Objective To evaluate a score system(Association of Coloproctology of Great Britain and Ireland ACPGBI)in prediction of postoperative mortality from colorectal cancer patients in a Chinese hospital. Methods We analyzed retrospectively 904 patients with histologically confirmed colorectal cancer who had colorectal surgery from 1992 to 2005.There were 525 colonic cancer patients and 379 rectal cancer patients.We divided patients into several groups according to operative urgency(elective or emergency);surgeons(colorectal specialists or other surgeons);cancer location(colon or rectal).According to ACPGBI score we got the prediction.This prediction was compared with the actual mortality;Chi-square test,receiver operator characteristic curve(ROC),Hosmer-Lemeshow goodness-of-fit test were used.Results Observed overall mortality within 30 days after surgery was 1.0%(9/904),and the predicted mortality was 8.3%(75/904).In all the subgroups the predicted momdity wag higher than observed mortality.We found that the actual mortality was higher in an individual subgroup in which the predicted mortality was higher. Conclusions For colorectal cancer patients undergoing a surgery the predicted mortality of ACPGBI score system was higher than the actual mortality in a Chinese hospital.

Objective To analyze the genotype and plasmid transfer of Enterobacteriaceae carring blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Methods From April 2012 to October 2014 ,a total of 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ( including Imipenem‐resistant , meropenem‐resistant or Ertapenem‐resistant) were isolated from 5 hospitals in Wenzhou and Hangzhou . Identification and antimicrobial susceptibility test were performed using Vitek 2 Compact automatic microbiology analyzer . Phenotypes of carbapenemase were screened using modified Hodge test and ethylenediamine tetraacetic acid‐disk synergy test .Extended spectrum βlactamase test was determined by the double disk combination test which was recommended by Clinical and Laboratory Standards Institute .AmpC activity was tested by a three‐dimensional Cefoxitin method .Drug resistant genes including blaNDM‐1 and linkage of ISAba125‐NDM were detected by polymerase chain reaction (PCR) .The purified PCR products were cloned and sequenced .Plasmid conjugation experiment and elimination method were carried out to test partial bacterial strain and K . pneumoniae carrying blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Results Of the 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ,28 were strains of K .pneumoniae ,1 strain of K . oxytoca,2strainsof Escherichiacoli,1strainof K.planticolaand1strainof E.cloacae.Thirteenstrains were isolated from Hospital of Sir Run Run Shaw of Zhejiang University ,thirteen from Wenzhou Hospital of Traditional Chinese Medicine ,one from Wenzhou People′s Hospital ,three from the First Affiliated Hospital of Wenzhou Medical University and three from Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine .Thirty‐one strains were confirmed as carbapenemase‐producing with 24 of blaKPC‐2 ,3 of blaNDM‐1 ,1 of blaNDM‐5 and 3 of blaIMP‐4 .Among them ,one strain carried blaNDM‐1 with blaIMP‐4 and one strain carried blaNDM‐1with blaKPC‐2 ,respectively .The plasmid transfer and conjugation experiment was performed between strains carrying blaNDM‐1 and Escherichia coli EC600 or K . pneumoniae ATCC13833 and genes of blaNDM‐1 and ISAba125‐NDM were obtained .Conclusions blaKPC‐2 gene is the popular carbapenemase genotype .blaNDM‐1 or blaNDM‐5 may be correlated with linkage gene of ISAba125‐N DM .Coexistence of blaNDM‐1 carrying blaIMP‐4 or blaKPC‐2 is detected in the same strain , respectively . Enough importance should be attached to the strains ,because most of them are multiple drug resistance with related genes located in the plasmid which is easily spread between strains .

This article introduced the clinical experience of national famous TCM doctor Professor Xu Xin in the treatment of blood withered menstrual closure combined with obstruction in the abdomen.Professor Xu Xin believes that premature ovarian failure belongs to the category of blood withered menstrual closure in TCM,the etiology of which can be seen in essence and blood depletion and emotional anomalies;the mechanism of the disease is closely related to the dysfunction of visceral organs,and the source of qi and blood is not available,and the lack of essence and blood of the Chong Ren cystic uterus.Therefore,the treatment should be based on the basic rules of tonifying essence,qi and blood,adjusting the viscera and organs,and promoting blood circulation,and regulating menstruation.If combined with the obstruction in the abdomen,the patients'syndrome of blood stasis will be highlighted,and it is necessary to pay attention to the choice of drugs for removing blood stasis at the same time of applying the basic treatment,so as to support the healthy qi of the disease without leaving blood stasis,eliminating the obstruction in the abdomen without harming the healthy qi of the disease,and regulating the qi and blood to balance yin and yang,in order to obtain a significant therapeutic effect.

To summarize the clinical experience and characteristics of Professor XU Xin in syndrome differentiation and treatment of polycystic ovary syndrome with insulin resistance （PCOS-IR）. XU Xin believes that the etiological factors of PCOS-IR is qi deficiency of the spleen and kidney， and the key disease mechanism is dysfunction in transportation and transformation of spleen and kidney， causing phlegm dampness and turbid heat accumulated in yangming， then evolving into the lower jiao， mixed with blood stasis， finally obstructing the chong （冲） and ren （任） mai and uterus. So in clinic， the method of boosting the kidney and fortifying the spleen was used through out the whole treatment commonly using modified Shoutai Pill （寿胎丸） and Sijunzi Decoction （四君子汤）. The main therapeutic method for treating PCOS-IR refers to clearing and draining dampness heat in yangming， invigorating blood and regulating period， with self-prescribed Yishen Quzhuo Formula （益肾祛浊方）， as a reference for the treatment of this disease.

In modern medicine,digestive diseases and gynecological diseases belong to different disciplines.From a holistic perspective of TCM,the combination of the two can be collectively referred to as Dai Meridian disease.TCM believes that the basic etiology and pathogenesis of this disease are the obstruction damp heat,the spleen obstruction of cold and dampness,the burning of fire and heat,and the deficiency of essence,qi,and blood causing the deficiency and depression of the meridian.The treatment mainly adopts the method of regulating Dai Meridian,which is a manifestation of the overall differentiation and treatment of TCM,by referring to the Dai Meridian,spleen,stomach,liver,and Thoroughfare Vessel and Conception Vessel.The method of regulating Dai Meridian includes clearing dampness and heat in the meridian,cooling and dampness in the warm meridian,relieving pain in the meridian,and strengthening the meridian deficiency.When treating abdominal symptoms including digestive and gynecological diseases in clinical practice,it is advisable to consider and flexibly apply it,simplify complexity,and with homotherapy for heteropathy.