Early recognition of severe sepsis and septic shock,early initiation of effective interventions,implementation of early goal-directed therapy may be key approaches for reducing the mortality and improving the prognosis.This article focused on the staging diagnosis systems for sepsis (PIRO sepsis classification system) and the systematic early warning or rapid response system.We also discussed the diagnostic value of biomarkers,proteomics and metabolomics in sepsis and severe sepsis.No single marker as golden standard has emerged that can provide clinicians with all the information they need for early recognition of sepsis.Therefore,we suggested that clinicians should have even more reason to combine the sepsis symptoms,signs and biomarkers for a comprehensive evaluation,and that they needed to dynamically monitor the changes in these parameters,in order to make reasonable clinical decisions and strategies.

Psychotherapy is a sort of arts based on science following the general principles of social science and natural science.Meanwhile,the content of psychotherapy,the process of the practice,and the relationship be-tween the help-seekers and the helpers reflect substantial humanistic connotation and are bound up with cultural and subcultural transmission and reality context.This paper is a commentary on the article written by an Indonesian fel-low T.Citraningtyas discussing the mother's role in the matriarchal society and its modern meanings.We discussed that the phenomenon of being cultural extinctionalso presents in China.Although the main stream in Chinese cul-ture is still patriarchic familism,the remainder of matriarchal society still exists in the basic emotional models of parent-child relationship.The deprivation and frustration related with filial piety and kinship may cause the conse-quence of cultural extinctionin the individual level.Referring the theory of Wen-Shing Tseng on the mechanisms of the cultural influence on psychopathology,from the perspective of understanding psychology,we emphasized the importance of cultural empathy and recommended the systemic clinical thinking way of empathic considering and contextualizing.Last but not least,we discussed the second case of the overseas migrant workers and their left-at-home childrenin this article within Chinese context.Moreover,besides the 61 million left-at-home children in rural areas,there are a large amount of substitute-raised children by their grandparents who might be also in the risk of being impaired physically and psychologically.This problematic phenomenon may relate to the living stress and the cultural encouragement as well.By providing a critique discussion with the related theories of correlation of the in-secure attachment with psychological disorders in childhood and adulthood,this commentary encouraged humble learning from our Indonesian fellows and appealed for greater appreciation of separate mothers and their children a-mong Chinese clinicians.

OBJECTIVE:To explore the effect of health intervention on blood pressure,medication compliance and the quali-ty of life in elderly patients with hypertension. METHODS:64 elderly patients with hypertension were selected and randomly divid-ed into observation group and control group,with 32 cases in each group. Both groups were given Amlodipine besylate tablet 5 mg,qd. Control group received routine hypertension knowledge education and regular recheck by guidance. Observation group addi-tionally received health intervention on the basis of control group. The blood pressure control,cognitive level of patients to hyper-tension,medication compliance,the level of trust in physicians and quality score of life were compared between 2 groups before and after intervention. RESULTS:There was no statistical significance in systolic blood pressure and diastolic blood pressure be-tween 2 groups before intervention (P>0.05). After intervention,systolic blood pressure and diastolic blood pressure of 2 groups were decreased significantly,and the observation group was significantly lower than the control group,with statistical significance (P<0.05). There was no statistical significance in cognitive level of patients to hypertension,medication compliance,the level of trust in physicians and quality score of life between 2 groups before intervention (P>0.05). After intervention,the observation group was better than the control group in terms of cognitive level of patients to hypertension,medication compliance,the level of trust in physicians and quality score of life,with statistical significance(P<0.05). CONCLUSIONS:Health intervention can effec-tively improve the cognitive level of elderly patients with hypertension to hypertension,improve the medication compliance and the level of trust in physicians,control blood pressure and improve the quality of life.

In type 2 diabetic patients the f re quencies of point mutations 3316G→A and 3394T→C in mitochondrial DNA (mt DNA) were 3.9% (6/152) and 5.3% (8/152) respectively, which were significantly higher than those in normal controls and patients with coronary heart disease. This fi nding suggests that mtDNA 3316G→A and 3394T→G mutations are related to type 2 diabetes.

Objective: To develop the Chinese mood adjective check list (CMACL) and study the validation of this scale. Methods: The CMACL was filled by 1010 subjects aged 21.0 ? 7.4, 507 males and 464 females (39 lost gender information), which were randomly split into two samples after balancing the gender for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). 232 middle school students divided into five groups according to their grades were engaged in the test-retest study at the first to fourth and sixth weeks. 34 volunteers finished the CMACL and self-rating depression scale (SDS) and 30 college students joined the validation study to test the correlation between the CMACL and state trait anxiety inventory. Results: A four-factor model was found by EFA and confirmed by CFA, which has the following dimensions: Fidget(F)?Happy and excited(HE), Pain and sad(PS),Angry and hate(AH). 30 items were also left in the CMACL after the modification(GFI=0.902,AGFI=0.883,NFI=0.884,TLI=0.931,CFI=0.937,RMSEA=0.046). Reliabilities of the four factors are higher than 0.80. Validation studies showed: (1) SDS total score is significantly positive-correlated with F (P

Objective: to develop the peptic ulcer (PU) symptoms self rating scale (PUSRS) and study the validation of this scale. Methods: The PUSRS was filled by 151 PU patients, 118 males and 30 females (3 lost gender information, aged 38.61?14.99), which were recruited from 18 gastroenterology departments. 30 PU patients were engaged in the test-retest study. 40 PU patients and 30 gastritis patients joined the discriminate validation study. Results: Two factors, pain factor (PF) and dyspepsia factor(DF), were found by exploratory factor analysis. Reliabilities of the two factors are 0.786 (PF) and 0.753(DF). Validation studies showed that PU patients have significantly higher PUSRS total score (P

OBJECTIVE:To provide reference for rational use of antithyroid drugs (ATD) in the clinic. METHODS:Retro-spective analyzed 60 cases of adverse reaction caused by Methimazole and Propylthiouracil in terms of age,gender,incubation peri-od,organ or system involved and clinical manifestation,which were searched from 2004 May-2014 Dec. in First Affiliated Hospital of Soochow University. RESULTS:Among 60 ADR cases,male was more than female,and the ratio of male to female was 1∶2.75;average age was(39.7 ± 13.4)years old,and 83.3%ADR occurred between 20 and 59 years old;66.7%ADR occurred within 30 days. Most common clinical manifestations were drug-induced liver disease(66.7%,40/60)and neutropenia(25%,15/60). There was statistical significance in the proportion of drug-induced liver disease caused by methimazole and propylthiouracil in all ADR cases(P<0.05),there was no statistical significance in the proportion of agranulemia caused by these two drugs(P>0.05). CON-CLUSIONS:Before and after the treatment of antithyroid drugs,it’s necessary to check hepatic function and the number of neutro-phile granulocyte,and we should monitor and follow up it to ensure the safe use of drugs.

Adrenal Cortex Diseases ; etiology ; Child ; Humans ; Sepsis ; complications ; physiopathology ; Shock, Septic ; complications ; physiopathology

Objective To analyze the clinical characteristics of male patients with systemic lupus ery thematosus in a cohort of Chinese patients.Methods 325 lupus nephritis patients (38 male and 287 female patients) admitted to our hospital from January 1997 to December 2006 were summarized in this cohort.The difference in manifestations and laboratory features were analyzed between male and female lupus nephritis patients.Results ① Male lupus nephritis patients had more frequent episodes of serositis (P＜0.05),while fe male lupus nephritis patients more frequently had arthralgia,malar rash,oral ulcers and neuropsychiatric lu pus.② The kidney was involved with early stage of the disease in male patients.The rate of misdiagnosis was higher in male lupus nephritis patients than that of the female patients.③ The prevalence of ANA positivity and thrombocytopenia was higher in male patients than that of the female patients.The prevanee of positive anti-ENA antibody,anti-Sin antibody,anemia and hypergammaglobulinemia was lower in male patients than those of female patients.No difference was found in the presence of positive anti-RNP antibody,hypocom plementemia,elevated erythrocyte sedimentation rate and leucoeytopenia between the two groups.Conclusion The clinical pictures of male systemic lupus erythematosus patients are atypical except for kidney involvement.The kidney involvement of male lupus patients is characterized by the early onset,rapid progression and high rate of misdiagnosis.Physicians should familiar with these differences.Early diagnosis and appropriate treat ment are essential for controlling disease progress.