ObjectiveTo find out the antimicrobial resistance of clinical sequential isolates of Serratia marcescens,investigate the primary antimicrobial resistant mechanism of Serratia marcescens to β-lactams antibiotics.MethodsReview the antimicrobial resistance data of 247 Serratia marcescens isolates collected sequentially from different clinical wards during 2007 to 2010 in the First Hospital of Ningbo,which their antimicrobial susceptihility testing was got by using Vitek2-Compact system and matching products of gram-negative susceptibility card (GNS).The antimicrobial resistant genes of 20 carbapenems resistant isolates were detected by PCR.Results The Serratia marcescens resistant rates to ceftriaxone,aztreonarn and ciprofloxacin in our hospital were 70.4％ ( 174/247 ),64.8％ ( 160/247 ),57.4％ ( 142/247),respectively,the resistant rates were lower to amikacin,gentamicin,imipenem and meropenem,which were 3.5％ ( 8/229 ),5.4％ ( 13/241 ),5.9％ ( 14/237 ),8.1％ ( 20/247 ),respectively.PCR experiment showed that the expression levels of the AmpC gene in 4 strains were higher than that of the negative reference strains.The expression levels were 98.3,102.3,121.5,87.3 times compared to the negative reference strains,respectively.Twelve strains (strain no.2,3,5,6,9,10,14,15,16,17,18 and 19)produce bothblaCTX-MandblaKPC-2 enzymes.Highly detecedhlaCTX-Mof Serratia marcescens in our hospital included CTX-M1,CTX-M2,CTX-M9.Isolates no.7 and 18 were carrying blaSHV gene,Isolates no.8 and 13 were carrying blaSME,Isolates no.11 and 20 were carrying blaTEM.There were 5 strains (no.3,4,5,7 and 16) lose the outer membrane protein (OMP) genes ompC and ompF.Two strains( no.1 and 12 ) lose OMP gene ompF only,and one strain ( no.20 ) was lose OMP gene ompC only.ConclusionsThe cause of β-lactam antibiotics resistance of Serratia marcescens was complicated,and the most important mechanism is producing β-1actams and loss of OMP.Understanding the evolution and drug resistant mechanisms will help for best use of antibiotics and reducing the selection of antibiotics to resistant isolates.

Objective To explore the efficacy and safety of probiotics combined with kangfuxin solution in treatment of mild and moderate active ulcerative colitis.Methods 80 cases of patients with mild and moderate active ulcerative colitis(UC)in Nanyang Central Hospital were divided into two groups according to order of admission,each group had 40 cases.The study group of patients were treated with probiotics combined with kangfuxin solution,while the control group of patients were given probiotics alone.All patients were treated for eight weeks,to compare comprehensive efficacy and colonoscopy disease activity score between two groups of patients. Results The total effective rate of the study group was 97.5%,significantly higher than 80%of the control group,and the difference was statistically significant(P<0.05 );The colonoscopy disease activity score of the study group after treatment was significantly lower than before treatment and of the control group,the difference was statistically significant(P<0.05 );The two groups of patients had no serious adverse reactions.Conclusion Probiotics combined with kangfuxin solution has a significant efficiency in treatment of active mild and moderate ulcerative colitis.

ObjectiveTo analyze the homology of Citrobacter freundii strains and detect multidrug resistant genes.MethodsThe minimum inhibition concentration was tested with standard agar dilution method and the the homology of C.freundii strains was measured with pulsed field gel electrophoresis (PFGE) and the PCR was used to perform the drug resistant genes such as β-lactamase,disappearing of outer membrane channel protein.ResultsThe four strains ( No.1,2,4,5 ) showed nineteen banding patterns with PFGE.PCR experiment showed that there were 2 strains (No.1,4) with blaCTX-M,3 strains (No.2,3,5 ) with blaDHA,1 strains(No.3) with blaACT/MIR,and 4 strains(No.1,2,4,5) with blaKPC-2.PCR analysis comfirmed that No.2 and No.4 disappearing of OmpF and No.3 disappearing both of OmpC and OmpF.The expression levels of the chromosomal ampC gene of No.3 isolates was 106.7 times higher than the negative isolates.ConclusionThere is high homology in carbapenem-resistant isolates and the mechanism of drug resistance is complex including blaKPC,AmpC,ESBLs,disappearing of outer membrane channel protein.The spreading of drug resistance result from above genes.

Objective To investigate the clinical distribution and the drug resistance of carbapenemresistant Proteus mirabilis strains isolated from 2009 to 2012 ; and to study carbapenemase genotypes of the isolates.Methods A total of 15 non-repetitive carbapenem-resistant Proteus mirabilis strains were selected from 422 Proteus mirabilis strains isolated from Ningbo First Hospital during January 2009 to December 2012.The minimal inhibitory concentrations (MIC) of 6 antibacterial agents,including imipenem (IPM),meropenem (MEM),ertapenem (ETP),ciprofloxacin (CIP),amikacin (AK) and minocycline (MIN),against 15 isolates were determined by E-test.The modified Hodge test (MHT) was used to detect the carbapenemase production in isolates.The PCR assay was performed to detect drug resistance genes of blaKPC,blaNDM-1,blaGES,blaSME,blaIMI-1/NmcA and blaSHV-38.Plasmids were extracted from the blaKPC-positive strains and then transformed into Escherichia coli J53 strains by electroporation.The transformed and untransformed Escherichia coli J53 strains were tested for MIC values and blaKPC gene by E-test and PCR respectively.Results The resistance rates of the 15 carbapenem-resistant Proteus mirabilis strains to IPM,MEM,ETP,CIP,AK and MIN were 100％,100％,100％,86.7％ (13/15),33.3％ (5/15) and 80％ (12/15),respectively.7 out of 15 strains were Hodge test positive,and 11 strains were blaKPC-2 positive.Results of PCR amplification showed that the transformed Escherichia coli J53 strains,whose MIC values to IPM,MEM,and ETP were increased by 2 to 64 times,were blaKPC-2 gene positive.Conclusion The carbapenem-resistant Proteus mirabilis strains in this study were resistant to many commonly used antibiotics,however,the resistance rates to AK were relatively low.The dominant carbapenemase genotype was blaKPC-2 carried by the plasmid.Attention should be paid to its easily transmissible feature among the strains in clinic.

Objective To study if the dose verification technique for three dimensional conformal radiation therapy ( 3 DCRT) can be applied for simplified intensity modulation radiation therapy ( sIM RT). Methods From 1988 patients treated by sIMRT in our department,12 were chosen randomly for the study. For each case,3 differert plans of 3DCRT,sIMRT,and IMRT were worked out with Pinnacle TPS,and the dose verification for each plan was carried out with Elekta Precise LA by using 2D diode-matrix of MapCHECK Model 1175. Results For slMRT,the overall average percentages of pass points for DD(DTA) 2% (2 mm) ,3% (3 mm)and 4% (4 mm) were 90.5% ,94.8% and 98.2% reapectively,which were slightly worse when comparing with those of 3DCRT with deterioration of 1.9% (t=2.19,P=0.040) ,1.0% (t= 1.52,P=0.144) and 0.2% (t=0.05,P=0.623), but slightly better comparing with those of IMRT with increment of 2.1% (t=2.17,P=0.041) ,1.5% (t=2.62,P=0.016) and 1.5% (t=3.68,P=0.001) for 2% (2 mm) ,3% (3 mm) and 4% (4 mm) ,respectively. Conclusions The sIMRT technique simplifies the complicated dose verification procedure of I MRT. When the sIMRT technique is formally used, the procedure of dose distribution verification for 3DCRT can be used directly for slMRT.

Shuyu Pill is the representative prescription for treating deficiency-essence. This article discussed the consistency of diabetes and deficiency-essence from TCM syndromes and etiology and pathogenesis, and probed into the correlation between Shuyu Pill and diabetic Western medicine of pathomechanism diabetes from the modern pharmacological research on Shuyu Pill. Therefore, it proposed that diabetes has the essence of deficiency-essence;the pathogenesis of diabetes should meet the efficacy of Shuyu Pill; pharmacological effects of Shuyu Pill can affect various pathological mechanism of diabetes, with a purpose to provide new ideas for the clinical treatment of diabetes.

Objective To evaluate the clinical efficacy and safety of metallic hemoclips in the treatment of gastric defects during endoscopic full-thickness resection. Methods Patients with submucosal tumors derived from the muscularis propria and adhesion of the gastric serosa diagnosed by EUS and CT were enrolled in the study.A total of 62 patients,22 males and 40 females,mean age 58.5 years,were recruited into the present study from June 2009 to December 2010,in which 37 patients were with tumors in gastric fundus,20 in gastric body and 5 in antrum.All patients were treated with endoscopic full-thickness resection.After the operation,metallic hemoclips were used to close the defects through endoscopic biopsy channel.The closure success rate with metallic hemoclips were assessed.The patients were followed up endoscopically for evaluation of efficacy and safety of the procedures.Results All patients underwent endoscopic full-thickness resection.Uncontrollable bleeding occurred in 1 patient,who subsequently underwent emergent laparoscopic surgery and was excluded from the study.Metallic hemoclips were applied to close defects in 57 patients,and metallic hemoclips combined with omentum obstruction in 4 patients.The overall success rate was 100％ in 61 patients.Endoscopic follow-up was completed in all patients in average of 4.4 months.The clinical wound healing rate was 100％.No complications such as fever,abdominal pain were found in 2months after the procedures.Conclusion Application of metallic hemoclips during endoscopic full-thickness resection for gastric defects is a safe and effective technique.

ObjectiveTo evaluate the clinical efficacy and safety of nylon ligation combined with endoscopic high-frequency electric snare for the treatment of colorectal polyps.MethodsThe clinical data of 345 patients with colorectal polyps who received the treatment of nylon ligation combined with endoscopic high-frequency electric snare at the Zhongshan Hospital of Fudan University from January 2006 to January 2011 were retrospectively analyzed.Complications including bleeding and perforation were observed.Postoperative wound healing and local residual recurrence were assessed during follow-up.ResultsA total of 362 colorectal polyps were successfully removed.The mean diameter of the colorectal polyps was 2.7 cm (range,1.5-4.0 cm). Operative bleeding occurred in 1 patient,and perforation in 1 patient.The results of histological examination showed that 93.6％(339/362) colorectal polyps were adenoma,17 were hyperplastic polyps,5 were inflammatory polyps,and caneeration of colorectal polyps in 1 patient was detected.Endoscopic follow-up was completed in 334 patients at the first month after operation,and 9 patients with residual benign colorectal polyps received endoscopic resection.No residue or recurrence was found in the other patients.Endoscopic follow-up was completed in 308 patients at the second months after operation,and no residue or recurrence was found.The overall effective rate was 97.1％ (299/308).ConclusionEndoscopic nylon ligation combined with endoscopic high-frequency electric snare is effective and safe for the treatment of colorectal polyps.

Background and purpose: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new minimally invasive method in the dignosis for mediastinal lymph nodes. This study was to evaluate the diagnostic yield of EBUS-TBNA for mediastinal lymph nodes. Methods: Twenty patients with mediastinal lymph nodes found by CT underwent the dignosis by EBUS-TBNA form April 1st 2009 to July 16th 2009. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were evaluated. Results: Twenty patients with 37 lymph node groups were studied. Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EBUS-TBNA for diagnostic were 84.62%, 100%, 100%, 77.78% and 90.00%, respectively. The diagnostic accuracy for cancer was 100%. The operation time was 11.9min per group in average with no serious complication. The median length of hospital stay was 1 (range from 1 to 17 days) day after operation. There were significant differences in the average operation time between the first three patients and the others (36.25 min vs. 7.76 min; z=3.247, P=0.001). Conclusion: Endobronchial ultrasound-guided transbronchial needle aspiration proved to be a safe procedure with a high yield for the diagnosis of mediastinal lymph nodes.

A new dibenzocyclooctadiene lignan, renchangianin E (1) was isolated from the stems of Kadsura renchangiana. Its structure and stereochemistry were elucidated by spectroscopic methods, including 2D-NMR techniques.