Objective To evaluate the activities of 18 pairs of antimicrobials combinations against non - duplicate clinical isolates of multidrug resistant Acinetobacter baumannii (MDRAB) in vitro.Methods Collect isolates of Acinetobacter baumannii from different patients from October 2009 to May 2010,which were isolated in Clinical Laboratory Center of Beijing Friendship Hospital,Capital Medical University.Use broth microdilution method to detect MIC of mono-antimicrobial,and checkerboard broth microdilution method to detect combinatied MIC,and calculate fractional inhibitory concentration (FIC) index to determine drug combinations effects.When the performance of the same drug combinations conflicted,appropriate strains were selected for screening of drug-resistant mechanisms by polymerase chain reaction( PCR),including efflux pump genes.Results In tests in vitro,rifampicin and polymyxin B,imipenem and gentamicin,cefepime and levofloxacin showed synergy at high proportion,68.1％,45.5％,40.9％,respectively.Minocycline and rifampicin,ampicillin/sulbactam and tobramycin.Ceftazidime and ciprofloxacin showed additive effect at high proportion,81.8％,68.2％,68.2％,respectively.There were several combinations which appeared the opposite effects to tested strains.Strains No.19 corresponding reaction was synergy and No.21,No.26 corresponding reactions were antagonism.The three strains above were selected for screening resistant mechanisms.The difference is that genotypes of adeS were negative in No.19 and positive in No.21 and No.26.Conclusion Rifampicin and polymyxin B combination showed synergy against the MDRAB in vitro,which can be considered as the treatment choice for critical infections caused by MDRAB.Imipenem and gentamicin,cefepime and levofloxacin also showed synergy in vitro,but in some isolates showed antagonism.This phenomenon may be due to the gene adeS activated by certain antibiotics,and the activated adeS drived efflux pump express or overexpress,which made the drugs in bacterial cells pumped out,causing antagonistic effect.The individual differences in strains should be considered when clinic strain apply these two combinations above.

Objective To evaluate the activity of antibiotics against pan-drug-resistant (PDR) Acinetobacter baumannii by combination antimicrobial susceptibility test in viro with epsilometric methods (Etest method) and microdilution checkerboard (CB method),and to detect a good correlation between timekill curve with the above mentioned two assays.Methods Thirty-one clinical isolates of PDR Acinetobacter baumannii were selected for mono and combination antimicrobial susceptibility test in vitro by E-test and CB method,then a comparison was conducted between the test results and the time-kill curve.Mono drugs involved tigecycline,colistin,imipenem and amikacin,and combinations involved two of drugs above,and three drugs involved imipenem/tigecycline,plus amikacin combination.Results Synergistic effect was detected in imipenem plus colistin and tigecycline plus imipenem combination.A high comparability was revealed between the E-test method with antimicrobial drugs added into the culture medium and the time-kill curves.Synergy in the combination of imipenem/tigecycline,plus amikacin was detected by the CB method and time-kill curves.Conclusion The results showed that the effect of specific combination of antibiotics against PDR Acinetobacter baumannii could be predicted by testing their synergistic effect with combination antimicrobial susceptibility test.

Objective To evaluate the effect of selective decontamination of digestive tract(SDD)on preventing ventilator-associated pneumonia by Meta-analysis based on theory and method of evidence-based medicine.Methods Six medical databases (PubMed,Excerpta Medica Database [EMBASE],China Biology Medicine disc[CBMdi-sc],China National Knowledge Infrastructure[CNKI],VIP database,from 1995 to 2014,and Cochrane Library of issue 12,2014 )were searched,literatures were selected,data were extracted,Meta-analysis was performed by using RevMan 5.3 software.Results 13 literatures were included (2 676 patients were involved),Meta-analysis revealed that the incidence of VAP in treatment and control group was 20.68% and 35.99% respectively (OR and 95%CI ,0.40 [0.28,0.56],P <0.001 ),the mortality rate of patients with mechanical ventilation in treatment group and control group were 20.60% and 20.03% respectively (OR and 95%CI ,0.99 [0.81 ,1 .20],P =0.91 ). Conclusion SDD can reduce the incidence of VAP in patients with mechanical ventilation,but can’t reduce mortali-ty rate.

Objective Comparison the corrective effect of plasma exchange method and formula method for chylemia on hematology analysis.Methods A total of 10 samples without hemolysis,jaundice and lipemia were set as control group,each sample was divided into 4 parts,then 5,10,20 and 40 μl lipid emulsion was added.Each chylous samples was treated by plasma exchange method for two times,and routine blood test was reanalyzed with hematology analyzer.The comparisons before and after the exchange was made,while the test results on each exchange were analyzed.For another part,the HGB of chylous plasma was tested,the value was substituted into HGBcorrected value =HGBbefore correction-(HGBchylous plasma-HGBchylous plasma ×HCTbefore correction).Results The chylemia could lead significant increase of HGB,MCH and MCHC (P＜0.05).After plasma exchanging for two times,the three parameters returned to normal and the count of WBC,RBC and PLT decline slightly with no significance.There were no differences between plasma exchange method and formula calibration method.Conclusion Plasma exchange method and formula calibration method could significantly reduce the impact of chylemia on routine blood analysis,which facilitate the clinical work with correct analysis of routine blood test.

OBJECTIVE To study the antibiotic sensitivities and characterization of ?-lacamase activity and the antibiotic resistance mechanisms.METHODS The extended-spectrum ?-lactamases were detected.Agar dilution method was used to determine the minimum inhibitory concentration(MIC)of severel antibiotics.The plasmids of clinical isolates were cloned into competent cells(K-12).RESULTS Isoelectric focusing(IEF):The last 5 clinical isolates have all got an activity at a high pH 9 which could be presumptively identified as AmpC.The last two clinical isolates had a weak activity with pH of about 8.0,which belonged to SHV type ?-lactamases.All the isolates had a group of activities at the lower pH range of the gel(pH5).These could be presumptively identified as TEM ?-lactamases.CONCLUSIONS The data suggest that each isolate clearly originate from the same population but possess mutations that leads to antibiotic resistance.The combinations of mutations in same isolates suggest that an earlier strain have infected other compartments and become the founder for later antibiotic resistant variants.

Objective To compare efficacy of indirect immunofluorescence (IFA) and real‐time fluorescent polymerase chain re‐action(PCR) in detection of mycoplasma pneumonia in children .Methods A total of 137 children clinically diagnosed as Mycoplas‐ma pneumoniae(MP) infection were selected and divided into groups by age ,including <1 years old group(35 cases) ,1- <5 years old group(69 cases) and 5-15 years old group(33 cases) .Blood specimen and throat swabs were collected and detected by using IFA and real‐time fluorescent PCR .At the same time ,all of the selected children were treated with conventional therapy ,according to total effective rate ,positive coincidence rates of the two methods were statistically analysed by age .Results The positive coinci‐dence rates in children with MP infection <1 years old and 1- <5 years old detected by using real‐time fluorescent PCR were high‐er than that detected by using IFA ,while among children 5-15 years old ,the positive coincidence rate was higher detected by using IFA compared with that detected by using real‐time fluorescent PCR ,all had statistically significant differences (P<0 .05) .The o‐verall positive coincidence rates of the two methods were not significantly different(P>0 .05) .Conclusion IFA and real‐time fluo‐rescent PCR both could be used as effective methods for detecting MP ,but there are some differences of detective efficacy between the two methods in each age group .Therefore ,it is suggested that for children under 5 years old real‐time fluorescent PCR might be selected ,for children aged 5 years old and over IFA might be selected ,in order to improve the detection accuracy and provide better guidance to clinical medication .

Objective To study the expression of homocysteine in serum of patients with common malignant tumor,and initially investigate the possibility of serum homocysteine as cancer biomarker.Methods Expression levels of homocysteine and caner biomarkers (CEA,AFP,CA125,CA199) in serum of 180 patients with established malignant tumor and 30 healthy controls (control) were measured,the results of homocysteine were compared with that of the cancer biomarkers based on the cutoff value used in clinic.Results The expression levels of homocysteine was significantly higher in patients with malignant tumor than in controls [(13.89 ± 4.95) μmol/L-(21.40 ± 9.38) μ mol/L vs (11.40 ± 3.13) μmol/L,P ＜ 0.05)].Conclusions The positive predictive rate of homocysteine is higher than the four kind of cancer biomarkers in lung cancer,breast cancer,esophageal cancer.The increase of homocysteine in tumors may be universal,and Homocysteine may be used as cancer biomarker in lung cancer,breast cancer and esophageal cancer.

Objective To investigate the diagnosis rate of early gastric calleer(EGC)with mucosa biopsy after compound staining under gastroseopy.Methods Two hundreds and six pafients who suspected tO be EGC by gastroscopy were randomly divided into two groups,the mucosa in control group(n=103)was biopsy directly under gastrescopy,and the experimental group(n=103)was biopsy after compound staining.Compared the diagnosis rate of ECG between these two groups.Results Twelve cases were confirmed to be EGC by surgery plus pathology among all the patients.Two cases were from control group,the other ten cases were from experimental group.Type Ⅱ c+Ⅲ accounted for 58.3%of twelve EGG.Eleven cases(91.7%)were positive with helicobacter pylori(Hp).Conclusion Compound staining may improve diagnosis rate of ECG.There is significant deference between directed and mueosa biopsy after compound staining under gastrescopy(P=0.033).TypeⅡc+Ⅲwere main type in endoscope of EGC.Hp infection is closely related to early gastric cancer.

Objective To discuss the best bacterial combination for the diagnosis of Bacterial vaginosis (BV).Methods This is a retrospective study,230 BV-positive patients and 360 healthy women were enrolled based on the Amsel criteria and Nugent score.5 BV-associated bacteria,including Gardnerella vaginalis,Atopobium vaginae and Leptotrichia/Sneathia species,et al.were amplified by specific-PCR assay,the detection rate were compared between two groups.ROC curve and Kappa test were used to select the best combination.Results The detection rate of Gardnerella vaginalis,Atopobium vaginae,Leptotrichia/Sneathia species,Megasphaera species and Mobiluncus mulieris in BV group (91.3％,83.5％,39.1％,42.6％ and 36.5％ respectively) were markedly higher than that in healthy women (37.2％,14.4％,11.7％,8.9％ and 5.6％ respectively),x2 value were 168.848,275.776,60.949,92.886 and 92.68,all P ＜ 0.05.The area under ROC curve of A.vag,G.Vag + A.vag,G.Vag + A.vag + Lepto,G.Vag + A.vag +Mega and G.Vag + A.vag + M.mul were 0.845,0.862,0.865,0.869 and 0.867,and the sensitivity and specifity were higher than 80％,the value of Kappa were larger than 0.75 (P ＜ 0.05).Thus,these five methods were coincident.Conclusion Detection of Atopobium vaginae may be a better way for the diagnosis of BV.

Clinical practice is an important part of cultivating the master of nursing specialist,this paper analyzed characteristics of clinical practice in domestic and foreign nursing students and revealed the problem in cultivation of master of nursing specialist in China,in order to provide references for the future construction and perfection of clinical practice of master of nursing specialist in China.