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.

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.

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 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 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 explore the correlation between ADAM33 SNP and asthma in Uygur and Han children in Urumqi. Methods Eighty-six Uygur and 111 Han children aged 3-15 years old who had asthma and lived in Urumqi were included. Meanwhile 56 Uygur and 64 Han healthy children were also included as control group. Genotyping of single nucleotide polymorphism (SNP) of V4 and T2 loci in ADAM 33 gene was performed by PCR, and verifications was made. Results There were statistical differences of V4 and T2 loci in ADAM 33 gene among asthma group and control group (P all??0.05) while there were differences in Uygur children (P all

OBJECTIVE: To ensure legal,rational and safe use of anesthetic drugs.METHODS: Based on the related laws and regulations as well as the actuality,the regulatory regime on the use of anesthetic drugs was set and enforced.RESULTS: The regulations about the use of anesthetic drugs were able to be implemented satisfactorily,and the regulatory regime has changed the abstract management connotation into rapid process.CONCLUSION: It's operative and efficient to adopt flow management on the use of anesthetic drugs.