Volume 98  ·  Issue 22  ·  2018

The knowledge system of laboratory medicine includes two parts: laboratory technology and analysis and interpretation of laboratory results. In the process of medical development from empirical medicine to evidence-based medicine, the inspection technology has done a lot of work from the aspects of inspection methods, inspection means and inspection quality management, focusing on the accuracy, stability and timeliness of inspection results, and has been greatly improved, which has achieved the first leap of laboratory medicine. With the development of evidence-based medicine to individualized medicine and precision medicine, the clinical requirements for the interpretation of test results are becoming more and more urgent. Especially with the increasing number of test items, the pathological changes reflected in the test results are more and more deep and detailed. The test indexes not only cover the physiological state, pathophysiological condition, biochemical reaction, immune reaction and regulation of the body, but also directly related to the causes, pathogenesis, disease course evolution, drug sensitivity and drug resistance, therapeutic effect and prognosis of the disease. Therefore, there is a special need for a professional and systematic interpretation of complex test results in clinical practice, which will surely drive the second leap of development of laboratory medicine.

Cataract is the top blinding eye disease in the World Health Organization's "Vision 2020, the right to see for all" action goal. cataract surgical rate (CSR) (number of cataract surgeries per million person-years) is one of the three major monitoring indicators of the World Health Organization's Universal Eye Health: Global Action Plan (2014-2019)^[1]。 After entering the 21st century, our government has taken many measures simultaneously to eliminate cataract blindness in our country, and achieved obvious results. CSR has been continuously improved, but there are still deficiencies. This paper reviews the measures and achievements of eliminating cataract blindness in China, analyzes the shortcomings, and puts forward the direction of efforts.

Diabetes is a group of metabolic diseases characterized by chronic hyperglycemia caused by multiple etiologies, which are caused by defects in insulin secretion and/or action. The test results are an important basis for the diagnosis, treatment and condition monitoring of diabetes mellitus. Correct analysis of test results is very important for the diagnosis, differential diagnosis, judgment of pathological process and evaluation of treatment effect. According to the etiology of diabetes, it is divided into: type 1 diabetes, type 2 diabetes, special types of diabetes and gestational diabetes. In order to better analyze the pathological significance contained in the data of the test report, save the time of consulting the test report, and improve the application effect of the test report, this consensus is specially formulated.

Dyslipidemia usually refers to elevated levels of cholesterol and/or triacylglycerol in the serum, commonly known as hyperlipidemia. In fact, dyslipidemia also generally refers to various dyslipidemia including low high density lipoprotein cholesterolemia.

Platelet activation (activation, adhesion and aggregation) is the key to the pathogenesis of acute coronary syndrome (ACS), and antiplatelet therapy is the cornerstone of prevention and treatment of acute vascular events throughout the treatment of ACS^[1,2]。 Dual antiplatelet therapy of aspirin combined with clopidogrel (or ticagrelor) is the most widely used in clinic^[3]。 However, anti-platelet drug therapy exhibit diversity differences between individuals, which are significantly associated with the occurrence of adverse events such as recurrent thrombosis or bleeding^[4,5]。 However, the relevant professional authorities have never formed a unified consensus. The reasons for this phenomenon may be as follows: (1) There are multiple signal-mediated pathways for platelet activation. Blocking a certain pathway by related drugs cannot completely inhibit platelet activation^[6]。 (2) Platelets have the functions of adhesion, aggregation, release, promoting coagulation and blood clot contraction, and the individual's response to antiplatelet drugs is also affected by metabolic genes, liver and kidney function, drugs, etc. So far, no single platelet function test (PFT) has captured the endpoint events triggered by these different pathways, that is, it can comprehensively assess the complexity of platelet physiology and function^[7]。 (3) Low degree of standardization, irregular operation and inadequate attention to details are also one of the reasons why PFT cannot be widely accepted in clinical practice^[8,9]。 (4) There are many methods and standards for platelet function testing. At present, there are no special guidelines (consensus) or recommendations to standardize platelet function testing in China, and clinicians and laboratory personnel have uneven understanding of platelet function testing.

Venous blood and peripheral blood are commonly used in clinical blood testing specimens. With the continuous development and improvement of the modernization, micro-quantity and convenience of laboratory medicine technology, the application of peripheral blood is becoming more and more extensive. Due to the poor compliance of voluntary cooperation and thin blood vessels, the success rate of venous blood sampling is lower and the incidence of complications is higher than that of adults^[1]Therefore, peripheral blood collection occupies an indispensable position in pediatric clinical work. Compared with venous blood, peripheral blood has many influential factors, such as irregular collection process operation, which can easily lead to variation or inaccuracy of test results. Therefore, it is very important to standardize peripheral blood collection operation. At present, there is a lack of unified standards and norms for peripheral blood collection operation in China, and the relevant guidelines abroad are difficult to meet the actual needs of China. In order to standardize the operation process of peripheral blood collection in China, the Expert Committee of Laboratory Medicine for Pediatric Diseases of Laboratory Physicians Branch of Chinese Medical Doctors Association and the World Chinese Laboratory and Pathologists Association jointly formulated this consensus, aiming at providing a reference basis for standardized collection operation of peripheral blood samples in China and improving the quality of peripheral blood sample inspection.

To analyze the clinical features of post-splenectomy pulmonary hypertension and effects of its target therapy, and improve the diagnosis and treatment of the disease.

Clinical data of 18 patients with post-splenectomy pulmonary hypertension admitted to Fuwai Hospital from October 2006 to March 2017 were systematically reviewed and analyzed.

Among the 18 patients with a mean age of (41±11) years old, 11 were women and 7 were men. The interval between splenectomy and the diagnosis of pulmonary hypertension was (11±6) years. Shortness of breath (14/18) and chest distress (12/18) were the most common clinical manifestations. Nine patients were in World Health Organization functional class (WHO-FC) Ⅲ-Ⅳ, and two patients were combined with pulmonary embolism. According to the cause of splenectomy, the pulmonary hypertension patients were divided into hepatocirrhosis portal hypertension group (10/18) and non-hepatocirrhosis portal hypertension group (8/18). In hepatocirrhosis portal hypertension group, patients were combined with chronic liver abnormalities presentation, and no pulmonary embolism was found in these patients. Cardiac output and cardiac index were significantly higher (P=0.007 and 0.011, respectively) and pulmonary vascular resistance was significantly lower (P=0.013) in hepatocirrhosis portal hypertension group as compared with non-hepatocirrhosis portal hypertension group. There was no difference in WHO-FC and mean pulmonary arterial pressure between two groups (P=0.448 and 0.379, respectively). After 3 months of target treatment in 8 patients, WHO-FC of 3 patients improved, systolic pulmonary artery measured by ultrasonic cardiogram was significantly decreased[(84±10) vs (71±12) mmHg(1 mmHg=0.133 kPa), P=0.005]and right ventricular end diastolic diameter/left ventricular end diastolic diameter was significantly reduced[(0.78±0.17) vs (0.62±0.16), P=0.010]compared to the baseline. The level of NT-proBNP also tended to be decreased, although not to a significant extent.

Post splenectomy pulmonary hypertension has various clinical features. Post splenectomy pulmonary hypertension resulted from hepatocirrhosis portal hypertension has better hemodynamics. Target treatment is effective for the patients with post splenectomy pulmonary hypertension.

To investigate the correlation of the expression of platelet microRNA-223 (miR-223) with the degree of platelet activation and the severity of coronary lesions in patients with coronary artery disease (CAD).

A total of 204 consecutive patients underwent coronary artery angiography (CAG) at Beijing Anzhen Hospital between April and December 2016 were enrolled. According to CAG results, all the patients were divided into two groups: 112 patients in CAD group and 92 patients in control group. Real-time fluorescent quantitative PCR was used to detect the expression level of platelet miR-223 and mRNA of its target gene P2Y12. Flow cytometry was performed to detect the expression of platelet associated complement-1 (PAC-1).

Compared with control group, the expression level of platelet miR-223 in CAD group was higher [(1.27 (1.17, 1.32) vs 0.73 (0.64, 0.79), P<0.001], while the expression level of P2Y12 mRNA was lower [0.75 (0.51, 0.96) vs 1.00 (0.80, 1.64),P<0.001]. The positive expression rate of PAC-1 of CAD group was higher than that of control group (P<0.001). The expression level of platelet miR-223 was negatively correlated with the expression of P2Y12 (r=-0.39, P=0.02), but positively correlated with the expression of PAC-1 (r=0.50, P<0.001). The platelet miR-223 expression level had a positive correlation with the Gensini score in CAD group (r=0.90, P<0.001), but had no significant correlation with platelet aggregation (r=-0.06, P=0.36).

The expression level of platelet miR-223 in patients with CAD may be an indicator for monitoring platelet activation and assessing the severity of CAD.

To investigate the value of stereotactic biopsy in the accurate diagnosis of lesions in the brain stem and deep brain.

A total of 29 consecutive patients who underwent stereotactic biopsy of brainstem and deep brain lesions between May 2012 and January 2018 were retrospectively reviewed. The Cosman-Roberts-Wells (CRW) stereotactic frame was installed under local anesthesia. Thin-layer CT and MRI scanning were performed. Target coordinates were calculated by inputting CT-MRI data into the radionics surgical planning system. The individualized puncture path was designed according to the location of the lesions and the characteristics of the image. Target distributions were as follows: 12 cases of midbrain or pons, 2 cases of internal capsule, 3 cases of thalamus, 12 cases of basal ganglia. The biopsy samples were used for further pathological and/or genetic diagnosis.

Twenty-eight of the 29 cases (96.6%) were diagnosed accurately by histopathology and genomic examination following stereotactic biopsy. Pathological results were as follows: 8 cases of lymphoma, 7 cases of glioma, 4 cases of demyelination, 2 cases of germ cell tumor, 2 cases of metastatic tumor, 1 cases of cerebral sparganosis, 1 case of tuberculous granuloma, 1 case of hereditary prion disease, 1 case of glial hyperplasia, 1 case of leukemia. The accurate diagnosis of one case required a combination of histopathology and genomic examination. Undefined diagnosis was still made in 1 cases (3.45%) after biopsy. After biopsy, there were 2 cases (6.9%) with symptomatic slight hemorrhage, 1 case (3.45%) with symptomatic severe hemorrhage, and 1 cass (3.45%) with permanent neurological dysfunction. No one died because of surgery or surgical complications.

Stereotactic biopsy is fast, safe and minimally invasive. It is an ideal strategy for accurate diagnosis of lesions in brain stem and deep brain.

To investigate the risk factors and preoperative evaluation of lymph nodes posterior to right recurrent laryngeal nerve (LN-prRLN) metastasis in papillary thyroid carcinoma (PTC).

Clinical data of 301 patients with right or double lobes who underwent surgery between August 2015 and October 2016 in the Department of Thyroid Surgery, the First Hospital of China Medical University, were retrospectively analyzed. The relationships between LN-prRLN metastasis and clinical pathology data and other factors were analyzed. The enhanced CT difference of LN-prRLN was analyzed by receiver operating characteristic (ROC) curves.

LN-prRLN metastasis was detected in 46 patients. Univariate analysis showed that age, tumor diameter, Delphian lymph node metastasis, lymph nodes anterior to right recurrent laryngeal nerve (LN-arRLN) metastasis number, and the number of lateral compartment lymph node metastases were significantly associated with LN-prRLN metastasis (all P<0.05). Multivariate logistic regression analysis showed that LN-arRLN metastasis and right lateral compartment lymph node metastasis were independent risk factors for LN-prRLN metastasis (bothP<0.05). The area under the ROC curve for contrast-enhanced thyroid CT was 0.948 (P<0.001), the cut-off value was 72 Hu, and the best sensitivity and specificity were 90.5% and 94.1%, respectively, with a Youden index of 0.846.

LN-prRLN dissection is recommended when there exists LN-arRLN metastasis or right lateral compartment lymph node metastasis in patients with PTC, especially when preoperative contrast-enhanced CT shows LN-prRLN and contrast-enhanced CT is ≥72 Hu.

To explore the effect and mechanism of exosome derived from lipopolysaccharide (LPS)-induced mouse macrophage (RAW264.7) on acute lung injury.

RAW264.7 were cultured in vitro and divided into 2 groups: control group and LPS-induced group. The exosomes were extracted from the two groups of cell supernatant by ultracentrifugation and classified into 2 groups: C-EXO group and LPS-EXO group. In vivo, random allocation was used to averagely divide the eighteen male C57BL/6 mice into 3 groups: control group, EXO-control group and EXO-LPS group. All mice were sacrificed after 12 h. The lung tissue was used for HE staining to assess the degree of acute lung injury as well as immunohistochemical staining for interleukin (IL) -1β and tumor necrosis factor (TNF)-α. The tissue protein expression levels of IL-1β, TNF-α, β-catenin, E-cadhein, ZO-1 and Occludin were measured by Western blot.In vitro, alveolar type Ⅱ epithelial cells (MLE-12) were cultured and divided into 3 groups: C-control group, EXO-control-induced group and EXO-LPS-induced group. The tissue protein expression levels of IL-1β, TNF-α, and Occludin were measured by Western blot after 12 h.

The two samples of C-EXO group and LPS-EXO group was proved to be exosomes. Under a light microscope, the lung tissue of EXO-LPS group showed inflammatory cell infiltration, hemorrhage, interstitial and alveolar edema, and the thickness of alveolar septum. The tissue protein levels of IL-1β and TNF-α in EXO-LPS group were obviously higher than the control group, EXO-control group (1.331±0.203 and 0.274±0.018, 0.892±0.074; 0.800±0.096 and 0.596±0.025, 0.441±0.061; allP<0.05). While the tissue protein levels of Occludin showed the opposite phenomenon (0.251±0.021 and 0.862±0.029, 0.453±0.013; allP<0.05).In vitro, Compared with the C-control group and the EXO-control-induced group, the expression levels of IL-1β and TNF-α increased significantly in the EXO-LPS-induced group (0.900±0.033 and 0.320±0.030, 0.661±0.028; 0.739±0.045 and 0.151±0.024, 0.360±0.037; allP<0.05). whereas the protein levels of Occludin expression were reversed in MLE-12 (0.585±0.082 and 0.941±0.090, 0.732±0.083; allP<0.05).

Exosomes derived from LPS-induced RAW264.7 can induced the acute lung injury by affecting barrier function, which probably is related to the low degree of Occludin in alveolar type Ⅱ epithelial cells.

To establish a canine model of slow transit constipation (STC), and to test the changes in defecation, gastrointestinal transit time and pathology sections.

Baseline information was measured in 8 beagle dogs, and these dogs were randomly divided into the control group and the model group. The dogs in model group were given a diet of canned meat, as well as a combination of compound diphenoxylate and alosetron hydrochloride for 5 weeks. Dogs in control group were given normal diet with no special intervention. Stool frequency and consistency were observed and recorded daily, and the gastrointestinal transit time (GITT) were measured every week. All animals underwent the midline laparotomy and the colonic tissues were taken from the rectosigmoid colon, then investigated by light microscopy, electron microscopy, and immunohistochemistry to evaluate changes of protein gene product 9.5(PGP9.5), synaptophysin and c-kit between two groups.

8 beagle dogs underwent all experiment items successfully.Both of the stool frequency and scores of stool consistency decreased in model group(F=6.568, P=0.043; F=25.954, P=0.002). GITT delayed in model group(F=42.573, P=0.001). After 5 weeks of intervention, in the model group, the myenteric neurons and interstitial cells of Cajal showed damage such as swelling of mitochondria under electron microscopy, and both of the PGP9.5 and synaptophysin integrated option density of rectosigmoid colon were decreased (t=3.471, P=0.013; t=2.506, P=0.046)under immunohistochemistry. The c-kit integrated option density showed no statistically significant differences between two groups(t=1.709, P=0.138).

The canine model of STC which was consistent with clinical symptoms and pathological changes was successfully established, and it can be used to observe and evaluate the therapeutic effect of electrical stimulation, surgery and so on.

To observe the effects of mulberry leaf polysaccharide (MLP) on insulin-like growth factor 1 (IGF-1) and insulin-like growth factor blinding protein 3 (IGFBP-3) as well as the expression of IGF-1 and IGFBP-3 mRNA in the kidney of type 1 Diabetic Nephropathy (DN) rats, and to investigate its therapeutic effects and underlying mechanisms.

Type 1 DN rat model was established by intraperitoneally injecting streptozocin (STZ). SD rats were randomly divided into the control, model, insulin and MLP groups, with eight rats in each group. Rats in MLP group were given orally with MLP 200 mg/kg daily for 8 weeks and insulin group rats were given subcutaneously injection of short acting insulin 1 U daily for 8 weeks. The changes in body weight, blood and urine parameters were recorded. Extracellular matrix (ECM) was calculated. The contents of IGF-1 and IGFBP-3 in blood serum were evaluated by enzyme-linked immunosorbent assay (ELISA). The mRNA expressions of IGF-1 and IGFBP-3 in the kidney were evaluated by fluorescence quantitative PCR.

Compared with rats in control group, blood glucose, triglyceride, total cholesterol, low density lipoprotein, very low density lipoprotein, 24 h urine protein, serum creatinine and urea nitrogen in the model group rats were significantly increased (all P<0.01), and these parameters of MLP group were significantly lower than the model group (allP<0.01). The contents of IGF-1 and IGFBP-3 in the blood serum of the model group were significantly higher than those in the control group (bothP<0.001), while in the MLP group they were lower than the model group[IGF-1: (0.777±0.018) ng/ml vs (0.864±0.022) ng/ml,P<0.001; IGFBP-3: (0.759±0.016) ng/ml vs (0.846±0.021) ng/ml,P<0.001]. The mRNA expressions of IGF-1 and IGFBP-3 in the kidney of the model group were significantly higher than those in the control group (bothP<0.001), while in the MLP group they were lower than in the model group (IGF-1: 1.450±0.032 vs 1.810±0.090,P<0.001; IGFBP-3: 1.684±0.018 vs 1.968±0.044,P<0.001). Compared with the model group rats, there were fewer pathological changes of kidney in MLP group rats.

MLP has a certain therapeutic effect on DN, which may be achieved by decreasing the contents of IGF-1 and IGFBP-3 in the blood serum and down-regulating the over-expression of IGF-1 and IGFBP-3 mRNA in the kidney.

A 99-year-old male was admitted to the hospital on February 20, 2017 due to "dyspnea for 7 days and unsteady standing for 3 days". 7 days ago, the patient had dyspnea without obvious trigger, accompanied by cough and white phlegm, and phlegm sounds could be heard, denying fever and chest pain. Three days ago, the patient had unstable standing, tilted to the left side, difficulty in walking, accompanied by urinary incontinence, unclear speech, choking, denial of fall and disturbance of consciousness. The patient came to the emergency department of Peking Union Medical College Hospital on February 20, 2017, with a heart rate of 120 beats/min, blood pressure of 126/63 mmHg (1 mmHg =0.133 kPa), finger oxygen saturation of 82% (natural state), and blood test routine: white blood cell count 9.4×10⁹/L, neutrophil percentage 88.3%↑, hemoglobin 111 g/L↓, platelet count 159×10⁹/L↓; Liver and kidney function: alanine aminotransferase 30 U/L, total bilirubin 12.3 μ mol/L, creatinine 199 μ mol/L↑, urea nitrogen 22.54 mmol/L↑, serum potassium 4.7 mmol/L, serum calcium 2.09 mmol/L↓ (2.13~2.70 mmol/L), hypersensitive C-reactive protein (hsCRP) 332 mg/L↑; Coagulation index was normal; Arterial blood gas analysis: pH 7.43, partial pressure of carbon dioxide 38 mmHg, partial pressure of oxygen 54 mmHg↓, bicarbonate 25.2 mmol/L. In the emergency department, the diagnosis of "acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and cerebrovascular disease is not excluded" is considered and admitted to the ward. Since the onset of the disease, the patient's spirit and appetite are poor, and wheezing is obvious, which affects sleep. Stools as usual, urine is difficult to control, and urine color and urine volume are still normal. Past history: hypertension, atrial fibrillation for 20 years, regular use of clobiglor, metoprolol tartrate, normal blood pressure, heart rate control is acceptable; He was diagnosed with chronic obstructive pulmonary disease (COPD) for 13 years, and was regularly controlled by salmeterol and ticasone aerosol. Acute exacerbations often occurred in winter, and he was hospitalized many times for this. Regular physical examination revealed liver cysts, gallbladder stones, renal cysts, prostatic nodules, and atherosclerosis. Relevant departments were followed up regularly, and there was no special treatment yet. The last physical examination was in September 2016, when serum creatinine was 80 μ mol/L, and no interstitial lesions were found on lung CT (FIG. 1A)。 Deny history of diabetes, deny history of viral hepatitis, no history of blood transfusion, deny history of food and drug allergies. Long-term history of heavy smoking, quitting smoking at age 69; Not alcoholic. The history of marriage and childbirth and family history are no different.

The patient, a 17-year-old male, was admitted to hospital on June 14, 2017 due to "thickened skin of the head and face and acrohypertrophy of the limbs for more than 2 years". Two years ago, the patient developed thick skin and increased wrinkles on the head and face, accompanied by greasy facial skin and hair, and the symptoms progressively aggravated; At the same time, acral hypertrophy of the limbs occurred, mainly thickening of the ends of fingers and toes. The parents were not intimate married, and there were no similar cases and other familial genetic history in the family. Physical examination: Height 182 cm, weight 71.0 kg, BMI 21.4 kg/m²Blood pressure 134/79 mmHg (1 mmHg =0.133 kPa). The skin of the head and face is thick and greasy, with enlarged pores, acne can be seen on the facial skin, and the skin of the head forms deep folds, which are cerebral gyrus-shaped; The ends of the fingers are thickened, showing pestle-shaped fingers, and both ankle joints are thick (Figure 1)。 No other positive signs were seen.

The pathogenesis of bronchial asthma (asthma for short) is very complex and has not been fully elucidated so far. At present, scholars from all walks of life generally accept that the pathogenesis of asthma is generalized as airway immune-inflammatory mechanism, neuromodulatory mechanism and their interaction, among which airway immune-inflammatory mechanism includes airway inflammation, airway hyperresponsiveness and airway remodeling.

Gallbladder cancer refers to a malignant tumor that occurs in the gallbladder (including the bottom, body, neck and cystic duct of the gallbladder), and is the most common malignant tumor of the bile duct system. The incidence of gallbladder cancer in China accounted for 0.4% ~3.8% of bile duct diseases in the same period, ranking sixth in the incidence of digestive tract tumors in China. The prognosis of gallbladder cancer is poor, and the 5-year survival rate of patients is only 5%^[1]。 There are significant differences in the geographical, ethnic and ethnic distribution of the incidence of gallbladder cancer worldwide, which suggests that genetic and environmental factors play an important role in the occurrence and development of gallbladder cancer^[2]。 With the rapid development of high-throughput technology in recent years, the research of molecular biology on tumors is increasingly in depth, and gallbladder cancer is one of them. At present, there is no breakthrough in the diagnosis and treatment of gallbladder cancer. It is generally recognized that in order to really improve the diagnosis and treatment of gallbladder cancer, it is necessary to fully study its molecular biological characteristics. The present situation and prospect of molecular biology research in gallbladder cancer are summarized as follows.