Objectives To consider the reliability of using flucloxacillin (FCC) and clavulanic with extended spectrum cephalosporin synergy method (double inhibitors diffuse synergy test, DIDST) to detect AmpC ? lactamases (AmpC BLA) and extended spectrum ? lactamases (ESBLs). Method The FCC and clavulanic were regarded as the inhibitors of AmpC BLA and ESBLs respectively. The disks of ceftriaxone and cefepime were placed 20 mm away from the inhibitors, the disks of cefotaxime and the inhibitors were 25 mm apart. DIDST with a double disk synergy test, a cefoxitin three dimensional test, and a double disk enhancement test detected AmpC BLA and ESBLs in 56 strains of gram negative bacilli at the same time. Results 20 (35.71%) strains of ESBLs, 12 (21 43%) for AmpC BLA and 1 (1.78%) for ESBLs+AmpC BLA were found using DIDST, in 56 strains of G - B. During the double disk synergy test was used for ESBLs, 15 strains were found when the distance of the disks was within 25 mm, another 5 strains were found when the distance decreased to 20 mm. Twenty strains of ESBLs were found using the double disk enhancement test, and 12 strains of AmpC using the cefoxitin three dimensional test. The result of DIDST was similar to that of other three kinds of test. Conclusions DIDST is an accurate and reliable method using one plate to detect ESBLs and AmpC BLA of the same time. It is suitable for different levels of hospitals.

ObjectiveTo investigate the clinical effect of EaLeSu on cervical intraepithelial neoplasia(CIN Ⅱ~Ⅲ)patients with HPV infection treated with loop electrosurgical excision procedure(LEEP). Methods 165 cases of CIN Ⅱ~Ⅲpatients with HPV infection who underwent LEEP operation were randomly divided into observation group(n=83)and control group(n=82). In the observation group,patients were given a piece of EaLeSu in cervical wound at once in postoperative and two vaginal EaLeSu per day from the first postoperative day for eight consecutive days. The patients in the control group were treated with routine debridement and wound dressing with iodine. We observed the vaginal drainage times within 4 weeks after operative,bleeding rate,cervical wound repair,and cervical HPV DNA infection after 6 months. Results There were significant differences in the bleeding rate,vaginal drainage time,cervical wound repair and HPV DNA infection between the two groups(P < 0.05). Conclusion EaLeSu showed a definite effect on cervical intraepithelial neoplasia(CIN Ⅱ~Ⅲ)patients with HPV infection treated with LEEP.

Objective To investigate the efficacy and safety of tirofiban for emergency interventional therapy in patients with acute ST segment elevation myocardial infarction.Methods The 96 acute ST segment elevation myocardial infarction patients having accepted emergency percutaneous coronary intervention (PCI) were divided into treatment group and control group according to the treatment method with 48 cases each.The treatment group was given conventional standard treatment combined with tirofiban treatment [tirofiban intracoronary injection 10 μ g/kg and then intravenous 0.15 μ g/(kg· min) for 24-48 h].The control group was given conventional standard treatment only.The postoperative 60 min electrocardiogram ST segment recovery,the coronary blood flow TIMI grade,the major adverse cardiac events (angina,myocardial infarction,heart failure,death) and postoperative bleeding in 4 weeks were compared between the two groups.Results The patients having postoperative 60 min electrocardiogram ST segment recovery in treatment group was 45 cases (93.8％,45/48),in control group was 35 cases (72.9％,35/48),and there was statistical difference (P ＜ 0.05).The incidence rate of infarction vascular TIMI grade ≥ 3 grade flow in treatment group was 95.8％ (46/48),in control group was 75.0％ (36/48),and there was statistical difference (P ＜ 0.05).The incidence rate of the major adverse cardiac events 4 weeks in treatment group was significantly lower than that in control group,and there was statistical difference (P ＜ 0.05).There was no statistical difference in the incidence rate of bleeding between the two groups (P ＞ 0.05).Conclusion In patients with acute ST segment elevation myocardial infarction,the emergency interventional therapy with tirofiban is efficacy and safety.

Objective To evaluate the performance of ACL TOP coagulation analyzer system in the laboratory of children′s hospital. Methods According to the documents of CLSI, the analytic characteristics including precision, accuracy, linearity, interference and carryover rate were examined; specimens from healthy children were collected and assayed to determine the reference range of Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Thrombin Time (TT), Fibrinogen (FIB) and D-Dimer (D-D) from children on ACL TOP. Results The within-run and between-day coefficient of variability (CV) were within an acceptable range; The accuracy deviation of PT , APTT and FIB were less than 1/2 allowed total errors; The results of determination of FIB linearity test were correlated with the results of calculation: Y = 1.002 1X-0.122, R2 =0.998 2; The extent of influence of low to middle grade of jaundice , fat and hemolysis on each test were all less than 1/2 allowed total error; The carryover rates were lower than 1.81% and within an acceptable range; The reference range of PT, APTT, TT and FIB were PT (9.1-13.1 s), APTT (24.9-42.1 s), TT (12.6-21.1 s), FIB (1.924-4.011 g/L). Conclusion The ACL TOP coagulation analyzer has good repeatability, stability, linearity and capability of anti-interference and anti-carryover.

Objective To investigate the postmortem redistrib ution of morphine in rat model of chronic morphine poisoning. Methods Samples including cardiac blood, liver, heart, kidney, lung and brain tissues were collected in the rats with chronic morphine poisoning at 0～96 h after death, respectively. The morphine amount was measured with solid phase ext raction-gas chromatography. Results The study showed an increase in morphine concentrat ion of postmortem cardiac blood. Significant increase in morphine level was also observed 24～96 h after death in liver, heart and brain tissues, while the kid ney morphine levels decreased at 96 h after death. In the liver there was the g reatest increase (25-fold) in morphine levels 96 h after death. All the sample s showed marked alterations in morphine concentration within 96 h after death c ompared with cardiac blood at time of death. The postmortem morphine levels in b rain were closely related to those in the heart blood. Conclusion The postmortem redistribution of morphine exists in rats with chronic morphine poisoning. The brain tissues may better represent morphine levels in heart blood at the time of death.

Objective To observe the effect of MG132 on the expression of extracellular regulated kinase 1/2 (ERK1/2) and connective tissue growth factor (CTGF) in rat peritoneal mesothelial cells (RPMCs) induced by high glucose.Methods RPMCs were isolated,cultured and passaged by trypsin,then identified.The second generation of cultured RPMCs were used in the experiment.RPMCs were divided into normal control group,high glucose (1.5％,2.5％,4.25％) for 24 hours,high glucose (2.5％) for 0,12,24,48 hours,incubated with MG132 (0.5,1,2 μmol/L) for half an hour and then with high glucose (2.5％) for 24 hours.ERK1/2 protein was detected by Western blotting,and CTGF protein in supernatant was detected by ELISA.Results Compared with the control group,the expression of p-ERK1/2 was significantly increased in the groups stimulated by high glucose (P ＜0.01),reached the peak at 24th hour (P ＜ 0.01),and then the expression decreased at 48th hour,but still was higher than that in the normal control group (P ＜ 0.01).CTGF protein expression of RPMCs induced by high glucose increased,in time-and dose-dependent manner (P ＜ 0.05).MG132 could significantly decrease the expression of ERK1/2 and CTGF induced by high glucose (P＜0.05).Conclusions MG132 can decrease the expression of p-ERK1/2 and CTGF in RPMCs induced by high glucose.The ubiquitin proteasome pathway participates in the development of peritoneal fibrosis,and blocking the way may contribute to the prevention of peritoneal fibrosis.

Objective To discuss the advantage of hispectral index(BIS) monitoring used in gastrointestinal endoscopy,and to observe elinical effects of target-controlled infusion(TCI) propofol combined with remifentanyl in elderly patients.Methods 120 patients aged from 65 to 78 with ASA physical status Ⅰ ～ Ⅱ were randomly divided into two groups,i,e.Group A (propofol with fentanyl ),Group B ( TCI propofol and remifentanyl with BIS).The amount of propofol was adjusted by consciousness and hemodynamics in Group A,while by BIS value in Group B.BIS was controlled at 55 ～60.The total amount of propofol and the time of wake-up,the incidence of complicatiors in each group were recorded.Results Compared with Group A,the changes of MAP and HR at T1 and T2 were smaller in Group B(P ＜ 0.05 ) ; Compared with Group A,the total amount of propofol and the time of wake-up were less in Group B ( P ＜ 0.05 ) ;Compared with Group A,the incidence of intraoperative respiratory depression and bradycardia were increased in Group B( P ＜ 0.05 ),there were no differences in the rest between the two groups.Conclusion Under BIS monitoring,TCl propofol and remifentanyl in elderly patients undewent gastrointestinal endoscopy may reduce propofol,and reach rapid recovery from anesthesia,but it needs additional management of respiration and circulation.

Objective To evaluate the clinical effects of large dosage capoten(captopril)combined with irbesartan in the treatment of congestive heart failure(CHF).Methods One hundreds thirty nine patients of CHF were occasionally divided into two groups:large dosage capoten group(n=61)and large dosage capoten+irbesartan group (n=78).240 days later,the changes of cardiothoracic ratio(CTR),left ventricular end diastolic diameter(LEVD),left ventricular end contract surface(LVES),left ventricular eiection fraction(LVEF),6-minute walking test (6MWT),admission frequency,and mortality rate were observed before and after therapy.Results Large dosage capoten+irbesartan group can significantly reduce the admission frequency of CHF patients(P＜0.01),while large dosage capoten group was better than large dosage capoten+irbesartan group in 6MWT,LEVD,LVES,and LVEF (P＜0.05).There was no significant difference in CTR and mortality rate between two groups(P＞0.05)Conclusion Capoten combined with irbesartan have better clinical effects than single capoten in the treatment of CHF and it was worthy of extending in clinic.

Glaucoma is an irreversible cause of blindness,and it does serious harm to visual functions.Symptoms of glaucoma,visual impairment,a variety of symptomatic treatment and adverse reactions of drugs result in great obstacles and reduce quality of life.Preventive treatment intervenes glaucoma at an early stage by providing patients with guidance on therapies,diet and daily life,which are effective and may effectively improve their quality of life.

ObjectiveTo observe the changes of HR,MAP,BIS and Narcotrend induced by different doses of propofol in elderly patients. MethodsOne hundred elder patients(60 ～ 85 years old), AS A class Ⅰ or Ⅱ, scheduled for selective surgeries,were divided equally into 5 different doses of propofol( constant intravenous injection for 1min) groups of 0.5mg/kg( Ⅰ ) ,0. 75mg/kg( Ⅱ ) ,1.0mg/kg(Ⅲ) ,1.25mg/kg( Ⅳ)and 1.5mg/kg(Ⅴ). HR,MAP,BIS and Narcotrend were monitored before propofol injection and at 1 and 5 min after propofol injection. ResultsHR of 5 group s as similar. At 1 min after pmpofol injection, MAP decreased remarkably compared with at before in all 5 groups( t =2. 17,2.84,2.49,5.63,7.10, all p ＜ 0.05 ), which in group Ⅳ and Ⅴ decreased significantly compared with at in group Ⅰ, Ⅱ and Ⅲ(t =4.67,2.77,2.45,5.49,4.57,2. 18,all P＜0.05).At 1 min after propofol injection,BIS and NI values decreased compared with at before in all 5 groups(t =7.74,11.74,28.18,30.34,45.28, 6. 65,10.52,17.27,26.28,30. 14,allP ＜0.05) ,which in groupⅢ, Ⅳ and Ⅴ were significantly lower than those in group Ⅰ and Ⅱ (t =12.59,11.08,16.72,15.12,17.67,15.64,allP＜0.05).Dose of propofol was negatively correlated with BIS and NI value ( r =-0. 898/0. 930, P ＜ 0.01 ). ConclusionPropofol 1.0mg/kg constant injection should meet the sedation and hypnosis demand of general anesthesia in elderly patients and could not inhibit circulatory system; Bispectral Index and Narcotrend could accuratly monitor depth of anesthesia in elderly patients.