OBJECTIVE To investigate antimicrobial resistance of Acinetobacter baumannii and detect metallo-?-lactamases (MBLs) in clinical isolates from ICU. METHODS Forty-two strains of A. baumannii were isolated from sputum samples between Jul 2005 and Mar 2007 in Affiliated Hospital of North Sichuan Medical College. Bacteria identification and antimicrobial susceptibility test were performed by VITEK-32 system and K-B disk method. Meanwhile,MBLs were detected by Etest. RESULTS Cefoperazone/sulbactam with low resistance accounted for 2.4%. The resistance to imipenem was 66.7%. The resistance to other antibiotics ranged from 69.4% to 100%. Nine MBLs-producing strains were detected by Etest. CONCLUSIONS Metallo-?-lactamases produced by A. baumannii are one of important mechanisms which caused resistance to imipenem. Cefoperazone/sulbactam and polymyxin can be chosen to treat resistant A. baumannii.

Objective To investigate the treatment effect of minimally invasive excision in intrahepatic bile duct stones. Methods Ac-cording to different treatment methods, 280 patients with intrahepatic bile duct stones were divided into the treatment group (180 cases) and the control group(100 cases). The control group were given open hepatic lobectomy while the treatment group were given minimally invasive treatment of hepatic lobectomy by laparoscopy. Results All patients had successfully completed surgery and the stones were removed. Compared the operation time,intraoperative blood loss,and blood transfusion of the two groups,and there were no statistically significance (P>0. 05). The postoperative hospitalization,time of drainage tube remove, time of analgestic drug use in treatment group were obviously lower than those in control group,which had statistically significance (P<0. 05). The common postoperative complications of the two groups were bile leakage,wound infection,pleural effusion and subphrenic abscess,et al. The complication rate of treatment group was 2. 2%, while it was 10. 1% in the control group, which had significant difference (P<0. 05). All the patients were followed-up for 6 months, and there was no death in patients. Conclusion Intrahepatic bile duct stones in progress could be treated by hepatic resection surgery. Laparoscopic techniques could accelerate the recovery of patients and reduce the complication rate,and it would become a new treatment option.

OBJECTIVE:To analyze the drug resistance of Klebsiella pneumoniae and drug use in patients infected with Klebsiella pneumoniae to promote rational drug use.METHODS:The Klebsiella pneumoniae separated during 2006 in our hospital was subjected to drug susceptibility tests and the results were given a statistical analysis.Meanwhile,the drug use in patients infected with Klebsiella pneumoniae was analyzed.RESULTS:The antibiotic resistance rates of 75% of the antibiotics were above 50%.On average,2.56 kinds of antibiotics were preventively or empirically used per in-patient.CONCLUSION:The drug resistance of Klebsiella pneumoniae is very serious.Clinical treatments should choose antibiotics rationally according to susceptibility tests.

Objective To disclose the variant rule of HIV-1 vertical transmission by studying the differences of genotypes and quasispecies in the individuals with HIV-1 vertical transmission. Methods RNA was extracted from the plasma of the individuals of vertical transmission and C2-V5 DNA segment of HIV-1 env gene was acquired by RT-PCR. Purified DNA segment was inserted into T vector and transformed into Top10 Escherichia coli. Positive clones were acquired by blue-white screening and used as models in PCR. PCR products were analyzed by conformation sensitive gel electrophoresis (CSGE). The clones of major and minor quasispecies were sequenced. Results HIV-1 quasispecies in the mother of the first group were less complex than her child, and their quasispecies nucleotide sequences were highly homologous and of HIV-1 of C subtype. HIV-1 quasispecies in the mother of the second group were more complex than her child, and their quasispecies nucleotide sequences were highly homologous and of HIV-1 of AE subtype. Conclusion HIV-1 genetic subtypes are generally not changed in vertical transmission, but HIV-1 quasispecies could be selected in vertical transmission and screened by the new environment of the new host which may both induce the changes of dominative and minor quasispecies. We also find that complexity of HIV-1 quasispecies is associated with immune status of host.

OBJECTIVE:To evaluate the effect of the implementation of comprehensive reform with“zero drug profit”and the like in Jingjiang City People’s Hospital. METHODS:Comparative analysis was made to the data for the adjustment of medical ser-vices and medicine specifications,control of medical expenses,general condition of hospital operation and hospital compensation mechanism before (2012) and after (2013) comprehensive reform in this hospital. RESULTS & CONCLUSIONS:After the com-prehensive reform,the number of medical services provided by this hospital increased from 1 408 to 1 426 (with increase rate of 1.28%),in which the prices of 949 services raised (accounting for 66.55%);the number of medicine specifications decreased from 1 875 to 1 670 (with decrease rate of 10.93%),but the number of essential medicine specifications increased from 261 to 377 (with increase rate of 44.44%);total medical expense and total medical expense per capita respectively increased from 477 565.0 thousand yuan and 633.21 yuan to 524 865.9 thousand yuan and 686.91 yuan(with increase rate of 9.90% and 8.48%), but total medicine expense and total medicine expense per capita respectively decreased from 207 656.8 thousand yuan and 275.33 yuan to 199 052.7 thousand yuan and 260.51 yuan(with decrease rate of 4.14% and 5.38%),the proportion of medicine revenue in total hospital revenue also decreased from 43.48%to 37.92%(with decrease rate of 5.56%);total medical revenue and expendi-ture respectively increased from 453 825.5 thousand yuan and 217 516.3 thousand yuan to 524 865.9 thousand yuan and 263 733.3 thousand yuan (with increase rate of 15.65% and 21.25%),but total drug revenue and expenditure respectively changed from 208 380.8 thousand yuan and 176 054.1 thousand yuan into 199 052.7 thousand yuan and 196 407.5 thousand yuan(with increase rate of -4.48% and 11.56%);although the compensation reached 26 596.0 thousand yuan after raising the prices of hospital ser-vices,the subsidies(including the subsidy for basic construction and equipment procurement,fund for public health services,fund for the retirement conforming to requirements and subsidy for the balance found after checking revenue and expenditure) which should be granted by the government has not become available. It is an urgent issue that government departments and the hospital further improve relevant management policies to promote sound development of medical and healthcare program.

Objective To investigate the clinical characteristics and related risk factors of infarction secondary to severe traumatic brain injury.Methods 480 traumatic brain injury patients were chosen.Depending on the occurrence of cerebral infarction,patients were divided into TCI groups and non-TCI group,clinical symptoms and signs of TCI group were observed,and its related risk factors was analyzed.Results In 480 cases patients,there were 30 cases of patients with traumatic brain injury secondary to cerebral infarction,the rate was 6.25%.Clinical manifestations included unilateral limb motor and sensory dysfunction,visual dysfunction,language dysfunction,dizziness,headache.10 cases Prognosis were good,6 cases were mild disability,3 cases were severe disability,1 case was plant survival,10 patients died.Univariate analysis showed that the rates of aged ≥50 years,GCS score ＜ 8 points,hernia,hypotension,subarachnoid hemorrhage,large doses of non-dehydrating agent in the TCI group were higher than those of non-TCI group,the differences were statistically significant (x2 =12.311 3,14.725 4,19.867 8,5.296 9,9.242 6,11.713 6,all P ＜ 0.05).Logistic multivariate analysis showed that age ≥50 years,GCS score ＜ 8 points,hernia,cerebral hypotension were important risk factors.Conclusion Brain injury patients with cerebral infarction secondary to clinical manifestations have some characteristics.Age ≥50 years,GCS score ＜ 8 points,hernia,hypotension are important risk factors.

Objective To evaluate the effect of a nurse-led case management intervention on arm function and uncertainty for women with breast cancer.Methods 90 women with breast cancer were divided into the intervention group and the control group according to their nurses,with 45 patients in each group.All participants were followed six months after surgery.The intervention group attended a 6-month nurse-led case management program,while the control group received the routine care and follow-up only.Questionnaires on arm function and uncertainty were administered 1 month,3 months and 6months after the surgery respectively.Score changes were compared by repeated-measure ANOVA and MANOVA.Results The arm function of the intervention group was better than the control group,except for the 10th day after the operation,there were significant differences at other three time points.The disease uncertainty level of the intervention group was better than that of the control group,except for the dimension of unpredictability,there were evident differences in other dimensions at other three time points.Conclusions The nurse-led case management intervention could improve arm function recovery and decrease the uncertainty to disease of breast cancer survivors.

Objective To investigate the diagnostic values of DCE-MRI quantitative evaluation of the activity of sacroiliac joints in ankylosing spondylitis.Methods Forty two patients (36 male and 6 female) with ankylosing spondylitis in our hospital were enrolled prospectively according to the standard of diagnostic criteria for ankylosing spondylitis revised in 1984.All of them were evaluated with the blood sedimentation,C-reactive protein and ankylosing spondylitis activity index (BASDAI).We divided the patients with ankylosing spondylitis into stationary phase group and active phase group.We analyzed each of the MRI images of the two patients groups using the extended Tofts model to determine the quantitative parameters of DCE-MRI,such as contrast transfer coefficient (Ktrans),reflux constant (Kep),extravascular extracellular volume fraction (Ve),plasma volume fraction (Vp).And then the differences of quantitative data between the two groups were compared.Spearman correlation analysis was performed between the parameters with statistically significant difference and BASDAI scores.Results Among the 42 patients,22 patients (18 male and 4 female) were in active phase group and the other 20 patients (18 male and 2 female) were in stationary phase group.Ktrans,Kep,Ve were (0.750± 1.130)/min,(1.008±0.732)/min,0.460± 1.735;(0.163±0.401)/min,(0.505 ± 0.902)/min,0.345 ±3.460 for active phase group and the stationary phase group,respectively.The results of the active phase group was significantly higher than the stationary phase group (Z=3.727,2.317,3.696,respectively;all P＜0.05).The Vp had no statistically significance for the active phase group (0.125 ± 0.310) and the stationary phase group (0.160 ± 0.329) (Z=1.209,P＞0.05).Strong correlations existed between Ktrans,Kep,Ve and BASDAI score,the correlation coefficients were 0.714,0.430,and 0.676 (P＜0.05).Conclusions Quantitative DCE-MRI parameters can evaluate the activity of the ankylosing spondylitis.Strong correlations exist between Ktrans,Kep,Ve and BASDAI score.

Objective To explore causes of complications after endovenous laser treatment (EVLT) , for patients with superficial varicosities of the lower extremities. Methods In this study, 207 patients with a total of 268 lower limbs were treated by EVLT combined with surgical procedures. According to CEAP classification, there were C2 in 268 limbs, C3 in 56 limbs, C4 in 101, C5 in 23 and C6 in 18. Simple EVLT was performed for 25 limbs in 21 patients; EVLT combined with external banding valvuloplasty of superficial femoral vein for 23 limbs in 23 patients; EVLT combined with ligation of great saphenous vein (CSV) and denudation of superficial varicosities for 220 limbs in 163 patients. Results An average of 10?5 (3-24) months of follow up was achieved in 175 cases. Early complications (within the first 2-weeks after operation) included bruising or ecchymosis (178 cases, 66.42%) and skin burning (56, 20.90% ). Three month complication included painful induration or trabs (235 cases, 87. 69% ) as well as thrombophlebitis (28, 10. 45% ). Long-term complication (after 3 months) included skin numbness or pain at medial knee or ankle region (15,5. 60% ). Recanalization of CSV occurred in 4( 1. 49% ) treated limbs. Residual or reoccurred varicose veins were found in 13(4. 85% ) cases. Movement related swelling appeared in 6(2. 24% ) lower limbs. Conclusion EVLT is effective for patients with superficial varicosities of the lower extremities. Minor complications most often subsided within 3 months. Strict surgical protocol and high ligation of the GSV could prevent local recurrence of the varicose veins and the recanalization of GSV.

Objective:To study the different effect of fused gene IL-2/Fc administrated at different time on immune responses induced by HBV preS_2S genetic vaccine.Methods:BALB/c mice were immunized with purified recombinant plasmids at 0, 2, 4 weeks. Two groups were designed. One group were injected with pcDNA3.1S_2S at first, then pcDNA3.1IL-2/Fc was administrated after three days. While the other group were injected two plasmids at the same time. We compared the immune responses through detecting the anti-HBs titers, CTL cytotoxicity level, proliferation of lymphocytes and cytokines levels secreted by cultural splenocytes.Results:The data demonstrated that the humoral and cellular immune responses induced by pcDNA3.1IL-2/Fc as adjuvant and administrated after HBV preS_2S DNA vaccine 3 days mice were dominant higher than other groups.Conclusion:Genetic adjuvant administrated after Ag priming can enhance its effect.