Objective To evaluate the activities of 18 pairs of antimicrobials combinations against non - duplicate clinical isolates of multidrug resistant Acinetobacter baumannii (MDRAB) in vitro.Methods Collect isolates of Acinetobacter baumannii from different patients from October 2009 to May 2010,which were isolated in Clinical Laboratory Center of Beijing Friendship Hospital,Capital Medical University.Use broth microdilution method to detect MIC of mono-antimicrobial,and checkerboard broth microdilution method to detect combinatied MIC,and calculate fractional inhibitory concentration (FIC) index to determine drug combinations effects.When the performance of the same drug combinations conflicted,appropriate strains were selected for screening of drug-resistant mechanisms by polymerase chain reaction( PCR),including efflux pump genes.Results In tests in vitro,rifampicin and polymyxin B,imipenem and gentamicin,cefepime and levofloxacin showed synergy at high proportion,68.1％,45.5％,40.9％,respectively.Minocycline and rifampicin,ampicillin/sulbactam and tobramycin.Ceftazidime and ciprofloxacin showed additive effect at high proportion,81.8％,68.2％,68.2％,respectively.There were several combinations which appeared the opposite effects to tested strains.Strains No.19 corresponding reaction was synergy and No.21,No.26 corresponding reactions were antagonism.The three strains above were selected for screening resistant mechanisms.The difference is that genotypes of adeS were negative in No.19 and positive in No.21 and No.26.Conclusion Rifampicin and polymyxin B combination showed synergy against the MDRAB in vitro,which can be considered as the treatment choice for critical infections caused by MDRAB.Imipenem and gentamicin,cefepime and levofloxacin also showed synergy in vitro,but in some isolates showed antagonism.This phenomenon may be due to the gene adeS activated by certain antibiotics,and the activated adeS drived efflux pump express or overexpress,which made the drugs in bacterial cells pumped out,causing antagonistic effect.The individual differences in strains should be considered when clinic strain apply these two combinations above.

Objective To evaluate the activity of antibiotics against pan-drug-resistant (PDR) Acinetobacter baumannii by combination antimicrobial susceptibility test in viro with epsilometric methods (Etest method) and microdilution checkerboard (CB method),and to detect a good correlation between timekill curve with the above mentioned two assays.Methods Thirty-one clinical isolates of PDR Acinetobacter baumannii were selected for mono and combination antimicrobial susceptibility test in vitro by E-test and CB method,then a comparison was conducted between the test results and the time-kill curve.Mono drugs involved tigecycline,colistin,imipenem and amikacin,and combinations involved two of drugs above,and three drugs involved imipenem/tigecycline,plus amikacin combination.Results Synergistic effect was detected in imipenem plus colistin and tigecycline plus imipenem combination.A high comparability was revealed between the E-test method with antimicrobial drugs added into the culture medium and the time-kill curves.Synergy in the combination of imipenem/tigecycline,plus amikacin was detected by the CB method and time-kill curves.Conclusion The results showed that the effect of specific combination of antibiotics against PDR Acinetobacter baumannii could be predicted by testing their synergistic effect with combination antimicrobial susceptibility test.

Objective To evaluate the effect of selective decontamination of digestive tract(SDD)on preventing ventilator-associated pneumonia by Meta-analysis based on theory and method of evidence-based medicine.Methods Six medical databases (PubMed,Excerpta Medica Database [EMBASE],China Biology Medicine disc[CBMdi-sc],China National Knowledge Infrastructure[CNKI],VIP database,from 1995 to 2014,and Cochrane Library of issue 12,2014 )were searched,literatures were selected,data were extracted,Meta-analysis was performed by using RevMan 5.3 software.Results 13 literatures were included (2 676 patients were involved),Meta-analysis revealed that the incidence of VAP in treatment and control group was 20.68% and 35.99% respectively (OR and 95%CI ,0.40 [0.28,0.56],P <0.001 ),the mortality rate of patients with mechanical ventilation in treatment group and control group were 20.60% and 20.03% respectively (OR and 95%CI ,0.99 [0.81 ,1 .20],P =0.91 ). Conclusion SDD can reduce the incidence of VAP in patients with mechanical ventilation,but can’t reduce mortali-ty rate.

Objective To discuss the best bacterial combination for the diagnosis of Bacterial vaginosis (BV).Methods This is a retrospective study,230 BV-positive patients and 360 healthy women were enrolled based on the Amsel criteria and Nugent score.5 BV-associated bacteria,including Gardnerella vaginalis,Atopobium vaginae and Leptotrichia/Sneathia species,et al.were amplified by specific-PCR assay,the detection rate were compared between two groups.ROC curve and Kappa test were used to select the best combination.Results The detection rate of Gardnerella vaginalis,Atopobium vaginae,Leptotrichia/Sneathia species,Megasphaera species and Mobiluncus mulieris in BV group (91.3％,83.5％,39.1％,42.6％ and 36.5％ respectively) were markedly higher than that in healthy women (37.2％,14.4％,11.7％,8.9％ and 5.6％ respectively),x2 value were 168.848,275.776,60.949,92.886 and 92.68,all P ＜ 0.05.The area under ROC curve of A.vag,G.Vag + A.vag,G.Vag + A.vag + Lepto,G.Vag + A.vag +Mega and G.Vag + A.vag + M.mul were 0.845,0.862,0.865,0.869 and 0.867,and the sensitivity and specifity were higher than 80％,the value of Kappa were larger than 0.75 (P ＜ 0.05).Thus,these five methods were coincident.Conclusion Detection of Atopobium vaginae may be a better way for the diagnosis of BV.

Objective To study the expression of homocysteine in serum of patients with common malignant tumor,and initially investigate the possibility of serum homocysteine as cancer biomarker.Methods Expression levels of homocysteine and caner biomarkers (CEA,AFP,CA125,CA199) in serum of 180 patients with established malignant tumor and 30 healthy controls (control) were measured,the results of homocysteine were compared with that of the cancer biomarkers based on the cutoff value used in clinic.Results The expression levels of homocysteine was significantly higher in patients with malignant tumor than in controls [(13.89 ± 4.95) μmol/L-(21.40 ± 9.38) μ mol/L vs (11.40 ± 3.13) μmol/L,P ＜ 0.05)].Conclusions The positive predictive rate of homocysteine is higher than the four kind of cancer biomarkers in lung cancer,breast cancer,esophageal cancer.The increase of homocysteine in tumors may be universal,and Homocysteine may be used as cancer biomarker in lung cancer,breast cancer and esophageal cancer.

Objective To discuss the practice effect about the waiting area in the hospital building of the daping hosptial ,the third military medical university to be reformed into digital subtraction angiography (DSA) composite operating room .Methods We reasonably choiced the form of purify conditioning ,medical C arm ,smallpox air supply ,and the efficient screening device layout at the end of smallpox air supply .Results The main parameters of the measured results met the national standards of indexes .The fan frequency was 48 Hz running at hundred grade ,and its operation energy consumption was about 25 kw/h ;the fan frequency was 35 Hz running at ten thousand grade ,and its operation energy consumption was about 12 kw/h;the conversion time was very short between hundred grade and ten thousand grade running ,about 10 minutes .Conclusion On the condition that the building environ-ment is not fit to install hanging medical C arm ,we can thorough choose floor type C arm ,adopt “leakage resistance type clean air supply smallpox” ,reasonably modify the form of purify air conditioning to design or modify a hundred grade operating room meet-ing requirement .

Objective To investigate the diagnosis rate of early gastric calleer(EGC)with mucosa biopsy after compound staining under gastroseopy.Methods Two hundreds and six pafients who suspected tO be EGC by gastroscopy were randomly divided into two groups,the mucosa in control group(n=103)was biopsy directly under gastrescopy,and the experimental group(n=103)was biopsy after compound staining.Compared the diagnosis rate of ECG between these two groups.Results Twelve cases were confirmed to be EGC by surgery plus pathology among all the patients.Two cases were from control group,the other ten cases were from experimental group.Type Ⅱ c+Ⅲ accounted for 58.3%of twelve EGG.Eleven cases(91.7%)were positive with helicobacter pylori(Hp).Conclusion Compound staining may improve diagnosis rate of ECG.There is significant deference between directed and mueosa biopsy after compound staining under gastrescopy(P=0.033).TypeⅡc+Ⅲwere main type in endoscope of EGC.Hp infection is closely related to early gastric cancer.

OBJECTIVE: To ensure legal,rational and safe use of anesthetic drugs.METHODS: Based on the related laws and regulations as well as the actuality,the regulatory regime on the use of anesthetic drugs was set and enforced.RESULTS: The regulations about the use of anesthetic drugs were able to be implemented satisfactorily,and the regulatory regime has changed the abstract management connotation into rapid process.CONCLUSION: It's operative and efficient to adopt flow management on the use of anesthetic drugs.

source water.

Objective To understand the prevalence and genotype distribution of human papillomavirus among male patients attending to venereal outpatient department and provide basic data for prevention and treatment of HPV.Methods Retrospective analysis method was used to analyze 1 074 patients from venereal outpatient department of Beijing Friendship Hospital during January to August in 2015.Swab specimen were analyzed by flow-through hybridization and gene chip to detect the type of HPV.Chi-square test was used to compare the distribution of CA and suspected patients.Results Among the 434 CA samples, the positive rate was 72.6%(315/434).The 58.1%(252/434) samples were high risk HPV positive and 14.5%(63/434) samples were low risk HPV positive.In high risk HPV infection, multiple infection accounted for 40.4%(175/434) and single infection was 17.7%(77/434), while in low risk HPV infection, single infection accounted for 12.9%(56/434).HPV-11, HPV-6, HPV-16, HPV-52, HPV-58 and HPV-51 were common.The positive rate among suspected CA patients was 36.6%(234/640) , and dominated in high risk HPV infection 25.3%( 162/640 ) .The positive rates of high risk HPV in CA patients [ 40.4%( 175/434 ) and 17.7%( 77/434 ) ] were obviously higher than that of suspected ones [12.9%(56/434) and 1.6%(7/434)], χ2 =95.956 and 9.122, both P<0.05.Conclusions Male patients from venereal outpatient department have a high prevalence of HPV, and common genotype are HPV-11, HPV-6, HPV-16, HPV-52, HPV-58 and HPV-51.The intensity of HPV screening should be strengthened in order to provide the vital basis for the prevention and treatment HPV related diseases.