Objective To explore the reliability of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)to evaluate the severity of the neurologic diseases and its accuracy to predict the outcome of patients with these diseases.Metllods Four hundred and four consecutive patients with severe neurologic diseases between 2005 and 2006 were enrolled to obtain the APACHE Ⅱ scores at 0.24,48,72 h after admission to neurointensive care unit.Results The APACHE Ⅱ scores were positively associated with the outcome of the patients with severe neurologic diseases.The higher score corresponded with the higher mortality rate.The areas under the receiver operating characteristic curves of APACHE Ⅱ to predict the outcome was 0.866(95% CI 0.824 to 0.907.P=0.000).The optimal cutoff of APACHE Ⅱ scores to predict the outcome was 17 scores with the sensitivity of 76.7%and the specificity of 78.7%.The predictive chance that was mostly associated with the outcome was 72 h after admission in logistic regression model (x2=137.345,P=0.000,correct class%=85%).The factors that were the most statistically associated with the outcome in the 14 parameters of APACHE Ⅱ were GCS score,heart rate,serum creatinine,body temperature and WBC count.Conelusion APACHE Ⅱ favorably reflects the severity of the neurologic diseases and reliably and accurately predicts the prognosis of the patients.

Objective To investigate the molecular characteristic,the virulence factors and antimicrobial resistance of Methicillin-resistant Staphylococcus aureus (MRSA) isolated from pediatric patients.Methods Ninety-eight non-duplicate strains of and 49 non-duplicate strains of Methicillinsusceptible Staphylococcus aureus (MSSA) isolated from the three children's hospitals in Shanghai in 2008 were investigated.Panton-valentine leukocidin (PVL) gene was detected by polymerase chain reaction (PCR).The genotypes of staphylococcal cassette chromosome mec (SCCmec) of the MRSA isolates were confirmed by multiplex PCR.The sequence type (ST) of each strain was determined by multilocus sequence typing (MLST),and the algorithm eBURST was used to identify groups of clonal complex (CC).The minimal inhibitory concentrations (MIC) of fourteen antibiotics for all isolates were determined by agar dilution method.Results Among 98 isolates of MRSA,the positive rate of PVL genes was 6.1％ (6/98).In contrast,the positive rate of PVL genes was 4.1％ (2/48) of the MSSA strains.Among 98 isolates of MRSA,4.1％ (4/98),23.5％ (23/98),53.0％ (52/98) and 15.3％ (15/98) of the strains harboured SCCmec types Ⅱ,Ⅲ,Ⅳ and Ⅴ,respectively. The remaining four isolates (4.1 ％) presented a unique SCCmec pattern that could not be classified to any known types by the employed typing assays.Combining the ST and SCCmec type,the predominant clones were ST59-SCCmec Ⅳ (30 strains) and ST239-SCCmec Ⅲ (23 strains),followed by ST5-SCCmecⅣ and ST1-SCCmecⅣ (8 strains for each clone),ST239-SCCmec Ⅴ (6 strains),ST88-SCCmecⅤ (5 strains),ST5 SCCmecⅡ (4 strains),ST59-SCCmec Ⅴ (3 strains),ST8-SCCmecⅣ and ST88-SCCmecⅣ (2 strains for each clone),ST22-SCCmecⅣ,ST910-SCCmecⅣ and S45-SCCmec Ⅴ (1 strain for each clone),eBURST analysis distributed the MRSA isolates into several CC.ST8 and ST239 belonged to ST8 CC,ST1 belonged to ST15 CC,ST910 belonged to ST 30 CC,ST59,ST5,ST88,ST45,ST22,ST9 and ST7 were the origin of their own CC.The results of MIC showed that the 67 strains of MRSA harboring SCCmec type Ⅳ or SCCmec type Ⅴ were more susceptible to various non-β-lactam antibiotics than 27 strains of MRSA harboring SCCmec type Ⅱ or SCCmec type Ⅲ,and no vancomycin-resistant strain was found.Conclusions In three children's hospitals in Shanghai,the PVL gene-positive rate of MRSA isolates is relatively low,SCCmec type Ⅳ and SCCmec type Ⅴ could spread among hospitals to cause a small scale epidemic and have a variety of ST.

Problems such as frequent medical disputes and lack of mutual trust between doctors and patients re -quire us to pay more attention to the medical professionals ' moral ethics practice .By means of deepening the un-derstanding of medical professionals ' moral psychology , it expected to promote medical ethics education and medi-cal management smoothly , meanwhile , alleviate medical disputes .This paper analyzed medical professionals ' com-ments on the Selfie in Operating Room Incident using a qualitative study .By analyzing their moral psychology be-hind these comments , it depicted three mental representations of medical professionals ' ethics practice , namely conflict,responsibility and concerns .

Two female patients with acute onset of sporadic food-borne botulism are reported. Both patients presented cranial nerve palsy symptoms and rapidly involving respiratory muscles causing respiratory failure. The tracheal intubation, mechanical ventilation and active supportive measures were given at admission. The skull imaging and cerebrospinal fluid examination were negative, and the electromyography showed peripheral motor nerve damage. One patient was complicated with severe pneumonia. The botulinum toxin test was positive, and botulism poisoning was diagnosed. After early targeted treatment, patients were improved and discharged. Both patients had no complications and recurrence after discharge in 8 months of follow-up.

  Objective  To study the demographic and clinical characteristics, correlation of genotype and phenotype and treatment of Blau syndrome to facilitate early diagnosis and timely treatment of Blau syndrome.  Methods  Seventy-two patients with Blau syndrome from 11 centers from May 2006 to April 2022 were retrospectively analyzed, and their general information, clinical data, laboratory examination and treatment medication were collected.  Results  The distribution of patients with Blau syndrome was uniform in geographical north and south of China, and there was no obvious gender bias. The mean age of onset was (14.30±12.81) months, and the age of diagnosis was (55.18±36.22) months. 35% of patients with Blau syndrome happened before 1 year old, and all patients developed before 5 years old. 87.50% (63/72) had granulomatous arthritis, 65.28% (47/72) had rash, 36.11% (26/72) had ocular involvement, 27.78% (20/72) had fever, and 15.28% (11/72) had pulmonary involvement. Arthritic manifestations of Blau syndrome were most at risk, followed by rash, ocular involvement, and fever.The first 25 months of the disease, the risk of developing a rash was the greatest. The risk of developing arthritis was the greatest between 25 months and 84 months. The main mutations were p.R334Q and p.R334W, and patients with p.R334Q mutation had relatively high incidence of fever (35.71%[5/14] vs. 14.29%[1/7], P=0.43) and ocular involvement (42.86%[6/14]vs. 28.57%[2/7], P=0.51). There was a relatively high incidence of rash (85.71%[6/7] vs. 64.29%[9/14], P=0.59) in patients with the p.R334W mutation. Forty-five patients(62.50%)were treated with a combina-tion of glucocorticoid and methotrexate. Twenty-two patients were treated with tumor necrosis factor antagonist in addition to glucocorticoid and methotrexate.  Conclusions  The risk of different clinical manifestations of Blau syndrome from high to low was arthritis, followed by rash, ocular involvement and fever. The main treatment was glucocorticoid combined with methotrexate, to which biological agents could be added.