Objective To investigate the reflect problems of nursing administrators in a municipal city public hospitals, in order to provide information to improve the management policies in public hospitals. Methods To investigate nursing department director (deputy director), departments, ward head nurses (deputy nursing officer) in the five public hospitals of a city, and analyzee the survey data in the way using of frequency analysis and weighted frequency analysis method. Results The top five of nursing administrators reflect problems of the city's public hospitals was lack of nursing staff (13.66%), head nurses lack of systematic management of knowledge ( 11.08% ), nurses have low wages ( 10.56% ), the low quality of nurses (7.64%) and many matters outside the scope of nursing (7.53%), problem and issue of all categories weighted total frequency of 50.47% ,which will take priority to be solved. Conclusions The top five problem in a weighted total order-bit frequency table will be given priority to be solved, to focus on resolving the primary problem of the lack of nursing staff can promote to solve other problems effectively.Public hospitals should improve the human resource system and the nursing management system construction to improve nursing management level.

Objective To investigate the relationship of the serum anti-lysosome associated membrane protein 2 (LAMP-2) antibody levels and anti-neutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis.Methods Thirty-three patients with new onset ANCA-associated glomerulonephritis and thirty healthy controls were enrolled.ANCA detection was performed using indirect immunofluorescence (IIF).Enzyme-linked immunosorbent assay (ELISA) was used to detect myeloperoxidase (MPO),proteinase-3 (PR3) and other ANCA-associated antibodies including LAMP-2.The cut-off value of the serum anti-LAMP-2 antibody was determined by a receiver operating characteristic (ROC) curve.Results The serum levels of anti-LAMP-2 antibody in new onset ANCA-associated glomerulonephritis patients were significantly higher than remission stage ANCA-associated glomerulonephritis patients and healthy controls (P ＜ 0.05).The serum levels of anti-LAMP-2 antibody showed no visible difference between the remission ANCA-associated glomerulonephritis patients and healthy controls (P ＞ 0.05).The levels of anti-LAMP-2 antibody showed a strong positive correlation with ESR,Scr,BUN,proteinuria,crescent proportion and Birmingham vasculitis activity score (BVAS) and a negative correlation with Ccr,Hb and Alb.Conclusions Anti-LAMP-2 antibody is correlated with the activity of ANCA-associated glomerulonephritis and the severity of renal damage.It may be a useful indicator on the activity of ANCA-associated glomerulonephritis.

Rational use of antibiotics can delay the emergence of antimicrobial resistance, and antimicrobial resistance surveillance provides the basis for standardizing clinical rational use of antibiotics. Therefore, antimicrobial resistance surveillance network is of great importance, and its construction can improve the rational use of antibiotics.The construction of antimicrobial resistance surveillance network should emphasize the capacity building of clinical microbiology laboratory and enhance quality control of resistance data based on the standards put forth by Clinical and Laboratory Standards Institute ( CLSI) .

Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis (Mtb) infection,remains a major global concern.The activation of anti-TB immune responses is mediated by several complicated mechanisms, among which the local immune microenvironment at the disease site plays a crucial role.In this review, we discuss the roles of anti-TB immunity, Mtb immune escape and the elements at the local site of infection.

Objective To study the genes of a carbapenem-resistant Klebsiella pneumoniae strain isolated from a patient. Methods The antibiotic sensitivity test of a multidrug-resistant Klebsiella pneumoniae strain was done according to K-B and MIC method. Metallo-β-lactamase was detected by Modified Hodge Test and EDTA-disk synergy test. Both nine genes encoding β-lactamases, including blaKPC, blaIMP , blaVIM , blaSME , blaCTX-M , blaSHV, blaDHA , blaACT, Class Ⅰ integrase and Class Ⅰ integron were detected by PCR. Positive products were sequenced. Results The Klebsiella pneumoniae was resistant to carbapenems, cephalosporins, cefoxitin, ampicillin and trimethoprim/sulfamethoxazole. Only susceptible to aztreonam, gentamicin, tobramycin, amikacin, ciprofloxacin and levofloxacin. The blaIMP-1 and Class Ⅰ integron were positive. The blaIMP gene was identified by PCR and DNA sequencing confirmed that the gene belong to IMP-1 type Metallo-β-lactamase gene. The strain also carried Class Ⅰ integron and IMP-1 was located in Class Ⅰ integron 5'. Conclusions It is the first detection of IMP-1 Metallo-β-lactamase in Klebsiella pneumoniae. The production of IMP-1 carbapenemase is the main mechanism of carbapenem-resistant in Klebsiella pneumoniae, and multidrug resistance is related to ClassⅠ integron.

Objective To investigate the clinical significance of CA242 combined with TGF-? to diagnose adenocarcinoma of pancreas.Methods Thirty patients were involved in this study,who were hospitalized from Dec.2004 to Sept.2005.ELISA was used both to investigate the expression of CA242 in 30 cases and TGF-? in 20 cases.Twenty healthy volunteers were as controls.Results CA242 was increased in adenocarcinoma of pancreas compared with controls[(312?5)kU/L vs(56?2)kU/L,P0.05.Conclusion The specificity of each of CA242 and TGF-? to diagnose adenocarcinoma of pancreas is high.The sensitivity of TGF-? is higher than that of CA242.CA242 combined with TGF-? can increase the diagnosis rate of adenocarcinoma of pancreas.

Objective To investigate the carbapenemases and integrons in imipenem-resistant Acinetobacter baumannii. Methods One hundred and three Acinetobacter baumannii were collected from Janurary 2008 to March 2010 in Tianjin Medical University General Hospital. The identification of strains and antimicrobial susceptibility test were performed by using Vitek-2 compact automatic system. Isolates of imipenem-resistant A. baumannii were screened for carbapenemases by modified Hodge test, improved threedimensional test and 2-mercaptopropionic acid synergy test. Isolates were then subjected to the multiplex PCR targeting genes encoding for OXA type carbapenemases, metallo-β-lactamases (MBLs) and integrases. The variable regions of integrons were amplificated and sequenced. Results Among the 103 isolates, 75 (72. 8% ) demonstrated positive in the modified Hodge test, 80 (77.7%)were positive in the improved three-dimensional test. No MBLs was found in the 2-mercaptopropionic acid synergy test. Eightyfour isolates were positive for blaOXA-51-like, blaOXA-23-like, and intI1; five were positive for blaOXA-51-like and blaOXA-23-like ;eight were positive for blaOXA-51-like and int11 ;two were positive for blaOXA-51-like and blaOXA-24-like ;four were only found positive for blaOXA-51-like. The blaOXA-58-like, IMP-1, VIM-2 and intI2 genes were all negative. Eighty-nine(96. 7% )of the intI1 positive strains owned the variable region. Two different cassettes arrangements were identified within class 1 integrons:81 isolates harbored aacA4-catB8-aadAI (2 300 bp) and 8 harbored aacCl-orX-orfX-orX'-aadAla (3 000 bp ) . Conclusion The presence of OXA-23 carbapenermase and class Ⅰ integrons are correlated with Acinetobacter baumannii resistant to carbapenems and multi-drug resistance.

Objective To investigate the distribution of vancomycin-resistant genes and virulence genes in vancomycin-resistant Enterococcus (VRE) isolates from intensive care unit (ICU).Methods A total of 180 anal swabs were collected from patients in ICU in Tianjin Medical University General Hospital during September 2012 and May 2013.VRE strains were screened by ChromID agar method.Vitek 2 Compact system was used in drug sensitivity test,and the sensitivities to vancomycin and teicoplanin were further determined using Kirby-Bauer disk diffusion method.Vancomycin resistant genes vanA,vanB,vanC1 and virulence genes esp,hyl were detected by polymerase chain reaction(PCR).Results Nineteen strains of vancomycin resistant Enterococcusfaecium were isolated from 180 anal swabs.All 19 VRE isolates were resistant to both vancomycin and teicoplanin,while they were susceptible to linezolid and tigecycline.All VRE isolates carried vanA and esp genes,and hyl gene was positive in 10 isolates.Conclusions VRE isolates from ICU are highly resistant to commonly used antibacterial agents,and most isolates carry vancomycin-resistant genes and virulence genes.Linezolid and tigecycline may be recommended for VRE infection in ICU.

Objective To compare different susceptibility testing methods of tigecycline against Acinetobacter baumannii and Klebsiella pneumoniae.Methods Fifty carbapenem-resietant A.baumannii (CRAB) strains and 49 K.pneumoniae strains were collected from Tianjin Medical University General Hospital during January and March 2012.Minimum inhibitory concentration (MIC) and inhibitory zone diameters for tigecycline were determined by broth microdilution,Vitek-2,MTS and disk diffusion methods.The results of Vitek-2,MTS and disk diffusion methods were compared with those of broth microdilution method.Results According to FDA standards,the susceptibilities of CRAB and K.pneumoniae to tigecycline determined by broth microdilution,Vitek-2 and MTS were 94.0％/91.8％,68.0％/91.8％ and 90.0％/91.8％,respectively.For CRAB isolates,the essential agreement (EA) and categorical agreement (CA) produced by Vitek-2 and MTS were 94.0％/72.0％ and 92.0％/90.0％.MICs determined by Vitek-2 were 1-2 dilutions higher than the reference method in 33 (66.0％) strains,and those determined by MTS were higher in 16 (32.0％) strains and lower in 11 (22.0％) strains.For K.pneumoniae isolates,the EA/CA produced by Vitek-2 and MTS were 95.9％/98.0％ and 83.7％/91.8％,respectively.MICs determined by Vitek-2 were 1-3 dilutions lower than the reference method in 17 (34.7％) strains,and those determined by MTS were 1-3 dilutions lower than the reference method in 39 (79.6％) strains.None of thetwo methods produced very major error (VME) and major error (ME) against two kinds of isolates.The results were determined by disk diffusion method using different breakpoints according different isolates.For CRAB,using ≥14 mm/≤ 10 mm as breakpoint,CA was 94.0％,which was higher than the breakpoint recommended by Jones et al (≥16 mm/≤12 mm,CA was 82.0％) ; and for K.pneumoniae,using the ≥ 14 mm/≤ 10 mm as breakpoint,CA was 93.9％,higher than the FDA Enterobacteriaceae breakpoint (≥ 19 mm/≤ 14 mm,CA was 67.3％).Conclusion For CRAB strains,MTS produces better consistence with broth microdilution,with several higher or lower MIC results.For K.pneumoniae strains,Vitek-2 has better correlation with reference method,with several lower MIC results.The consistence between disk diffusion method and broth microdilution is comparatively lower,and the breakpoint should be adjusted according to different bacteria.