Objective To investigate the diagnostic threshold value and the influencing factors of high‐sensitivity troponin I measurement in the diagnosis of patients with acute myocardial infarction .Methods Collecting 9 236 patients who are the first time hs‐cTnI testing in the internal emergency department of our hospital(including 9 099 patients with non‐AMI and 137 patients with AMI) as participants ,then dividing non‐AMI patients into elder group(>60 years old) and younger group(≤60 years old) ,hs‐cTnI concentrations were compared between the elder and the younger group with different gender .The optimal threshold value of hs‐cT‐nI for acute myocardial infarction was determined by receiver operating characteristic(ROC) curve of AMI patients with different age and gender .Results The hs‐cTnI concentrations of non‐AMI patients in the elder male group were 39 .21 ng/L [(37 .48-40 .93)ng/L] ,which was higher than those of non‐AMI patients in the younger male group 22 .38 ng/L[(21 .16-23 .6)ng/L] and the difference was statistically significant(P<0 .05) ,the same result was seen in the elder female group and the younger female group .The total male group was 31 .26 ng/L [(30 .17 -32 .34)ng/L] ,it was higher than the total female group 26 .8 ng/L [(25 .73-27 .86)ng/L] .According to the ROC curve ,the optimal threshold value for AMI diagnosis was 45 ng/L in total AMI group and 135 ng/L in the elder male group and 45 ng/L in the elder female group ,which was different with the cut off value(120 ng/L) .Conclusion the hs‐cTnI levels were related with age and gender ,it is very important for us to consider these factors when we make the optimal threshold value with our own data .

OBJECTIVE To investigate the prevalence and resistance of extended spectram ?-lactamases(ESBLs) producers in Escherichia coli and Klebsiella pneumoniae.METHODS ESBLs producing strains were screened by double disk test and confirmed by the NCCLS confirmatory test.Susceptibility test to antimicrobial agents was performed by disk diffusion method and analyzed by WHONET 5.3 and Excel.RESULTS The isolated ratio of ESBLs producing E.coli and K.pneumoniae increased from 14% and 15% in 1999 to 30.1% and 30.4% in 2002.Bacteremia caused by the two kinds of ESBLs producers accounted for 30.2% and 30.4%,respectively.ESBLs producing K.pneumoniae and(ESBLs) producing E.coli were 19.8% and 14.0% for outpatient and 26.6% and 31.6% for inpatient.The resistance of(E.coli) to 17 kinds of agents was similar,no matter it was isolated from blood,urine or sputum.Susceptibility of(ESBLs) producing E.coli and K.pneumoniae in urine to cefoperazone/sulbactam,and piperacillin/tazobactam were 85% and 65.2%,66.6% and 29.4%,although to other 15 agents there were no difference.None of the(isolates) showed resistance to imipenem.CONCLUSIONS There is an increasing trend of ESBLs producing E.coli and K.pneumoniae(isolated) from various kinds of specimens and from different wards.It is important for clinical physicians to understand the distribution and the resistance characteristics of ESBLs producing E.coli and(K.pneumoniae) to antibiotics.

0.05).CONCLUSIONS The rising rates of the drug-resistant Uu strains may be resulted of no-standard treatments.The treatment time will be shortened and the curative effects will be better if the treatments are based on the results of the susceptibility test.

The current outpatient payment method based on fee-for-service induced serious demand, which increased the waste of medical insurance fund. The authors briefly introduced ambulatory patient groups(APG)with the same concept of diagnosis-related groups. According to the current situation of outpatient medical insurance payment and the degree of informatization in China, suggestions are put forward: launch a pilot project first and starting with chronic disease to promote reform; improve the quality of outpatient electronic medical records, and develop APG suitable for China; under the background of aging, cooperate with the total budget to ensure the security of medical insurance.