Objective:To study bacterial distribution and antimicrobial resistance of 489 strains of bacteria isolated from clinical urinary specimens of inpatients in department of kidney diseases of our hospital from 2001 to 2002,and propose rational use of antibiotics.Methods:Bacteria was isolated and identified by routine methods.Antimicrobial susceptibility was tested by K-B method.Results:in the 489 strains,there were307 strains of gram-regtive bacilli which account for 62.5%,mean while,there were 182 strains of gran-positive cocci which acconnt for 37.5%.The gram-negative bacilli mainly included K.pneumonice P.mirabilis and E.aerogenes.And the gram-positive cocci mainly included enterococcus and serum coagulase negative staphylococcus.The gram-negative bacilli were sensitive to imipenem and piperacillin/tazobactam,while the gram-positive cocci were sensitive to vancomycin and Teicoplamin.Conclusion:The urinary system infection is always induced by E.coli and Enterococcus.The periodical detection for bacterial resistance has an important significance for clinical treatment.

Objective:To monitor the rug resistance and epidemiology state of pseudomonas aeruginosa(PA)isolated clinical pa- tient.Methods:antimicrobial sensitivity tests were performed by K-B method and metallo-?-lactamases-producing PA was genotyped by the randomly amplified polymorphic(PAPD)assay.Results:Among24 strains resistant to imipenem.19(8%)strains produced metal enzyme which could be distingurished into 10 kinds of PAPD type.the type ability was 100%.There was same gene type strain.Isolated from three patient and there were two kinds of gene types. Among 2 strains isolated from the same patient at the different time.Conclusions:the K-B method could be used to determine metal enzyme,rapidly and eonviently. And PAPD could to be used in the molecular epidemiological study of PA.

Early recognition of severe sepsis and septic shock,early initiation of effective interventions,implementation of early goal-directed therapy may be key approaches for reducing the mortality and improving the prognosis.This article focused on the staging diagnosis systems for sepsis (PIRO sepsis classification system) and the systematic early warning or rapid response system.We also discussed the diagnostic value of biomarkers,proteomics and metabolomics in sepsis and severe sepsis.No single marker as golden standard has emerged that can provide clinicians with all the information they need for early recognition of sepsis.Therefore,we suggested that clinicians should have even more reason to combine the sepsis symptoms,signs and biomarkers for a comprehensive evaluation,and that they needed to dynamically monitor the changes in these parameters,in order to make reasonable clinical decisions and strategies.

32 Cases of coronary heart diseases (M 20, F 12; age 58+10 y) were treated with polysacchairde sulfate (PSS). PSS 200 mg in 10% glucose solution 500 ml iv, drip, qd, and 14 d, as a course. The results showed; The cardiac function, blood fat and indices of hemorheology were significantly improved ( P

Adolescent ; Adult ; Chronic Disease ; Female ; Humans ; Laryngeal Diseases ; etiology ; therapy ; Male ; Middle Aged ; Occupational Diseases ; therapy ; Singing ; Young Adult

Objective To understand the pathogenic bacteria distribution and drug resistance in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods The retrospective analysis was per-formed in the sputum culturs and drug resistance results of 740 patients with AECOPD. Results The positive rate of bacterial infection was 39. 1%. Among them, gram-negative bacteria were 196 strains (62. 4%), gram-positive bacteria 21 strains (6. 7%), and fungi 97 strains(30. 9%). The main kinds of gram-negative bacteria were Pseud-omonas aeruginasa, Acinetobacter baumannii,Klebsiella pneumoniae,Stenotrophomonas maltophilia and Escherichia-coli. Staphylococcus haemolyticus, Streptococcus pneumoniae and Staphylococcus aureus were the most frequent gram-positive bacteria. The major fungi was Candida albicans. Gram-negative bacteria showed high resistance to the third-generation cephalosporins,penicillins, moderate resistance to aminoglycosides,low resistance to imipenem. Gram-positive bacteria were resistant to many kinds of antibiotics, but they were responsive to linezolid and vancomycin. Fungi showed high sensitivity to antifungal agents. Conclusion The pathogens of AECOPD mainly are gram-nega-tive bacteria with a high drug resistance rate. To monitor pathogenic bacteria is conducive to master the pathogens distribution, drug resistance and provide the basis of rational use of antibiotics,which can slow down the emergence and spread of resistant bacteria.

The specific aspects of big data management practice for the Million Veteran Program (MVP) in USA were summarized by investigating it with network survey method and literature survey method, including large scale collection of data, structure of data management organizations, platform for data integration, privacy and security of data.The enlightenments of big data management practice for the MVP in USA on big data management of precision medicine in China were analyzed from 5 aspects.

Microcirculation disturbance and ischemia of the pancreas are important pathophysiological changes in the onset of acute pancrea-titis,and organ hypoperfusion is a risk factor for poor prognosis.During the first 12 to 24 hours after admission,fluid resuscitation is the most important medical treatment for the early stage of acute pancreatitis,and timely and rational fluid infusion helps to improve prognosis. However,there lacks high -quality clinical evidence for type of fluid,infusion speed,and monitoring methods,and more randomized con-trolled trials are needed.

AIM:To explore the effect of gypenosides ( GPs) on PCSK9 gene expression in hyperlipidemic rat liver and the blood lipids lowered by simvastatin .METHODS: Healthy male SD rats ( n=60 ) were randomized into 5 groups:normal control group , hyperlipidemic model group , simvastatin group , GPs group and GPs combined with simvasta-tin group ( combined group ) .The rats in all groups were fed high-fat diet except normal control group which were fed with ordinary diet.The rats in control group and hyperlipidemic model group were gavaged with 0.3%CMC-Na every day.The rats in GPs group were gavaged with GPs at 160 mg? kg-1? d-1 .The rats in simvastatin group were gavaged with simvas-tatin at 5 mg? kg-1? d-1 .The rats in combined group were gavaged with GPs and simvastatin .The experiment lasted for 8 weeks.The rats were anesthetized with chloral hydrate , and abdominal arterial blood samples were collected to detect the total cholesterol ( TC) , triglyceride ( TG) , low-density lipoprotein cholesterol ( LDL-C) and high-density lipoprotein cho-lesterol ( HDL-C) .The body weight and the wet weight of the livers were measured , and the liver index was calculated . The pathological changes of the livers were observed under microscope with HE staining .The expression of PCSK9 and low-density lipoprotein receptor ( LDLR) at mRNA and protein levels was determined by real-time PCR and Western blot .RE-SULTS:The model of hyperlipidemia rats was established successfully .Compared with model group , the levels of TC , TG and LDL-C in simvastatin group, GPs group and combined group were obviously decreased (P<0.05), and the HDL-C levels were obviously upregulated (P<0.05).Compared with model group, the liver indexes in simvastatin group, GPs group and combined group were obviously decreased (P<0.05).The pathological changes of the liver tissues showed that hepatic adipose appeared in model group , and that in simvastatin group and GPs group had different degrees of relief , espe-cially in combined group .Compared with model group , the mRNA expression levels of PCSK 9 and LDLR in simvastatin group were obviously increased , while the mRNA expression levels of PCSK 9 in GPs group and combined group were obvi-ously decreased (P<0.05), and the mRNA expression of LDLR in combined group was obviously increased (P<0.05). Compared with model group , the protein expression of PCSK 9 and LDLR in simvastatin group was obviously increased , while the protein expression levels of PCSK 9 in GPs group and combined group were obviously reduced , and the LDLR pro-tein levels were obviously increased (P<0.05).CONCLUSION:Gypenosides inhibit the expression of PCSK9 and in-crease the expression of LDLR in the liver .The combination of gypenosides and simvastatin promotes the lipid-lowering effect of simvastatin and attenuates hepatic steatosis , which may be related to inhibiting the expression of PCSK 9 in the liv-er.

As a mode of pay for performance,hospital value-based purchasing has been become widespread the US.Medicare managed to encourage the service providers to provide medical services with more value and quality.The implementation background,financing,payment mode and performance evaluation of hospital value-based purchasing were briefly introduced.In the payment reform of China,it also needed to focus on the medical service quality,learn from the performance evaluation system,incentive mechanism and multiple measurement,reasonably design the implementation scheme.