Objective To evaluate the compliance of sepsis bundles and its impact on the mortality rate in patients with sepsis shock.Methods Fifty-eight adult patients with sepsis shock admitted in the intensive care units from January to December 2007 were enrolled in the study,and the compliance with the 6-h bundle was analyzed.Age,gender,sites of infection,acute physiology and chronic health evaluation II (APACHE II)score,duration of mechanical ventilation,ICU stay and the mortality rate were compared between patients completed 6-h bundles and those not completed 6-h bundles.Results Compliance with the 6-h bundle was obtained in 22 out of 58 patients(37.9%).Patients receiving bundle care had shorter duration of mechanical ventilation and shorter length of ICU stay than non-bundle patients(t=-2.225 and -3.702,P=0.037 and 0.001,respectively),and the mortality rate in 6-h bundle patients was also lower (X2=10.236,P=0.000).Conclusion The application of 6-h bundle care can reduce the mortality rate of the patients with sepsis shock.and the compliance should be improved.

Objective To review the status of diagnosis and treatment for invasive fungal pulmonary infections(IFPI)in Lishui Central Hospital.Methods The clinical data of 79 patients with IFPI were retrospectively analyzed.Results The diagnostic status could be classified ills follows:6 eases had confirmed diagnosis,30 had clinical diagnosis,35 had suspected diagnosis and 8 misdiagnosed.The treatments were all effeetive in 6 COnfirmed cases;in 30 clinically diagnosed cases,6 were eriective.21 were inefiective and 3 died;in 35 suspected cases.3 were effective.25 were iHefieetive and 7 cflses did not receive antifungal treatment.Aspergillus and Cryptococcus pulmonary infections were predominant in confirmed cases.and the antifungal treatment lasted for 3 to 6 months.Conclusion Diagnosis and treatment for IFPI need to be improved.

Objective To identify the AD hybrid strains and its hybrid types within Cryptococcus neoformans.Methods Difierent hybrid types of AD strains were analyzed by PCR 0f STE20 and MF genes within MAT locus and CIA4 and GPal genes out of MAT locus.The PCR-RFLP analysis of g6341 gene was also performed.Results The mating types of 18 AD strains were precisely identified by PCR of STE20 gene,whereas those of H strain were not identified.CL44 gene was better than the GPal gene in PCR identification of the AD hybrids.In the RFLP analysis of g6341 gene,AD strains were grouped into 2 distinct RFLP patterns based on the mating type on serotype A allele.The mating types of AD strains were not identified by the molecular analyses based on the CL44,GPal and g6341 genes.Conclusion It is necessary to use multi-locus analyses of genes within and out of the MAT locus in precise identification of the AD strains and their hybrid types of Cryptococcus neoformans.

Objective To investigate the clinical significance of quantitative detection of serum HBsAg.Methods Serum concentrations of HBsAg were detected by chemiluminescent microparticle immunoassay in 7612 hospitalized non-hepatitis patients.The distribution of HBsAg positive patients and the relationship of HBsAg concentration with serum anti.HBs.HBeAg and HBV DNA were analyzed.Results The HBsAg positive rate was 11.4%(870/7612)in this series.The serum HBsAg ranged from 0.08 U/mL to 125 000 U/mL with a median of 932.28 U/mL.No significant difference of HBsAg concentrations between male and female patients was observed(Z=-0.366,P＞0.05).1.There were negative correlation of HBsAg concentration with the age of patients(r=-0.370,P＜0.01),and positive correlations of HBsAg with HBeAg(r=0.654,P＜0.01)and HBV DNA levels(r=0.765,P＜0.01).Conclusion The quantitative determination of seFum HBsAg may be useful in estimating the hepatitis B viral replication and clearance.

Objective To investigate the trend of antimicrobial resistance and the prevalence of resistant genes in Pseudomonas aeruginosa strains isolated from Hangzhou First People's Hospital.Methods Antimicrobial susceptibilities of 1489 Pseudomonas aeruginosa strains isolated from 2003 to 2007 were statistically analyzed using WHONET.MICs of 11 antimicrobisis to 36 multi-drug-resistant Pseudomonas aerugionosa strains were determined by agar dilution method.Genes of β-lactamases(BLA)and aminoglycoside-modifying enzymes(AMEs)were detected by PCR and the PCR products were sequenced.Results The resistant rates to aztreonam,imipenem,ceftazidime,cefepime,piperacillin,piperacillin/tazobactam.cefoperazone/sulbactam,ciprofloxacin,levofloxacin,gentamicin and amikacin were increased from 13.4%,10.6%,8.7%,7.9%,12.7%,12.7%,6.7%, 15.8%,20.5%,24.7% and 10.9%in 2003 to 35.3%,40.9%,18.4%, 32.4%,32.9%,32.0%,21.9%,37.8%,38.6%, 39.4% and 34.8% in 2007.respectively.Hish MICs of 11 antimicrobiMs for multi-drug resistant Pseudomonas aerouginosa were determined with MIC90≥128 μg/mL.In 36 multi-drug resistant Pseudomonas aeruginosa strains,21(58.3%)strains carried β-lactamase genes and 32 strains(88.9%)carried aminoglycosidemodifying enzyme genes,while the deletion rate of oprD2 was 80.6%(29/36).Conclusions The resistant rates to common antibiotics of Pseudomonas aeruginosa have increased.resulting in multi-drug resistance.Genes of β-lactamases and aminoglycoside-medifying enzymes are prevalent in multi-drug resistant Pseudomonas aeruginosa strains,with the common deletion of oprD2.

Objective To investigate the significance of procalcitonin(PCT),C-reactive protein (CRP)and WBC counts in predicting the postoperative jnfections in patients with bone fractures.Methods Clinical data of 49 patients with open fractures were retrospectively analyzed,and the patients were grouped into the infeeted(n=24)and non.infected(n=25).PCT,CRP and WBC values were detected 1,4,7and 10 days after the operations,and the results were compared with those taken from the healthy controls.Areas under the receiver operating characteristic(ROC)curves were used to determine the value in predicting postoperative infections.Results PCT,CRP and WBC values in the infected group and the noninfected group were higher than those in health controls(F=19.84,57.71 and 35.44,P＜0.01).PCT,CRP and WBC values in the infected group were higher than those in the non-infected group 4.7 and 10 days after the operations(tPCT=7.31,7.74 and 4.59;tCRP=2.23,5.75 and 8.01;tWBC=2.34,2.51 and 4.07,P＜0.05).ROC curves suggested that PCT value was more sensitive and had higher specificity than CRP and WBC values in the diagnosis of postoperative infections.Conclusions PCT,CRP and WBC values arise in bone fracture patients with postoperative infections.Detection of PCT has higher sensitivity and specificity.which can be used in early diagnosis of postoperative infections.

Objective To evaluate the safety and tolerance of the first-line hiighly active antiretroviral therapy(HAART)regimen in Chinese HIV/AIDS patients.Methods The clinical data and laboratory results were retrospectively reviewed in 95 HIV/AIDS outpatients receiving first-line HAART regimen of zidovudine,lamivudine and efavirenz(or nevirapine)in Public Heahh Clinical Center Affiliated to Fudan University during January 2005 and August 2008.Mixed effects model and X2 test or Fisher test were used to analyze panel data and ratio data respectively.Results Totally 81%(77/95)patients had adverse events in the course of treatment,11.6%(11/95)developed grade 3 or higher adverse effects.Hematological adverse events and hepatotoxity were the most common in term of laboratory events with the total incidence of 46.3%(44/95)and 27.4%(26/95)respectively;8.4%(8/95)and 6.3%(6/95)were grade 3 or higher.In clinical events,30.5%(29/95),37.8%(36/95)and 27.4%(26/95)patients had dermatological,gastrointestinal and neurological adverse events respectively,however,only 1.1%(1/95)experienced grade 3 or higher dermatological adverse events.Conclusion The first line HAART regimen is safe and well tolerated in Chinese HIV/AIDS patients.

Objective To investigate ehloramphenicol,tetracycline,rifampicin and trimethoprimsulfamethoxazole resistance and the related genes in multi-drug resistant Acinetobacter baumannii(MDR-ABA).Methods Sixty-two strains of MDR-ABA were isolated from clinical samples,and their susceptibilities to 22 antimicrobial agents were detected by Kirby-Bauer disk diffusion tests.Genes related to chloramphenicol(catB and cmlA),rifampicin(arr-2/3),tetracycline(tetA and tetB)and trimethoprimsulfamethoxazole(sull,dfrA1,dfrA5,dfrA7/17,dfrA12,dfr85)resistance and drug emux genes(tehA,emrB,emrD,emrE,smr-2,mdfA)were analyzed by PCR and verified by DNA sequencing.Results Resistant rates of these MDR-ABAs to chloramphenicol,rifampicin,tetracycline and trimethoprimsulfamethoxazole were 100.0%(62/62),100.0%(62/62),90.3%(56/62)and 82.3%(51/62)respectively,while62 strains(100.0%),46 strains(74.2%),36 strains(58.1%)and 8 strains (12.9%)were detected to carry mafA,tetB,sull and tehA genes,respectively.The lest 13 genes were all negative.tetB,sull,tehA and mafa genes(2 for each)chosen optionally from positive ones were verified by DNA sequencing and BLASTn.and all were identified as the same sequences in GenBank.Conclusions MDR-ABAs show hish resistance to chloramphenicol,tetracycline, rifampiein and trimethoprimsulfamethoxazole.Multi-drug resistant phenotypes of MDR-ABAs may be closely related to mdfA genes harboring in strains.

Objective To analyze molecular evolution and binding free energies in substrates of KPC-2,KPC-5 and KPC-10 carbapenemases.Methods Minimum Evolution method in MEGA 4.1 was used to analyze molecular evolution of KPC-2,KPC-5 and KPC-10 carbapenemases,Dock module in ArgusLab 4.1 was used to perform molecular docking of these 3 carbapenemases to 10 kinds of β-lactams substrates,and calculate binding free energies(△G).Results Ambler Class A β-lactamases with carbapenemase activities were grouped in the same cluster and had good conservation,while ordinary Ambler Class A β-lactamases without carbapenemase activities were groupod in the other cluster.Binding free energies of KPC-2,KPC-5 and KPC-10 carbapenemases were lower to carbapenem antibiotics than the thirdgeneration cephalosporins,while binding free energies to aztreonam and clavulanic acid were of comparatively higher levels.Conclusion Catalytic activities of KPC to carbapenem antibiotics are higher than those to the third-generation cephalosporins,but the activities to aztreonam and clavulanic acid are low.

Objective To investigate Helicobacter pylori(Hp)infection and HLA-DQA1 allelic frequency in family members of children with recurrent abdominal pain.Methods One hundred and eighteen family members of 20 children with recurrent abdominal pain were divided into two groups:with and without recurrent abdominal pain.Serum Hp antibody was tested by dot immunogold filtration assay and immunophenotyping was determined by Western blot(immunobiot)technique.Polymerase chain reactionsequence specific primers(PCR-SSP)technique Was applied to identify HLA-DQAi allelic frequencies.Hardy-Weinberg equilibrium test was performed(P>0.05),and Chi-square test was used to compare the frequency of HLA-DQA1 alleles between the groups.Results The Hp seropositive rate in 118 members Was 100%and the Hp immunophenotyping was 96.6%.The prevalence of Hp Ⅰ and Ⅱ type was 55.1%(65/118)and41.5%(49/118).HLA-DQA1*0302 allelic frequency Was significantly higher in subjects with recurrent abdominal pain than that in subjects without one(23%vs.2%,X2=13.277,P=0.000).Conclusion There is immunogenetic difference between familial members with and without recurrent abdominal pain infected by Hp,and HLA-DQA1*0302 may be the associated gene contributing to different clinical outcomes after Hp infections.