Literature review to build optional indexes pool,Delphi method to screen indexes,fuzzy model used to calculate the weight,for building such a system.An index system centering on public wellbeing is thus constructed,comprising three level 1 indicators,six level 2 indicators,40 level-3 indicators.The system can satisfactorily reflect the vision of county-level public hospitals reform,and showcase outcomes of such a reform.

Objectives To evaluate methods to diagnose Budd-Chiari syndrome with inferior vena cava (IVC) thrombosis.Methods 31 cases underwent phlebography, 28 cases received color Doppler sonography preoperatively. Radical thrombectomy was carried out in 28 cases. Results IVC thrombi was found by phlebography in 24 cases, and by color Doppler sonograhy in 25 cases. There was no intraoperative death, nor acute pulmonary embolism.All patients were discharged uneventfully. Follow-up of 6 to 80 months found recurrence in 3 cases.Conclusions Large or lateral thrombi can be easily diagnosed by phlebography. Fresh or floating thrombi often missed by phlebography could be rushed out by blood stream at the time IVC was incised.The thrombi adhered to the IVC wall could be taken out with large balloon catheter or manually.

Objective To evaluate endovascular treatment of segmental occlusive Budd-Chiari syndrome(BCS). Methods We retrospectively analyzed the clinical data of segmental occlusive BCS of 45 cases. Inferior vena cava (IVC) puncture, percutaneons transluminal angioplasty (PTA) and stent implant were performed, respectively. Three-dimensional digital subtraction angiography (3D-DSA) was used to evaluate the IVC lesion from multi-angles and to identify the best work angle in complex BCS cases during endovascular treatment. Results IVC puncture and dilation was successful in 43 cases. The pressure of IVC decreased from (35. 3 ± 3.9)cm H2O to (9.5 ± 2. 0) cm H2O (t = 43. 68, P < 0. 01). The puncture failed in 2 cases and the patients were converted to veno-atrial graft shunt. Acute pericardial tamponade developed during PTA in one case. Postoperatively 35 cases were followed-up for 3 months to 46 months and the follow-up rate was 77. 8%. IVC stent thrombosis was identified in one case necessitating veno-atrial graft shunt 15 months post-operatively. There were no stent migration and hepatic venous obstruction in the remaining cases. The case of pericardial tamponade was cured and discharged after IVC repair. Symptoms disappeared except for intercostal neuralgia during 6 months follow-up. There were no pulmonary embolism and death. Conclusions Good medium and long term result could be achieved after endovascular treatment of segmental occlusive BCS. 3D-DSA is helpful for endovascular treatment of BCS.

Research-oriented study is a comprehensive learning method focusing on the experimental process deriving from a main issue.Given our clinical teaching experience in years,we incorporated the research-oriented studies into the undergraduate Clinical Medicine course for grade 2009,integrating the trait of the clinical skills education and our local professional training objectives.In the studies,students selected their own topic,designed and did their experiments,searched for the information,processed and analyzed the experiment result and finally completed the thesis.Practice showed that after the strict implementation of research learning plan,students' learning interest,innovative thinking,practical skills,research ability and cooperation spirit all significantly enhanced.

Objective To investigate the effect of resistance nodulation division (RND) efflux pumps on reduced susceptibility to tigecycline in carbapenem-resistant Acinetobacter baumanii.Methods Totally 631 isolates of Acinetobacter baumanii were collected from 16 hospitals in 7 provinces in 2010.Genes oxa-51 and oxa-23 were detected by PCR method,and the ST profiles were determined by multilocus sequence typing (MLST).The disk susceptibility assay was used to determine the inhibition zone diameters of β-lactams,aminoglycosides,macrolides,tetracyclines,carbapenems,tigecycline and polymyxin.The minimum inhibitory concentration (MIC) of tigecycline was determined by E-test in strains with inhibition zone diameters ≤ 12 mm on tigecycline.The expression of operon genes adeB,adeG and adeJ was determined with efflux pump inhibitor NMP (N-methyl-2-pyrrolidone) for detection of efflux pump inhibitor phenotype.The isolates of Acinetobacter baumanii which were resistant both to tigecycline and carbapenems and with the inhibited phenotype of efflux pump inhibitor were collected as the experiment group,the isolates which were susceptible to tigecycline but resistant to carbapenems were collected as the control group,and ATCC 19606 was used as the reference strain.The expressions of adeABC,adeFGH and adeIJK were quantified by q-PCR at the transcriptional level.Genes adeR,adeS and adeL were amplified and sequenced using PCR method to find polymorphic locus and insertion sequences.Results There were 32 isolates of Acinetobacter baumanii with reduced susceptibility to tigecycline and carbapenem-resistant.Eight isolates were with the inhibited phenotype by efflux pump inhibitor.And 4 strains which were susceptible to tigecycline but resistant to carbapenems were selected as the control.The expressions of adeABC in A518,Z1219 and A527 of experiment group were 13-fold,5-fold and 7-fold higher than reference strain ATCC19606,respectively.The expressions of adeFGH and adeIJK were up-regulated slightly in some isolates.Transcript of adeABC was not found in control group strains A207 and A1731,and the expressions of adeABC,adeFGH and adeIJK were not up-regulated in other isolates.The single nucleotide polymorphism (SNP) was detected in adeR (E220K) and adeS (A130D),respectively.ISAab1 insertion sequence was identified in adeS of adeABC-over expressed isolates.No mutation was found in adeL.Conclusion High expression of adeABC pump may play an important role in tigecycline resistance in carbapenem-resistant Acinetobacter baumannii,mainly due to the insertion of ISAba1 sequence in its regulator gene adeS,but other mechanism of tigecycline resistance may not be excluded.

Objective To evaluate the effect of endovascular stenting combined with external constriction valvuloplasty of superficial femoral vein for the treatment of Cockett syndrome. MethodsForty two cases of Cockett syndrome with femoral veins reflux were treated with iliac vein stent implantation or venoplasty, and superficial femoral veins were constricted with ePTFE graft patch at the level of the first valves. ResultsThe iliac veins were all patent after stent implantation. A follow up of 8 to 45 months revealed that limb swelling disappeared in 38 cases with no varicose. Slight limb swelling was left over in 3 cases. Stent thrombosis developing in one case two months later subsided after a successful thrombolysis. ConclusionThe procedure is mini invasive, safe and effective for the treatment of Cockett syndrome.

Objective To evaluate the role of temporary arteriovenous fistula(AVF) in the treatment of acute deep venous thrombosis(DVT) with Amplatz thrombectomy device(ATD). Method Seventy-six cases of acute DVT underwent mechanical thrombolysis with ATD, in which 50 cases received a temporary AVF after interventional therapy. Result One case died of pulmonary embolism. Ipsilateral limbs swelling subsided and pain alleviated in the remaining 72 cases since first post-operative day. Secondary contralateral DVT developed in 2 cases on the 7th post-operative day. The patency of temporary AVF was 86%(43/50). Sixty-eight cases (90.7%) were followed-up for 10~42 months post-operatively with limbs swelling completely subsided in 59 cases and ameliorated in 6 cases. Secondary inferior vena cava thrombosis developed in one case and 2 cases died of unrelated diseases. Conclusion Temporary AVF increases blood flow volume and blood velocity in the thrombectomized vein segment to improve the vein patency, hence is a valuable auxiliary means of ATD.

Objective This study aimed to evaluate the clinical significance of detecting cytokine expression with Crohn's disease(CD) by Luminex liquid chip.Methods A total of 76 patients with CD and 50 healthy volunteers as healthy control group were recruited in this study.The expression of cytokines IL-2,IFN-γ,TNF-α,IL-4,IL-6,IL-10 and IL-17A were detected by Luminex liquid chip according to the instruction of MILLIPLEX MAP Kit.Enzyme-linked immunosorbent assay(ELISA) was used to detect the levels of anti-saccharomyces cerevisiae antibodies(ASCA).Then the relationship and differences among these groups were analyzed.Results Except IL-17A,the level of IL-2,IFN-γ,TNF-α,IL-4,IL-6,IL-10 was higher in the CD group than those in control group.The serum levels of IFN-γ,TNF-α and IL-6 in patients with active stage of CD group were significantly higher than those with remission stage and healthy control group.The level of TNF-α and IL-6 in moderate and severe stages were higher than those in slight stage.The serum level of ASCA had significant difference between CD group and control group.Compared with ASCA negative group,the ASCA positive patients have a higher level of IL-6 and TNF-α.ConclusionThe cytokines like IL-6 and TNF-α is correlated with CD severity,which is important for inflammatory activity and progression of CD.Altogether,these results demonstrated that the dynamic change of cytokines had a clear relativity in stage of CD,which is very imperative for diagnosis and clinical appraisal of CD.

Objective To establish the biological reference interval of procalcitonin(PCT) applicable for children in Chongqing.Methods Serum PCT level were detected in 120 healthy children with age from 0 to 16 years, including 73 cases of male and 47cases of female children, by using by Maglumi2000 plus PCT analysis system.All data was evaluated according to EP28-A3c document to establish the biological reference interval.Results Data of PCT levels were with non-normal distribution, and without statistical difference between children of different ages and genders(P>0.05).The biological reference interval of PCT was less than or equal to 0.038 μg/L.Conclusion It might be important to establish a usefully biological reference interval in different laboratories with relative detection system, especially for children.

Objective To evaluate the safety and effectiveness of modular flexible ureteroscope combined with holmium laser lithotripsy in treatment of bilateral renal calculi smaller than 1.5 cm. Methods Clinical data of 24 patients from August 2013 to March 2016 using a modular flexible ureteroscope in treatment of bilateral renal calculi smaller than 1.5 cm was retrospectively analyzed. The clinical data included operation time, stone clearance rate and occurrence of complications. Results All the 24 patients were successfully placed in bilateral ureteral sheath soft lenses, and enter lithotripsy smoothly. The operation time was 40~105 (71.0 ± 21.5) min. Lithotripsy success rate was 100.00% and 1 month stone clearance rate was 89.50% (43/48), 5 sides with residual stones diameter 7~10 mm, were given extracorporeal shock wave lithotripsy, 3 months stone clearance rate was 93.75% (45/48), 3 sides with residual stones 5~7 mm located lower calyx accepted regular review. 4 cases with postoperative fever were cured after anti-inflammatory treatment. There was no bleeding, ureteral perforation, postoperative avulsion, renal dysfunction, septic shock and other complications. Conclusion Modular flexible ureteroscope lithotripsy in treatment of bilateral renal calculi smaller than 1.5 cm is safe and effective.