Objective To evaluate the killing efficacy of chlorine-releasing agents (CRAs) with different concentrations on multidrug-resistant Acinetobacter baumannii.Methods Totally 30 clinical strains of multidrug-resistant Acinetobacter baumannii were collected from November 2008 to December 2009.Killing efficacy of CRAs on these strains was evaluated by quantitative suspension test.The one-way analysis of variance was performed.Results The log values of killing to 30 strains of multidrug-resistant Acinetobacter baumannii were all ≥5.00,when the bacteria were exposed to available chlorine concentrations 400 mg/L of CRAs for 10 min,600 mg/L for 10 min,800 mg/L for 3 min and 1000 mg/L for 1 min,respectively.And effective rates were all 100％. Furthermore,there were significant differences among different available chlorine concentrations exposed for the same time ( except 10 min) ( F =72.72,64.79 and 32.33,P =0.00),and among different exposure time in the same available chlorine concentration ( except 1000 mg/L) ( F =110.42,20.41 and 3.20,P=0.00,0.00 and 0.03).Conclusion Satisfactory killing efficacy of CRAs to multidrug-resistant Acinetobacter baumannii can be achieved with available chlorine concentration 500 mg/L to 1000 mg/L and exposure time 10 min to 30 min.

OBJECTIVE To investigate the qacA/B genes in meticillin-resistant Staphylococcus aureus(MRSA) and their significance.METHODS Totally 221 MRSA strains were clinically isolated.The genes of qacA/B were analyzed using polymerase chain reaction(PCR).RESULTS From them 101 strains were found the qacA/B genes,the positive rate of qacA/B genes was 45.7%.And 71 strains were selected for qacA PCR detection,20(28.2%) were with qacA gene and 27(38.0%) were with qacA/B gene,suggesting that the seven strains be with qacB gene.CONCLUSIONS MRSA strains have emerged the high-frequency qacA/B disinfectant resistance gene.Application of chlorhexidine and other disinfectants to prevent postoperative nosocomial infections must be reassessed.The efficacy of existing disinfectants or disinfection methods should arouse our wider attention.Disinfectant resistance gene detection technology provides a practical means for the research of the disinfectant-resistant bacteria and the clinical application of the molecular epidemiology research.

OBJECTIVE To investigate the genes of AmpC and ?-lactamases and antibiotic resistance of A.baumannii strains in elderly.METHODS The sensitivity to 13 kinds antibacterials was analyzed according to CLSI 2005′s Standard.The genes of AmpC and ?-lactamases were detected by polymerase chain reaction(PCR).RESULTS Most of the strains were A.baumannii.In 20 strains of A.baumannii,the positive strains of AmpC(chromosome) were 17(85%),that of TEM and PER 5 strains were 11 strains(55%) and 25%,respectively.CONCLUSIONS High positive percentages of AmpC(chromosome),TEM and PER genes in A.baumannii strains isolated from elderly are found.

Objective To recognite the importance of early emergent management of and prevention therapy of complication in acute cervical spine injury. Methods early emergent support and 8 types and 715 early complications and their prevention and management in 194 cases with acute cervical spinal cord injury admitted through 1989 to 1995 were reviewed.Results Mortality in early stage can be markedly reduced with routinely and standardization of early emergency treatment obviously reduced the mortality procedure,pulmonary complication being the main cause of death, while early complications can delay surgical treatment,increase the cost and the staying in hospital and reduce difficulty of rehabilitation.Conclusion Early complication occurring in the first days with its own feature, prevention or treatment properly will be benefit for the treatment of the neural lesion and following rehabilitation.

Objective To explore the effect of resilience in the relationship between workplace bullying （WPB） and professional identity among nursing interns. Methods A total of 292 nursing interns from six grade A hospitals were selected as the research subjects using convenience sampling method. The WPB，professional identity，resilience，perceived stress and coping styles were investigated by the Negative Acts Questionnaire Revised， the Professional Identity Questionnaire for nurse students，the Chinese version of 10-item Connor-Davidson Resilience Scale，the Chinese Perceived Stress Scale and the Simplified Coping Style Questionnaire. Results The scores of WPB and perceived stress were negatively correlated with those of professional identity，resilience，and positive coping styles（PCS）［Spearman correlation coefficients（rS ）were −0.354，−0.316，−0.388，−0.488，−0.636 and −0.478，all P<0.01］. There was a negative correlation between negative coping styles（NCS）and professional identity（rS =−0.117，P=0.046）. The scores of resilience and professional identity were positively correlated with that of PCS（rS were 0.539 and 0.482，both P<0.01）. There was a positive correlation between resilience and professional identity （rS =0.567，P<0.01）. The scores of WPB and perceived stress were positively correlated with that of NCS（rS were 0.350 and 0.281，both P<0.01）. There was a positive correlation between WPB and perceived stress（rS =0.419，P<0.01）. The scores of resilience and PCS were not correlated with that of NCS（both P>0.05）. Resilience played a mediating role between WPB and professional identity. The interaction between WPB and NCS could predict the professional identity and resilience of nursing interns（standardized regression coefficient were 0.31 and 0.17，both P<0.01）. Conclusion WPB can directly or indirectly affect nursing interns’professional identity through resilience，and NCS plays a moderating role on the direct effect of WPB and professional identity，and the relationship between WPB and resilience.

Adolescent ; Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Olecranon Process ; injuries ; surgery ; Suture Techniques ; Ulna Fractures ; surgery

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.

BACKGROUND: It is often seen in clinical practice that children, aged3-15 years, suffer from knee pain of unknown cause at night, which occurs frequently. Most of them can be called "pain of growth".OBJECTIVE: To analyze the related factors of knee pain in adolescents and observe the interventional effect of alpha-D3 (α-D3).DESIGN: Case control analysis, self-control analysis SETTING: Department of Orthopaedics, Jinshan Hospital Affiliated to Shanghai Fudan University PARTICIPANTS: We admitted 22 children outpatients, aged 3 to 15years, who suffered from recurrent attack of knee pain of unknown reasons and received treatment in Jinshan Hospital Affiliated to Shanghai Fudan University from June 1998 to August 2002, servingas group A. Another 20children outpatients of fracture recovered for half a year were recruited simultaneously, serving as Group B (control group).METHODS: Group A adopted the therapy of α- D3 of 0.25 μg taken orally once everyday for successive 7 days then stopped to observe the symptoms for the next three weeks. Four weeks was one therapeutic course.If the pains were still alive or reoccurred, another therapy period was needed until they vanished. The contents of bone gla protein (BGP), blood calcium (Ca2+), blood phosphorus (P3+), blood magnesium (Mg2+), alkaline phosphatase (ALP) and bone mineral density (BMD) of patients were detected between Group A and Group B. GBP index and change of pain in knee at night was observed with α-D3 before therapy and 1,3 and 6months after therapy. After one therapy period, the levels of blood Ca2+, P3+,Mg2+, ALP, BGP, CT, urine and X-ray of knees were detected again, so was BMD after 6 months.MAIN OUTCOME MEASURES: ① Blood Ca2+, P3+, Mg2+, ALP contents of children patients were detected before and after therapy . ② In the Group A, content of BGP was detected before and 1,3 and 6 months after therapy, and BMD before and 6 months after therapy; The above indexes were detected 6 months and one year after bone fracture healing in the control group. ③ Therapeutic effect of α-D3.RESULTS: All the 42 patients entered the stage of result analysis. ① The levels of blood Ca2+, P3+, Mg2+, ALP of patients who suffered pain in knee were all normal before and after therapy . ②BGP content of patients in the control group was significantly lower 1 year after bone fracture healing than 6 months after bone fracture healing [(7.06±0.74), (7.44±1.16)μg/L,P ＜ 0.01]; BGP content of patients in Group A was 15.98 μg/L before therapy , which was significantly higher than that in the control group .BGP content was (12.12±2.2), (10.6±81.31), (7.60±0.95)μg/L , respectively in 1,3 and 6 months after therapy. There was significant difference of BGP content between before and after therapy (P ＜ 0.05). ③ There was no significant difference of BMD of patients between two groups (P ＞ 0.05).④ Symptoms of pain in knee at night improved or disappeared after α-D3therapy, and the therapeutic time was 9 to 83 days.CONCLUSION: Although the knee pain of adolescents and children at night can not reach the diagnostic criterion of rachitis, it is still correlated with the deficiency of bone mineralization, in clinical practice, the BGP determination should be used as a means of monitoring the pain of unknown cause. There is significant effect using vitamin D3 in treatment of knee pain of children at night.

Objective To analyze molecular evolution of carbapenemase KPC-12 and its binding free energies with β-lactams.Methods Class A beta-lactamases were divided into 2 clusters:those with carbapenemase activities and those without.Minimum Evolution method in MEGA4.1 software was used to analyze molecular evolution of class A beta-lactamases with carbapenemase activity,including KPC-2 to KPC-13,SFC-1,SME-1,IMI-1,NMC-A,and class A beta-lactamases without carbapenemase activity,including TEM-1,SHV-1.Then,tertiary structure of KPC-12 was predicted by homology modeling as reported in SWISS-MODEL database depending on tertiary structure of KPC-2.Moreover,DOCK module in ArgusLab 4.1 software was used to perform molecular docking of KPC-12 to 10 kinds of beta-lactams substrates,and the binding free energies (△ G) were calculated.Results Molecular evolution between KPC-12 and KPC-2 was the closest.The top three decline in binding free energies of β-lactams were penicillin G sodium salt (△G =-8.45149 kcal/mol),ertapenem (△G =-8.36383 kcal/mol) and ampicillin (△G =-8.19326 kcal/mol),while the last two decline in binding free energies of β-lactams were aztreonam (△G =-6.50614 kca]/mol) and clavulanic acid (△G =-6.88533 kcal/mol).Conclusion Carbapenemase KPC-12 has high catalytic activities to penicillin G sodium salt,ertapenem and ampicillin,while has low catalytic activities to aztreonam and clavulanic acid.

Objective To investigate the distribution of β-lactamase genes in a pan-drug resistant Klebsiella pneumoniae isolate JM45.Methods Klebsiella pneumoniae JM45 was isolated from the blood sample of a patient admitted in the intensive care unit,the Second Affiliated Hospital,Zhejiang University School of Medicine on April 7,2010.The susceptibilities to 26 antibiotics were tested using E-test method.Cica-β-Test was performed to detect β-lactams,and modified Hodge test was performed to detect carbapenemase.Resistant genotypes were detected using PCR,DNA sequencing and BLAST algorithm.Whole genome sequencing (complete graph) was performed by high throughput Roche 454 sequencing approach to analyze the distribution of β-lactamase genes.Results Except polymyxin B and tigecycline,JM45 was resistant to other 24 kinds of antibiotics including cephalosporins and carbapenems.Several β-lactamases were positive in Cica-β-Test,and modified Hodge test was positive.Based on PCR typing,TEM-1,SHV-11,CTX-M-24 and VEB-3 were positive,but carbapenemase genes and metallo-β-lactamase genes were negative.A complete genome (chromosome) sequence (GenBank accession number:CP006656) and 2 plasmids sequences (GenBank accession number:CP006657,CP006658) were obtained by wholegenome sequencing.CTX-M-24 (Locus tag:N559_5233),TEM-1 (Locus tag:N559_5242) and VEB-3 (Locus tag:N559_5248) were positive in plasmid 1.CTX-M-24 located in insertion sequence (IS903-CTXM-24-ISEcp1),while TEM-1 and VEB-3 located in transposons (tnpA-TEM-1-rmtB and VEB-3-tnpA).SHV-11 (Locus tag:N559_2715) was positive in genome (chromosome),and 4 putative β-lactamase genes or β-lactamase domains were obtained:(1) metallo-β-lactamase domain protein (Locus tag:N559_0119,780 bp) ; (2) putative β-lactamase (Locus tag:N559_1633,1308 bp) ; (3) β-lactamase domain protein (Locus tag:N559_2279,813 bp); (4) β-lactamase domain protein (Locus tag:N559_3769,1101 bp).No insertion sequence or transposase gene was observed near SHV-11.Conclusion The resistance to antibiotics including cephalosporins and carbapenems is correlated with TEM-1,SHV-11,CTX-M-24,VEB-3 and 4 kinds of putative β-lactamase genes or β-lactamase domains.