OBJECTIVE To analyze the sequences of drug resistance genes of the novel CTX-M type of extended spectrum ?-lactamases((ESBLs)) in Hefei Anhui Province. METHODS A pair of primers were designed to detect the groups of CTX-M-9 by PCR from 98 strains confirmed(ESBLs)-producing Klebsiella pneumoniae and Escherichia coli isolated between 1999 and 2000 in Hefei,and then sequenced the productions of PCR,Compared the sequences on blast via GenBank and analyzed the molecular structure to find out whether the change in nucleotides had induced the destitution of amino acid in specific site. RESULTS Of 29 strains,8 variant sequences of CTX-M-14 had been discovered in several sites and resulted in the destitution of amino acid. CONCLUSIONS There are novel CTX-M types of(ESBLs) in Hefei,which come from CTX-M-14.

To investigate the changes of drug resistance of pseudomonas aeruginosa ( PA) to common antimicrobial agents in recent 3 years in Anhui province. The average drug resistance rate was 15. 3%, 17. 0% for piperacillin/tazobactam, amikacin respectively, while the average resistance rate was higher for the third generation cephalospo-rin cefotaxime, ceftriaxone and ceftizoxime, which was between 42. 0% and 55. 0%. The average drug resistance rate was 25. 2% for imipenem. The resistance rates for ceftazidime, cefepime, ceftriaxone and ceftizoxime were sig-nificantly increased( P<0. 05 ) . The resistance of PA to the third generation cephalosporin and ciprofloxacin in-creased gradually, close attention should be paid to it in clinical practice.

OBJECTIVE To investigate the trend of resistance to antimicrobial agents among clinical isolates of Escherichia coli and Klebsiella pneumoniae in 2006-2007.METHODS Agar diffusion test was used to analyze the changes in drug susceptibility of E.coli and K.pneumoniae from 30 hospitals in Anhui in 2006-2007.The resistant rate,intermediate rate and susceptibility rate of drugs were calculated according to the criteria in guidelines of CLSI(2007).RESULTS Carbapenems were the most active antimicrobial agents tested against E.coli and K.pneumoniae.Cefepime,ceftazidime,piperacillin/tazobactam and amikacin showed excellent activity against E.coli and K.pneumoniae.E.coli and K.pneumoniae were still resistant to cefuroxime,ceftriaxone,cefotaxime and aztreonam.ESBLs-producing E.coli strains accounted for 48.9% in the year of 2006 and for 47.2% in the year of 2007.ESBLs-producing K.pneumoniae strains accounted for 36.6% in the year of 2006 and for 40.0% in the year of 2007.CONCLUSIONS Imipenem remains highly active against E.coli and K.pneumoniae.

OBJECTIVE To obtain the statistics of the resistance of Staphylococcus spp to 12 antibacterial agents. METHODS The clinical non-repeated isolates of Staphylococcus aureus and coagulase negative Staphylococcus(CNS) were collected in September 2004 in 13 hospitals of Anhui Province.According to National Committee for Clinical Laboratory Standards(NCCLS) of America(2004),agar dilution method was performed to determine the MICs of 12 antimicrobial agents against the isolates. RESULTS All S.aureus and 92.9% of CNS were resistant to penicillin respectively.Multi-resistance to antibiotics such as macrolides,and fluoroquinolones were found in these strains,and all the isolates of Staphylococcus spp were susceptible to vancomycin. CONCLUSIONS Staphylococcus spp exhibit some degrees of resistance to antimicrobial agents in Anhui Province.Therefore,the drug resistance of surveillance must be imposed,and we must emphasize on reasonable option of antimicrobial agents in clinical therapy in our area.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Female ; Humans ; Joints ; injuries ; Male ; Meridians ; Middle Aged ; Sprains and Strains ; therapy ; Young Adult

Objective To observe the therapeutic effect and safety of the umbilical blood stem cell transplantation on patients with end-stage cirrhosis.Methods We chose 80 patients diagnosed with end-stage cirrhosis.All the re-lated contraindications were excluded .Communicated with all the patients, 50 patients chose the umbilical blood stem cell transplantation and conservative treatment , and 30 patients only chose conservative treatment .The 50 pa-tients were defined as observation group and the left were defined as control group .After transplantation, clinical symptoms and laboratory data were recorded at the 1 month, 6 month, and 12 month.Results ① 12 months after transplantation, clinical symptoms were improved in 38 cases(76%) in the observation group and that in 12 cases (40%) in the control group.② The laboratory data, including ALB, TBiL, ALT, AST, PTA were improved after transplantation in observation group (P <0.05).No significant difference was found in the control group after thera -py.③ After transplantation, the improvement of ALB, A/G, TBiL, PTA in observation group was higher than the control group(P <0.05).Conclusion After transplantation of the umbilical blood stem cell transplantation , the liver function and life quality of patients are significantly improved .This method is better than conservative treat -ment.The method is safe and effective in the treatment of patients with end -stage cirrhosis.

Objective To conduct targeted surveillance of nosocomial infections in intensive care units(ICU)to provide reference for comprehensive infection control . Methods All the 374 patients treated in ICU in 2013 were investigated by targeted surveillance methods .Results A total of 82 episodes of nosocomial infections were identified in 62 (16 .6% )of the 374 patients . The cumulative hospital stay was 2 724 days .The infection incidence per patient‐day was 22 .8‰ .The infection in ICU was primarily pneumonia (75 .6% ,including 39 ventilator‐associated pneumonia) ,bloodstream infections (including 6 central line‐associated bloodstream infections ) and catheter‐associated urinary tract infections . The incidence of ventilator‐associated pneumonia ,central line‐associated bloodstream infection and catheter‐associated urinary tract infection was 33 .3‰ ,2 .8‰ , 2 .3‰ patient‐day ,respectively .Overall ,74 strains of pathogens were isolated ,of which 93 .2% ,5 .4% and 1 .4% were gram‐negative bacilli ,gram‐positive cocci and fungi ,respectively .The top three gram‐negative bacilli were Pseudomonas aeruginosa(25 .7% ),Klebsiellapneumoniae(14 .9% ),and Acinetobacterbaumannii(10 .8% ).Conclusions Theincidenceof nosocomial infection was 16 .6 % in ICU patients ,of which device‐related infection accounted for 62 .2 % .Control of equipment‐related infections is critical for curbing the nosocomial infections in ICU . The antimicrobial regimens for ICU patients should cover gram‐negative bacilli .

Objective To observe the safety of the compound Tiaoshi-plaster's use to skin,providing the scientific foundation for its use to the treatment for the younth's short sight.Methods Experiment 1,acute toxicity test for skin of rabbits:rabbits were randomly divided into two groups:a integrated skin group and a damaged skin group,in addition,every group further divide into high and low dosage group and vehicle control group,totally 5 groups.All above groups received the plaster or vehicle for 24 hours,then take away the drug,and after lh,24 h,48 h,72 h since the 7th day,observe each group's reaction separately everyday,to see whether there is a acute toxicity reaction or not.Experiment 2,self control group,use onerabbit's left and right sides' skin to observe stimulus toxicity via skin:divide the rabbits into a integrated skin group and a damaged skin group,in addition,every group further divide into high,low dosage group and vehicle control group,totally 6 groups.Observe the reaction after multiple doses,after 7 days' successive doses,take the drug-used tissues to do pathological examination.Experiment 3,cavy's skin irritation test:cavies were divide into vehicle group,plaster group,positive group,totally 3 groups,at the 6h,7th day,14th day,take off right side's skin of every group to do the provocative test respectively.On the 28th day,take off the left side's skin to do the provocative test.To see if the skin or the whole body is allergic to the plaster.Results In experiment 1,toxic response could not be found in any group; In experiment 2,rabbits in the integrated skin group didn't show redness or edema,rabbits in the damaged skin group all had redness and edema,but the differences were not statistically significant,compared with the corresponding time of vehicle group (P＞0.05).Such skin damage was not caused by plaster usage but inflammatory reaction of skin damage.In experiment 3,the vehicle group and the study group didn't show any abnormal anaphylactic reaction.Conclusion The compound Tiaoshiplaster is safe to skin.

Objective To compare the 96-week efficacy of de novo combination therapy with lamivudine ( LAM ) and adefovir dipivoxil (ADV) to that of optimization monotherapy for chronic hepatitis B (CHB).Methods A total of 155 CHB patients were collected from the First Affiliated Hospital of Anhui Medical University during 2007 and 2009.All patients were randomly assigned to LAM monotherapy group ( n =53 ),ADV monotherapy group ( n =50 ) or LAM with ADV combination group ( n =52 ) according to randomized digital table.The liver and kidney functions,HBV serum markers,and HBV DNA loads were tested every 24 weeks.If patients in LAM or ADV group had poor response or virological breakthrough,they were given optimized therapy with ADV or LAM at week 24,48 or 72.One-way ANOVA (normal distribution and homoscedasticity ) and non-parametric test (non-normal distribution ) were performed to compare measurement data among groups.The impact factors of early virological response were analyzed by binary Logistic regression method.Results At week 24,the complete virological responses in LAM group,ADV group,and LAM + ADV group were 66.0％ ( 35/53 ),34.0％ ( 17/50 ) and 90.4％ ( 47/52 ),respectively (x2 =35.282,P ＜ 0.01 ) ; while,at week 96 the complete virological responses in three groups were96.2％ (51/53),86.0％ (43/50) and 100.0％ (52/52),respectively (x2 =19.115,P＞0.05).At week 96,the cumulative recover rates of ALT in LAM group,ADV group,and LAM + ADV group were 86.8％ (46/53),82.0％ (41/50)and 94.2％ (49/52),respectively (x2 =3.613,P ＞0.05);however,the ALT levels in three groups were statistically different (x2 =11.195,P ＜ 0.01 ).At week 96,the HBeAg seroconversion rates in LAM group,ADV group,and LAM + ADV group were 31.3％ ( 10/32),20.7％ ( 6/29 ) and 38.7％ ( 12/31 ),respectively (x2 =2.313,P ＞ 0.05 ).Early virological response was not found in I patient in LAM group and 19 patients in ADV group; virological breakthrough occurred in 11 patients in LAM group and 1 patient in ADV group.All patients in LAM + ADV group had early virological responses and had no virological breakthrough.Logistic regression showed that complete virological response at week 24 was correlated with the baseline HBeAg,the initial treatment and HBV DNA load.Layered evaluation showed that there were significant differences in early complete virological responses among three groups for patients with positive HBeAg,HBV DNA ＞ 6.28 × 106 copies/mL and ALT ≤5 ×ULN (x2 =7.726,10.921 and6.100,P＜0.05 or ＜0.01) ; for those with HBV DNA ＞6.28 × 106copies/mL,complete virological response was not observed in ADV group treated for 24 weeks.Conclusion LAM combined with ADV has stronger antiviral activity,lower resistance rate and can improve liver function and virological response,especially for the patients with HBeAg-positive,high HBV DNA loads and ALT ≤5 × ULN.

Objective To compare the clinical characteristics and prognosis of bacterial liver abscess in patients with or without type 2 diabetes mellitus, in order to guide clinical diagnosis and treatment.Methods The clinical data of 110 patients with bacterial liver abscess at the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed.Among them, 45 cases with type 2 diabetes mellitus and 65 cases without type 2 diabetes mellitus were included in the study.The demographic data, clinical signs and symptoms, laboratory findings, pathogenic results, imaging findings, treatment and prognosis were compared between the two groups.Differences among the quantitative data with normal distribution were compared using t test, while count data were compared with χ2 test or Fisher exact test.Multivariate Logistic regression was used to determine the prognostic risk factors of two groups.Results Fever as initial symptom in diabetic group and non-diabetic group were 37 cases and 40 cases, respectively, while abdominal pain presented in 7 cases and 22 cases of the two groups, respectively, both with statistically significant difference (χ2=5.417 and 4.582, respectively, both P<0.05).As for laboratory examination, neutrophil counts in the two groups were (12.87±8.83)×109/L and (10.24±4.86)×109/L, respectively, the percentages of neutrophils were 0.841±0.077 and 0.799±0.103, respectively, albumin levels were (28.36±4.65) g/L and (30.67±6.16) g/L, respectively, with statistically significant difference (t=2.010, 2.317 and-2.265, respectively, all P<0.05).Patients with elevated blood urea nitrogen in the two groups were 13 cases and 8 cases, respectively, patients with elevated creatinine were 9 cases and 4 cases, respectively, with statistically significant difference (χ2=4.733 and 4.892, respectively, both P<0.05).In diabetic group, pus culture was positive in 13 out of 19 cases, and blood culture was positive in 7 out of 21 cases.In non-diabetic group, pus culture was positive in 9 out of 13 cases, and blood culture was positive in 6 out of 25 cases.The positive rates of Klebsiella pneumoniae in the two groups were 37.5% (15/40) and 15.8% (6/38) , respectively, with statistically significant difference (χ2=4.669, P=0.031).The effective rates of the two groups with glycemic control were 84.4% (38/45) and 84.6% (55/65), respectively, and the mortality rates of the two groups were 2.2% (1/45) and 1.5% (1/65), respectively.Multivariate Logistic regression showed that multiple abscess (OR=34.61, 95% CI: 1.601-748.457, P=0.024) was prognostic risk factor and invasive intervention (OR=0.028, 95%CI: 0.001-0.984, P=0.049) was protective factor in the diabetes mellitus group.Hypoalbuminemia (OR=14.793, 95% CI: 1.605-136.322, P=0.017) and the history of abdominal surgery within two years (OR=7.624, 95% CI: 1.294-44.913, P=0.025) were prognostic risk factors in the non-diabetic group.Conclusions Patients with bacterial liver abscess showing symptoms of severe infection in diabetic group are more frequently than patients in non-diabetic group.Klebsiella pneumoniae infection rate is also higher in diabetic group.Patients with bacterial liver abscess and diabetes mellitus should receive antibiotic treatment combined with invasive therapy in time.