Objective To explore the method and performance of using multiple indices to diagnose sepsis and to predict the prognosis of severe ill patients.Methods Critically ill patients at first admission to intensive care unit (ICU) of Changzheng Hospital, Second Military Medical University, from January 2014 to September 2015 were enrolled if the following conditions were satisfied: ① patients were 18-75 years old;② the length of ICU stay was more than 24 hours; ③ All records of the patients were available. Data of the patients was collected by searching the electronic medical record system. Logistic regression model was formulated to create the new combined predictive indicator and the receiver operating characteristic (ROC) curve for the new predictive indicator was built. The area under the ROC curve (AUC) for both the new indicator and original ones were compared. The optimal cut-off point was obtained where the Youden index reached the maximum value. Diagnostic parameters such as sensitivity, specificity and predictive accuracy were also calculated for comparison. Finally, individual values were substituted into the equation to test the performance in predicting clinical outcomes.Results A total of 362 patients (218 males and 144 females) were enrolled in our study and 66 patients died. The average age was (48.3±19.3) years old. ① For the predictive model only containing categorical covariants [including procalcitonin (PCT), lipopolysaccharide (LPS), infection, white blood cells count (WBC) and fever], increased PCT, increased WBC and fever were demonstrated to be independent risk factors for sepsis in the logistic equation. The AUC for the new combined predictive indicator was higher than that of any other indictor, including PCT, LPS, infection, WBC and fever (0.930 vs. 0.661, 0.503, 0.570, 0.837, 0.800). The optimal cut-off value for the new combined predictive indicator was 0.518. Using the new indicator to diagnose sepsis, the sensitivity, specificity and diagnostic accuracy rate were 78.00%, 93.36% and 87.47%, respectively. One patient was randomly selected, and the clinical data was substituted into the probability equation for prediction. The calculated value was 0.015, which was less than the cut-off value (0.518), indicating that the prognosis was non-sepsis at an accuracy of 87.47%. ② For the predictive model only containing continuous covariants, the logistic model which combined acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score to predict in-hospital death events, both APACHE Ⅱ score and SOFA score were independent risk factors for death. The AUC for the new predictive indicator was higher than that of APACHE Ⅱ score and SOFA score (0.834 vs. 0.812, 0.813). The optimal cut-off value for the new combined predictive indicator in predicting in-hospital death events was 0.236, and the corresponding sensitivity, specificity and diagnostic accuracy for the combined predictive indicator were 73.12%, 76.51% and 75.70%, respectively. One patient was randomly selected, and the APACHE Ⅱscore and SOFA score was substituted into the probability equation for prediction. The calculated value was 0.570, which was higher than the cut-off value (0.236), indicating that the death prognosis at an accuracy of 75.70%.Conclusion The combined predictive indicator, which is formulated by logistic regression models, is superior toany single indicator in predicting sepsis or in-hospital death events.

Objective To discusse the fouling mechanism of 0.2 ?m Al_2O_3 ceramic membrane in the microfiltration of Qiju Dihuang Pill aqueous extract. Methods Qiju Dihuang Pill aqueous extract was microfiltered in this experiment. The distributions of filtration resistance were studied according to the Darcy-Poiseuille principle. The substance of deposit on the membrane surface was analysed by Fourior transform infra-red spectrum and particle diameter analysis. The characteristic of the surface and cross section of the polluted membrane was observed by SEM. Results The filtration resistance was mainly concentrated on the surface of deposit resistance, the membrane itself and the concentration polarization resistance were less important, and the pore blocking resistance was the least important. Moreover, this result was proved by SEM analysis. The molecule of the fouling substance mainly contained peptid, carbonyl, and hydroxy bonds by IR. The particle size distribution of the deposit substance on the polluted membrane surface: The particle radius taking a larger percentage in volume concentrated in 18.267 ?m around, while the particle radius taking a larger percentage in quantity concentrated in 0.424 ?m around. Conclusion Study on the fouling mechanism of the membrane in the microfiltration provides a great significant guidance for exploring the effective measure of relieving the reduced membrane flux and the appropriate cleaning procotrol.

Objective To discuss the fouling mechanism of ceramic membrane in the microfiltation of extract of Qijudihuang Wan and obtain the effective cleaning method. Method The extract of Qijudihuang Wan was microfilted in this experiment, and the distributions of filtration resistance were studied according to the Darcy-Poiseuille principle. The characteristic of the surface and section of the polluted membrane was analysed by SEM also. Result ①For the main body, the filtration resistance is mainly decided by the deposit resistance, the membrane itself and the concentration polarization resistance are less important, and the pore blocking resistance is least important. Moreover, this result is proved by the analysis of SEM. ②The effective four-step cleaning procotrol, which can almost recover original membrane flux, is achieved by three cleaner, including ultrasound, NaOH solution and HCl solution. Conclusion Based on the different fouling mechanism, the appropriate cleaning method can be obtained. This provides great significance for the application of the industrialized manufacture.

AIM: To discuss the fouling mechanism of 0.2 ?m Al_2O_3 ceramic membrane in the microfiltation of extraction of Qijudihuang Pills, and obtain the effective cleaning procotrol. METHODS: The extract of Qijudihuang Pills microfiltered and the distributions of filtration resistance were studied according to the Darcy-Poiseuille principle. The characteristic of the surface and section of the polluted membrane were analysed by SEM also. RESULTS: ① For the main body, the filtration resistance was mainly decided by the deposit resistance, the membrane itself and the concentration polarization resistance were less important, and the pore blocking resistance was minimum. Moreover, this result was proved by the analysis of SEM. ② The effective four-step cleaning procotrol, which could almost recover original membrane flux, was achieved by three cleaner, including ultrasound, NaOH solution and HCl solution. CONCLUSION: Based on the different fouling mechanism,the appropriate cleaning procotrol can be obtained. This provides great significance for the application of the industrialized manufacture.

AIM: To discuss the fouling mechanism in 0.2 ?m Al_2O_3 commie membrane microfiltation of Tangkeqmg Compound water extract. METHODS: The total filtration resistance and its distribution were used as indexes to study the effect of pore size and materials of ceramic membrane on membrane fouling in clarification. SEM (scanning electronic microgragh) technology was used to study the microstructure of surface and section of new membrane and contammted membrane and physica and chemical examination were done on the fouling substances on the membrane surface. RESULTS: The pore size and materials of membrane affected the total filtration resistance and its distribution in clarification. The results of filtration resistance dislribution and SEM suggested that the fouling of 0.2 ?m Al_2O_3 membrane mainly lied on the surface. The contaminations on membrane surface were mostly the substances holding function groups, such as C=O, CO-NH and C-O-C. According to volume percentage, the semidiameter of contaminations on the membrane was mostly around 23.738 ?m. However, according to quantity percentage, the semidiameter of contaminations on the membrane was mostly around 0.521 ?m. CONCLUSION: Study on the fouling mechanism of the membrane is of great significance for looking for the effective measures for relieving the downward trend of the membrane flux and for the appropriate membrane cleaning in the clarification of Tangkeqing Compound extract using 0.2 ?m Al_2O_3 ceramic membrane.

Objective To study the distribution of filtration resistance in AL2O3(0.2 ?m) ceramic membrane microfiltration of Tangkeqing water extract,obtain the effective membrane cleaning methods,and enrich the theory of ceramic membrane cleaning technology.Methods The filtration resistance and its distribution were got with the filtration model of the Darcy-Poiseuille principle which was modified by M.MDa-Cin,etc.Meanwhile,The microstructure of fouled membrane surface and cross-section was analyzed by SEM.Results The main parts of filtration resistance lay in deposit layer and concentration polarization layer with the ratio of 52.5% and 34.4%,respectively.However,the membrane itself and the pore blocking were in the fewer ratios of 8.8% and 4.3%,respectively.The result was in accordance with that of SEM.The fouled AL2O3 membrane was cleaned with low-pressure tap water and ultrasonic wave successirely.Conclusion The appropriate cleaning means are chosen based on the filtration resistance,which can provide good instructions for the industrialized production.

ObjectiveTo determine the diversity of outer membrane protein expression of Leptospira interrogans during infection of human THP-1 monocytes,and protein antigen candidates for developing leptospiral genetically engineering vaccines.MethodsThe outer membrane proteins(OMPs) of Leptospira interrogans serogroup Icterohaemorrhagiae serovar Lai strain Lai before or after infection of human THP-1 monocyte line were extracted using Triton X-114 method.The OMPs extracts were separated by two-dimensional gel electrophoresis(2-DGE) and then detected using silver staining method.Four up-regulated and four down-regulated OMPs were selected for hydrolysis by trypsin and then identified by using liquid chromatography-tandem mass(LC-MS/MS) method.The transmembrane regions and signal peptides in the eight target OMPs were analyzed using bioinformatic software.Several real-time fluorescent quantitative RT-PCRs were performed to determine the mRNA level changes of the eight target genes of L.interrogans strain Lai before or after infection of THP-1 cells.The prokaryotic expression systems of target genes were generated and the immunoprutection of target recombinant proteins was determined using leptospire-infected guinea pigs model.ResultsAfter a 60 min infection of THP-1 cells,four OMPs( Loa22,GroEL,F0F1 ATP synthase alpha- and beta-subunits) of L interrogans strain Lai were noticeably up-regulated ( P＜0.05 ),while the other four OMPs( FlaB2,LigB,OmpA family protein and OmpA) were significantly down-regulated (P＜0.05).The results of real-time fluorescent quantitative RT-PCRs were coincident with those confirmed by the 2-DGE phus silver staining.The bioinformatic analysis indicated that among the eight OMPs,OmpA and OmpA family protein belonged transmembrane proteins,while the rest had no membrane structure.Loa22,LigB and OmpA family protein contained a signal peptide in their sequences.200 μg of the recombinant proteins rLoa22 and rGroEL presented 75.0％ immunoprotective rates in the infected guinea pigs.Conclusion An obvious change of the OMP expression map of L.interrogans strain Lai occurs during infection of host cells.The up-regulated leptospiral OM Ps during infection,especially for the GroEL and Loa22 proteins,can be used as the immunogen candidates for developing leptospiral genetically engineering vaccines.

Objective To determine the function of toxic protein VapC in toxin/antitoxin system of Leptospira species and the cytotoxicity to host cells of the toxic protein.Methods Using genomic DNA of pathogenic L.interrogans serogroup Icterohaemorrhagiae serovar Lai strain Lai as the template,several PCRs were performed to amplify entire vapB,vapC and vapBC genes.Subsequently,the prokaryotic expression systems of vapB,vapC and vapBC genes were constructed.Expression of the target recombinant proteins rVapB and rVapC was detected by SDS-PAGE and the expressed rVapB and rVapC were extracted by NiNTA affinity chromatography.Activity of rVapB and rVapC to lyse the DNAs or RNAs from L.interrogans strain Lai and THP-1 cells were then determined.The changes of transcription and expression of vapB and vapC genes of L.interrogans strain Lai before and after infection of THP-1 cells were detected by real-time fluorescent quantitative RT-PCR and Western blot assay.The eukaryotic expression vectors of the vapB and vapC genes were generated for transfection of host cells and CCK-8 agent was used to detect the effect of leptospiral VapB and VapC proteins on activity of host cells.Results The nucleotide and putative amino acid sequences of the cloned vapB and vapC genes were completely identical with the reported corresponding genes.The constructed prokaryotic expression systems could express rVapB and rVapC,respectively.rVapC displayed RNase avtivity but did not lyse DNA.When L.interrogans strain Lai infected THP-1 cells,the transcription and expression of vapB and vapC genes were upregulated and partial VapC protein was secreted from the leptospiral cells.The mass mortality was observed in HEK293 human renal tubular epithelial ceils containing the vapC gene through transfection.Conclusion VapC protein of L.interrogans strain Lai is a RNase and is secreted during infection of host cells with obvious cytotoxicity.

BACKGROUND: With development of modern medical sciences, the out comes after meningioma surgery cannot be fully assessed using morbidity,livability and mortality merely. Quality of life (QOL) is a health-related multivariable index, which provides integrated inf ormation associated with physiological,sychological and social adaptation status of the patients to doctors. Assessment of the QOL in meningioma patients may be one of a relatively good method for guiding surgery and reducing reoccurrence of tuOBJECTIVE: To evaluate the QOL in meningioma patients and then to provide relevant data for assessing the outcomes of meningioma surgery comprehensively.DESIGN: It was a single-sample investigation. SETTING: Neurosurgery Department, Second People's Hospital of Wuxi City of Nanjing Medical University.PARTICIPANTS: Totally 147 patients underwent meningioma surgery in the Neurosurgery Department of the Second Affiliated Hospital of Wuxi City affiliated to Nanjing Medical University between January 1995 to January 2001 were selected, 61 males and 86 females, with a male/female ratio of 2:3 and an age ranging from 5-77 years old, in average of 43 years old, and the median was 43 years old.METHODS: Based on World Health Organization Quality of Life 100item questionnaire (WHOQOL-100) and Karnofsky Performance Scale (KPS), we designed a questionnaire on QOL in patients with meningioma.Outcomes of the transverse investigation on 147 meningioma patients were compared with healthy controls. Surgery-related QOL curve was used for identifying the threshold satisfactory point of QOL. In addition, with selfcontrol, influence of surgery on QOL was assessed.MAIN OUTCOME MEASURES: Relationship between QOL and clinical histories, radiological analysis, operation grading, histological properties and reoccurrence were investigated.RESULTS: All of the 147 patients entered the statistical analysis. ①In patient with meningioma, Cronbach's coefficient was 0.9521 and the correlated coefficient was 0.8685, which suggested that QOL questionnaire for patients with meningioma had a good reliability and validity. ②QOL ≥70 represented that the patient was satisfied with the QOL. ③In patients underwent surgical treatment, their physiological functions, self-help and self-care except for psychological functions were significantly improved (P ＜ 0.001 ).CONCLUSION: Surgical treatment enables patients to get a satisfied QOL. QOL questionnaire for patients with meningioma is helpful to provide relevant data for meningioma operation.

Editor's note: The research on effective constituents of traditional Chinese medicine is one of the crucial areas of basic research of traditional Chinese medicine. It is also a research hotspot which gains widespread attention and active application of projects of national natural science funds in the discipline of traditional Chinese medicine. In 2013, the National Natural Science Foundation of Chinese traditional medicine in the application code H2803 in the research field of effective constituents of traditional Chinese medicine , the direction of gener-al project , Youth Science Foundation and the regional Science Foundation project application 449 , which accept-ed 425 . In this paper , the general situation of the application and approved projects of national natural science funds in the research field of effective constituents of traditional Chinese medicine in 2013 has been introduced. The research strategies and plans of the approved projects have been summarized , and the problems of the ap-plications have been also analyzed .