Objective To evaluate the susceptibilities of different testing methods of tigecycline against IRAB. Methods MIC and inhibitory zone diameters of 32 strains of IRAB for tigecyclinc were determined by different testing methods.Data were analyzed by comparing the results from each method to those produced by the reference macro broth dilution method. Results The rates of sensitivity intermediate resistance detected by macro broth dilution method , agardilution , MTS and Vitek-2 instrument , disk diffusion method were as follows , 34.375%, 65.625%, 0%, 3.125%, 81.25%, 15.625%, 75%, 25%, 0%, 78.125%, 21.875%, 0%, 3.125%, 81.25%, 15.625%. Compared with macro broth dilution method ,the key major error rate of other methods was 0% by FDA breakpoints , but the CA and EA rates were less than 90%. Conclusions Tigecycline has good activity against the IRAB, with significant difference in susceptible rate among the different methods.

Objective To investigate the clinical characteristics of pulmonary actinomycosis and to improve the understanding of the clinical misdiagnosis of pulmonary actinomycosis. Method Clinical data of 4 pulmonary actinomycosis patients were analized and related literatures were reviewed. Results All the 4 pulmonary actinomy-eosis cases were misdiaguosed as lung cancer. Pulmonary actinomycosis can be correctly diagnosed through lung bi-opsy by CT-guided percutaneous paracentesis,fiberoptic,bronchoscopy,or pathological examination of the resected pulmonary lobe. Conclusions Pulmonary actinomycosis is a rare lung infection caused by fungus,and is liable to be misdiagnosed as peripheral lung cancer. The capacity of distinguishing pulmonary actinomycosis from peripheral lung cancer needs to be improved.

Objective To report the use of self expanding metallic stents in treatment of benign tracheobronchial stenosis. Methods Nineteen patients with benign tracheobronchial stenosis were treated with implantation of self expanding stents (Ultraflex, Microvasive). Results Stents produced immediate improvement in clinical pulmonary sign and symptoms. Pulmonary function tests in 10 patients demonstrated a mean improvement in FEV1of 45%, FVC of 38%. Following up duration ranged from 10-18 months. Complications included recurrent pneumonia in 3 patients, airway obstruction due to granuloma formation in 2 patients, and stent migration in 1 patient. They were treated successfully with antibiotic therapy, laser therapy, and stent reimplantation, respectively. Conclusion Self expanding metallic stent implantation is a feasible and effective method of treating benign tracheobronchial stenosis.

Objective To evaluate the clinical value of endobrochial ultrasound (EBUS) examination,a new ultrasound technique.Method 15 patients with space occupying lesions in lung or doubted obstructive pneumonia or atelectasis were examined by EBUS.The procedure was performed with ultrasound catheters,which were introduced into bronchi through the operating channel of fiberoptic bronchoscope and a full 360℃ cross-sectional image was obtained.Result The bronchial wall was highly echogenic and laminated.The lung parenchyma appeared echo rich and patchy.Pulmonary vessels can be identified by the echo free lumen and the pulsatile changes.Echo poor bronchial carcinomas proved in pathology destructed bronchial wall in different extent were detected in 10 patients.1 patient with nodule in right apical segment who had intact bronchial wall was with tuberculosis proved by operation.1 patient with pleural effusion and atelectasis was detected by EBUS and found no abnormal echo,showing that the reason for atelectasis was compression instead of obstruction.Among the 3 patients who were suspected to have obstructive pneumonia,in 1 case ultrasound scanning showed enlarged lymph node outside the bronchus compressing the wall caused the channel mild narrow;as to the other 2 cases,because bronchial wall was complete and no tumor like echo were found,the obstructive factor was excluded.The ultrasound examination had no particular risk and caused little discomfort.Conclusion Endobronchial ultrasound scan can clearly demonstrate the adjacent extraluminal lesion or structure within the brochial wall itself,which is safe and effective.

Objective To evaluate the diagnosis and treatment for the patients infected with Candida species.Methods A total of 47 patients with persistent fever,pathology of pulmonary infection,no response to the antibiotic therapy,Candida species found in sputum after long time hospitalization were retrospectively analyzed.Results The 47 patients were 24 males and 23 females.The mean age was 57.0?16.1.The mean temperature was(38.4?0.6)℃ and all lasted for over 6 days.Pulmonary infections with Candida species was diagnosed at the(17.7?5.2)th day after admission.The species isolated were 38 strains Candida albicans,5 strains Candida glabrata,2 strains Candida kruseic,1 strain Candida tropicalis,and 1 strain Candida lusitaniae.Fluconazole was given to 28 patients(2 with voriconazole as sequential therapy),itraconazole to 9(2 with voriconazole too),voriconazole in 7(including the 4 patients mentioned above),Casfungin aceate to 7,Amphotericin B to 1(Casfungin aceate was given alone later for serious adverse reactions).Results two patients infected with C.albicans and Candida glabrata separately had no improvement in the 28 patients treated with fluconazole,but voriconazole showed good effect on the 2 patients.Two patients infected with C.albicans and Candida glabrata separately had no improvement to itraconazole in the 9 patients treated with Itraconazole,but voriconazole showed good effect on them too.The 7 patients treated with voriconazole all had good effect,including 3 infected with Candida glabrata,1 with Candida lusitaniae,3 with C.albicans.Conclusion Candida albicans is the main pathogen in this group of invasive pulmonary infections with Candida species.All the patients have fever and long-time hospitalization.The currently used antifungal drugs,such as voriconazole,Casfungin aceate,are reliable.Caspofungin is generally better tolerated than other antifungal drugs.

Objective To study the characteristics of child acute lymphocytic leukemia (ALL) immuno-phenotype and evaluate its diagnosis value. Methods Direct immunofluorescence staining and CD45/Side Scatter (SSC) gating of flow cytometry were used for immunophenotyping in 111 cases of child ALL. The relation of mor-phology and immunology classification was analyzed. Results Three categories could be identified,including 81 ca-ses (73.0%) of B lineage ALL, 16 cases (14.4%) of T lineage ALL and 14 cases (12.6% ) of B/T lineage ALL. There were 25 cases (22.5% ) of ALL expressing myeloid-associated antigens. According to the FAB Morphology classification,59 cases (53.2%) of L1 type and 47 cases (42.3%) of L2 type were diagnosed. The two cases (1.8%) of L3 type were classified as one case of null-ALL and one case of B-ALL. One case (0.9%)of acute my-eloblastic leukemia (AML-M2a) was identified as null-ALL. The two cases that could not be diagnosed by FAB clas-sification were c-ALL. Conclusion The immunophenotyping helps to identify the character of leukemia with an im-portant value in diagnosis of child ALL.

The paper explored the online real-time system built at the hospital to monitor clinical care quality using EMR.The methodology,procedures and index system were established for real-time clinical care quality control.With the online control in place,significant improvements were found in such care indexes as implementation of essential healthcare regulations,EMR quality,rational drug use and rational blood use,making quality control much efficient than before.EMR-based online clinical care quality control can improve quality of care,make it efficient and guide clinical care and quality control as well.

Objective To explore the characteristics of infection after cardiac-lung transplantation.Methods March 23th 2006,one patient received orthotopic heart-lung transplantation,the clinical data were observed and analyzed.Results Depend on etiology,antibioti and antifungul were selected,the patient recoved.Conclusion It is very important to early etiology diagnosis and reasonable selection of antibiotic.

Education of evidence-based medicine in clinical research is important in enhancing primary hospital clinical research capacity and quality.Dongyang People's Hospital of Zhejiang Province has carried out evidence-based medicine education and training,and greatly improved the performance of clinical research and development of scientific researchers.

Clinical thinking of Clinicians in Dongyang People's Hospital is gradually shifting from ‘empirical medicine’ to ‘evidence-based medicine’ after popularizing of evidence-based medicine, training core members and implementing multi-layered, multi-channeled, comprehensive and sustainable resident doctor training mode with clear steps and purposes within three years. This paper discussed on reasonable clinical practice of evidence-based medicine in primary hospital and provided realistic basis for the further development and improvement of training of evidence-based medicine in primary hospital.