OBJECTIVE To evaluate the drug resistance of Candida isolated from patients' specimen in clinic.METHODS The minimal inhibitory concentration(MIC) test to 243 Candida strains was performed using ATB-Fungus drug susceptibity plate provided by Bio-Merieux.RESULTS The most popular species of Candida in clinic was Candida albicans(64.6%),C.glabrata(14.4%),C.tropicalis(11.1%),C.parapsilosis(5.8%)and C.krusei(4.1%).There was a certain resistance to the 4 kinds of common antifungals including flucytosine,amphotericin B,fluconazole and itraconazole.The resistance status of C.krusei was the most serious,Its resistance rate to 4 kinds of antifungals was 20.0%,50.0%,30.0% and 40.0%,respectively.The drug resistance rate of 5 species of Candida to itraconazole was higher than that to fluconazole.CONCLUSIONS The commonly encountered Candida produce particular resistance to common antifungals,and it is very necessary to detect and control them.

OBJECTIVE To explore the distribution of 16S rRNA methylase and aminoglycoside modifying enzymes in continuous isolates of Pseudomonas aeruginosa(PAE).METHODS The antibiotics susceptibility was tested by K-B method,the 16S rRNA methylase(rmtB) and aminoglycoside modifying enzymes were detected by polymerase chain reaction(PCR),the positive genes were amplified and sequenced by PCR fluorescence spectrophotometry.RESULTS Among 20 strains of PAE,the 16S rRNA methylase and 5 kinds of aminoglycoside modifying enzymes had been detected.The 5 kinds of aminoglycoside modifying enzymes were aac(3)-Ⅱ,aac(6′)-Ⅰb,aac(6′)-Ⅱ,ant(3″)-Ⅰ and ant(2″)-Ⅰ,respectively.And more,the rmtB in the first and third strains was sequenced,and translated into amino acid,and the translated amino acid sequence was compared with GenBank,suggesting there be different amino acid sequence.This was confirmed as two new subtypes.CONCLUSIONS Resistant to antibiotics PAE in our hospital is mainly related to 16S rRNA methylase and 5 aminoglycoside modifying enzymes,and 2 new subtypes of 16S rRNA methylase are discovered.

OBJECTIVE To explore the distribution of ?-lactamase and drug resistant gene mediated by transposon and integron in continuous isolates of Pseudomonas aeruginosa.METHODS The antibiotics susceptibility was tested by K-B method;the ?-lactamase and the outer membrane protein gene oprD2 were detected by polymerase chain reaction(PCR);the genotype of merA encoding Tn21/Tn501 type trandsposon and qacE?1-suI1 encoding Ⅰ type integron was detected by PCR and the positive genes were amplified and sequenced by PCR fluorescence spectrophotometry.RESULTS The TEM type,OXA-2,OXA-10 and CARB of ?-lactamase genes had been detected in 20 strains of P.aeruginosa,but plasmid-mediated ampC enzyme and metallo-?-lactamase had not been detected,the gene oprD2 encoding porins was not detected.The gene merA was detected in 7 strains(35.0%),and the qacE?-sul1 had been detected in 10 strains(50.0%).The gene OXA-2 in the isolate No.2 was sequenced,and translated into amino acid,and the translated amino acid sequence was compared with GenBank,the results indicated that amino acid sequence of OXA in the isolate No.2 was simlar to that in GenBank,exsited 2 different amino acid sequences,so was confirmed as a new subtype.CONCLUSIONS Resistance to ?-lactamase compounds in P.aeruginosa of our hospital is related to TEM,OXA and CARB genes,and integron and transposon contribute to the drug resistance and multidrug resistance in P.aeruginosa.

OBJECTIVE To explore the distribution of related resistance genes of chloramphenicol and tetracycline in Pseudomonas aeruqinosa isolates.METHODS The antibiotics susceptibility was tested by K-B method,catB cmlA,tetA tetB and smr-2 were detected by polymerase chain reaction(PCR),the gene cmlA was sequenced by PCR fluorescence spectrophotometry.RESULTS The drug-resistant rates of 20 strains of P.aeruginosa against 17 kinds of antibiotics ranged from 10.0% to 100.0%,and multidrug resistant strains were found.The gene of cmlA had been detected in 6 strains of 15 resistant P.aeruginosa isolates,but the genes of tetA,tetB and smr had not been detected.The cml was sequenced,and compared with GenBank,the result showed the gene fragment shared 99.0% homology in nucleotides with the GenBank sequences of cmlA7 and cmlA8.CONCLUSIONS Resistance to antibiotics in P.aeruginosa of our hospital is mainly related to cmlA.The resistance to chloramphenicol and tetracycline was not related to tetA,tetB and smr-2.

Objective To observe the molecular mechanism of adaptive response of the kidney and skeleton and brain issues in the high altitude hypoxia; To discuss the unity of yin and yang oscillation relationship of kidney and brain marrow.Methods SPF KM mice were randomly divided into control group and model group according to random number table method. Mice in the model group were exposed to high altitude hypoxia cabin for successive 21 d. On the 22nd day, mice got out of the cabin and their body weight was measured, and then they were put to death through eyeball blood sampling. The activities of lactic LDH and Na+-K+-ATPase in brain tissue were detected by spectrophotometric colorimetry. The PFK activities of brain and skeletal muscle were detected by ELISA. Meanwhile the contents of EPO and EPOR in the kidney were measured by ELISA. The mRNA expressions of HIF-1α and AQP-4 in brain were assessed by RT-PCR. At the same time, the protein expressions of HIF-1α and AQP-1 in brain and the protein expression of Mb in skeletal muscle were detected by Western blot.Results Compared with the normal group, the LDH and PFK in brain tissue and the content of EPO in kidney tissue were all raised in the model group(P<0.05). Meanwhile the mRNA expressions of HIF-1α and AQP-4 and the protein expressions of HIF-1α and AQP-1 in brain were all increased in the mice from the model group; the activities of PFK and the protein expression of Mb in skeletal muscle were also raised in the model group. But the activity of Na+-K+-ATPase in brain tissue and the content of EPOR in kidney tissue both decreased in the model group (P<0.05,P<0.01).Conclusion Adaptive response and the unity of yin and yang oscillation relationship between kidney, skeleton and brain tissue happen in high altitude hypoxia.

Modern medical quality management is characterized by professionalism, continuity and comprehensiveness. It is necessary to strengthen the communication and cooperation among health administrative authorities, medical institutions and professionals. Since 2011, based on the guidance of the interactive governance theory and the governance interface as a platform, Zhejiang Province had explored and established a relatively independent third-party quality evaluation service organization, which aimed to correct such setbacks as the imbalance and inadequacy of medical quality management. Through the interaction of organization interface, management interface, service interface, information interface and method interface, the province had initially achieved the multi-level diagonal governance in medical quality management, and transformed the traditional management relationship into an interactive relationship. This practice had achieved desirable results in improving the quality control work network, updating management methods, and improving medical quality and safety, serving as reference in upgrading the medical quality and safety management of medical institutions in China.

Objective: To determine whether noncontrast computed tomography (NCCT) models based on multivariable, radiomics features, and machine learning (ML) algorithms could further improve the discrimination of early hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (sICH). Materials and Methods: We retrospectively reviewed 261 patients with sICH who underwent initial NCCT within 6 hours of ictus and follow-up CT within 24 hours after initial NCCT, between April 2011 and March 2019. The clinical characteristics, imaging signs and radiomics features extracted from the initial NCCT images were used to construct models to discriminate early HE. A clinical-radiologic model was constructed using a multivariate logistic regression (LR) analysis. Radiomics models, a radiomics-radiologic model, and a combined model were constructed in the training cohort (n = 182) and independently verified in the validation cohort (n = 79). Receiver operating characteristic analysis and the area under the curve (AUC) were used to evaluate the discriminative power. Results: The AUC of the clinical-radiologic model for discriminating early HE was 0.766. The AUCs of the radiomics model for discriminating early HE built using the LR algorithm in the training and validation cohorts were 0.926 and 0.850, respectively.The AUCs of the radiomics-radiologic model in the training and validation cohorts were 0.946 and 0.867, respectively. The AUCs of the combined model in the training and validation cohorts were 0.960 and 0.867, respectively. Conclusion NCCT models based on multivariable, radiomics features and ML algorithm could improve the discrimination of early HE. The combined model was the best recommended model to identify sICH patients at risk of early HE.