OBJECTIVE To study antibiotic resistance and drug-resistant genes in AmpC and ESBLs-producing Klebsiella pneumoniae(KPN) in Wenzhou and Taizhou of Zhejiang Province.METHODS Antimicrobial susceptibilities of AmpC and ESBLs-producing KPN were tested by broth dilution motheds and VITEK 60 and VITEK 32;the genotypes of extended-spectrum beta-lactamases(ESBLs),cephalosporinase C(AmpC) and Genotypes AMEs were analyzed by polymerase chain reaction(PCR).RESULTS All tested KPN strains were susceptible to imipenem and resisitant to more other drugs.TEM genes were amplified in 20(100%) strains,CTX-MⅠgenes were examined in 18(90%) strains,SHV genes were examined in 2(10%) strains,DHA genes were tested in 17(85%) strains,MIR genes were examined in 3(15%) strains and 3 kinds of AMEs genes were tested in 18(90%) strains.CONCLUSIONS AmpC and ESBLs-producing KPN is multiple drug-resisitant,in which 2 to 6 resistant genes exist,Imipenem is the best drug.

OBJECTIVE To realize AmpC genotypes of plasmid-mediated AmpC beta-lactamases in Escherichia coli and Klebsiella pneumoniae in Taizhou and Wenzhou,Zhejiang Province of China.METHODS Twenty strains of E.coli and 20 strains of K.pneumoniae which plasmid mediated AmpC beta-lactamases were detected by three methods such as three-dimensional-test of enzyme-extract,cefoxitin-triphase-test,cloxacillin-double-slips-synergia-test and detected ampC genotypes.RESULTS Five DHA genotypes,2 MIR and 2 FOX genotypes were found in 20 strains of E.coli with plasmid-mediated AmpC beta-lactamases.Seven DHA genotypes and 1 MIR genotype were found in 20 strains of K.pneumoniae with plasmid-mediated AmpC beta-lactamases.DHA and MIR genotypes were found in a strain of E.coli that ESBLs were positive but AmpC was suspicious.CONCLUSIONS The ampC genotypes of E.coli in Taizhou and Wenzhou are DHA genotypes mainly and then MIR and FOX genotypes;the ampC genotypes of K.pneumoniae in Taizhou and Wenzhou are DHA gene mainly and then MIR gene;their positive rates of DHA genes are 25%(E.coli) and 35%(K.pneumoniae),their positive rates of MIR genes are 10%(E.coli) and 5%(K.pneumoniae),and the positive rate of FOX is 10%(E.coli),no other genotypes were found.

Objective To seek an effective and feasible treatment for esophageal carcinoma with unequal fractionation radiotherapy.Methods 160 patients with esophageal squamous carcinoma were randomized into an unequal frationation radiotherpy (UEFRT) group and a conventional fractionation radiotherapy (CFRT) group with 80 cases on each side. All the patients were simulated and irradiated by three port technique. Patients in the UEFRT group received D T70 Gy, at 4 Gy once daily, 5 days in the first week, then at 2 Gy daily, 5 days per week during the following five weeks. In the CFRT group,70 Gy was delivered with the routine regimen. Results The 5 year local control rates in UEFRT and CFRT groups were 46.3% and 27.5%(P

Objective To study the clinical efficacy of the treatment of traditional Chinese medicine combined with western medicine for extended -spectrum β-lactamase (ESBLs ) bacterial infection associated pneumonia.Methods 80 patients with ESBLs bacterial infection associated pneumonia in our hospital from January 2015 to June 2016 were randomized into the control group (western medicine routine treatment)and the observation group (treatment of traditional Chinese medicine combined with western medicine)according to the random number method,40 patients in each group.The disappearance time of clinical symptoms and signs and hospitalization time, sputum culture results,and the clinical efficacy of treatment in the two groups were compared.Results Compared with the control group,the disappearance time of cough[(6.5 ±1.3)d vs (8.2 ±1.5)d],t=4.38,P<0.05],fever [(5.1 ±1.2)d vs (6.8 ±1.4)d,t=4.19,P<0.05],pulmonary rales[(6.2 ±1.3)d vs (7.8 ±1.6)d,t=4.27,P<0.05]and the hospitalization time[(9.1 ±1.3)d vs (11.8 ±1.6)d,t=5.06,P<0.05]were significantly reduced in the observation group.Compared with the control group,the negative rates of pneumonia klebsiella (25.0% vs 8.0%,χ2 =4.30,P<0.05)and Escherichia coli (70.0%vs 60.0%,χ2 =4.75,P<0.05)in sputum were obviously increased in the observation group.Compared with the control group,the markedly effective rate of treatment was significantly improved in the observation group(92.5%vs 75.0%,χ2 =4.50,P<0.05).Conclusion The treatment of traditional Chinese medicine combined with western medicine can significantly increase the clinical efficacy of ESBLs bacterial infection associated pneumonia,improve the negative rates of sputum bacteria,and it is worthy of clinical promotion.

OBJECTIVE To explore pathogens and drug resistance in ventilator-associated pneumonia caused by Acinetobacter baumannii,and to provide the corresponding clinical prevention strategies.METHODS The clinical resords and the bacterial susceptibility results of sputum cultivation in 62 cases with VAP caused by A.baumannii between from 2003 and 2006 in ICU of our hospital were reviewed.RESULTS All of the patients suffered from severe underlying diseases,the aged accounted for 77.4%.At least one kind of antibiotic was used in all cases before occurrence of VAP.30.6% of the cases had mixed infection.VAP caused by A.baumannii had the rise trend year by year.The results of bacterial susceptibility showed that A.baumannii had multiple drug resistance,but was lowly resistant to cefoperazone/sulbactam and imipenem.CONCLUSIONS The reasonable choice for antibiotic of VAP caused by A.baumannii should be based on the latest local surveillance on etiology and drug resistance.

OBJECTIVE To compare and analyze the drug resistance of Chryseobacterium meningosepticum which producing metallo-?-lactamase(MBL) and extended-spectrum-?-lactamases(ESBLs) from ICU patients′ and non ICU patients′ specimens of sputa so as to guide the rational application of antibiotics.METHODS Identified the strains with VITEK 32,MBL and ESBLs were also screened by double disk synergy;the antimicrobial sensitivity of clinical isolates was tested by VITEK GNS143 and the antimicrobial sensitivity was added and tested by K-B method.RESULTS As a result the rate of producing MBL of C.meningosepticum was 49.0% from ICU patients′ specimens of sputa which was higher than the rate of 13.8% from non ICU patients′;the rate of producing ESBLs of C.meningosepticum was 37.2% from ICU patients′ specimens of sputa which was higher than the rate of 30.6% from non ICU patients′;the rate of drug resistance to AMP/SUB,TZP,CEP,CIP,and LEV from ICU patients′ was higher than that from non ICU patients.CONCLUSIONS Why the high resistance rate of C.mengingosepticum in ICU patients′ specimens of sputa might be due to the high producing ?-lactamases(MBL and ESBLs).

Objective To investigate drug resistance,especially the resistance to aminoglycoside and the prevalence of the genes for aminoglycoside-modifying enzymes in Escherichia coli producing ESBLs.Methods VITEK-32 GNI+ cards and K-B methods were used to identify E.coli and detect the resistance to 18 kinds of antibiotics such as aminoglycoside and ?-lactams respectively in E.coli isolated from our hospital from January to December,2006.PCR method was used to detect the genes for aminoglycoside-modifying enzymes such as aac(3)-Ⅰ,aac(3)-Ⅱ,aac(6')-Ⅰb,aac(6')-Ⅱ,ant(3″)-Ⅰ and ant(2″)-Ⅰ in those 17 strains producing ESBLs.Results Resistance rates were 100.0%,100.0%,41.6%,100.0%,69.5%,30.5%,98.2%,81.0%,81.0%,79.6%,79.2%,34.8%,15.4%,7.1%,7.9%,5.4% and 81.0% for ampicillin,ampicillin/sulbactam,aztreonam,cefazolin,cefepime,ceftazidime,ceftriaxone,ciprofloxacin,levofloxacin,gentamicin,tobramycin,amikacin,cifoxitin,nitrofurantoin,piperacillin/tazobactam,cefoperazone/sulbactam and co-trimoxazole respectively in E.coli producing ESBLs.No drug-resistant strain imepenem was found.Positive rate was 46.4% for ESBLs.Resistance rates were 52.9%(9/17),100.0%(17/17) and 100%(17/17) for amikacin,gentamycin and tobmycin respectively in those 17 strains producing ESBLs.The most genotype for aminoglycoside-modifying enzymes was aac(3)-Ⅱ(94.1%),the second was aac(6')-Ⅰb(35.3%).The positive rates of aac(3″)-Ⅰ and ant(2″)-Ⅰ were 11.8% and 5.9% respectively.of them,one strain was resistant to aminoglycoside on phenotype,but no genes mentioned above was detected.4strains were classical on genotype,one with aac(6')-Ⅰb-Cr,the other one with a new subtype among the 6 strains of E.coli with aac(6')-Ⅰb.Conclusions Drug resistance in E.coli is rather serious.Typically,E.coli producing ESBLs shows multi-drug resistance.Positive rate for aac(3)-Ⅱ takes the first place,followed by aac(6')-Ⅰb among the genes for aminoglycoside-modifying enzymes.Aac(3″)-Ⅰand ant(2″)-Ⅰ show both lower positive rates.Aac(3)-Ⅰ and aac(6')-Ⅱ were not found.There exist at least 3 sub-types of aac(6')-Ⅰb,one kind of gene for aminoglycoside-modifying enzymes in strains of E.coli.Among those sub-types,the classical type is the main,accompanied by aac(6')-Ⅰb-Cr and its new sub-type.

OBJECTIVE To investigate drug resistance of Escherichia coli,especially the prevalence of the genes for TEM and SHV type ?-lactams in ESBLs-producing E.coli. METHODS A total of 2277 strains of E.coli collected in our hospital from Jan 2006 to Nov 2008 were analyzed for drug resistance to 21 kinds of antibiotics such as aminoglycoside,?-lactams and quinolones using VITEK-32 GNS-145 or GNS-448 card following GNI + for identification.PCR methods were used to analyze TEM and SHV type ?-lactams genes in 36 strains of E.coli with ESBLs so as to study their prevalence. RESULTS From them 1025 strains of E.coli were found positive for ESBLs,with a positive rate of 45.0%.Drug resistance rates were 83.0%,74.0%,52.0%,52.0%,29.1%,27.8%,16.5%,47.0%,31.0%,54.5%,53.0%,56.8%,10.0%,53.9%,38.5%,5.0%,4.0%,5.0% and 5.0%,respectively,for ampicillin,ampicillin/sulbactam,cefazolin,cefuroxime,aztreonam,cefepime,ceftazidime,ceftriaxone,cefotaxime,ciprofloxacin,levofloxacin,gentamicin,amikacin,tobramycin,Co-trimoxazole,nitrofurantoin,piperacillin /tazobactam,cefoperazone/sulbactam and cefoxitin.None was found resistant to imipenem or meropenem.Twenty-five and 14 strains of E.coli were found positive for TEM and SHV genes,respectively(69.4% and 38.9%). CONCLUSIONS Drug resistance of E.coli is severe.The local E.coli with ESBLs shows high positive rates of TEM and SHV genes,which play an important role in its severe drug resistance.

Objective To evaluate the value of i-Scan in the diagnosis of Barrett′s esophagus.Methods 52 patients diagnosed with Barrett′s esophagus by gastroscopies and pathological examinations were observed under the ordinary edoscopy and i-Scan respectively.Besides,the Barrett's esophageal mucosa were classified by Endo with i-scan mode, the target lesions was taken to be biopsied and pathologically examined.Results ( 1 ) In the 52 patients,mucosal lesions were found in 46 cases (88.5%) under i-Scan and 35 cases (67.3%) under ordinary edoscopy respectively,mucosal lesion detection rate in i-Scan was significantly higher than normal white mode( P<0.01).In the 33 patients which found mucosal lesions in the two modes,the definition of lesion margins,morphology of lesion cryptaeand mucosa capillaries revealed by i-Scan were superior to that by white lighted endoscopy ( P<0.05);(2) Under i-scan mode,the detection of specific intestinal metaplasia ( SIM) of typeⅣ,type V in sensitivi-ty,accuracy,specificity were respectively 90.0%,93.5%,94.4%.Conclusion i-Scan is very easy to operate and has a clear lesion of Barrett′s esophagus,which helps to target the lesion at pathological biopsy.

The Delphi method was called into play to determine the level-1 indicator,level-2 indicator and plus-minus indicator for evaluating clinicians of various academic titles,while the ranking method was used to determine the weight of these indicators.The Chi-square test found P＞0.05,proving this indicators system as consistent for clinicians at all levels; the t test found the majority as P＞0.05,indicating the weight of level-2 indicators for dimciam of different titles as different with partial consistence.This system is proved to be scientific,comprehensive,objective and authentic in evaluating clinicians of various levels Targeted evaluation and appraisal system guarantees quality of care and medical safety,which functions as an efficient meansfor better hospital management and better quality of care,paving the wayfor reforms in income distribution system and personnel system in the hospital.