Table of Content

30 September 2021, Volume 36 Issue 9

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Drug resistance genotype,transposon structure and MLSA of vancomycin-resistant Enterococcus

WANG Jingjing, WU Linqing, CHEN Rushou, WANG Yufeng

2021, 36(9):  891-895.  DOI: 10.3969/j.issn.1673-8640.2021.09.001

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Objective To study vancomycin-resistant Enterococcus（VRE） drug resistance genes and multilocus sequence typing（MLST）. Methods Totally,80 isolates of VAN-resistant Enterococcus faecium and 12 isolates of Enterococcus faecalis isolated from the clinical specimens in Sanya Central Hospital were collected and were identified by VITEK MS microbial identification system. The susceptibilities of VRE to 14 kinds of commonly used antibiotics were determined by VITEK 2 Compact automatic drug sensitivity test system. The minimum inhibitory concentrations（MIC）of vancomycin and tekoranin were determined by microdilution broth method. Virulence genotypes（esp,hyl,gelE,asal,cy1A,efaA and ace） and transposon structure of VRE isolates were screened by polymerase chain reaction（PCR）. MLST was used to analyze the multi-site sequence typing of VRE. Results A total of 80 isolates of Enterococcus faecium and 12 isolates of Enterococcus faecalis were identified by mass spectrometry. Both Enterococcus faecium and Enterococcus faecalis showed 100.0% drug resistance to vancomycin in in vitro drug susceptibility test,and the drug resistance rates to ampicillin were 97.5% and 50.0%,respectively,but the drug resistance rates to furantoin were low. All the isolates of VRE were resistant to vancomycin and tekoranin,and MIC were 192-256 and 32-256 μg/mL,respectively,representing VanA phenotype. All the VRE isolates were vanA genotype,and the proportion of esp virulence genotype was the highest（82.5%）,Enterococcus faecium was common in esp-hy1 gene combination,and Enterococcus faecalis was mainly in multi-gene combination. The Tn1546 transposon structure analysis could be classified into A-E types. MLST showed that 92 isolates of VRE could be classified into 7 ST types,including ST17（43.5%）,ST78（32.6%）,ST203（6.5%）,ST363（5.4%）,ST555（4.3%）,ST1392（4.3%） and ST1394（3.4%）,among which ST17 and ST78 were the most common types,belonging to CC17 clone complex. Conclusions The 92 VRE isolates are all multi-drug resistant isolates,vanA genotype and CC17 clone complex,and they are highly carrying drug-resistant genes and virulence genes.

HLA-B*5801 gene carrying rate and laboratory testing indicators in patients with gouty arthritis

FANG Zhongjun, JI Weiqing, ZHANG Jingxian, WU Jintao, WU Weihua, JIANG Ying, HAN Zhenge, HE Dongyi, BIAN Yanqin, SHEN Yu, XIAO Lianbo, XIE Donghao, SUN Yang

2021, 36(9):  896-900.  DOI: 10.3969/j.issn.1673-8640.2021.09.002

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Objective To investigate the correlation of HLA-B*5801 gene carrying status and laboratory testing indicators in patients with gouty arthritis（GA）. Methods Totally,120 GA patients were enrolled to determine HLA-B*5801 genotype,uric acid（UA）,alanine aminotransferase（ALT）,alkaline phosphatase（ALP）,C-reactive protein（CRP）,the percentage of neutrophil,the percentage of lymphocyte,the percentage of eosinophil（EO%）,mean platelet volume（MPV） and erythrocyte sedimentation rate（ESR）,and the neutrophil/lymphocyte ratio（NLR） and ALT/ALP ratio were calculated. A total of 50 healthy subjects were enrolled as healthy control group. According to the levels of UA,120 GA patients were classified into low-level UA（UA<420 μmol/L） group,medium-level UA（UA 420-600 μmol/L） group and high-level UA（UA>600 μmol/L） group. The correlation between laboratory testing indicators with UA was evaluated by Correl analysis. Results Among the 120 patients,35（29.2%） cases carried HLA-B *5801 gene,the UA,NLR,EO%,CRP,ESR and ALT/ALP ratio in GA group were higher than those in healthy control group（P<0.05）,and MPV was lower（P<0.05）. Compared with HLA-B*5801 gene carrying group,EO% and MPV were higher than those in non-carrying group（P<0.05）,while UA was lower than that in non-carrying group（P<0.05）,and NLR,CRP,ESR,ALT/ALP ratio had no statistical significance（P>0.05）. ALT/ALP ratios were increased in turn among low-level,medium-level and high-level UA groups（P<0.05）. EO% in medium-level UA group was lower than that in high-level UA group（P<0.05）,and NLR and ESR were higher than those in high-level UA group and low-level UA group（P<0.05）. MPV and CRP had no statistical significance among the 3 groups（P>0.05）. NLR,ESR and ALT/ALP ratio were positively correlated with UA（r values were 0.959,0.953 and 0.994,respectively,P<0.05）,while MPV was negatively correlated with UA（r=-0.998,P<0.05）. There was no correlation between EO%,CRP and UA（r values were 0.647 and 0.091,respectively,P>0.05）. Conclusions The gene carrying rate of HLA-B*5801 gene in patients with GA is high. The determination of HLA-B*5801 gene and related laboratory testing indicators will be helpful to comprehensively evaluate the disease status of patients.

Clinical application value of CTC combined determination with CEA and CA125 in colorectal cancer

YANG Chaomei, FENG Jie, LANG Lei, YAN Guangtao

2021, 36(9):  901-905.  DOI: 10.3969/j.issn.1673-8640.2021.09.003

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Objective To investigate the clinical application value of the combined determination of circulating tumor cell（CTC） number,carcinoembryonic antigen（CEA）and carbohydrate antigen（CA）125 in colorectal cancer. Methods A total of 115 patients with colorectal cancer（colorectal cancer group）and 99 patients with colorectal polyps（polyp group）were enrolled. All research subjects were determined for alpha-fetoprotein（AFP）,CEA,CA125,CA19-9,CA15-3,CA72-4 and CTC number. According to CTC number,the patients with colorectal cancer were classified into group Ⅰ（CTC 0/7.5 mL）,group Ⅱ（CTC 1-4/7.5 mL） and group Ⅲ （CTC≥5/7.5 mL）. According to TNM stage of colorectal cancer,the colorectal cancer patients were classified into 0-Ⅱ stage group,Ⅲ stage group and Ⅳ stage group. Logistic regression analysis was used to evaluate the risk factors of colorectal cancer. Receiver operating characteristic（ROC）curve was used to evaluate the value of various indicators in the differential diagnosis of colorectal cancer. Results The levels of serum CEA,CA19-9 and CA72-4 in Ⅰ group were lower than those in Ⅱ group and Ⅲ group（P<0.05）,the level of serum AFP was lower than that in Ⅱ group（P<0.05）,and the level of serum CA125 was lower than that in Ⅲ group（P<0.05）. There was no statistical significance in the indicators between Ⅱ group and Ⅲ group（P>0.05）. There was statistical significance in CTC number and serum CEA,CA125,CA19-9 and CA72-4 levels between polyp group and colorectal cancer group（P<0.05）,while there was no statistical significance in serum AFP and CA15-3 levels among the groups（P>0.05）. There was statistical significance in CA19-9 and CA724 levels between TNM stage 0-Ⅱ group and stage Ⅳ group and between stage Ⅲ group and stage Ⅳ group（P<0.05）. There was statistical significance in CTC number between stage 0-Ⅱ group and stage Ⅳ group（P<0.05）. There was no statistical significance in serum CEA,AFP,CA125 and CA15-3 levels among the 3 groups（P>0.05）. Logistic regression analysis showed that the odds ratios（OR） of CEA,CA125 and CTC number were 1.368,1.135 and 5 560 619.101,respectively. 95% Confidence intervals（CI） were 1.120-1.672,1.037-1.244,0.000-2.129×10²¹⁴,respectively. ROC curve analysis showed that the areas under curves（AUC） of CEA,CA125,CTC number single determinations and combined determination were 0.840,0.741,0.822 and 0.943,respectively. Conclusions The combined determination of CTC number,CEA and CA125 plays a role for patients with colorectal cancer.

Application role of human gamma interferon-induced protein 16 in childhood infectious mononucleosis

YU Lisha, YANG Huijie, YIN Xuerui, GE Hanyu, WANG Huiyan, ZHENG Xiaoqun

2021, 36(9):  906-908.  DOI: 10.3969/j.issn.1673-8640.2021.09.004

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Objective To investigate the clinical application value of serum human gamma interferon-induced protein 16（IFI16） in childhood infectious mononucleosis（IM）. Methods A total of 73 children with IM（IM group）were recruited,of which 20 children with IM had acute phase and recovery phase. Totally,75 healthy children were enrolled as control group. White blood cell（WBC） count,the percentage of lymphocyte（LYMPH%）,the percentage of atypical lymphocyte,lymphocyte subsets and serum levels of IFI16 were determined. Pearson correlation analysis was used to analyze the correlations. Results WBC count,LYMPH%,the percentage of atypical lymphocyte and serum levels of IFI16 in IM group were higher than those in control group（P<0.01）. Serum level of IFI16 among IM children in recovery phase was higher than that in acute phase（P<0.05）. Serum level of IFI16 in IM group was positively correlated with LYMPH%,the percentage of CD4⁺ T cell and the ratio of CD4⁺/CD8⁺（r values were 0.24,0.27 and 0.29,respectively,P<0.05）. There was no correlation with the percentage of atypical lymphocyte,the percentage of CD3⁺ T cell,the percentage of CD8⁺ T cell,the percentage of CD19⁺ B cell and the CD16⁺CD56⁺natural killer cell（r values were -0.13,-0.18,-0.19,0.12 and 0.09,respectively,P>0.05）. Conclusions Serum level of IFI16 may be used for the auxiliary diagnosis and prognosis judgment of IM.

Anti-Müllerian hormone in evaluating ovarian reserve among women with autoimmune thyroid disease undergoing controlled ovulation hyper-stimulation

HU Deyu, QIAN Jun, YANG Haiou, WANG Yu, LUO Jun, TANG Zhenhua

2021, 36(9):  909-913.  DOI: 10.3969/j.issn.1673-8640.2021.09.005

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Objective To evaluate the role of serum anti-Müllerian hormone（AMH） in infertile women with autoimmune thyroid disease（AITD） and its influence on the outcome of controlled ovulation hyper-stimulation（COH）. Methods A total of 245 infertile women who underwent in vitro fertilization（IVF） for the first time were classified into AITD positive group and AITD negative group. Thyroid stimulating hormone（TSH）,follicle stimulating hormone（FSH）,luteinizing hormone（LH）,estradiol（E2） and prolactin（PRL） and progesterone on the 3rd and 21st days of menstrual period were determined. According to the levels of AMH,the patients were classified into low-level and high-level AMH subgroups. Results Compared with AITD negative group,the level of AMH in AITD positive group was decreased（P<0.05）,and the level of FSH was increased in AITD positive group（P<0.05）. There was no statistical significance in age,body mass index（BMI）,TSH,E2,PRL,LH,progesterone,polycystic ovary syndrome and endometriosis between the 2 groups（P>0.05）. The dosage of recombinant follicle stimulating hormone（r-FSH）in AITD positive group was higher than that in AITD negative group（P<0.001）,the ratio of E2/r-FSH was lower（P<0.001）. There was no statistical significance in the numbers of MⅡ oocytes and primary embryo survival between AITD positive and negative groups（P>0.05）. The AMH level and E2/r-FSH ratio in AITD positive group were lower than those in AITD negative group（P<0.05）,the dosage of r-FSH was higher（P<0.05）,and there was no statistical significance for FSH,TSH and the number of primary embryo survival（P>0.05）. In the low AMH group,the number of MⅡoocytes in AITD positive group was lower than that in AITD negative group（P<0.001）. In the high AMH group,there was no statistical significance in the number of MⅡoocytes between AITD positive and negative groups（P>0.05）. Conclusions In infertile women,the low expression of AMH（low ovarian reserve） and AITD status have negative impacts on the outcome of COH. AITD should be accessed in which the ovarian reserve function is evaluated before COH.

Auxiliary diagnostic and clinical prognostic evaluation value of thymidine kinase 1 determination in hepatocellular cancer

HU Tao, LU Renquan, GUO Lin

2021, 36(9):  914-919.  DOI: 10.3969/j.issn.1673-8640.2021.09.006

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Objective To investigate the auxiliary diagnostic and clinical prognostic evaluation value of thymidine kinase 1（TK1）determination in hepatocellular cancer（HCC）. Methods A total of 123 newly diagnosed HCC patients（HCC group）,83 other liver disease patients（disease control group） and 97 healthy subjects（healthy control group） were enrolled. Serum TK1,alpha-fetoprotein（AFP） and carbohydrate antigen 19-9（CA19-9）were determined. The general data and clinicopathologic characteristics of HCC patients were collected. HCC patients' serum TK1 levels were determined in 1 week,1 month,3 months and 6 months after operation. HCC recurrence was evaluated and followed up for 12 months. Receiver operating characteristic（ROC） curve analysis was used to evaluate the diagnostic value of different tumor markers in HCC. Kaplan-Meier survival curve and multivariate Cox proportional regression analysis were used to assess the prognosis of HCC patients and the risk factors for HCC recurrence. Results The levels of serum TK1 among HCC,disease control and healthy control groups decreased sequentially（P<0.001）. Serum TK1 levels of HCC patients in TNM stage Ⅲ to Ⅳ were higher than those in stage Ⅰ to Ⅱ（P<0.05）,while there was no statistical significance in serum TK1 levels between HCC patients with different clinicopathologic characteristics（P>0.05）. ROC curve analysis showed that the areas under curves（AUC） of TK1,AFP and CA19-9 for the diagnosis of HCC were 0.798,0.903 and 0.683,respectively. The TK1+AFP combined determination had the highest diagnostic efficiency,and the AUC for diagnosing HCC auxiliarily was 0.922. Kaplan-Meier survival curve analysis showed that the progression-free survival（PFS） of patients with high preoperative serum TK1 level（TK1≥2.00 pmol/L） was shorter than that of patients with low serum TK1 level（TK1<2.00 pmol/L）（P<0.001）. Multivariate Cox proportional regression analysis showed that AFP and TK1 were independent risk factors for predicting HCC recurrence [hazard ratios（HR） were 1.000 and 1.016,and 95% confidence intervals（CI） were 1.000-1.001 and 1.010-1.023,respectively]. Serum TK1 dynamic monitoring results showed that serum TK1 levels in recurrence group were increased 6 months after operation（P<0.05）,and there was no statistical significance in serum TK1 levels in the progression-free group at various time points after operation（P>0.05）. Conclusions Serum TK1 has a certain value in the auxiliary diagnosis and clinical prognostic evaluation of HCC,and it is an independent risk factor for predicting the recurrence of HCC.

Diagnosis value of Xpert MTB/RIF assay for different types of lymph node tuberculosis

ZHANG Guoying, HE Fang, XIA Xia, GUO Yidi, XU Weiping, HUANG Zihui

2021, 36(9):  935-938.  DOI: 10.3969/j.issn.1673-8640.2021.09.011

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Objective To investigate the diagnostic value of Xpert MTB/RIF assay for different types of lymph node tuberculosis. Methods Xpert MTB/RIF assay was used to determine 235 patients with different types of lymph node tuberculosis and 81 patients with non-tuberculosis lymphadenopathy（control group）,and the positive determination rates were compared with those of acid-fasting staining and gamma-interferon release assay（IGRA）. The efficiency of Xpert MTB/RIF assay in the diagnosis of different types of lymph node tuberculosis was analyzed. Results Compared with control group（the positive determination rate was 0）,the positive determination rate of Xpert MTB/RIF assay in patients with lymph node tuberculosis was higher（the positive determination rate was 84.7%）（P<0.001）. The sensitivity of Xpert MTB/RIF assay（84.7%） was higher than that of acid-fasting staining（7.7%,P<0.001）,but it was lower than that of IGRA（91.5%,P<0.001）. The specificity was consistent with that of acid-fasting staining（100%）,and it was higher than that of IGRA（80.2%,P<0.001）. The positive determination rate of Xpert MTB/RIF assay in axillary lymph node tuberculosis was the highest（90.2%）,and there was no statistical significance for different types of lymph node tuberculosis（P>0.05）. The positive determination rates of Xpert MTB/RIF assay were 91.7%,78.0% and 84.8% in the 3 pathologic types of lymph node tuberculosis with caseous type,proliferative type and mixed type,respectively（P>0.05）. Conclusions Xpert MTB/RIF assay is a method with high sensitivity,good specificity and low biohazard,which can be used for the rapid diagnosis of different types of lymph node tuberculosis.

Establishment and clinical application of multiple RT-PCR MassARRAY for the determinations of 27 respiratory pathogens

LIU Hongqian, SONG Chaohui, LIANG Qiaomi

2021, 36(9):  939-946.  DOI: 10.3969/j.issn.1673-8640.2021.09.012

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Objective To establish a method based on multiple reverse transcription polymerase chain reaction（RT-PCR）MassARRAY for the determinations of 27 respiratory pathogens,and to investigate its clinical application value. Methods Multiple polymerase chain reaction amplification and extension primers were designed for pathogens,and the sensitivity,specificity and repeatability of multiple RT-PCR MassARRAY were evaluated with the standard plasmid of pathogens established. Totally,207 clinical specimens were determined by multiple RT-PCR MassARRAY,and the results were compared with real-time RT-PCR. Results The minimum detection limit of the established multiple RT-PCR MassARRAY for 27 respiratory pathogens was 1×10¹-1×10³ copies/μL,with a high specificity. The 57 of 207 clinical specimens were positive,and the positive rate was 27.54%. Streptococcus pneumoniae,Moraxella catarrhalis,Mycoplasma pneumoniae and Haemophilus influenzae were the most common bacterial pathogens,and parainfluenza virus,human metapneumovirus and influenza A virus had high detection rates.”Compared with real-time RT-PCR,the total consistency rate was 99.03%,with high consistency and a kappa value of 0.98. Conclusions The detection system of 27 respiratory pathogens based on multiple RT-PCR MassARRAY has high sensitivity and specificity,simple operation and high throughput,which can provide a reference for the clinical diagnosis of respiratory pathogens.

Application of Xpert MTB/RIF in tuberculosis diagnosis in high altitude localities

ZHAO Ying, Gasongzhuoga, Cibai, LIU Zhijuan, XU Yingchun

2021, 36(9):  947-950.  DOI: 10.3969/j.issn.1673-8640.2021.09.013

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Objective To evaluate the application role of Xpert MTB/RIF in tuberculosis（TB）diagnosis in high altitude localities. Methods The clinical specimens of 1 759 cases of clinically suspected TB were collected from June 2016 to October 2018 in Tibet Autonomous Region People's Hospital. All the specimens were determined for Mycobacterium tuberculosis（MTB） by smear acid-fast staining（both fluorescence staining and modified Ziehl-Neelsen staining） microscopy and Xpert MTB/RIF. The positive rates of the 2 methods were compared. Results Of the 1 759 suspected cases,100（5.7%） cases were positive for smear acid-fast staining microscopy,and 254（14.4%） cases were positive for Xpert MTB/RIF. The positive rate of Xpert MTB/RIF was higher（χ²=628.24,P<0.05）. Rifampicin resistance was determined by Xpert MTB/RIF in 37（2.1%） specimens. For 100 smear-positive specimens and 1 659 smear-negative specimens,Xpert MTB/RIF got positive results of 100 specimens and 154 specimens,respectively. The age group of 18-24 years old had the highest positive rates of the 2 methods and the highest rate of rifampicin resistance,followed by the age group of <18 years old. There was no statistical significance in the positive rate of the 2 methods and rifampicin resistance between males and females. Conclusions Xpert MTB/RIF is a useful assay for the rapid diagnosis of tuberculosis in high altitude localities,considering that the results can be given in the same day of sample collection,and it is superior in sensitivity than microscopy.

Application of CNV-seq in the genetic detection of elevated fetal nuchal translucency

LUO Yinghua, LIU Bailing, HUANG Jiwei, WANG Yuanliu, ZENG Dingyuan, TANG Ning

2021, 36(9):  951-956.  DOI: 10.3969/j.issn.1673-8640.2021.09.014

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Objective To investigate the application role of whole-genome copy number variation（CNV） sequencing （CNV-seq） in the genetic detection of elevated fetal nuchal translucency（NT）. Methods The clinical data of 110 fetuses NT≥3.0 mm in the first trimester of pregnancy were collected and analyzed. The fetal villi or amniotic fluid samples with NT thickening were taken for karyotype analysis and CNV-seq. The pathogenicity of CNV was analyzed by querying the common database resources such as ClinGen,ClinVar,DECIPHER,OMIM,UCSC,the database of genomic variants（DGV） and PubMed. Results Among the 110 cases,26 cases were abnormal in karyotype,and the detection rate was 23.6%. Among them,25 cases were abnormal in aneuploidy,and 1 case was abnormal in small supernumerary marker chromosome（sSMC）（chimeric ratio was 20%）. CNV-seq detected 36 abnormal cases and 10 cases of microdeletions/microduplications（7 cases of unknown clinical significance and 3 cases of suspected pathogenic variations）that could not be detected by karyotype analysis,and defined the origin of one sSMC derived from 12 p13.33-p11.1（34.66 Mb,chimeric ratio was 20%）. Conclusions CNV-seq can detect the abnormal chromosome submicrostructure which is difficult to be finded by karyotype analysis,and it can define the source and fragment size of marker chromosome,which is helpful to improve the diagnosis of the genetic cause of the fetuses with NT thickening.

Development of the national standard materials of total bilirubin in frozen human serum

YU Ting, SHEN Min, QU Shoufang, SUN Nan, SUN Jing, HUANG Jie

2021, 36(9):  957-961.  DOI: 10.3969/j.issn.1673-8640.2021.09.015

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Objective To develop the national standard materials of total bilirubin in frozen human serum,and to evaluate the accuracy and promote the standardization of total bilirubin assay. Methods Serum samples without hemolysis,jaundice and lipemia were collected. After multiple filtration sterilization,serum pools were packed in ampoules in 2-level candidate materials（Ⅰ and Ⅱ） and stored in -70 ℃. Homogeneity for candidate material was evaluated by single factor analysis of variance. The stability for candidate material was evaluated by linear regression analysis. The value for candidate material was assigned by reference method,and the uncertainty was calculated. The commutability was evaluated as well. Results The F values of homogeneity for candidate material level Ⅰ and level Ⅱ were 0.801 1 and 1.234 1,respectively. They were all <F_0.05. The stabilities of candidate material level Ⅰ and level Ⅱ can be last at least 30 and 5 d at -20 ℃,respectively. The assigned values of candidate material level Ⅰ and level Ⅱ were（7.01±0.28）μmol/L（k=2） and（27.10±0.54）μmol/L（k=2）,respectively. The values for candidate material level Ⅰ and level Ⅱ were all within 95% confidence intervals. Conclusions The homogeneity and commutability of candidate material are good. The stability of candidate material meets the requirement,and their values are assigned accurately and reliably. They can be used as national standard.

Application of patient-based real-time quality control using exponentially weighted moving average method on internal quality control procedures for serum ion items

YANG Fan, DONG Danfeng, LU Yide

2021, 36(9):  962-968.  DOI: 10.3969/j.issn.1673-8640.2021.09.016

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Objective To investigate the application of patient-based real-time quality control（PBRTQC）using exponentially weighted moving average（EWMA） method on internal quality control（IQC） procedures for serum ion items. Methods The serum ion item determination results of outpatients and inpatients in Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from October 2019 to May 2021 were collected. Based on PBRTQC professional intelligent software system,the normal distribution test of test data,parameter setting,procedure establishment,real-time operation and performance verification were carried out. The estimated value of EWMA for each result was included in the analysis. The cumulative coefficient of variation（CV） was calculated and was compared with the criteria of precision quality standard and the analytical IQC CV. The early-warning cases by the EWMA quality control program were recorded and analyzed for the potential reasons of analytical performace changes. Results The truncated concentration range of K（3.40-5.00 mmol/L）,Na（135-145 mmol/L）,Cl（99-110 mmol/L）,Ca（2.10-2.36 mmol/L）,Mg（0.74-0.98 mmol/L） and P（0.90-1.31 mmol/L） were shown distributed normally. The optimal weighted coefficients of K,Na and Cl were 0.02,and the optimal weighted coefficients of Ca,Mg and P were 0.05. The actual cumulative precisions（CV） of the 6 items were all smaller than the precision quality target. A total of 13 warning cases were recorded. The number of alarm cases in K,Na,Cl,Ca,Mg and P were 3,1,2,2,3 and 2,respectively. Among them,serum K,Mg and P each had 1 false positive case. Conclusions PBRTQC quality control using EWMA,as a supplementary IQC procedure,has the advantage of monitoring micro-changes in order to avoid the potential quality risks.

Analysis of clinical test quality in non-government medical institutions in Shanghai

LOU Jiao, JIANG Lingli, ZHU Jun, YANG Xue, WANG Qing, WANG Hualiang

2021, 36(9):  969-972.  DOI: 10.3969/j.issn.1673-8640.2021.09.017

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Objective To investigate the status and analyze the problems of clinical test quality in non-government medical institutions in Shanghai. Methods Statistical analysis was performed on the non-conformities of on-site clinical test quality inspection of 40 medical laboratories and 36 socially run hospitals with 100 or more approved beds in Shanghai in 2019. Results A total of 654 non-conformities were found,which mainly focused on equipments,reagents and consumables（16.21%）,ensuring quality of examination results（14.98%）,evaluation and audits（7.49%）,quality management system（7.03%）,personnel（6.57%）,examination by referral laboratories（6.57%）,management review（5.50%） and organization and management responsibility（5.20%）. The corresponding sub-clauses more prevalent or severe were equipment calibration（54.72%）,inter-laboratory comparison（43.88%）,internal quality control（40.82%）,internal auditing（42.86%）,procedures and documents（82.61%）,personnel qualifications（37.21%）,training（34.88%）,capability assessment（18.60%）,selection and assessment on referral laboratories（72.09%）,management review report（58.33%）,management review procedures（38.89%）,laboratory director（47.06%）and organization（14.71%）. Conclusions There are many deficiencies and weaknesses that could affect the clinical test quality in non-government medical institutions in Shanghai,so it is imperative to strengthen the training and comprehensive supervision to promote the continued healthy and standardized development of non-government medical institutions' medical laboratories.

Research progress in burn infection pathogens and drug resistance with the length of stay during hospitalization

HE Ping'an, LU Yanzhou, YANG Xu, LÜ Mei, XIA Qing, LI Qingrong

2021, 36(9):  973-975.  DOI: 10.3969/j.issn.1673-8640.2021.09.018

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With the continuous development of medical standards,burn patients can get timely medical treatment,and more fluid resuscitation and sufficient nutrients reduce the mortality of patients in acute stage. However,because of the destruction of skin barrier of burn patients,infection has become the main cause of death of burn patients during hospitalization. The researches on the overall pathogens and drug resistance of burn patients have not been able to meet the needs of clinicians. This review focuses on the changes in burn infection pathogens and drug resistance with the length of stay（LOS） in the recent years,in order to provide the methods for effective antibiotic use for clinic.

Explainable artificial intelligence in disease diagnosis and treatment

JING Jie, WANG Beilei, LIU Shanrong

2021, 36(9):  976-980.  DOI: 10.3969/j.issn.1673-8640.2021.09.019

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Explainable artificial intelligence（XAI） refers to an artificial intelligence（AI）system based on some AI principles that can be understood and trusted by users,and has broad application prospects in the field of laboratory medicine. This review is based on the research status of clinical laboratory medicine,combined with the basic concepts,importance and implementation methods of XAI,focuses on the research ideas of XAI technology based on knowledge graphs in the field of clinical laboratory medicine,and looks forward to the application prospects of XAI in disease diagnosis and treatment,research challenges and application limitations.