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Reference intervals are very important for clinical laboratory diagnosis and physiological evaluation. 1 The accuracy and applicability of such reference intervals directly affect the efficient diagnosis and treatment of the disease. Hematology is commonly used to assess health and disease states associated with blood disorders, infectious diseases, and the immune system. 2 However, suitable age-and sexspecific reference intervals of hematologic analytes of children are often lacking or incomplete. Children are not small adults, and consensus guidelines for adults may not apply to children. 3 Hematological reference intervals are affected by many factors such as the location of the population, economic background, lifestyle habits, and dietary structure. While it is inappropriate to randomly use the reference intervals established in other countries, there are no standard pediatric reference intervals for China. Therefore, it is necessary to establish a hematological reference range for Chinese children. The purpose of this study was to establish the age-and Abstract Introduction: Reference intervals for pediatric laboratory tests need to be interpreted in the context of age-and sex-dependent dynamics. However, few reference intervals for healthy ethnic Han Chinese children have previously attempted to establish using large sample sizes. As such, there are no national hematological standards in China for pediatric reference intervals. Methods:We used a direct method to enroll a total of 2164 healthy 1-to 7-year-old children from Henan province. Hematological reference intervals were established by analyzing venous blood sample data on 17 hematologic analytes. The reference values for different ages and sexes were estimated using both parametric methods (mean ± 2 SD) and nonparametric methods (2.5-97.5th percentiles). Results:We provided reference intervals for 17 hematologic analytes including red blood count, hemoglobin concentration, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width, white blood count and differential count as well as platelet count and related parameters. Conclusion:We established age-and sex-specific reference intervals that can provide more evidence-based guidance for the diagnosis and treatment for pediatric diseases. Our findings provide the basis for the next step in establishing national blood testing standards. K E Y W O R D Schildren, hematologic analytes, reference interval, venous blood

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Aims Physiological changes that occur during pregnancy can influence biochemical parameters. Therefore, using reference intervals based on specimens from non-pregnant women to interpret laboratory results during pregnancy may be inappropriate. This study aimed to establish the essential reference intervals for a range of analytes during pregnancy. Methods A cross-sectional study was performed in 13,656 healthy pregnant and 2634 non-pregnant women. Fifteen biochemical measurands relating to renal and hepatic function were analysed using an Olympus AU5400 analyzer (Olympus, Tokyo, Japan). All the laboratory results were checked for outliers using Dixon's test. Reference intervals were established using a non-parametric method. Results Alanine aminotransferase, aspartate aminotransferase, albumin, cholinesterase, creatinine, direct bilirubin, gamma-glutamyl transpeptidase, total bilirubin, total bile acid and total protein showed a decrease during the whole gestational period, while alkaline phosphatase and uric acid increased. Urea nitrogen, β-microglobulin and cystatin-C fell significantly during the first trimester and then remained relatively stable until third trimester. Reference intervals of all the measurands during normal pregnancy have been established. Conclusions The reference intervals established here can be adopted in other clinical laboratories after appropriate validation. We verified the importance, for some measurands, of partitioning by gestational age when establishing reference intervals during pregnancy.

Several studies have explored the relationship among traditional semen parameters, sperm DNA fragmentation (SDF), and unexplained recurrent miscarriage (RM); however, the findings remain controversial. Hence, we conducted a meta-analysis to explore the relationship among traditional semen parameters, SDF, and unexplained RM. Multiple databases, including PubMed, Google Scholar, MEDLINE, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI), were searched to identify relevant publications. From the eligible publications, data were extracted independently by two researchers. A total of 280 publications were identified using the search strategy. According to the inclusion/exclusion criteria, 19 publications were eligible. A total of 1182 couples with unexplained RM and 1231 couples without RM were included in this meta-analysis to assess the relationship among traditional semen parameters, SDF, and unexplained RM. Our results showed that couples with unexplained RM had significantly increased levels of SDF and significantly decreased levels of total motility and progressive motility compared with couples without RM, although significant differences were not observed in the semen volume, sperm concentration, and total sperm count between couples with and without RM. The SDF assay may be considered for inclusion in evaluations of couples with unexplained RM.

Established reference intervals (RIs) of coagulation parameters generally based on the general population are not applicable to specific women. In order to accurately evaluate the coagulation status of non-pregnant women and pregnant women, specific RIs should be established. Our study recruited 465 non-pregnant women and 1972 pregnant women aged 20–45 years. Eight tests including antithrombin (AT), protein C (PC), free protein S (fPS), lupus anticoagulant (LA), D-dimer, fibrin/fibrinogen degradation products (FDP), coagulation factor VII (FVII), and factor VIII (FVIII) were performed on ACL TOP automated coagulation instrument. The RIs for these tests were established in non-pregnant and pregnant women at different gestational weeks. Compared to the non-pregnant group, the medians of AT and fPS were lower, while the medians of PC, LA normalized ratio, D-dimer, FDP, FVII, and FVIII were higher. During pregnancy, AT and fPS activity showed a decreasing trend, with the increase of gestational age. PC activity, LA normalized ratio, D-dimer concentrations, FDP concentrations, FVII, and FVIII activity presented an increasing trend, with the increase of gestational age. The non-pregnant women-specific RIs and the gestational age-specific RIs of AT, PC, fPS, LA normalized ratio, D-dimer, FDP, FVII, and FVIII needed to be established for accurate clinical diagnoses.

Studies suggest that semen quality is declining globally, however, the debate remains open due to the possible effects of ethnic and geographical differences. This study aimed to explore whether semen quality of sperm donor candidates has changed in Henan Province, China from 2009 to 2019. In this retrospective study, we included 23,936 sperm donor candidates who were recruited by the Henan Human Sperm Bank of China between 2009 and 2019. To minimize intra-individual bias, we included only the first ejaculate provided by each sperm donor candidate. The following parameters were measured: volume, sperm concentration, total sperm count, progressive motility, and total motility. After adjustment for age, body mass index (BMi), and sexual abstinence duration, we evaluated changes in main semen parameters over time using multiple linear regression analyses. The sperm concentration decreased from 62.0 million/mL in 2009 to 32.0 million/mL in 2019 (P < 0.001), with an average annual rate of 3.9%. The total sperm count decreased from 160.0 million in 2009 to 80.0 million in 2019 (P < 0.001), with an average annual rate of 4.2%. The progressive motility decreased from 54.0% in 2009 to 40.0% in 2019 (P < 0.001), with an average annual rate of 2.5%. The total motility decreased from 60.0% in 2009 to 46.0% in 2019 (P < 0.001), with an average annual rate of 1.9%. Our results indicated that semen quality among sperm donor candidates had decreased during the study period in Henan Province, China. The semen analysis is the most important and the most widely used clinical laboratory test to evaluate male fertility potential. In 2010, the World Health Organization (WHO) criteria had reduced the reference interval of sperm concentration from 20 to 15 million/mL. Concerns about a global decline in semen quality have attracted the attention of researchers and the general public alike. There is an ongoing debate on whether semen quality is declining. In 1992, Carlsen et al 1. reviewed 61 studies and found a worldwide decline trend in semen volume and sperm concentration between 1938 and 1991. After that, several studies have reported a decrease in semen quality in Paris 2 , Tours 3 , Marseille 4 , São Paulo 5 , Shandong 6 , Changsha 7 , and South India 8. In contrast, several other studies have reported no significant change in semen quality in Sydney 9 , Malmö 10 , Montevideo 11 , and Copenhagen 12. These discrepancies could be explained by ethnic, geographical, lifestyle, environmental and between-center variations 13-16. To accurately evaluate changes in semen quality, ethnic, geographical, and between-center variations must be taken into account 15,16. A single-center retrospective investigation of possible changes in semen quality, using the same equipment and based on a large population over a long period of time, has been recommended to minimize these confounding factors 17,18. Based on this, laboratories must conduct their local studies over a certain period of time. Large and long-term population studies on time trends in se...

STUDY QUESTION Is there a relation between the characteristics of potential sperm donors and the acceptance rate of these potential donors? SUMMARY ANSWER A relatively higher acceptance rate was observed for potential sperm donors who were aged ≤ 35 years, were married, had children, and who had received higher education, and acceptance rates were also higher during spring and winter than summer and autumn. WHAT IS KNOWN ALREADY Recruiting donors to a sperm bank program is difficult and slow owing to the high rates of rejection and dropout. STUDY DESIGN, SIZE, DURATION A total of 24040 potential sperm donors were screened by the Henan Human Sperm Bank from 2006 to 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Potential sperm donors were recruited using the following baseline requirement: height of 168 cm or taller; age 22-45 years; currently attending or had graduated from high school or above. Men who met the criteria for age, height, and education level were invited for semen quality screening. The acceptable criteria for semen samples included liquefaction time &lt; 60min, volume ≥ 2mL, sperm concentration ≥ 60 × 106/mL, progressive motility ≥ 60%, post-thaw motility ≥ 40%, pre-freezing total motile sperm per vial &gt; 30 × 106/mL, post-thaw total motile sperm per vial &gt; 12 × 106/mL, and freeze-thaw survival rate ≥ 60%. Any potential sperm donors meeting the minimum criteria for acceptable semen quality on two consecutive semen samples were scheduled for clinical assessment, physical examination, and laboratory tests. The reasons for sperm donor rejection were analyzed. The characteristics of accepted and rejected donors were compared using the chi-square test, and multivariate logistic regression analyses were conducted to identify factors associated with the acceptance rate of potential sperm donors and the positive rate of sexually transmitted diseases (STDs). MAIN RESULTS AND THE ROLE OF CHANCE Only 23.38% (5620/24040) of potential sperm donors were accepted. The top four reasons for rejection were suboptimal semen quality (90.27%), STDs (6.26%), dropped out (2.65%), and chromosomal abnormalities (0.35%). The most common reason for the rejection of donors with an STD was a positive test for mycoplasmas (49.05%), followed by hepatitis B virus (27.56%), Chlamydia trachomatis (4.68%), and Escherichia coli (3.03%). n this study, the acceptance rate for men aged ≤ 35 years was significantly higher than that for men aged &gt;35 years (P &lt; 0.05). The acceptance rates were also significantly higher for men with a higher education than for men with lower education, married men than unmarried men, and men with children than men without children (P &lt; 0.05). Moreover, acceptance rates were significantly higher during spring and winter than during summer (P &lt;0.05) but were not significantly higher during autumn than during summer (P &gt;0.05). LIMITATIONS, REASONS FOR CAUTION This study was not performed to analyze the effect of lifestyle habits, such as alcohol consumption and cigarette smoking, on the acceptance rate of potential sperm donors. WIDER IMPLICATIONS OF THE FINDINGS Only a small proportion of potential sperm donors were accepted in this anonymous sperm donor program. New strategies for sperm donor recruitment may be required to improve the acceptance rate. In the future, we may have to target potential sperm donors who are aged ≤ 35 years and who received higher education in order to improve the acceptance rate. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Joint Construction Project of Henan Medical Science and Technology Research Plan under grant number LHGJ20190389. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A