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 observe the effect of integrated therapy of Chinese medicine and chemical drugs on adverse reaction and curative effect of initial treatment of secondary pulmonary tuberculosis. Methods Totally 1404 patients with secondary pulmonary tuberculosis and TCM lung consumption diagnostic criteria (syndrome of lung yin deficiency, qi-yin deficiency, yin-deficiency caused excessive fire) were chosen for single blind, randomized, controlled, multicenter clinical trials. Trial group was given 2HRZE/4HR, 1 time/day with Chinese medicine 2 or 3 times/day, and control group was given 2HRZE/4HR only for six months. The adverse reactions and clinical symptoms were observed to evaluate clinical efficacy and safety. Results In terms of reducing liver damage and other adverse reactions, the ratio of trial group had statistical difference with that of control group (P<0.001). In symptom scores of lung yin deficiency syndrome treated for 2, 4, 6 months, yin-deficiency caused excessive fire syndrome treated for 6 months, qi-yin deficiency syndrome treated for 4, 6 months, the differences between the two groups were significant (P<0.001). TCM syndrome curative effect between the two groups was statistical different (P<0.001). Safety evaluation result between the two groups was statistical different by tratified analysis (P<0.001). Conclusion Integrated therapy of Chinese medicine and chemical drugs can improve the symptoms and reduce adverse reactions caused by chemical drugs. It can enhance the curative effect and safety.

Objective To investigate the resistance-mechanism of the carbapenems-resistant Klebsiella pneumoniae isolated from clinical.Methods The clinical isolates of carbapenems-resistant Klebsiella pneumoniae from top three comprehensive hospitals of Nanjing area were examined by 40 beta-lactamase,porin-coding genes and linkage of KPC-ISKpn6 using PCR method,the PCR positive results were picked out for sequencing and sequencing BLAST search for comparison analysis.Results Twenty-four strains of carbapenems-resistant Klebsiella pneumoniae were detected,the positive rate of A beta-lactamase TEM-1 and SHV was 100％ (24/24),KPC-2 and LAP-2 was 95.8％ (23/24),45.8％ (11/24) respectively,and C beta-lactamase DHA was 4.2％ (1/24).Meanwhile,the positive detection rates of KPC-ISKpn6 linkage was 95.8％ (23/24),and the mutation rate of porin-coding genes ompK35 and ompK36 were up to 95.8％ (23/24) and 100％ (24/24).Conclusion High incidence of beta-lactamase TEM-1,SHV,KPC-2 and LAP-2 was found in the group of Klebsiella pneumoniae isolates,and carbapenems-resistant of which was primarily due to the high carrying rate of KPC-2 and the high mutation rate of porin-coding genes ompK35 and ompK36.The Insertion sequence ISKpn6 may be involved in the KPC-2 gene mediated-expression.

Objective To make certain about the phase of time from the culminated point of instantaneous accelerating wave intensity (W1) to that of instantaneous decelerating wave intensity (W2) wave intensity(WI) technique. Methods The ejection time of the curve of Doppler rate of flow in aortic opens and W1～W2 of common carotid arteries of both sides were detected in 66 healthy adults by Prosound α10 color Doppler ultrasound and the data were contrasted and analyzed. Results There were no statistical significances in the standardized value difference of ejection time of aorta and of time from starting point of W1 to culminated point of W2 in common carotid arteries of both sides (P>0.05). And there were all statistical significances in the standardized value difference of ejection time of aorta and of time in other groups (P<0. 001). Conclusions The ejection time is the time from starting point of W1 to culminated point of W2. The beginning of cardiac ejection should be the starting point of W1 curve,and the culminated point of W2 is the terminal time of ejection.