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 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 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 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 clinical value of prealbumin (PA) and C-reactive protein (CRP) level for the diagnosis of children patients with bacterial community acquired pneumonia (CAP).Methods Seventy-two children with bacterial CAP (CAP group) between July 2012 and December 2013 were enrolled in the study.Fifty healthy children were selected as healthy control group.The level of serum PA and CRP were measured by flow cytometry and turbidimetric immunoassay respectively.The results were compared.Results Before treatment,the level of CRP in CAP group was higher than that in healthy control group,and the level of PA in CAP group was lower than that in healthy control group,there was significant difference (P ＜ 0.01).The level of white blood cell count and the rate of neutrophilic granulocyte in CAP group was higher than that in healthy control group,but there was no significant difference(P ＞ 0.05).After treatment,the level of CRP in CAP group was decreased and the level of PA was increased,there was significant difference (P ＜ 0.05).Pearson analysis showed that the level of CRP in CAP patients had negative relationship with the level of PA (r =-0.613,P ＜ 0.01).Conclusion Detection of serum PA and CRP contributes to clinical diagnosis of children bacterial CAP and evaluation of anti-infection effect.

Objective To compare CT perfusion changes of patients 1 month after living liver transplantation with healthy volunteers. Methods Twenty perioperative patients without complications and 25 healthy volunteers underwent dynamic multi-slice CT scan. On each targeted slice, liver was divided into 3 regions of interest (ROI) according to hepatic venous drainage, i.e. anterior segment area drained by middle hepatic veins (MHV) which was most likely congested, risk area drained by both MHV and RHV which was posterior to anterior segment, reference area drained by RHV. Perfusion parameters and relative perfusion difference were calculated.Results The relative perfusion differences of anterior segment and risk area in study group were as follows: BF 44.56±43.19 vs 25.41±27.49 ［ml/(min〖DK〗·100 g)］; BV 3.91±2.45 vs 2.15±1.86(ml/100 g); PVP 41.50±39.15 vs 22.66±23.82 ［ml/(min·100 g)］. Significant differences of RPDs of BF, BV and PVP were found in anterior segment (P<0.0001) and risk area (P＜0.01) compared with control group.Conclusion In perioperative period, there are hemodynamic differences in hepatic segments drained by RHV and MHV. BF, BV, PVP of anterior segment decreases obviously.

Objective To assess the value of CT, PET, PET/CT in diagnosis of peritoneal metastases with Meta analysis. Methods Articles of CT, PET or PET/CT on peritoneal metastases published in English or Chinese from Jan 2000 to May 2008 were collected, and histopathological and (or) surgical findings were taken as golden standards. The sensitivity, specificity, summary receiver operating characteristic (SROC) curves, area under the curve (AUC) and the heterogeneity were calculated with software of SAS 8.0, Meta-DiSc 1.4 and STATA 10.0. Results The results of Meta analysis from 11selected articals showed that PET had the highest pooled specificity [0.96, (0.91-0.98)];PET/CT had highest pooled sensitivity [0.77, (0.67-0.85)]. The AUC and Q~* of PET, PET/CT and CT was (0.92, 0.85), (0.99, 0.96), (0.91, 0.84), respectively. AUC of PET/CT was higher than that of CT (Z=2.33, P<0.05). Conclusion PET/CT is a high accuracy diagnostic tool for detecting peritoneal metastases.

Objective To discuss the practice effect about the waiting area in the hospital building of the daping hosptial ,the third military medical university to be reformed into digital subtraction angiography (DSA) composite operating room .Methods We reasonably choiced the form of purify conditioning ,medical C arm ,smallpox air supply ,and the efficient screening device layout at the end of smallpox air supply .Results The main parameters of the measured results met the national standards of indexes .The fan frequency was 48 Hz running at hundred grade ,and its operation energy consumption was about 25 kw/h ;the fan frequency was 35 Hz running at ten thousand grade ,and its operation energy consumption was about 12 kw/h;the conversion time was very short between hundred grade and ten thousand grade running ,about 10 minutes .Conclusion On the condition that the building environ-ment is not fit to install hanging medical C arm ,we can thorough choose floor type C arm ,adopt “leakage resistance type clean air supply smallpox” ,reasonably modify the form of purify air conditioning to design or modify a hundred grade operating room meet-ing requirement .

The authors give an account of their guiding ideology, implementing methods and practical experience in setting up research funds for nursing. Their experience is as follows. Establishment of the funds in their hospital has played a positive role in promoting research on nursing. Greater increase in intellectual input and creation of a sound environment for the conduction of research on nursing is an effective guarantee for the successful conduction of the work. Emphasis has been rightly put on clinical projects by orienting the research funds towards projects involving clinical nursing. And making a good job of the whole nursing procedure is the key to the proper application of the research funds for nursing. Besides, to give full play to the role of research funds for nursing, it is imperative to cultivate academic leaders in nursing able to keep abreast of the times, aim closely at the frontier research in the field and bring into effect the starting and catalytic action of research funds for nursing.

Objective To set up assessment indexes of nursing process quality in hospitals that are scientific, practical and in keeping with the times so as to provide hospital departments in charge of nursing with the basis for reasonable assessment and scientific decision-making. Methods Typical investigations were conducted to understand the content and methods of the current assessments of nursing process quality in hospitals; the basic scope of the assessment indexes was determined through meeting discussions; the indexes were selected, verified, and established by means of brainstorming and the Delphi method; field surveys were conducted to assess and analyze the nursing process quality in 25 departments. Results A system of comprehensive assessment of nursing process quality in hospitals was established. It covered four categories, viz. nursing services, nursing control, nursing skills and nursing safety, and decomposed into assessment indexes of different levels, with the overall structure consisting of 1 overall goal, 4 first-level indexes, 12 second-level indexes, 5 third-level indexes and 290 subindexes. Conclusion The new system of indexes, which stresses the idea of nursing services, highlights the quality control principle of focusing on the patients,and is characterized by clear-cut structure and easy operability, provides a reliable guarantee for scientifically and rationally assessing nursing process quality.