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 prevent the nosocomial infection event in the clinical laboratory.METHODS To improve the management,amplify necessary rules and regulation,fine study and training,and do well in self-protection among department staff.Abacterial technical operation be carried out strictly.Keep the rooms clear,and disinfect the instrument and medical garbage.RESULTS By means of above mentioned management and prophylaxis,to control the risk factors of nosocomial infection in clinical laboratory.CONCLUSIONS The management and controlling measures of risk factors in clinical laboratory are the keys to prevent the nosocomial infection event in clinical laboratory.

Objective To analyze effects of different anesthesia procedures on heart rate variability(HRV) as an index of autonomic nervous activity and hemodynamics during CO2 pneumoperitoneum pressure in laparoscopic cholecystectomy(LC).Methods 45 patients of ASA I or II phage scheduled for LC were divided into general anesthesia group(Group I,Control Group),general anesthesia combined with esmolol group(Group II) and general anesthesia combined with epidural block group(Group III) according to operation date.HRV,HR and MAP were measured before anesthesia(T1),before pneumoperitoneum(T2) and at 5 min(T3),10 min(T4),20 min(T5),30 min(T6) after pneumoperitoneum.Results As compared with pre-pneumoperitoneum(T2),low frequency(LF),low frequency/high frequency(LF/HF) in the Group I increased significantly(P0.05).Comparisons among the three groups,LF,LF/HF in the Group I at all time points after pneumoperitoneum were significantly higher than those in the II and III Group(P0.05).Conclusions Esmolol can relieve stress reaction induced by pneumoperitoneum,but it can't completely block increasing of sympathetic nerve activity;using general anesthesia combined with epidural block in LC can inhibit sympathetic nerve excitation,sustain automatic never stability.

Objective To explore the effect of NF-?B activation induced by lipopolysaccharide(LPS) in rat Kupffer cells(KCs). Methods KCs were divided randomly into three groups. A group was control group. KCs were co-cultured with LPS in B group. KCs were co-cultured with LPS and PDTC in C group. NF-?B activity of KCs was determined with EMSA. Content of I-?B protein in KCs was detected with western blot. Expression levels of TNF-? mRNA, IL-6 mRNA of KCs were measured with RT-PCR. Results LPS induced NF-?B activation of KCs, decreased I-?B content of KCs, and increased expression levels of TNF-? mRNA and IL-6 mRNA markedly. PDTC could diminish the above effects of LPS on KCs. Conclusions NF-?B activation induced by LPS may induce cell injury by promoting expressions of TNF-? mRNA and IL-6 mRNA in KCs. PDTC could decrease mRNA expression of proinflammatory mediators by suppressing excessive NF-?B activation in KCs.

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 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 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.