Objective To investigate the therapeutic effect and safety of albumin combination furosemide in treatment of eld cerebral hemorrhage patients,and provide evidence for clinical treatment of eld cerebral hemorrhage patients.Methods Two hundred eld cerebral hemorrhage patients were divided into control group (110 cases) and observation group (90 cases) by systematic sampling method.The two groups were given the monitor of vital signs,support of organ function,reduce of intracranial pressure and other conventional treatment,on the basis of which albumin (10 g,2 times/day) and furosemide (20 mg,intravenous injection) were given to observation group for 10 days.The levels of arterial blood lactate and vein serum C reactive protein (CRP) of 2 groups were compared at admission,treatment for 7 and 14 days.Moreover,the mortality rate of 2 groups at 14th day of treatment was also compared.Results There were no statistical differences in the condition of patients between the 2 groups at admission (P ＞ 0.05).The levels of arterial blood lactate of control group at treatment for 7 and 14 days were significantly higher than those of observation group [(2.56 ± 0.63) and (1.98 ± 0.65) mmol/L vs.(1.91 ± 0.70) and (1.28 ± 0.68) mmol/L],there were statistical differences between the 2 groups (P＜0.05).The levels of vein serum CRP of control group at treatment for 7 and 14 days were significantly higher than those of observation group [(120.02 ± 40.65) and (48.75 ± 30.11) mg/L vs.(60.52 ± 30.83) and (13.45 ± 6.02) mg/L],there were statistical differences between the 2 groups (P ＜ 0.05).The mortality rate at 14th day of treatment of control group was significantly higher than that of observation group [22.73％ (25/110) vs.13.33％ (12/90)],there was statistical differences between the 2 groups (P ＜ 0.05).Conclusion Albumin combination furosemide in treatment of eld cerebral hemorrhage patients can relieve the inflammatory reaction and decrease the mortality rate,it is expected to become the routine treatment in eld cerebral hemorrhage patients.

Objective To compare the clinical effect of small bone flap craniotony and skull drill drainage in treatment of hypertensive cerebral hemorrhage.Methods Ninety -eight patients with hypertensive cerebral hemorrhage were classified into group A and group B by random number table with 49 cases in each.Group A was used small bone flap craniotony,and group B was used skull drill drainage.The clinical effects between two groups were compared.Results The short-term total effective rate in group A was 83.7％(41/49 ),which was significantly higher than that in group B with 65.3％(32/49 )(P ＜ 0.05 ).The long-term good rate in group A was 55.1％(27/49),which was significantly higher than that in group B with 26.5％ (13/49) (P ＜ 0.05 ).Conclusion Both the short-term and long-term effective rate of small bone flap craniotony for hypertensive cerebral hemorrhage are better than skull drill drainage.

Objective To investigate the mechanism related to reduced antibiotic sensitivity of Acinetobacter baumannii inducted by meropenem in vitro.Methods Three strains of clinically isolated carbapenems-sensitive Acinetobacter baumannii were induced by meropenem in vitro, and the mutant strains (MS1, MS2 and MS3) were obtained.Minimal inhibitory concentrations (MICs) of antimicrobial agents to strains before and after induction were determined by automatic drug sensitivity analyzer .The homology of strains was analyzed by Enterobacterial repetitive intergenic consensus -polymerase chain reaction ( ERIC-PCR).Modified Hodge test and EDTA-Na2-double disk synergy test were used to detect carbapenemase and metallo-β-lactamase (MBL), respectively.Main carbapenemase genes were detected by PCR and followed by DNA sequencing.Expressions of adeB and outer membrane proteins in strains before and after induction were detected with fluorescence quantitative PCR and SDS -polyacrylamide gel electrophoresis , respectively.t test was used for data analysis .Results The sensitivity of mutant Acinetobacter baumannii strains to meropenem and most antibiotics was reduced , except to imipenem, amikacin and polymyxin; and the reduced sensitivity to meropenem in MS2 and MS3 was of genetic stability.ERIC-PCR showed 100%homology between the mutant strains and parental strains .Both carbapenemase and metallo -β-lactamase were negative in mutant strains and parental strains , and only OXA-51 gene was found.The expressions of adeB gene in mutant strains were 24.26 ±0.91, while those in parental strains were 22.81 ±0.38, and the difference was not significant (t =2.534, P >0.05).Outer membrane protein with molecular weight 54 000 was missing in MS1, while that with molecular weight 47 000 was missing in MS2 and MS3.Conclusion Reduced antibiotics sensitivity in meropenem -induced Acinetobacter baumannii may be correlated with the deficiency of outer membrane protein with molecular weight 47 000.

Objective To analyze the epidemiological characteristics of brucellosis for improving its clinical and laboratory diag‐nostic ability .Methods The clinical and laboratorial data of the patients with brucellosis in our hospital from January 2013 to Sep‐tember 2015 were retrospectively analyzed .Results In 39 cases of brucellosis ,the majority had the sheep‐contacting history and the clinical manifestations were mainly fever (100 .0% ) ,bone and joint pain(64 .1% ) ,hidrosis(51 .3% ) ,weak(33 .3% ) ,lymph node en‐largement(23 .1% ) and hepatosplenomegaly(12 .8% ) .The laboratory detections showed the abnormal liver function ,rapid erythro‐cyte sedimentation rate(ESR) ,hypersensitive C ‐ reactive protein(hs‐CRP)increase ,lymphocytes percentage increase ,positive for brucellosis antibody agglutination test ,positive blood culture or medulloculture ,which was identified as Brucella melitensis by bacte‐riology .Conclusion The clinical manifestations of brucellosis are diversity and is easy to be misdiagnosed .The sporadic cases in northern Jiangsu area are increased year by year .The epidemiological clue should be paid attention to and the recognition on brucel‐losis should be strengthened .The patients with fever of undetermined origin should be conducted the blood culture and brucellosis antibody agglutination test as early as possible .

Objective To identify the drug resistance-related genes in a clinically isolated strain of Enterobacter cloacae.Methods A strain of Enterobacter cloacae was isolated from sputum of a patient with chronic obstructive pulmonary disease from the Affiliated Hospital of Xuzhou Medical University in March 2013.Modified Hodge test and metal enzyme inhibition test were performed for drug-resistant phenotype screening.Carbapenemase genes blaMUS-1, blaVIM-1, blaVIM-2, blaIMP, blaKPC-2, blaNDM-1, blaOXA-48 and blaGESwere amplified by polymerase chain reaction (PCR), and the positive products were sequenced and analyzed.Plasmid conjugation and transformation experiments were used to confirm that the resistance gene mediated by plasmids.Agar dilution method was used for antibiotic susceptibility test.Results Both modified Hodge test and metal enzyme inhibition test were positive in this strain of Enterobacter cloacae.blaNDM-1 gene and blaKPC-2 gene were detected by PCR, and further confirmed by sequencing.blaNDM-1 gene was carried by IncX plasmid with 54×103 bp, KPC-2 gene was carried by untyping plasmid with 42×103 bp.The strain was only sensitive to tetracycline (MIC=2 μg/mL) and tigecycline (MIC=1 μg/mL).The symptoms were improved after the patient was treated by tigecycline combined with Piperacillin/Tazobactam.Conclusion blaNDM-1 and blaKPC-2 genes in Enterobacter cloacae can be mediated by plasmids, and appropriate therapy for its infection should be based on the result of antibiotic susceptibility test.

Objective To understand the prevalence of resistance gene and homology of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated from ICU of emergency.Methods A total of 19 CRKP isolates were obtained from emergency ICU of the Affiliated Hospital of Xuzhou Medical University from July 2015 to August 2016.PCR was performed to screen the genes encoding carbapenemase,extended spectrum beta-lactamase (ESBL) and AmpC.Pulsed field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used for molecular typing of these bacterial strains.Results Among the 19 CRKP,carbapenemase-resistant genes were detectable in 18 CRKP isolates,including 17 isolates of harboring blaKPC gene and 1 strain of harboring blaNDM gene.All the 18 strains carried ESBLs genes which were identified as 8 blaSHV-12,3 blaSHV-11,5 blaSHV-2a,15 blaTEM-1,10 blaCTX-M-65,3 blaCTX-M-15,1 blaCTX-M-14 and 1 blaCTX-M-27.The 13 strains harboring cephalosporin-resistant genes were all identified as blaDHA-1.PFGE results revealed that the 19 CRKP strains were grouped into 4 types (A,B,C and D) and 4 subtypes(A1,2,3 and 4):A1 (n =12),A2(n =1),A3 (n=1),A4(n=1),B(n=2),C(n=1) and D(n=1).MLST showed that ST11 was the predominant sequence type (n=15) among the 19 CRKP strains,and ST48 (n =2),ST37 (n =1) and untyped (n =1) were also identified.The 15 blaKPC-2-producing CRKP ST11 clone shared the A type of PFGE pattern.Conclusion The report on CRKP suggested the dissemination of blaKPC-2-producing ST11 clone was existed in the ICU of emergency department in this hospital.The surveillance for drug-resistance and effective disinfectant quarantine measures should be strengthened.

Objective To evaluate the applicationof the double-disk synergy test(DDST) and combined disk test(CDT) in clini cal metal enzyme phenotype deteetion.To evaluate the value of multiplex PCR in detecting the metallo-β-1actamase in clinical.Methods 56 strains of metallo-β-1actamase-positive strains were identified [NDM-1(n=9),VIM(n=32),IMP(n=15)]for appraise the two methods.By optimizing the design of PCR primers,3 pairs of primers were designed and detected (IMP,VIM,NDM-1) in one tube for evaluate the method.Results The DDST was 80.36％(45/56),and 100.00％(56/56) in the CDT.The accuracy of multiplex PCR was 100.00 ％ (56/56),and the size of the amplified fragment was used to distinguish three types of metallo-β-lactamase.Conclusion The CDT is more suitable for clinical application than DDST.Multiplex PCR has the characteristics of simple,rapid and accurate in detection of metallo-β-1actamase.It is suitable for daily use of clinical microbiological laboratory,which will help the clinical timely and effective administration.

This study aims to prepare altrenogest extended-release tablets,evaluate their quality and establish a content determination method.The hydrophilic gel skeleton type,dosage and core thick-ness of altrenogest extended-release tablets were used as the investigating factors,and the release degree of the tablets was used as the investigating index,the prescription process of altrenogest ex-tended-release tablets was optimized by one-factor screening and central combinatorial design re-sponse surface method,and quality evaluation was carried out,the in vitro release model was es-tablished,and a high-performance liquid chromatography(HPLC)assay method was set up for the determination of altrenogest extended-release tablets.The results showed that the optimal pre-scription of altrenogest extended-release tablets was 2％as the main drug,70％as the solubilizer,0.5％as the lubricant,19.1％as the filler,8.4％as the hydrophilic gel skeleton material,and the thickness of the tablets was 3.8 mm.The in vitro drug release conformed to the Higuchi model,and the altrenogest showed a good linear relationship with the R2=0.999 98 in the range of 10-80 mg/L.The optimized process for the extended-release tablets was stable and had a good quality.The extended-release tablets were stable and had significant slow-release effect.The HPLC method is accurate and reliable and can be used for the determination of altrenogest in extended-release tablets.

Albendazole sulfoxide and ivermectin compound pouring agent were prepared with dime-thyl sulfoxide and 1,2-propanediol as solvents.The central composite design response surface method was used to optimize the formula of pouring agent.Franz diffusion cell method was used to investigate the transdermal performance of pouring agent in vitro.The permeation amounts of the two drugs were determined by HPLC.The best formula of pouring agent was ivermectin 0.5％,al-bendazole sulfoxide 5％,dimethyl sulfoxide 52％,propylene glycol 39％,and the rest was 100％anhydrous ethanol.The cumulative permeation amounts of ivermectin and albendazole sulfoxide were up to 20.78 μg/cm2 and 249.02 μg/cm2,respectively.The in vitro release model of the two drugs accords with the first-order kinetic equation.There is a good linear relationship between al-bendazole sulfoxide and ivermectin in the range of 1-100 mg/L and the peak area.The precision and stability RSD of the two methods are less than 2％.The preparation process of albendazole sul-foxide compound pouring agent is simple,stable and easy to pour.The established HPLC method is simple and accurate,and can be used for the determination of albendazole sulfoxide and ivermectin in pouring agent.

Objective: To investigate the clinical and microbiological characteristics of Myroides odoratimimus producing MUS-1 carbapenemase. Methods: A strain of gram-negative bacterium isolated from the urine sample of one patient hospitalized in the oncology department of Affiliated Hospital of Xuzhou Medical University was identified by the Vitek 2 automatic microbial analyzer and 16S RNA sequencing, and its bla MUS-1 gene was detected with PCR. The minimum inhibitory concentrations (MICs) of antimicrobial drugs were determined by the broth dilution method. Results: One strain of MUS-1 carbapenemase producing Myroides odoratimimus was found. The drug susceptibility test showed that it was resistant to most of antibiotics conventionally used, but sensitive to minocycline and meropenem, the MIC of imipenem was 8 μg/mL, which was judged as intermediate. Conclusion The bla MUS-1 gene may be the cause leading Myroides odoratimimus to resistant carbapenems drugs.