Volume 95  ·  Issue 12  ·  2015

With the rapid development of science and technology, clinical laboratory testing instruments and methods have made revolutionary progress, but the satisfaction of the service objects-clinical medical care and patients has not fundamentally changed. This makes laboratory workers begin to think and seek a scientific management method to continuously improve the quality of laboratory test results to meet the increasing needs of customers. International standards such as the International Organization for Standardization (ISO) and the American Society of Pathologists (CAP) are constantly coming into our field of vision. In particular, the National Health and Family Planning Commission officially promulgated the Administrative Measures for Clinical Laboratories in Medical Institutions on June 1, 2006, which clearly defines the definition of medical laboratory as "a laboratory that performs hematology, biology, chemistry, microbiology, biophysics, immunology, blood immunology, cytology and other tests on various specimens taken from the human body, and provides clinical medical testing services". Article 20 stipulates that "clinical laboratories of medical institutions shall provide interpretation and consultation services of clinical test results". This change has changed the working orientation and concept of medical laboratories^[1]It also makes clinical laboratory managers start to look at the quality assurance measures of clinical test results from a systematic perspective and formulate overall solutions. Regardless of the standard selected, or to meet the basic requirements of the Administrative Measures for Clinical Laboratories in Medical Institutions, a comprehensive quality management system must first be established-that is, the core of inspection quality assurance, and effectively operated and continuously improved. The construction of medical laboratory quality management system has been implemented internationally for many years. It has been proved by practice that it has played a very positive role in standardizing laboratory management, ensuring the quality of inspection results and improving the quality of personnel^[2]。 According to the present situation of quality management in medical laboratories, solve the problems existing in quality management, and guide medical laboratories to carry out quality management more systematically and scientifically, so as to promote the continuous improvement of service quality and enhance the core competitiveness of medical laboratories^[3,4]。

Thyroid cancer is the most common malignancy of the endocrine system, accounting for the first place in head and neck malignancies, accounting for about 3% of all malignancies, and has a high incidence in women. Thyroid cancer includes papillary thyroid cancer, follicular thyroid cancer, undifferentiated thyroid cancer, and medullary thyroid cancer. In recent years, the incidence of thyroid cancer in China has been increasing year by year. Although the overall death rate from thyroid cancer has remained flat, the absolute number of deaths from thyroid cancer each year is rising. With the increasing incidence of thyroid cancer, researchers pay more and more attention to the basic research of thyroid gland. In recent years, great progress has been made in the research on the mechanism of thyroid cancer. However, at present, the deeper basic research on thyroid cancer is still being explored, so the following hot issues are listed for discussion and research.

Clinical biochemistry (hereinafter referred to as biochemistry) tests are of great significance for the diagnosis and outcome of diseases. With the development of medical career, clinicians have put forward higher requirements for obtaining accurate test results. However, compared with the practice of applying supporting systems to ensure the traceability and comparability of measurement abroad, the common coexistence of supporting systems and non-supporting systems in China makes many laboratories unable to effectively guarantee the traceability of measurement. Metrological traceability refers to the characteristic of linking a measurement result or value of a measurement standard to a prescribed reference standard, usually a national standard or an international standard, through an uninterrupted chain of comparison with a prescribed degree of uncertainty^[1]。 Non-supporting system, also called self-built system in China^[2]That is, the laboratory selects calibrators, instruments, reagents, testing procedures and other components from different sources to establish a testing system. However, the self-built system cannot maintain the metrological traceability of the original system, which affects the consistency of biochemical test results between different systems and different laboratories. Therefore, how to improve the accuracy of inspection results, especially the accuracy of non-supporting system inspection results, so as to better ensure the inspection quality and comparability of results is a realistic problem faced by many medical institutions.

The annual San Antonio Breast Cancer Conference (SABCS) was held as scheduled from December 9 to 13, 2014. The event brought together 8,000 scholars from more than 90 countries and regions around the world to share the annual feast in the field of breast cancer diagnosis and treatment. The conference announced important research results in the fields of basic breast cancer medicine, translational medicine, adjuvant treatment of early breast cancer and treatment of advanced breast cancer, which are here to share and discuss with you.

The American Society for Clinical and Laboratory Standardization (CLSI) has been working to develop a series of documents for evaluating clinical testing methods. It adopts a unique consensus process in developing relevant standards and guidelines, including the establishment, endorsement and publication of protocols, extensive, detailed and comprehensive commentary on relevant documents, and revision of documents based on user comments to ensure their adaptability, etc^[1]。 CLSI first introduced EP9-P (proposed guideline) in January 1986, EP9-T (tentative guideline) in April 1993, and then revised EP9-A (approved guideline) in December 1995^[2]。 Subsequently, it was revised three times, namely EP9 – A2 of September 2002^[3]EP9 – A2 – IR (interim revision), July 2010, and the latest version EP9 – A3, August 2013^[4], namely, Method Alignment and Offset Assessment with Patient Samples: Approved Guidelines – Third Edition, EP9 – A3 provides manufacturers and clinical laboratories with the latest methodological alignment and offset assessment guidelines. The author will briefly introduce its basic structure, main uses, comparison requirements, experimental scheme, statistical methods and other contents for peers' reference.

To establish a system of monitoring the key indicator of quality for inspection (KIQI) on a laboratory information system (LIS), and to have a better management of KIQI.

Clinical sample made in PUMCH were collected during the whole of 2014. Next, interactive input program were designed to accomplish data collecting of the disqualification rate of samples, the mistake rate of samples and the occasions of losing samples, etc. Then, a series moment of sample collection, laboratory sample arrived, sample test, sample check, response to critical value, namely, trajectory information left on LIS were recorded and the qualification rate of TAT, the notification rate of endangering result were calculated. Finally, the information about quality control were collected to build an internal quality control database and the KIQI, such as the out-of-control rate of quality control and the total error of test items were monitored.

The inspection of the sample management shows the disqualification rates in 2014 were all below the target, but the rates in January and February were a little high and the rates of four wards were above 2%. The mistake rates of samples was 0.47 cases/10 000 cases, attaining the target (<2 cases/10 000 cases). Also, there was no occasion of losing samples in 2014, attaining the target too. The inspection of laboratory reports shows the qualification rates of TAT was within the acceptable range (>95%), however the rates of blood routine in November (94.75%) was out of range. We have solved the problem by optimizing the processes. The notification rate of endangering result attained the target (≥98%), while the rate of timely notification is needed to improve. Quality inspection shows theCV of APTT in August (5.02%) was rising significantly, beyond the accepted CV(5.0%). We have solved the problem by changing the reagent. The CV of TT in 2014 were all below the allowable CV, thus the allowable CV of the next year lower to 10%.

It is an objective and effective method to manage KIQI with the powerful management mode of database and information process capability on LIS.

To monitor the the genotype and subgenotype c of hepatitis C among the immigrations. To identify the new genotype and trace the transmission.

From 2009 to 2013, 235 positive Anti-HCV samples were collected from Sichuan, Liaoning, Guangdong, Shenzhen and Yunnan ITHC. Specific PCR primers were used to amplify the HCV Core, then the PCR products were sequenced by genetic analyzer. The genotypes were identified by aligning the GenBank reference sequences and constructing the phylogenetic tree of Core.

One hundred and twenty-nine samples showed HCV-RNA positive (54.9%) in 235 samples which were anti-HCV positive. We detected six kinds of genotypes in 115 cases of sequncing successfully, of which 72 cases of genotype 1 (G1, 62.6%), followed by G3 (18.2%), G2 (9.6%), G4 (6%), G6 (2.6%) and G5 (0.9%). Genotype 1b was the most common subtype, accounting for 47% of all infections. The phylogenetic tress indicated the HCV 4 strains in immigrations had high affinity with that in Egypt and Europe, while HCV 6 strains closed with that in China.

HCV 1b is the advantage of popular genotype in HCV carriers. Subtype 4 may be a possible new genotype transmited into China. The immigrations may be the sources of new genotype of HCV.

To explore the relationship between serum level of thyroxin-stimulating hormone (TSH) and development and progression of papillary thyroid microcarcinoma (PTMC) in nodular thyroid disease.

A total of 365 eligible patients with thyroid nodules undergoing initial thyroidectomy were enrolled, including 113 patients with PTMC diagnosed by postoperative pathology (PTMC group) and 252 patients with benign thyroid nodules (BTN group). Their clinical data were retrospectively reviewed. The serum levels of TSH in two groups and the proportion of PTMC in different serum TSH level groups in all patients were compared respectively. The relationship of preoperative serum TSH levels with tumor size and lymphatic metastasis in patients with PTMC were analyzed.

No significant difference existed in serum TSH levels between PTMC and BTN groups (P>0.05). The median age was younger in PTMC group than that in BTN group (Z=-2.877, P=0.004). And the TGAb levels were higher in PTMC group than those in BTN group (Z=-2.887, P=0.004). They were divided into 6 groups according to the serum TSH levels, and there weren't significant difference in the proportion of PTMC among those group (P>0.05). Binary logistic regression analysis showed age was the only risk factor of PTMC (OR=0.971, 95%CI: 0.953-0.990, P=0.003). The serum TSH levels were positively correlated with tumor size in patients with PTMC (r=0.218, P=0.025). However, the proportions of lymphatic metastasis were comparable among different TSH levels groups in patients with PTMC (P>0.05).

Serum TSH is probably associated with the de novo oncogenesis of PTMC. However, serum TSH may be involved in the growth of preexisting PTMC.

To evaluate the role of carbon nanoparticles for dissecting lymph nodes and preserving parathyroid glands in patients with thyroid carcinoma undergoing total thyroidectomy plus bilateral central neck dissection.

A total of 86 patients with thyroid carcinoma undergoing primarily total thyroidectomy plus bilateral central neck dissection were randomly divided into trial and control groups. Carbon nanoparticles were injected into thyroid gland of trial group. Total lymph node, metastasis lymph node, black stained lymph node and black stained metastasis lymph node of trial group were counted in central compartment dissection specimens. And total lymph node and metastasis lymph node of control group were counted in central compartment dissection specimens. Parathyroid glands in central neck dissection specimens were counted in two groups. For two groups, serum total calcium and parathyroid hormone were measured pre-operation and 1 day, 3 days, 5 days, 1 month, 3 months and 6 months post-operation.

In trial group, the average counts of (10.19±4.27) lymph nodes and (8.44±4.31) black stained lymph nodes were more than those in control group at (6.26±2.98) lymph nodes (all P<0.01). Parathyroid gland was found in trial group (n=7) and control group (n=11). And the difference had no statistical significance (χ²=1.124, P=0.289). The preoperative serum levels of calcium and parathyroid hormone decreased within 6 months postoperatively in both groups (all P<0.01). Without extracapsular invasion, serum levels of calcium and parathyroid hormone were higher in trial group than those in control group at 5 days, 1 month and 3 months post-operation (allP<0.05). In an event of lymph node metastasis, serum levels of calcium (t=3.446, P=0.001) and parathyroid hormone (t=2.441, P=0.017) in trial group were higher than those in control group at 1 month post-operation. When there was extracapsular invasion or no lymph node metastasis, the serum levels of calcium and parathyroid hormone had no inter-group statistical differences within 6 months post-operation (all P>0.05). When tumor size was less than or equal to 4 cm, the level of parathyroid hormone was higher in trial group than that in control group at 1 month post-operation (t=2.703, P=0.009). But no inter-group statistical differences existed within 6 months post-operation (all P>0.05) when tumor size surpassed 4 cm. Regardless of tumor size, the serum levels of calcium in trial group were higher than those in control group at 1 month post-operation (allP<0.01).

For thyroid carcinoma patients, total thyroidectomy plus bilateral central neck dissection increases the incidence of hypoparathyroidism. Lymph nodes of central compartment may be tagged by carbon nanoparticles so as to boost the detection rate of lymph node. In events of lymph node metastasis or no extracapsular invasion, carbon nanoparticles can adequately protect parathyroid functions.

To explore the ultrasonic signs of <5 mm nodules of multifocal papillary thyroid carcinoma (MPTC) so as to boost its preoperative detection rate and lower its residual cancer and reoperative risk.

The sonographic appearances of 251 suspicious nodules smaller than 5 mm in MPTC were retrospectively reviewed by univariate (Chi-square test) and multivariate analysis (logistic regression analysis). A total of 202 papillary thyroid microcarcinoma (PTMC) in MPTC were confirmed pathologically.

Among 251 nodules, vague edge were found in 141 (69.8%) PTMCs and in 23(46.9%) benign thyroid nodules (BTN), 193(95.5%) PTMCs were solid while non echo areas were found in 23(46.9%) BTNs, 191(94.6%) PTMCs were low echo while 20 in BTNs (40.8%), 167(82.7%) PTMCs were aspect ratio larger than 1(L/S>1) and 24(49.0%) BTNs were L/S<1, micro-calcifications were found in 40(19.8%) PTMCs and in 9(18.4%) BTNs, 44(21.8%) PTMCs and 15(30.6%) BTNs showed blood flow signal in nodules, surrounding echo halo about nodules were absent in 152(75.2%) PTMCs but were found in 20(40.8%) BTNs, 168(83.2%) PTMCs and 37(75.5%) BTNs elasticity score great than or equal to 3. Ill-defined margin, hypoechoic, solid composion, aspect ratio larger than 1(L/S>1) and absent of surrounding echo halo were reliable sonographic signs to indicate PTMC(P<0.05) by univariate analysis. Hyperechoic spots and blood signals in nodules, elasticity score great than or equal to 3 show limited helpless in diagnosis of PTMC. 4 kinds of ultrasonic characteristics such as hypoechoic, solid composion, L/S>1 and absent of surrounding echo halo are directly related to PTMC by multivariate analysis (P<0.05).

Uni and multi-variate analyses of ultrasonic signs for nodules <5 mm may guide the preoperative diagnosis of MPTC.

To explore the therapeutic efficacies of decitabine application prior to hematopoietic cell transplantation (HSCY) in patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).

Retrospective reviews were conducted for 46 patients with MDS (n=14) and AML (n=32) on a therapy of decitabine prior to allo-HSCT between September 2009 and February 2013.

In MDS patients, complete remission (CR, n=10), partial remission (PR, n=2) and stable disease (SD, n=1) were achieved prior to HSCT. And the remission rate of one course was 10/14. After decitabine dosing, 17/32 patients achieved CR in 32 with AML and the remission rate of one course was 53.1% (17/32) and effective rate of one course (CR+ PR) achieves 78.1% (25/32). Successful engraftment was attained in all MDS patients and 12/14 patients survived disease-free and one died of pneumonia after relapse. And 28 patients with AML attained successful engraftment after using decitabine prior to allo-HSCT and there were 20 disease-free survivors. Ten patients died and another lived with tumor. The incidences of acute and chronic graft-versus-host disease (GVHD) among evaluable patients were 4.3% (2/26) and 23.9% (11/46) respectively. After a median follow-up of 8 months for survivors, the treatment-related mortality was 23.9% (11/46). The 30-month disease-free survival (DFS) rate was 53.1% and 30-month overall survival rate after decitabine dosing 61.9%.

Thus decitabine is an effective therapy during bridge time to HSCT in patients with MDS and AML.

To explore the early evaluations of Bedside Index for Severity in Acute Pancreatitis (BISAP) plus C-reactive protein (CRP) in predicting the severity and prognosis of acute pancreatitis (AP).

A total of 114 cases of AP at our hospital over the last 2 years were retrospectively analyzed. The levels of amylase, serum glucose, serum calcium, CRP and D-dimer in 24 hours were measured. According to the evaluation standard, the scores of BISAP, acute physiology and chronic health evaluation (APACHE Ⅱ), Ranson and computed tomography severity index (CTSI) were obtained. Mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), severe acute pancreatitis (SAP), death toll and their proportion were compared in different BISAP scores. Correlation analyses were conducted for BISAP scores and laboratory indices, CRP and different scoring systems. We compared the evaluative value of BISAP plus CRP and other scoring systems in SAP.

With rising BISAP scores, both severity and mortality increased in acute pancreatitis (χ²=78.616, P<0.01). BISAP scores were positively correlated with CRP, D-dimer and serum glucose (r=0.451, 0.329, 0.241, P<0.01) and negatively correlated with serum calcium ((r=-0.315, P<0.01). CRP was positively correlated with APACHE-Ⅱ, Ranson's, BISAP and CTSI scores (r=0.407, 0.392, 0.451, 0.427, P<0.001). When CRP was included into the BISAP scores, the area under the curve (AUC) of predicting SAP was 0.873 and the AUC of predicting death 0.909 so that BISAP score plus CRP had a good predictive value for the severity of AP and death.

In clinical practice, the simple BISAP scoring system may predict the severity of AP. And BISAP score plus CRP has a better predictive value for AP.

To explore the effects of different forms of glucocorticoid excess on cortisol/cortisone ratio and to reveal the mechanisms of hypokalemia in Cushing's syndrome patients.

The levels of urinary free cortisol (UFF) and urinary free cortisone (UFE) were determined in 6 adult patients with ectopia adrenocorticotropic hormone (ACTH) syndrome, 6 normal serum level of potassium adults with hypercortisolism due to adrenal tumor, 5 hypokalemic adults with hypercortisolism due to adrenal tumor and 6 healthy volunteers using high-performance liquid chromatography plus tandem mass spectrometry (LC-MS/MS).

For 4 groups, the results of UFF+ UFE were (2 787±820), (689±163), (697±120) and (70±27)μg/L and UFF/UFE ratio 2.98±0.35, 1.03±0.42, 2.24±0.37 and 0.42±0.20 respectively. The values of UFF+ UFE had no statistical difference between normal and low levels of serum potassium adults with hypercortisolism. And the ratio of UFF/UFE of hypokalemic adults with hypercortisolism was significantly higher than that of normal serum level of potassium adults with hypercortisolism. It suggested that the deficiency of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD 2) was present in hypokalemic adults with hypercortisolism.

Due to a deficiency of 11β-HSD2, active cortisol can not be transformed into inactive cortisone in some patients with ACTH-independent Cushing's syndrome.

To explore the effects of methyleugenol (MEG) on central respiratory drive to inspiratory-activated airway vagal preganglionic neurons (IA-AVPNs).

The 3 to 5-day-old Sprague-Dawley rats were anesthetized and rhodamine was injected into trachea wall for labelling IA-AVPNs in ventrolateral vicinity of nucleus ambiguous (vNA). And then a brainstem slice preparation with hypoglossal rootlets was made. IA-AVPNs were identified and excitatory synaptic inputs were recorded with patch-clamp techniques. Brainstem slice preparations were divided into the groups of control prior to application of MEG and MEG during MEG application. The data from the last 10 consecutive inspiratory phases prior to application of MEG were chosen as control. And the data from the last 5 respiratory cycles prior to rhythm blockade were used to represent the maximal effects of MEG group. Paired Student'st-test was used for comparing inter-group differences.

Compared with control, MEG group had lower frequency, amplitude, duration and area of hypoglossal bursts (2.14±0.87 vs 5.39±1.93 burst/min, 1.27±0.53 vs 2.94±0.92 mV, 178±37 vs 249±54 ms, 330±173 vs 983±534 mV·ms, all P<0.001). The duration, amplitude and area of phasic inspiratory inward current were lower in MEG group, accounting for (66.3±4.4)%, (58.5±4.3)%, (44.9±7.5)% (allP<0.05) of control respectively. Compared with control, the frequency of phasic excitatory postsynaptic currents (EPSCs) was lower (29.87±3.70 vs 42.27±11.95 Hz) during inspiratory bursts but the amplitude was higher (83.13±15.97 vs 49.26±7.40 pA) (allP<0.05). However, compared with control, no significant differences existed in the frequency and amplitude of tonic EPSCs during inspiratory intervals (allP>0.05).

MEG inhibits central respiratory drive to IA-AVPNs through inhibiting excitatory synaptic transmission.

To explore the expression of caveolin-1 (Cav-1) induced by interleukin-17F/IL-17 receptor C (IL-17F/IL-17RC) in rat pulmonary microvascular endothelial cells (PMVECs).

Cultured PMVECs were divided into two groups of time-dependent experiment and IL-17RC signal pathway intervention according to the results of time-dependent experimental group: namely peak time of IL-17F-induced Cav-1 and its phosphorylation (p-Cav-1) expression of PMVEC for formulating the incubation time between IL-17F and PMVEC in IL-17RC signal pathway intervention group. Time-dependent experiment group: Western blot was used to detect the expression of Cav-1 after IL-17F stimulation for 0, 0.5, 1.5, 3.0, 6.0, 12.0, 24.0 h. Cav-1 and its phosphorylation expression after IL-17F challenge for 0, 10, 30, 60, 90, 120 min were evaluated by Western blot. IL-17RC signal pathway intervention group: PMVECs were divided into two groups after a 3-day pre-treatment of siRNA. The first group received a 60-min stimulation of 100 ng/ml IL-17F before detecting the expression of p-Cav-1 while the second group was subject to a 24-hour stimulation of 100 ng/ml IL-17F before detection. In addition, control, meaningless-siRNA, IL-17RC-siRNA, IL-17F and meaningless-siRNA+ IL-17F groups were set as references for two groups respectively.

IL-17F up-regulated the expression of Cav-1 in a time-dependent manner. At 0, 0.5, 1.5, 3.0, 6.0, 12.0, 24.0 h, the relative expression levels of Cav-1 were (1.139±0.134), (1.276±0.166), (1.604±0.080), (2.115±0.231), (2.763±0.226), (3.309±0.493) and (3.963±0.169). At 1.5 h, it was significantly higher than 0 h, peaked at 24.0 h and remained significantly higher than 0, 0.5, 1.5, 3.0, 6.0, 12.0 h (all P<0.05). And IL-17F increased the expression of p-Cav-1 in a time-dependent manner. At 0, 10, 30, 60, 90, 120 min, the relative expression levels of p-Cav-1 were (0.540±0.085), (0.880±0.084), (1.437±0.297), (1.491±0.212), (1.017±0.210) and (0.882±0.074). At 10 min, p-Cav-1 was significantly higher than 0 min, peaked at 60 min, remained significantly higher than 0, 10, 30, 90, 120 min (allP<0.05) and gradually decreased. At 120 min, it was still higher than 0 min. Compared with IL-17F group, IL-17RC-siRNA significantly inhibited IL-17F-induced Cav-1 and its phosphorylation (2.126±0.318 vs 3.897±0.424 and 1.014±0.136 vs 1.431±0.298, allP<0.05).

IL-17F up-regulates the expressions of Cav-1 and p-Cav-1 in a time-dependent manner in PMVECs. And the silenced expression of IL-17RC in PMVECs by IL-17RC-siRNA significantly inhibits the IL-17F-induced expressions of Cav-1 and p-Cav-1.

To explore the effects of different fluid resuscitation regimens on vascular permeability during burn stage in swines.

A total of 24 Guangxi-BAMA miniature swines were numbered from 1 to 24 and randomly divided by EXCEL 2007 into 4 groups of succinylated gelatin, hydroxyethyl starch (HES 130/0.4), Parkland (lactated Ringer's solution) and allogeneic plasma (n=6 each). The model of severe burn shock was established. And fluid resuscitation therapy was applied according to the established regimens of burn shock fluid resuscitation. The parameters of heart rate, blood pressure, urine volume, central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) were recorded. Blood samples were collected prior to burns and at intervals of 4, 8, 24 and 48 h post-burns. The plasma colloidal osmotic pressure was measured. Evens blue was intravenously injected at 30 min before sacrificing. Then lung tissue samples were obtained and pulmonary vascular permeability index (PMPI) was measured. Statistical analyses were performed.

All swines survived shock stage. The inter-group comparison revealed no statistical difference in heart rate, blood pressure, urine volume, CVP or PCWP. The plasma colloidal osmotic pressures (mmHg, 1 mmHg=0.133 kPa) of four groups at each interval were as follows: (1) pre-burn: 25.4±1.0, 25.9±0.9, 25.5±1.1, 25.0±1.0; (2) 4 h: 24.3±1.0, 25.6±0.9, 13.2±0.5, 25.0±1.1; (3) 8 h: 23.3±0.8, 25.2±1.2, 12.7±0.5, 24.0±0.9; (4) 24 h: 22.0±0.8, 23.1±1.0, 12.4±0.4, 23.3±0.8; (5) 48 h: 22.3±0.8, 24.1±0.8, 18.1±0.4, 23.5±0.9. No statistically significant differences existed at the intervals of pre-burn between four groups (all P>0.05). The HES 130/0.4 group at 8 h was significantly higher than that of allogeneic plasma group at the same interval (P<0.05). The Parkland group at 4, 8, 24, 48 h were significantly lower than those of allogeneic plasma group (allP<0.05). The succinylated gelatin group at 8, 24, 48 h, the HES 130/0.4 group at 8, 24, 48 h, the Parkland group at 4, 8, 24, 48 h and allogeneic plasma at 8, 24, 48 h decreased versus those at pre-burns (allP<0.05). No statistically significant differences existed in pulmonary vascular permeability between the groups of succinylated gelatin (7.6±0.9) μg/g, HES 130/0.4 (7.9±1.8) μg/g, and allogeneic plasma (7.6±1.2) μg/g, but all lower than the Parkland group (26.1±2.3) μg/g (allP<0.05).

Natural colloid or artificial colloid (HES 130/0.4 or succinylated gelatin) have similar effects on vascular permeability in swines with severe burns during shock stage. Both are superior to the Parkland group.

Myelodysplastic syndromes (MDS) are a group of highly heterogeneous malignant clonal diseases of the hematopoietic system that involve abnormal changes in multiple genes in multiple steps. The main manifestations are abnormal development of one or more lines of myeloid cells of bone marrow, ineffective hematopoiesis leading to refractory anemia or pancytopenia and increased risk of evolving into acute myeloid leukemia^[1]。 The 2008 WHO hematological tumor classification system classified MDS as one of the five major categories of myeloid tumors. Since the 1990s, the incidence of MDS has been increasing significantly, especially in people over 70 years old. The annual incidence of MDS has increased from (2~12) to (30~50) /100 000, much higher than that of acute myeloid leukemia (AML) and myeloproliferative tumors (MPN)^[2]。 Therefore, the understanding and in-depth research of MDS is increasingly important.

Trauma, burns, abnormal pigmentation and scars are common skin lesions, which cause great physical pain, mental stress and economic burden to patients. How to restore the normal shape and function of damaged skin is one of the common problems faced by burns, cosmetology and plastic surgery. Autologous skin grafting has always played an important role in the repair of skin defects. With the advancement of medical science and technology, a new technology – ReCell^®Cell autologous in vitro regeneration technology (hereinafter referred to as ReCell^®Technology) has been widely used in skin wound repair in the fields of burn, cosmetology, plastic surgery and other fields because of its characteristics that autologous skin cell suspension can be obtained without culture, and has achieved certain results, which are summarized below.

sodium pyruvate has not been used in clinic except for a few clinical trials. Because it has many excellent biological characteristics such as improving cellular hypoxia tolerance, it is suitable for clinical prevention and treatment of hypoxic lactic acidosis (LA). It has important theoretical significance and application value in critical care medicine.