Objective To learn the prevelance of Acinetobacter baumannii and its drug resistance related with Ⅰ class integron. Methods 22 kinds of antibiotics commonly used in our hospital were used to detect the sensitivity of the clinically separated Acineto-bacter baumannii.Methods PCR was used to detect Ⅰ class integron enzyme gene of Acinetobacter baumannii,and then parts of variable region of Ⅰ class integron enzyme gene were amplified and analyzed for gene sequence.Results The drug resistance of Acinetobacter baumannii phenomenon was very serious,which was multiple drug resistance.The resistance rate of Acinetobacter baumannii to CPZ/SB was 1.2%.And the resistance rates to tigecycline,ofloxacin,imipenem,biapenem,and amikacin were 1 5.4%-69.5%,but the resistance rates to other antibiotics were above 71%.There were 72 of 102 strains including Ⅰ class integron (positive rate was 70.2%).The resistance of strains with Ⅰ class integron was stronger than that of the strains without.The varia-ble area of Ⅰ class integron produced the same enzyme bands when analyzed with double enzyme,suggesting the Acinetobacter bau-mannii was homologous.The gene sequence analysis of Ⅰ class integron showed that the Ⅰ class integron of the Acinetobacter bau-mannii carried kinds of resistant genes such as aacA4,catB8 and aadA13.Conclusion From 2010 to 2013,the Acinetobacter bau-mannii in our hospital is highly resistant to cephalosporins,broad-spectrum penicillin,aminoglycosides and fluoroquinolones and is severely multiple drug resistant.So the antimicrobial drugs for the treatment of infections caused by Acinetobacter baumannii are limited.Ⅰ class integron is closely related to the multiple drug resistance of Acinetobacter baumannii.

Objective To observe the effect of Succinate injection combined with Bifico on the myocardial enzymes changes of the children with rotavirus enteritis.Methods A total of 146 children with rotavirus enteritis were enrolled and included in this study. Children were randomly divided into the control group (n=73) and the observation group (n=73). The control group was received Bifico on the basis of routine treatment, and observation group was received Succinate injection combined with Bifico. The IL-17, IL-6, TNF-?, LDH, CK, and CKMB was detected by ELISA. The rates of clinical effects was compared.Results After treatment, the IL-17 (22.35 ± 4.21 ng/mlvs. 30.24 ± 6.07 ng/ml,t=2.395), IL-6(31.26 ± 6.14 ng/mlvs. 43.72 ± 8.22 ng/ml,t=2.347), TNF-? (35.62 ± 6.24 ng/mlvs. 49.18 ± 8.72 ng/ml,t=2.421), LDH (135.16 ± 31.25 U/Lvs. 174.08 ± 40.22 U/L,t=2.373), CK (37.82 ± 7.39 U/Lvs. 50.21 ± 11.16 U/L,t=2.385), and CKMB (90.14 ± 11.63 U/Lvs. 113.22 ± 18.35 U/L,t=2.392) in the observation group were lower than those in the control group (P<0.05). The rates of clinical effects was 94.5% (69/73) in the observation group and 83.6% (61/73) in the control group. There was significant difference between the two groups (χ2=2.352,P=0.047).Conclusions The Succinate injection combined with Bifico could reduce the inflammatory indices and alleviate the myocardial injury in the RVE patients.

Objective To explore the effect of I kappa B kinase (IKK) on liver during hepatic ischemia reperfusion (HIR) in rats.Methods Wister rats were divided randomly into HIR group in which hepatic reperfusion was given after 60 minutes of ischemia by interruption of the arterial and portal venous blood supply to the left lobes and middle lobes of the liver; HIR + PDTC treatment group in which PDTC (120 mg/kg) were injected via the dorsum vein of penis before ischemia reperfusion; and sham control group in which midline laparotomy was performed without vascular occlusion and treatment.Expression levels of IKK were measured with In situ hybridization(ISH).The NF-κB activities were determined with EMSA.Expression levels of TNF-α were measured with immunohistochemistry (IH).Serum levels of ALT were measured.Results Expression level of IKK was increased markedly from 0 to 12h and peaked 6h after reperfusion in HIR group.NF-κB was activated 0 ～ 12h after reperfusion and activities of NF-κB were maximal 6h after reperfusion in HIR group rats compared with sham control group.Expression level of TNFα was increased markedly from 0 to 12h and peaked 6h after reperfusion in HIR group.Serum levels of ALT were increased significantly after reperfusion in H1R group.Expression level of IKK was lowered markedly in HIR + PDTC group from 0 to 12h after reperfusion.NF-κB activities were significantly lower in HIR +PDTC group than in HIR group from 0 to 12h after reperfusion.Expression level of TNF-α was lowered markedly in HIR + PDTC group as compared with HIR group from 0 to 12h after reperfusion.Serum level of ALT was decreased significantly after reperfusion in HIR + PDTC group as compared with HIR group.Conclusion HIR can activate IKK-β which promotes the activation of NF-κB,then NF-κB results in upregulation transcription of TNF-α gene which gives rise to the release of other inflammatory cytokines and triggers uncontrolled inflammatory response,and induces hepatic injury.Blocking IKK-NF-κB pathway may be an effective approach to checking the generation and development of ALI,PDTC plays important prophylaxis and treatment roles in hepatic injury after HIR.

Objective To explore the application of a system dynamics(SD) model to military medical expenses in PLA hospitals.Methods According to relevant theories of SD, the study has selected some important variables and defined the primary function relations in order to establish a military medical expenses SD model.Results and Conclusion The SD model is suited to modeling the PLA medical expenses and can serve as a theoretical basis for the policy innovation of the PLA medical system.

The reform in cultivating professional-degree programs in Clinical Medicine Education contributes to the transformation of training mode, which surpasses the connotative bounds of the inherent education management. The personalized training of students has made it more challenging for both the tutor and the faculty to involve in education management, the effectiveness of which is highly valued due to the pressing need for sound medical ethics. Furthermore, the development of information technology calls for the reform of education management as well as the emphasis of student-centered approach. This article summa-rizes the existing problems of current education management mode for master degree programs of profes-sional clinical medical education. In addition, a three-level management system composed of medical experts is brewed and put forth. This system, based on compensation and restraint, assessment and incentive, ser-vice as well as security, is meant to facilitate the training of application-oriented medical talents.

OBJECTIVE:To know about the implementation and existing problems of current Reasonable Medicine List for Mil-itary(Medicine List for short)(2014 edition). METHODS:The data of field investigation were summarized and analyzed. Compar-ative analysis was made to the data of medicines used by military patients and local insured patients in the general hospitals,hospi-tals affiliated to the military medical university,central hospitals,authorities'clinics and cadre's sanitariums'clinics (a total of 20)of 4 military regions in Nanjing,Lanzhou,Chengdu and Shenyang before and after the modification of the Medicine List. RE-SULTS & CONCLUSIONS:After the modification of the Medicine List,all the above-mentioned medical institutions of the 4 mili-tary regions used more varieties of medicines as set forth in the Medicine List,where there was the highest average increase up to 12.2% in the varieties of the medicines used by central hospitals,and the lowest average increase of 4.8% in those by general hos-pitals. Central hospitals used the largest number of varieties of medicines as set forth in the Medicine List,accounting for 83.3% of all varieties in the Medicine List on average;followed by hospitals affiliated to the military medical university,accounting for 80.6% on average;and the cadre's sanitariums'clinics used a smaller number of varieties thereof,only accounting for 63.9%. For military inpatients and outpatients,the medicine expense per capita increased by 15.0% and 18.0% respectively,which was differ-ent from that for local insured patients in the same period. It is suggested that the implementation of the Medicine List should be monitored and evaluated on a regular basis pursuant to the survey,to provide a reference for future adjustment of the Medicine List.

Objective To explore the role of endotoxin during hepatic ischemia reperfusion (HIR) in rats. Methods Wister rats were randomly divided into endotoxin, HIR and HIR plus endotoxin (HIRE) groups. In the HIR group, hepatic reperfusion was performed after 60 minutes of ischemia by interruption of the arterial and portal venous blood supply to the left lobes and middle lobes of the rat liver. In the HIRE group, LPS(1.0mg/kg) was injected via the dorsum vein of rat penis after ischemia and reperfusion. In the endotoxin group, LPS (1.0mg/kg) was injected via the dorsum vein of penis in the rats without ischemia and reperfusion. The NF-?B activities in the liver tissue of the rats were determined with EMSA. TNF-? expression levels in the liver tissue of the were measured with immunohistochemical staining. Serum ALT levels of the rats were also measured. Results NF-?B activity increased after reperfusion and remained high 12h after reperfusion in HIRE group compared with endotoxin group and HIR group. Both TNF-? expression levels and serum ALT levels increased markedly after reperfusion in HIRE group. Conclusion Endotoxin during HIR could induce hepatic injury. Endotoxin induced liver injury possibly by activating NF-?B followed by the subsequent expression of proinflammatory mediators in the liver tissue.

Objective To evaluate the predictive performance of the target controlled infusion (TCI) system for propofol using Marsh pharmacokinetic parameters in the elderly patients. Methods Sixteen ASA grade I - Ⅱ patients of both sexes (9 male, 7 female) aged 65-75 yr weighing 49-76 kg scheduled for elective lower abdominal surgery were enrolled in this study. The patients were unpremedicated. Right internal jugular vein was cannulated for drug and fluid administration and left radial artery was cannulated for BP monitoring and blood sampling. Anesthesia was induced with TCI propofol (target plasma concentration was set at 3 ?g?ml-1 ) and TCI fentanyl (target plasma concentration set at 2 ng?ml-1 ) . Tracheal intubation was facilitated with succinyl choline 1.5mg?kg-1 . The patients were mechanically ventilated ( VT 8 ml?kg-1 , RR 10 bpm) . Anesthesia was maintained with TCI propofol and fenlanyl and intermittent i.v. boluses of vecuronium. The target plasma concentration of propofol and fentanyl were the same as that for induction. MAP, HR, SpO2 and BIS were continuously monitored during operation. Blood samples were taken at 5, 10, 15, 20, 30, 45, 60, 90, 120 min during TCI of propofol for determination of plasma propofol concentration with HPLC. The predictive performance was evaluated by PE% [measured concentration (Cm) - predicted concentration (Cp)] /Cp ? 100% , MDPE, MDAPE and wobble. Results BIS was maintained between 38-55. The MDPE was 6%, MDAPE 14% and wobble 18 % with this TCI system incorporating Marsh pharmacokinetic parameters for propofol. Conclusion The TCI system incorporating Marsh pharmacokinetic parameters for propofol is acceptable for elderly patients.

Objective To analyze the impact of the declining balance rate in military hospitals during new healthcare reform.Methods A military medical expense model was established,the parameters of the model were changed and the impact of the declining balance rate was analyzed.Results and Conclusion Military hospitals have to face up to the negative influence caused by the declining balance rate,actively promote expenditure compensation mechanism reforms,increase funding,enhance supervision,and separate revenues from expenditures.

Object:To create a practicable and valid scale used to evaluate postgraduate tutors in medical universities.The scale will be applied to tutor evaluation in order to activate the tutors in their responsibility for postgraduate education.Method:Some mature scales and questionnaires offered by some oversea'universities such as University of Michigan were offered for reference.The scale designed for tutor evaluation in medical universities was applied to evaluate most of the master tutors in Capital Medical University.All of the data was analyzed by SPSS 11.5,and the scale was modified according to the results of statistic analysis.Conclusion:The modified scale showed satisfactory reliability and validity.