Objective To study the predicting value of four different scoring systems such as the acute physiology and chronichealth evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score and systemic inflammatory response syndrome (SIRS) score for the prognosis of septic patients. Methods A retrospective analysis were conducted. Septic patients in intensive care unit (ICU) of the First People's Hospital of Chenzhou form July 1st, 2012 to June 30th, 2016 were enrolled.Patients were divided into survival group and death group according to 28-day outcome. The difference of clinic data, the worst clinical index value within 24 hours, whether mechanical ventilation performed on first day, length of stay in ICU, APACHE Ⅱ score, SOFA score, qSOFA score and SIRS score were compared between the two groups. The significant different factors of sepsis outcome in univariate analysis were analyzed by multiple logistic regression, and the ability of four scoring systems was tested by receiver operating characteristic (ROC) curve.Results 311 patients were enrolled in this study (221 survivals, 90 deaths, 28-day mortality rate 28.9%). Univariate analysis showed age, mechanical ventilation ratio, urine output, length of stay in ICU and the fastest heart beat rate (HR), the lowest systolic blood pressure (SBP), the lowest mean arterial pressure (MAP), HCO3-, minimum arterial blood oxygen partial pressure (PaO2), minimum oxygenation index (PaO2/FiO2), the maximum fraction of inspired oxygen (FiO2), Na+, the highest concentration of blood urea nitrogen (BUN), the highest concentration of serum creatinine (SCr), minimum concentration of plasma albumin (Alb), Glasgow coma score (GCS) score, APACHE Ⅱ score, SOFA score, qSOFA score, within 24 hours after diagnosis were significantly different between two groups (allP < 0.05). Multiple logistic regression showed age [odds ratio (OR) = 1.388, 95% confidence interval (95%CI) = 1.074-1.794,P = 0.012], PaO2/FiO2 (OR = 0.459, 95%CI = 0.259-0.812,P = 0.007), concentration of plasma Alb (OR = 0.523, 95%CI = 0.303-0.903,P = 0.020), GCS score (OR = 0.541, 95%CI = 0.303-0.967,P = 0.038) and SOFA scores (OR = 3.189, 95%CI = 1.813-5.610,P = 0.000) were independent risk factors for sepsis outcome. ROC curve test showed the APACHE Ⅱ score, SOFA score and qSOFA score had the ability to predict the outcome in critical ill patients with sepsis, the SOFA score of the most powerful, the area under the ROC curve (AUC) was 0.700,when the cut-off value was 7.5 points, the sensitivity was 73.3% and specificity was 58.8%.Conclusions APACHE Ⅱ score, SOFA score and qSOFA score have the predictive properties for septic patients. SOFA score is an independent prognostic risk factor of sepsis, while qSOFA score can be widely used in clinical practice as the advantage of quick evaluating.

AIM: To study the recombinant plasmid pDL121 and its expression product in E.coli. METHODS: pDL121 was analysed by using 6 different restriction endonucleases and dot blotting, and the isolated 23 kDa protein band was cut and injected twice into rabbits to raise anti-23 kDa serum. RESULTS: The restriction map of pDL121 was quite different from other leptospiral genes reported and digoxin labeled recombinant DNA probe of pDL121 could detect the pathogenic leptospires, whereas, not the nonpathogenic leptospires. The anti-23 kDa serum could recognize the sonicated antigen of L.interrogans serovar lai strain 017 and 23 kDa protein expressed in pDL121 and the titer of the antiserum were very high, approximately 1/12 800. Injection of the E.coli lysate of pDL121 with Freund's adjuvant into guinea pigs resulted in some protection of the animal against the challenge with strain 017. CONCLUSION: It indicated that 23 kDa protein had good imunogenicity and could serve as a candidate for protective antigen of L.interrogans and the inserted fragment of pDL121 could be a new gene .

Objective To expand the utilization of minimally invasive technologies for parapancreatic abscess,and summarize the application experience of choledochoscope for treatment of parapancreatic abscess.Methods The clinical data and treatment effectiveness of 36 patients with parapancreatic abscess from Dec.2000 to Dec.2008 were analyzed retrospectively.These patients had experienced percutaneous puncture and been placed drainage tube under the ultrasound guidance first,then expanded the sinus tract gradually,and performed debridement by choledochoscope.The flexibility of choledochoscope was used to remove the necrotic tissue and pyogenic membrane repeatedly by clamping,netting and vacuum aspiration in every domain.Results Thirty-six patients were performed percutaneous puncture and placed drainage tube,3 cases were given canalis singularis,7 cases were double tube,26 cases were over three tube.The debridement times were 3-14 by choledochoscope,average 5.6 times.There were 6 cases with improving systemic symptoms,blood routine and temperature recovering normal,and drink and food recovering,then discharged from hospital with tube after 1-2 times of debridement.Length of stay was 25-132 d,average 76 d.The curing rate was 91.7% (33/36).Two cases were turned into open surgery because of broad necrotic tissue range combined with many abdominal cavity abscess with good postoperative recovery and cured.One case was dead of severe multiple organ failure combination.There were 2 patients with hemorrhage,3 patients with external intestinal fistula.Conclusions The debridement of choledochoscope for parapancreatic abscess treatment is a simple,flexible and effective method.It changes the viewpoint that parapancreatic abscess can be cured only by operation drainage,decreases the patients’ trauma and accomplishes the idea of damage control by minimally invasive technologies.

AIM: To study the recombinant plasmid pDL121 and its expression product in E.coli. METHODS: pDL121 was analysed by using 6 different restriction endonucleases and dot blotting, and the isolated 23 kDa protein band was cut and injected twice into rabbits to raise anti - 23 kDa serum. RESULTS: The restriction map of pDL121 was quite different from other leptospiral genes reported and digoxin labeled recombinant DNA probe of pDL121 could detect the pathogenic leptospires, whereas, not the nonpathogenic leptospires. The anti - 23 kDa serum could recognize the sonicated antigen of L. interrogans serovar lai strain 017 and 23 kDa protein expressed in pDL121 and the titer of the antiserum were very high, approximately 1/12 800. Injection of the E. coli lysate of pDL121 with Freund's adjuvant into guinea pigs resulted in some protection of the animal against the challenge with strain 017. CONCLUSION: It indicated that 23 kDa protein had good imunogenicity and could serve as a candidate for protective antigen of L. interrogans and the inserted fragment of pDL121 could be a new gene .

Objective To explore a new method of parapancreatic abscess treatment and establish an idea of minimally invasive technologies for parapancreatic abscess to improve the recovery rate of acute pancreatitis. Methods The patients had experienced percutaneous puncture and placed drainage tube under the ultrasound guidance first, then the sinus tract was expanded gradually to 24F perimeter by Cook's fascia expender. Finally, the necrotic tissue and pyogenic membrane was removed and repeatedly washed under guidance of choledochoscopy. Results The recovery rate was 91.1 %(33/36). The complication incidence was 10.7% (hemorrage:2 cases, external intestinal fistula:3 cases, and fatal MOF: 1 case). Conclusions The viewpoint which parapancreatic abscess only can be cured by drainage operation can be changed by associating debridement by choledochoscope with percutaneous puncture drainage under the ultrasound guidance. It is a simple, safe and effective method. It can be used to reduce the patients' damage, complication and mortality and accomplish the idea of damage control by minimally invasive technologies.

This paper compared the practice and service mode of general practitioners ( GPs) from a selection of typical countries and regions and discovered that GPs from most of the countries were self-employed, with various forms of employment, freedom to practice and work in different institutions;fixed practices were supplemented, and service types were transformed from individual services to the multi-disciplinary team of services. Result: GPs’ free-dom to practice in different institutions requires a certain social environment and circumstances. The multi-disciplina-ry team of practices has become the development direction for the service modes of GPs. GPs have played different roles in establishing the referral system in the health systems of different countries. Consequently, the paper suggests that establishing a diverse and relaxed practice environment to provide conditions for the transformation of the service mode of GPs. The construction of a multi-disciplinary team to promote changes in community service modes was must be strengthened. Health insurance regulations should be encouraged to establish the gatekeeper system and realize a grading of systems. Social capital should be encouraged to organize general medical services to promote the develop-ment of the health care industry.

Objective:Development of health resources is extremely uneven in China. It is need to consider the situation of each region for China 's health regional planning, so area classification should be in progress. Methods Considering the economic, social, population and health factors, the study conducted principal component analysis and factor analysis by statistical yearbook data to calculate the composite score for each region. Then cluster analysis was conducted. Results Principal components and factor analysis were both divided the country in to six categories. Conclusions:The study divided the country into six regions, the first class area:Shanghai, Beijing;the second class area:Tianjin; the third class area: Jiangsu, Zhejiang, Guangdong; the fifth class area: Guangxi, Ningxia, Xin-jiang, Gansu, Guizhou, Yunnan, Qinghai;the sixth class area:Tibet. The rest is the forth class area.

Objective To evaluate the effectiveness of using anti‐cyclic citrullinated peptide (anti‐CCP) antibody or rheumatoid factor(RF) as the single laboratory parameter for rheumatoid arthritis(RA) diagnosis ,versus to using the two parameters in com‐bination .Methods A total of 56 cases of patients with RA were enrolled into RA group ,other 34 cases of patients with out RA were enrolled into non‐RA group .Levels of anti‐CCP antibody and RF were detected by using electro‐chemiluminescence immunoas‐say(ECLIA)and compared between the two groups .And the diagnostic efficacy of single and combined detection of anti‐CCP anti‐body and RF were evaluated .Results The levels of anti‐CCP antibody and RF in the RA group were higher than those in the non‐RA group ,had statistically significant differences(P<0 .05) .In diagnosis of RA ,the areas under receiver operating characteristic (ROC)curve of anti‐CCP antibody and RF were 0 .925 and 0 .822 respectively .The sensitivity and specificity of anti‐CCP antibody were both higher than those of RF .Compared with single detection of anti‐CCP antibody ,there was no significant increase of sensi‐tivity in using anti‐CCP antibody/RF ,whereas the specificity dropped significantly .Combined detection of anti‐CCP antibody and RF ,compared with single detection of anti‐CCP antibody ,had significantly lower sensitivity ,but no significant changes were found in specificity .Conclusion Single detection of anti‐CCP antibody is more effective than RF for diagnosing RA ,while combined detec‐tion of anti‐CCP antibody and RF could not significantly improve the specificity and sensitivity .It is suggested to only use anti‐CCP antibody for diagnosis of RA .

Objective To investigate the effective methods for detecting the susceptibility of Staphylococcus aureus to Vancomycin. Methods An isolate of h-VRSA (heterogeneous Vancomycin-resistant Staphylococcus aureus) isolated from clinical specimen was inoculated on the increasing concentration of vancomycin agars. Varied degree of vancomycin of resistant S. aureus were obtained. The susceptibilities of these S. aureus to vancomycin were tested by agar screening test, broth microdilution method, E-test, disk diffusion method and automated methods. Results Agar screening test, broth microdilution method and E-test are effective for detection of vancomycin-intermediate S. aureus VISA, but disk diffusion and automated methods could not detect VISA. Conclusion Broth microdilution method and E-test are acceptable methods for susceptibility testing of S. aureus to vancomycin. The laboratories using automated methods and disk diffusion method as routine susceptibility test should consider adding a vancomycin agar screen plate to enhance detection of VRSA and VISA.

Objective To investigate about establishment the animal model of atrial fibrillation(AF) by high thyroxine and electrophysiological study of left atrium.Methods 49 rabbits were randomly divided into three groups, control group (10, injection of saline), withdrawal group (20, injection of levo-thyroxine 50μg/kg, change to inject isodose saline after two months), continuous dosing group (19, injection of levo-thyroxine 50μg/kg everyday).the data of left atrium effective refractory period(AERP), conduction velocity(CV), wavelength(WL) and AF induced ratio were collected after four months.Results The withdrawal group and continuous dosing group AERP200, AERP150 were more shorter than the control group after two months(P<0.05), The continuous dosing group AERP200, AERP150 was shorter significantly than withdrawal group and control group after four months ( P<0.01 ).The withdrawal group and continuous dosing group CV were slower than control group after two months ( P<0.05 ).The continuous dosing group CV was slower significantly than withdrawal group and control group after four months ( P<0.01 ).The withdrawal group and continuous dosing group WL were shorter than control group after two months(P<0.05), The continuous dosing group WL was shorter significantly than withdrawal group and control group after four months (P<0.01).The AF induced ratio in the continuous dosing group increased significantly(P<0.01). After four months, but the withdrawal group decreased, the control group did not induce AF.Conclusion It's feasible to establish the rabbit model of AF by high thyroxine, with left atrium electrophysiological changes, which provides animal model for further to study the pathogenesis of AF cause of hyperthyroidism.