01.001

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Objective To investigate the correlation between the gene polymorphism of apolipoprotein E（apo E） and blood lipid levels in late-onset Alzheimer’s disease（LOAD） patients. Methods The apo E gene polymorphism was determined by gene chip in 150 LOAD patients and 150 healthy subjects. Total cholesterol（TC）,triglyceride（TG）,low-density lipoprotein cholesterol（LDL-C）,small and dense low-density lipoprotein cholesterol（sd-LDL-C）,high-density lipoprotein cholesterol（HDL-C）,apolipoprotein B（apo B） and lipoprotein （a）[Lp（a）] levels were also determined. Multivariate unconditional Logistic regression analysis was used to screen the related risk factors of LOAD. Results The frequencies of E2/3 and E3/3 genotypes in LOAD group were lower than those in healthy control group（P<0.05）,and the frequencies of E3/4 and E2/4 genotypes were higher than those in healthy control group（P<0.01）. The frequency of ε3 allele in LOAD group was lower than that in healthy control group（P<0.05）,and the frequency of ε4 allele in LOAD group was higher than that in healthy control group（P<0.01）. Compared with healthy control group,the levels of TC,LDL-C and sd-LDL-C were increased（P<0.01）,while HDL-C was decreased（P<0.01） in LOAD group. There was no statistical significance in the other blood lipids（P>0.05）. The levels of TC and LDL-C were gradually increased in LOAD patients with the phenotypes of ε2,ε3 and ε4（P<0.05）. The LDL-C level of ε4 phenotype was higher than that of ε2 phenotype in healthy control group（P<0.05）. The apo E ε4 allele and LDL-C were the risk factors for LOAD,the odds ratios（OR） were 14.454 and 5.824,and 95% confidence intervals（CI） were 5.793-16.368 and 2.582-7.973,respectively. HDL-C was the protective factor for LOAD（OR=0.020,95% CI 0.006-0.352）. Conclusions The apo E gene polymorphism is closely related to lipid metabolism,and the apo E ε4 allele may be one of the important genetic factors in the pathogenesis of LOAD.

Correlation between serum biochemical parameters and the degree of coronary artery stenosis in patients with coronary heart disease

WANG Beili, LI Huijun, WU Yan’an, DAI Wanru, LI Yihao, GUO Wei, PAN Baishen

2020, 35(1):  6-10.  DOI: 10.3969/j.issn.1673-8640.2020.01.002

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Objective To investigate the correlation between serum biochemical parameters and the degree of coronary artery stenosis in patients with coronary heart disease. Methods A total of 574 patients with coronary heart disease undergoing coronary angiography were enrolled from 3 Grade A Class 3 hospitals in Shanghai,Wuhan and Fuzhou. The coronary artery stenosis data obtained during percutaneous coronary intervention（PCI）were recorded and quantified to calculate Gensini score. Clinical data and the results of serum biochemical parameters,including total bilirubin（TB）,direct bilirubin（DBil）,total protein（TP）,albumin（Alb）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,gamma-glutamyltransferase（GGT）,lactate dehydrogenase（LDH）,fasting plasma glucose（FPG）,total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,lipoprotein（a）[Lp（a）],apolipoprotein A1（apo A1）,apolipoprotein B（apo B） and high-sensitivity C-reactive protein（hs-CRP）,were collected. Logistic regression analysis was used to assess the correlation between each parameter and the degree of coronary artery stenosis. Results Compared to low Gensini score group,the proportion of males and TP,Alb,ALT,AST,FPG,HDL-C,Lp（a）,apo A1,apo B,hs-CRP levels in high Gensini score group had statistical significance（P<0.05）,while the other parameters had no statistical significance（P>0.05）. Logistic regression analysis showed that Alb decreasing,AST increasing,FPG increasing,HDL-C decreasing,Lp（a） increasing and male were risk factors for coronary artery stenosis [odds ratios（OR） were 0.932,1.011,1.121,0.299,1.005 and 1.753;95% confidence intervals（CI） were 0.886-0.980,1.002-1.020,1.024-1.227,0.143-0.624,1.002-1.008 and 1.110-2.767,respectively]. Conclusions FPG and Lp（a） are risk factors for predicting the degree of coronary artery stenosis in patients with coronary heart disease,and they can be used for preliminary judgment. Whether AST,Alb and HDL-C can be used as the predictors of coronary artery stenosis remains to be further studied.

Correlation between serum apo A1,apo B,apo E and atopic dermatitis

TANG Manling, ZHOU Juan, JIANG Zuiming, GU Min, LIN Wei, LI Jianhong, HU Wei, LI Juan, LUO Wenhui

2020, 35(1):  11-14.  DOI: 10.3969/j.issn.1673-8640.2020.01.003

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Objective To investigate the relationship between atopic dermatitis and the levels of serum apolipoprotein（apo） A1,apo B and apo E. Methods Totally,230 AD patients and 100 healthy subjects without the history of allergic diseases were enrolled. The levels of apo A1,apo B,apo E,total immunoglobulin E（IgE） and allergen [specific immunoglobulin E（sIgE）] were determined. Logistic regression analysis was used to evaluate the relationship between all the items and AD risk. Results Serum apo A1 levels of females in AD group and healthy control group were higher than those of males（P<0.05）. Serum apo A1 level of females in AD group was higher than that in healthy control group（P<0.05）. Serum apo B level of males in AD group was lower than that in healthy control group（P<0.01）. There was no statistical significance for the ratio of males and females with positive sIgE and total IgE>200 kU/L（P>0.05）,and there was no statistical significance between the group ≤7 years old and the group >7 years old（P>0.05）. Serum apo A1,apo B and apo E were positively correlated（r=0.190 and 0.287,respectively,P<0.01）. Serum apo A1 and apo B were not correlated（r=0.030,P>0.05）. Serum apo A1,apo B and apo E were positively correlated with age（r=0.191,0.417 and 0.143,respectively,P<0.01）. Logistic regression analysis showed that apo A1 could enable AD happening easily [odds ratio（OR）=7.346,95% confidence interval（CI） 2.349-22.977],however,total IgE and sIgE had no correlation. After adjusting age and sex,apo B was not correlated with the risk of AD,while it can put total IgE>200 kU/L more in danger（OR=6.694,95%CI 1.739-25.762）. Serum apo E always had no correlation with the risk of AD,total IgE and sIgE regardless of age or sex adjustment. Conclusions Serum apo A1 may be a risk factor contributing to the risk of AD,which is independent from IgE mediating. As apo B is influenced by factors,like age and sex,whether it can contribute to the risk of AD is not clear. Serum apo E will not cause the risk of AD.

Establishment of HLA-B27 cut-off value by flow cytometry and related grey zone sample genotype determination

WU Beiying, GU Yanying, FAN Zhenjia, CAI Gang

2020, 35(1):  15-19.  DOI: 10.3969/j.issn.1673-8640.2020.01.004

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Objective To establish the cut-off value of human leukocyte antigen（HLA）-B27 by flow cytometry（FCM）,and to find a solution for related samples in grey zone. Methods Peripheral blood samples of 132 low back and joint pain patients were collected. The expression of HLA-B27 was determined by FCM,and the HLA-B typing was determined by flow reverse sequence specific oligonucleotide（Flow-rSSO）. Results The positive rates of HLA-B27 by FCM and Flow-rSSO were 18.18% and 73.48%,respectively. According to the recommendation rules of FCM HLA-B27 kit,45 samples in grey zone were confirmed by Flow-rSSO,which were all HLA-B27 positive. After the genotype analysis of samples with different d values（the difference between mean fluorescence intensity and the median value of calibrated magnetic beads）,the cut-off values were setted. The d>2 was positive,d≤-7 was negative,and -7<d≤2 was weak positive（grey zone）. The false negative and false positive rates were 0%. The detection rate of HLA-B27 in grey zone was 80.6%. The fluorescence intensity of B27 antigen was not related to the typing of HLA-B27,and there was a relation with the number of HLA-B27. The grey zone samples had HLA-B7 and HLA-B37 genotype. Conclusions Clinical laboratories should establish their own rules for reducing false negative rate and shrink the range of grey zone as far as possible. Grey zone samples usually have special HLA-B genotypes,which can be further determined by Flow-rSSO to improve the accuracy of HLA-B27 determination.

Changes of plasma fibrinolytic markers in idiopathic membranous nephropathy disease progress

LI Zhen, LI Zhen, CHEN Weiqin, YIN Hongmei, HU Xiaobo

2020, 35(1):  25-28.  DOI: 10.3969/j.issn.1673-8640.2020.01.006

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Objective To analyze the difference of plasma fibrinolytic markers in different chronic kidney disease（CKD） stages of idipothic membranous nephropathy（IMN）. Methods A total of 200 IMN patients（IMN group,including 103 cases of CKD1,53 cases of CKD2,30 cases of CKD3 and 14 cases of CKD4-5） and 97 healthy subjects（healthy control group） were enrolled. The levels of plasmin-α2 antiplasmin complex（PIC）,tissue plasminogen activator-inhibitor 1 complex（tPAIC）,fibrinogen（Fib）,fibrin degradation product（FDP ） and D-dimer（DD） were determined. Results Fib,FDF,DD and PIC in IMN group were higher than those in healthy control group（P<0.01）,and tPAIC level was lower. With different CKD stages,Fib and tPAIC levels had statistical significance（P<0.05）. With the increasing of CKD stages,Fib levels were increased,and tPAIC levels were decreased. For Fib and tPAIC,there was statistical significance between CKD1 and CKD3,CKD4-5 （P<0.05）,and there was no statistical significance for FDP,DD and PIC with different CKD stages（P>0.05）. Conclusions IMN patients have poor fibrinolytic system function,and it is easy to form thromboembolia. Fib and tPAIC are related to disease stage,which can be used as the indicators of IMN disease progress and thromboembolia prevention monitoring.

Changes of plasma fibrinolytic markers in idiopathic membranous nephropathy disease progress

LI Zhen, LI Zhen, CHEN Weiqin, YIN Hongmei, HU Xiaobo

2020, 35(1):  25-28.  DOI: 10.3969/j.issn.1673-8640.2020.01.006

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Objective To analyze the difference of plasma fibrinolytic markers in different chronic kidney disease（CKD） stages of idipothic membranous nephropathy（IMN）. Methods A total of 200 IMN patients（IMN group,including 103 cases of CKD1,53 cases of CKD2,30 cases of CKD3 and 14 cases of CKD4-5） and 97 healthy subjects（healthy control group） were enrolled. The levels of plasmin-α2 antiplasmin complex（PIC）,tissue plasminogen activator-inhibitor 1 complex（tPAIC）,fibrinogen（Fib）,fibrin degradation product（FDP ） and D-dimer（DD） were determined. Results Fib,FDF,DD and PIC in IMN group were higher than those in healthy control group（P<0.01）,and tPAIC level was lower. With different CKD stages,Fib and tPAIC levels had statistical significance（P<0.05）. With the increasing of CKD stages,Fib levels were increased,and tPAIC levels were decreased. For Fib and tPAIC,there was statistical significance between CKD1 and CKD3,CKD4-5 （P<0.05）,and there was no statistical significance for FDP,DD and PIC with different CKD stages（P>0.05）. Conclusions IMN patients have poor fibrinolytic system function,and it is easy to form thromboembolia. Fib and tPAIC are related to disease stage,which can be used as the indicators of IMN disease progress and thromboembolia prevention monitoring.

Pathogen infection of adult community-acquired atypical pneumonia

SHEN Chunmei, LEN Beizheng, LIU Yajun, ZHANG Hui, ZHOU Cong, XU Maosuo, HE Leqi

2020, 35(1):  29-32.  DOI: 10.3969/j.issn.1673-8640.2020.01.007

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Objective To analyze the laboratory findings of adult community-acquired atypical pneumonia caused by classic microorganisms,like Mycoplasma pneumoniae （MP）,and to provide a reference for clinical diagnosis and treatment. Methods A total of 188 adults with community-acquired pneumonia were enrolled. Real-time fluorescence quantitative polymerase chain reaction（qPCR） was used to determine MP,Chlamydia pneumoniae and Legionella pneumophila in sputum and/or orotharyngeal（OP）swabs. The clinical characteristics,laboratory findings and radiological data were analyzed. Results The positive rate of MP was 21.8%（41 cases）. Only 1 case was positive for Chlamydia pneumoniae,and all samples were negative to Legionella pneumophila. There were 23 positive cases of bacterial culturing（12.23%）. Compared with MP negative group,MP positive group was younger,with fewer basic diseases,and pulmonary involvement was mainly unilateral. There was no statistical significance in the other clinical symptoms and laboratory findings. The positive rate of MP in autumn and winter was higher than those in spring and summer（P<0.05）. Conclusions MP is the main pathogen of adult community-acquired atypical pneumonia. The qPCR has advantages in the early diagnosis of acute MP infection.

Establishment on UPLC and its performance evaluation for the rapid determination of vancomycin concentration

ZHOU Qiang, PAN Qingqing, SHEN Min, CHEN Shuangshuang

2020, 35(1):  39-46.  DOI: 10.3969/j.issn.1673-8640.2020.01.010

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Objective To establish ultra performance liquid chromatography（UPLC） for the rapid determination of vancomycin concentration, and to evaluate the performance. Methods Norvancomycin was used as internal standard,serum sample was treated with 0.3 mol/L aqueous solution of zinc sulfate,and a simple protein precipitation method was used for pre-treating serum samples. The chromatography was carried out on Phenomenex Kinetex C18 column（2.6 μm,100 mm×2.1 mm）,the flow rate was 0.5 mL/min,UV detector wavelength was 220 nm,and column temperature was 40 ℃. Using mobile phase acetonitrile-25 mmol/L potassium dihydrogen phosphate buffer（pH value was 2.5）,gradient elution was performed. The linearity,accuracy（recovery rate）,precision,carry-over rate,limit of quantitation and limit of detection were evaluated. A total of 50 clinical samples were determined by the present UPLC method and the validated high performance liquid chromatography（HPLC） method,and the results were compared using linear regression analysis. Results The linear range for serum concentration of vancomycin was 2.0-99.6 μg/mL,with 0.1 μg/mL detection limit and 1.0 μg/mL quantitation limit. The within-run coefficients of variation（CV）of low-,middle- and high-levels were 3.28%,2.21% and 2.59%,and the between-run CV were 5.73%,2.75% and 0.82%,respectively. The recovery rates of low-level（2.0 μg/mL）,middle-level（19.9 μg/mL） and high-level（79.6 μg/mL） were 104.06%,99.80% and 100.19%,respectively. The carry-over rate of middle- and high-levels were 0.57% and 0.19%,respectively. There was a correlation between the 2 methods（r=0.991 9）. Conclusions The established UPLC for the determination of vancomycin concentration is reproducible,simple,sensitive and accurate,which is suitable for monitoring clinic serum vancomycin concentration and experimental subject research.

Role of NKX2-5 on tamoxifen resistance in breast cancer patients and its regulation mechanism

ZHAO Zheng, LI Yi, YANG Feixiang

2020, 35(1):  47-55.  DOI: 10.3969/j.issn.1673-8640.2020.01.011

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Objective To investigate the role of NKX2-5 on tamoxifen（TAM） resistance in breast cancer and its regulation mechanism. Methods The expressions of NKX2-5 in breast cancer tissues and adjacent tissues were determined by immunohistochemical staining assay. Using Gene Expression Omnibus（GEO） database,the relative data of breast cancer patients were analyzed,and the correlation between NKX2-5 and the survival rate of breast cancer patients was analyzed. The TAM-resistant cell lines（MCF-7/TAM） were constructed,and cell viability was determined by CCK-8 kit after the treatment with different concentrations of TAM. The expressions of the related proteins were determined by western blotting,and NKX2-5 mRNA expression was determined by reverse transcription polymerase chain reaction（RT-PCR）. Results The expression of NKX2-5 was higher in adjacent tissues than that in cancer tissues（P<0.05）,and NKX2-5 expression in TAM-sensitive tissues was higher than that in TAM-resistant tissues（P<0.05）. Low expression of NKX2-5 was associated with poor overall survival rate and relapse free survival rate in breast cancer patients（P<0.05）,and high NKX2-5 expression level also predicted better outcome for patients with TAM endocrine therapy（P<0.05）. Compared to the MCF-7 cells,the expression of NKX2-5 protein was decreased in MCF-7/TAM cells（P<0.05）. Overexpression NKX2-5 plasmid（Ad-NKX2-5） and empty plasmid（Ad-NC） were transfected in MCF-7/TAM cell（Ad-NKX2-5 group and Ad-NC group） by transient transfection technology. NKX2-5-small interfering RNA plasmid（NKX2-5-siRNA） and blank control（NC-siRNA） were transfected in MCF-7 cell（NKX2-5-siRNA group and NC-siRNA group）. After treatment with 50 and 100 μmol/L TAM,the cell proliferation inhibition rates were increased in Ad-NKX2-5 group compared to Ad-NC group（P<0.05）. The cell proliferation inhibition rates were decreased in NKX2-5-siRNA group compared to NC-siRNA group（P<0.05）. The expressions of phosphorylated-P38 mitogen-activated protein kinase（p-P38MAPK）,phosphorylated-c-Jun N-terminal kinase（p-JNK）,phosphorylated-extracellular regulated protein kinase（p-ERK）proteins were increased in MCF-7/TAM cell compared to MCF-7 cell（P<0.05）. The expressions of p-P38,p-JNK and p-ERK proteins were increased in Ad-NKX2-5 group compared to Ad-NC group（P<0.05）. Meanwhile,the expression of p-P38,p-JNK and p-ERK proteins were decreased in NKX2-5-siRNA group compared to NC-siRNA group（P<0.05）. Conclusions NKX2-5 is down-regulated in TAM-resistant breast cancer cell,and overexpressive NKX2-5 overcomes TAM resistance in breast cancer via suppressing mitogen-activated protein kinase（MAPK） signaling pathway.

Mechanism of resistance nodulation division efflux pumps mediated tigecycline-insensitive multidrug-resistant Acinetobacter baumannii

ZHANG Xinyu, DU Xuefei, ZOU Guiling, JIANG Xiaofeng

2020, 35(1):  56-60.  DOI: 10.3969/j.issn.1673-8640.2020.01.012

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Objective To investigate the mechanism of resistance nodulation division（RND） efflux pumps mediated tigecycline-insensitive multidrug-resistant Acinetobacter baumannii（MDR-AB）. Methods A total of 21 isolates of tigecycline-insensitive Acinetobacter baumannii and 39 isolates of tigecycline-sensitive MDR-AB in the Fourth Affiliated Hospital of Harbin Medical University from 2015 to 2018 were collected. Using broth microdilution method as the standard method,tigecycline-insensitive isolates [minimun inhibitory concentration（MIC）≥2 μg/mL] were used as experimental group,and tigecycline-sensitive isolates（MIC≤1 μg/mL） were used as control group. Polymerase chain reaction（PCR） was used to determine RND efflux pump genes for tigecycline sensitivity decreasing of Acinetobacter baumannii（adeB,adeG and adeJ）and upstream regulatory genes（adeS,baeR and baeS）,and adeS amplification products were sequenced to find insertion sequence. Real-time quantitative polymerase chain reaction（RT-qPCR） was used to determine and compare the transcript levels of efflux pump adeABC,adeFGH,adeIJK,adeRS and baeRS in experimental and control groups. Results In the 21 isolates of Acinetobacter baumannii,12 isolates of tigecycline-insensitive MDR-AB were screened. The RND gene detection rate associated with decreased tigecycline sensitivity was 100%,and the ISAbaⅠ insertion mutation of adeS was found in the 2 isolates. The expression of adeABC in experimental group was higher than that in control group,which were 3.3,3.5 and 2.7 times of the standard isolate（ATCC 19606）,respectively. The expression level of adeFGH was increased,and the levels of adeIJK,adeRS and baeRS were slightly up-regulated in some isolates. Conclusions RND efflux pump mediated MDR-AB with decreased tigecycline sensitivity is related to high expressions of adeABC and adeFGH. The high expression of adeABC is mainly related to the presence of ISAbal insertion mutation in the upstream regulatory gene adeS,and there may be other tigecycline resistance mechanisms.

Application of shortened APTT in the post-analytical quality management of routine coagulation assay

WANG Wei, XU Wei, ZHANG Lin, LI Jun, WANG Gang

2020, 35(1):  63-67.  DOI: 10.3969/j.issn.1673-8640.2020.01.013

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Objective To investigate the application of shortened activated partial thromboplastin time（APTT） in the post-analytical quality management of routine coagulation assay. Methods A total of 249 coagulation assay reports with APTT being lower than the lower limit of reference interval were collected,and the results were verified through post-analytical quality management. The verified samples’ data were collected,and statistical analysis was carried out. Results A total of 249 samples had no inaccurate anticoagulant ratio and related interference factors. A total of 31 unqualified samples were found after post-analytical result verification,which came from different 14 clinical departments,and all of them contained tiny clots or fibrin filaments. The qualified samples concentrated with specific departments. The distribution of diseases in these cases mainly included nephritic syndrome,coronary heart disease and multiple myeloma. The unqualified reports accounted for 12.4% of the total number of shortened APTT,and 21 of them had only APTT shortening,accounting for 8.4% of the total number of APTT shortened reports,accounting for 67.7% of the unqualified reports. The shortened APTT data had no statistical significance between qualified and unqualified reports（P=0.199）. Conclusions The shortened APTT can be used as an independent factor for judging whether the blood sample contains tiny clots or fibrin filaments,and it can guide the manual verification of sample quality based on clinical information.

Establishment of routine dry biochemical test IQC rules based on six sigma quality management method

WANG Xinqin, QIU Wei, CHEN Sumei, LIU Dongsheng

2020, 35(1):  66-69.  DOI: 10.3969/j.issn.1673-8640.2020.01.014

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Objective To apply the six sigma（σ） quality management method designing internal quality control（IQC） rules of routine dry biochemical test. Methods The 16 dry biochemical tests’ IQC data under control were collected from December 2017 to May 2018,and the imprecision was calculated. The bias was calculated using the external quality assessment of Jiangsu Province. The coefficient of variation（CV） was used as allowable total error（TEa）,and the design of IQC rules conformed to the actual IQC. By the quality control index,the performance characteristics of the tests that needed to be improved were found. Results The alanine aminotransferase（ALT）,urea（Urea） and creatine kinase（CK） IQC rules were designed to be 1₃s（N=2,R=1）,and the total bilirubin（TB） IQC rules were designed as 1₃s/2₂s/R₄s（N=2,R=1）. Total protein（TP）,creatinine（Cr）,uric acid（UA）,glucose（Glu）,K,Cl and Ca IQC rules were designed as 1₃s/2₂s/R₄s/4₁s（N=2,R=2）,and albumin（Alb）,aspartate aminotransferase（AST）,lactate dehydrogenase（LDH）,Na and amylase（AMY） IQC rules were designed as 1₃s/2₂s/R₄s/4₁s/8x（N=2,R=4）. All tests were needed to be optimized the performance characteristics of imprecision. Conclusions The IQC method meeting the actual requirements and the clinical quality requirements has been established.

Aptamer-based assay for biomolecules and cells

LIU Chang, LIU Fei, SHU Liqiong, QIAN Dan, TIAN Ye, PU Xiaoyun

2020, 35(1):  70-74.  DOI: 10.3969/j.issn.1673-8640.2020.01.015

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Aptamers are DNA or RNA nucleic acid ligands that are isolated from the libraries of oligonucleotides by an in vitro selection process called systematic evolution of ligand by exponential enrichment（SELEX）. Aptasensors,which are based on the specificity of aptamer-target recognition analytical purposes,have received particular attention due to their high sensitivity and selectivity,simple instrumentation and good stability,and they have the advantages of rapid response,low cost and easy operation as well. This review summarizes the application of aptasensors for biomolecules,including small molecules,nucleic acids,bacteria and proteins. In this review,the limitations and the main problems are discussed. Furthermore,the remaining challenges and opportunities to aptasensing platforms in the determination of biomolecules are summarized.

Laboratory diagnosis of periprosthetic joint infection after total joint arthroplasty

PAN Yunqi, TANG Jin, WANG Jianqiang, LI Yungai

2020, 35(1):  75-78.  DOI: 10.3969/j.issn.1673-8640.2020.01.016

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Periprosthetic joint infection（PJI） is a serious complication in total joint arthroplasty patients,which leads to severe consequences if unresolved timely. Because of the low sensitivity and specificity of the conventional diagnostic tools,the diagnosis of PJI is still a challenge in modern medicine. In the recent years,some new diagnostic techniques,with high sensitivity and specificity,such as biomarker determination and the culture of pathogenic bacteria,have been developed. This review is to provide a comprehensive and up-to-date review on the diagnostic strategies for PJI.