2016年 · 第96卷第14期

After the rapid development of recent decades, the training and accumulation of laboratory medicine personnel has been greatly improved. The training of talents in the whole industry not only pays attention to the study of laboratory knowledge system and the accumulation of laboratory medicine experience, but also pays special attention to the combination of laboratory and clinical practice, which greatly improves the knowledge service ability of laboratory medicine talents, and grows a group of professional laboratory talents with rich laboratory medicine experience and good communication ability with clinical disciplines. Laboratory medicine has not only cultivated undergraduate students with solid professional knowledge, but also cultivated a large number of master's and doctorate students. Since the standardized training of resident physicians in China in 2005, the standardized training of laboratory physicians has been incorporated into the national unified training system. At present, the structure of the elderly, middle-aged and young people in the laboratory medicine discipline is far better than in the past. It is no longer the state of low academic qualifications and few talents that people usually think, but a clinical professional discipline that integrates the advantages of medicine, teaching and research. It can not only complete the work before and during the analysis, but also undertake the work after the analysis, so that the laboratory medicine knowledge service system can be continuously improved and expanded.

The incidence of sexually transmitted diseases is increasing, and the prevention and treatment of sexually transmitted diseases is a problem that cannot be ignored in the world. In 2006, the State Council promulgated the Regulations on the Prevention and Control of AIDS^[1]In 2012, the Ministry of Health revised and promulgated the Administrative Measures for the Prevention and Control of STDs^[2]European and American countries have also formulated guidelines for STD management, diagnosis and treatment, etc.^[3,4]。 Laboratory diagnosis is the gold standard of STD diagnosis, and laboratory report is the decisive basis of clinical diagnosis. It is an inevitable trend to improve the quality of laboratory medicine to formulate a scientific and complete laboratory diagnosis report model. In order to ensure the accuracy and correctness of STD diagnosis and give full play to the role of laboratory medicine in the diagnosis and treatment of STD, the Expert Committee of STD Laboratory Medicine of Laboratory Physicians Branch of Chinese Medical Doctors Association referred to the Regulations on AIDS Prevention and Control promulgated by the State Council^[1]Administrative Measures for the Prevention and Treatment of STDs issued by the Ministry of Health^[2]National Clinical Laboratory Operating Procedures^[5]Infectious Diseases^[6]"Medical Microbiology"^[7]And related literature at home and abroad, and combined with the latest progress of STD laboratory medicine at home and abroad and the current situation of clinical laboratory and diagnosis at home, the expert consensus on STD testing and diagnosis report model was formulated.

Alzheimer's disease (AD) is a common progressive neurodegenerative disease, which is characterized by memory impairment, aphasia, apraxia, agnosia, impaired visual and spatial skills, executive dysfunction, and personality and behavior changes. The early symptoms lack characteristics^[1,2]。 There is no uniform standard for the detection and diagnosis of AD at home and abroad. Alzheimer's Disease Laboratory Medicine Expert Committee of Laboratory Physicians Branch of Chinese Medical Doctors Association according to the latest AD diagnostic standards at home and abroad, some authoritative research reports, etc.^[3,4,5,6,7]The AD test (auxiliary) diagnostic path was developed. Based on this path, this expert committee reached an expert consensus on the diagnostic reporting model of AD testing.

The laboratory diagnosis report is a report issued by the laboratory physician that has guiding value for clinical diagnosis, differential diagnosis and treatment, and can improve the clinical service ability and clinical diagnosis and treatment ability of the laboratory. The examination and diagnosis reports are relatively perfect in foreign medical institutions, but they are uneven in China. This consensus aims to standardize the examination report mode and lay the foundation for mutual recognition of examination reports among hospitals. Common intestinal infectious diseases include acute enteritis, viral diarrhea, Clostridium difficile infection and cholera caused by bacteria and their toxins, viruses, fungi and parasites. Clostridium difficile has become one of the main pathogens of nosocomial intestinal infections^[1,2,3,4]Clostridium difficile infection (CDI) clinically manifests as diarrhea, pseudomembranous colitis, toxic megacolon, and even death^[5,6,7,8,9]。 The main risk factors for CDI include recent use of antimicrobial drugs, and other risk factors include old age, hospitalization, immunosuppression, gastrointestinal and emergency surgery, etc^[6]。 In recent years, the incidence, recurrence and mortality of CDI have been increasing significantly^{[2,10,11,12,13]}So timely and accurate laboratory diagnosis is very necessary. Taking Clostridium difficile intestinal infection as an example, this paper aims to standardize the examination and diagnosis report mode of Clostridium difficile intestinal infection, and provide laboratory basis for clinical effective diagnosis and treatment of Clostridium difficile intestinal infection.

Clinical genetic testing has covered tumors, genetic diseases, blood diseases, infectious diseases, neuropsychiatric diseases, organ transplantation, birth defects, individualized drug therapy and other fields^{[1,2,3,4,5,6,7,8]}Clinical genetic test diagnosis reports have important reference value for body susceptibility assessment, disease diagnosis, prognosis, treatment monitoring, genetic counseling, health management and family birth plan formulation. Therefore, the clinical genetic test diagnostic report should be clear, concise, accurate and reliable, and have sufficient explanation, credibility and authority. The Molecular Diagnosis Expert Committee of Laboratory Physicians Branch of Chinese Medical Doctors Association organized relevant experts to discuss the clinical genetic test diagnosis report model and reached the following consensus.

Tumor molecule targeted therapy is a therapeutic mode in which specific genes or expression products of genes expressed by tumor cells but less expressed or not expressed by normal cells are used as therapeutic targets to kill tumor cells to the greatest extent and harm normal cells less. Human epidermal growth factor receptor 2 (HER2) is an important prognostic indicator in breast cancer patients and a major predictor of anti-HER2 drug therapy. As the first humanized monoclonal antibody against HER2, the clinical application of trastuzumab has significantly improved the prognosis of HER2-positive breast cancer patients, changed the diagnosis and treatment mode of breast cancer, and is an important breakthrough in targeted therapy of breast cancer. In recent years, new anti-HER2 therapeutics including lapatinib, pertuzumab, and Kadcyla (T-DM1) have been emerging, further improving the prognosis of HER2-positive breast cancer patients. In order to better promote the standardized HER2 standard detection, accurately assess patient prognosis, give full play to the clinical efficacy of HER2 targeted drug therapy, reduce treatment blindness, and benefit more patients. Member of the expert group of the breast cancer professional committee of China Anti-cancer Association, according to the "Expert Consensus on Clinical Diagnosis and Treatment of HER2-positive breast cancer" published in 2012^[1], combined with the research results at home and abroad, and updated as follows after expert discussion.

A 62-year-old male was admitted with high fever for 7 d. The patient had fever after catching cold, with a maximum body temperature of 41℃, accompanied by dry cough and fatigue. After intravenous treatment with etilmicin for 1 d, cephalosporins for 3 d and meropenem for 1 d in another hospital, his body temperature did not drop, and he developed transient delirium. He was admitted to our hospital with "community-acquired pneumonia". Previous diabetes for 7 years. Physical examination: body temperature 39.0 ℃, pulse 101 beats/min, blood pressure 140/80 mmHg (1 mmHg =0.133 kPa), 18 breaths/min. Sleepiness, a little wet rales can be heard in the left lung, but no obvious abnormalities are seen. Auxiliary examination blood routine: white blood cells 5.7×10⁹/L, neutrophils 75.7%; Urine routine: occult blood + +, protein + + +, glucose + +, 1.15 white blood cells/high power field; Blood gas analysis : pH 7.5, PaO₂65 mmHg, PaCO₂30 mmHg, HCO₃^-23.4 mmol/L; Blood CRP 125 mg/L, alanine aminotransferase 107 U/L, aspartate aminotransferase 105 U/L, blood glucose 9.46 mmol/L, potassium 3.74 mmol/L, sodium 126 mmol/L, D-dimer 977 μ g/L, cardiac enzyme, troponin I, renal function and blood amylase were not abnormal; Mycoplasma antibody, Legionella antibody, Legionella urine antigen and blood bacteria culture were all negative. Lung CT showed scattered consolidation in large ground glass shadows in the upper lobe of the left lung (FIG. 1A)。 After admission, the patient was given intravenous anti-infection and symptomatic supportive treatment with moxifloxacin, and the body temperature dropped to normal 72 hours after admission. Moxifloxacin was administered intravenously for 8 days and sequentially orally for 4 days. All indexes returned to normal after re-examination, and the pulmonary lesions were obviously absorbed compared with before (FIG. 1B), meeting the discharge criteria for community-acquired pneumonia (CAP). Treatment was not continued after discharge, and the body temperature rose again to 37.6 ℃ after 3 days. The results of Legionella antibody detection (indirect immunofluorescence method-German EU reagent) in the serum sample of the patient before discharge showed that the antibody of Legionella mickedei was positive with a titer of 1:320, and the patient was diagnosed as Legionella mickedei pneumonia. After stopping the drug, the patient's condition recurred, and he was instructed to continue taking moxifloxacin orally, and his body temperature dropped again. The overall course of treatment reached 3 weeks, and there was no recurrence.

The incidence of inflammatory bowel disease (IBD) has been increasing gradually in the past 50 years. Crohn's disease (CD) and ulcerative colitis (UC), as the two most common IBDs, have complicated clinical manifestations, low cure rate and easy recurrence and disability, which seriously affect the quality of life. It is agreed that the immune response to microbial abnormalities in the gut of genetically susceptible hosts is associated with IBD pathogenesis under the influence of environmental factors. A large number of literatures have reported that bacteria play an important role in the pathogenesis of IBD^[1]However, due to the relatively small number of fungi in the digestive tract and the limitation of experimental techniques, they have not received enough attention in previous studies. In recent 10 years, the development of high-throughput sequencing technology and bioinformatics has made it possible to explore the relationship between digestive tract fungi and IBD.

Allogeneic composite tissue transplantation is undoubtedly an ideal method for repair and reconstruction surgery to repair large area and special tissue defects (limb, face, penis, etc.). However, long-term high-dose immunosuppressive therapy after transplantation often leads to complications such as infection, diabetes, and even malignant tumor, which becomes an obstacle to the clinical development of allogeneic composite tissue transplantation^[1,2,3]。 Therefore, it is an urgent topic to explore the methods of inducing immune tolerance to reduce the dosage of immunosuppressant^[3]。 In recent years, many studies have shown that mesenchymal stem cells (MSCs) have immunomodulatory effects in animals in vitro and in vivo^[4,5]Some immunosuppressive effects were also observed with MSCs after clinical allotransplantation^[6]。