Vaneomycin resistance in Staphylococcus aureus(hVISA)has been reported woddwide in recent years,although it was previously thought that vancomycin resistance was seldom.Heteroresistant vancomycin intermediate hVISA has strong impact on the efficacy of vancomycin treatment and it's prevalence has been increasing.However,hVISA is uneasy to be detected.In this issue,Wang Hui research group reports the high prevalence of hVISA,which was detected with reliable method,in MRSA strains collected from 14 cities in China.This finding should attract clinician's attention.

Mycoplasma pneumoniae,Chlamydia pneumoniae and Legionella pneumophila are recognized as common and important pathogens in community-acquired respiratory tract infections(RTIs).Macrolides,tetracyclines and fluoroquinolones are the most commonly employed drugs in the treatment of these atypical pathogen infections.Macrolide-resistant M.pneumoniae strains have been reported in Japan,China,France and the United States since 2000.Advances in atypical pathogen infections,etiological resistance and antimicrobial treatment are reviewed in this article. Abstract:Summ ary:Mycoplasma pneum oniae,Chlamydia pneum oniaeandLegionella pneum ophilaare recogn ized as common and important pathogens in commun ity-acqu ired resp iratory tract infections(RTIs).M acrolides,tetracyc lines and fluoroqu ino-lones are the most common ly emp loyed drugs in the treatm ent of these atyp ical pathogen infections.M acrolide-resistantM.pneumon iae strains have been reported in Japan,Ch ina,France and the Un ited States since 2000.Advances in atyp ical pathogen infections,etiological resistance and antim icrob ial treatm ent are reviewed in th is artic le.

The curative effect on 124 cases with multi drug resistant pulmonary tuberculosis from January 1996 to June 1999 was reported.All the cases, with an average history of 5.84 years, were recurrent ones. They included 78 cases of infultative pulmonary tuberculosis,46 cases of chronic fibrocavitative pulmonary tuberculosis. Sputum of all the cases was cultured for Mycobacterium hominis tuberculosis with Kuang`s culture medium and drug susceptibility test was done. As a result, the drug resistant rate to 2 drugs, 3 drugs,4 drugs, 5 drugs and more were 20.16%,25.0%,20.9%,33.72% respectively.The authors added 1～2 kinds of anti TB drugs never used before in each case to KOP (Kanamycin, Ofloxacin, Sodium Aminosalicylate),with a mean 3.3 months treating course. The sputum negative conversion rate was 66.9%,foci absorption rate was 72.6%, cavity close up 50.0% . There wasn′t any serious adverse effect encounted. It suggest that KOP synergetic bacteriocidal to Mycobacterium tuberculosis either inside or outside cells, with fewer side effect, is a good regimen for multi drug tuberculosis treatment.

Objective To investigate bacterial resistance of Streptococcus pneumoniae against erythromycin and clindamycin, and resistance phenotypes of erythromycin resistant S. pneumoniae. Methods The MICs of erythromycin and clindamycin against 345 strains of S. pneumoniae were tested with agar dilution method, the phenotypes of erythromycin resistant S. pneumoniae were detected by double disc test. Results The resistance rates of S. pneumoniae to erythromycin and clindamycin were 53.0%(183/345) and 49.6%(171/345), respectively. Among erythromycin resistant S. pneumoniae , the percentages of cMLS, iMLS and M phenotype were 90.3% (159/176), 5.7% (10/176) and 4.0%(7/176), respectively. Conclusions The resistance rate of S.pneumoniae against erythromycin is very high in Shanghai. The main phenotype is cMLS.

Objective To investigate the predictors and characteristics of the surgical outcomes of lumbar discectomy. Methods A total of 204 patients undergoing lumbar discectomy in our hospital from 1985-2003 were selected. The data on the surgical outcomes were collected using questionnaire, communication, and clinical follow-up. The cases were divided into four groups according to the different postoperative time: 1-2, 2-4, 4-8 years, and more than 8 years. The correlated factors in surgical outcomes in the four groups were analyzed by multiple regression analysis. The predictors and characteristics of the surgical outcomes in the four groups were compared. Results The duration between symptom onset and operation was significantly associated with the surgical outcomes. There was no statistical difference in surgical outcomes between the four groups. Conclusion The surgical outcomes of lumbar discectomy are closely associated with the preoperative onset of symptoms and remain unchanged in 2 years after operation.

One hundred and forty-five mice were randomized into 4 groups:Group Ⅰ consisted of 25 mice with sham operation,group Ⅰ of 40 mice with hemisplenectomy,group Ⅲ of 55 mice with hemisplenic autotransplantation,and group Ⅳ of 25 mice with splenectomy.Twelve weeks after operation,it was found under optical microscopy,transmission electron microscopy and scanning electron microscopy that the autografted hemispleen was viable.The contents of alpha-naphthol acetylate esterase (ANAE) and acid phosphatase (ACP) in the splenic tissue were measured with microspectrophotometer.ACP level decreased continuously in group Ⅰ (0.462?0.013),group Ⅱ (0.304?0.009),and group Ⅲ(0.180?0.014) (P

Objective To study the protective effect of pure carbachol or combined with dietary fiber on intestinal mucosal barrier of rats after diffuse brain injury (DBI).Methods An adult male Wistar rat model of DBI was reproduced by gravitational shock method. The rats injured and survived after resuscitation were divided into three groups: model group (n = 40), carbachol group (n = 40) and carbachol combined with dietary fiber group (combined group,n = 32). In addition, a control group was established by simply an incision performed on the scalp, and the rats could drink freely (n = 5). In the experimental groups, 2 hours after resuscitation the rats began to receive gavage, 6 hours once, the liquid amount 15 mL/kg should be assured in every 6 hours, and if insufficient, normal saline was supplemented. In model group, normal saline 90 mL/kg was given, in carbachol group, carbachol 300μg/kg was administered and in combined group, carbachol 300μg/kg combined with dietary fiber 60 mL/kg was supplied. At 3 (combined group being excluded), 6, 12, 24 and 48 hours after resuscitation, the rats were anesthetized to collect samples and detect the plasma levels of D-lactate and activity of diamine oxidase (DAO) respectively, and the changes of villus height of small intestine were examined by a light microscope.Results The plasma D-lactate levels and the activities of DAO at any time point in the experimental groups were significant higher than those in control group (allP < 0.01). Along with the prolongation of time, the levels of plasma D-lactate and DAO activities in carbachol and carbachol plus diatary fiber groups were gradually lower than those of the model group, and at 48 hours after injury they reached their valley values [D-lactate (ng/L): 6.32±0.79, 7.46±1.67 vs. 17.65±1.53, DAO activity (kU/L): 0.76±0.01, 0.86±0.01 vs. 2.23±0.15]. Under light microscopy, compared with control group, the villus height of small intestinal mucosa at any time point in any experimental group was gradually lowered, and reached the valley values at 12 hours, then gradually increased , and peaked at 48 hours, the villus height in carbachol group and combined group was higher than that in model group (μm: 265.36±10.20, 261.54±10.38 vs. 247.51±9.39, bothP < 0.05).Conclusion When only carbachol is administered into the rat intestine early after diffuse brain injury in rats, beginning from 6 hours after injury, the protective effect of intestinal mucosal barrier is shown, representing decrease of plasma D-lactate level and DAO activity, amelioration of intestinal mucosal damage and protection of intestinal mucosal barrier; under the same above situation, the carbachol combined with dietary fiber was applied, showing the similar above carbachol protective effects.

Objective To investigate the appearance and characteristics of hepatic tuberculosis lesions on low mechanical index contrast-enhanced ultrasound. Methods Eight patients with hepatic tuberculosis lesions were studied with conventional ultrasound and contrast-enhanced ultrasound. Lesions,distribution.size,echogenieity,blood flow,enhancement phase,enhancement patterns and intensity were studied. ResuIts Fifteen lesions were found in eight patients. On conventional ultrasound,mean size of the lesions was(21.7±10.7)mm×(30.3±22.4)mm,and 66.7%(10/15)lesions located under liver capdule,and 33.3%(5/15)were in hepatic parenchyma.All lesions were hypoechoic except the largest one (50 mm x 102 mm)which demonstrated heterogeneous.Doppler signals were not demonstrated in all 15 lesions.After administration of SonoVue,satisfied image data were obtained in 13 lesions for aterial phase,and 15 lesions for portal venous phase and parenchyma phase.84.6%(11/13)of the lesions demonstrated hyperenhancing on aterial phase,mean enhancing start time was(8.6±1.6)s,ranging from 5 s to 10 s.and mean enhancing end time was(25.6±2.8)s,ranging from 20 s to 29 s. Of 13 lesions,6 lesions demonstrated circle periphery hyper-enchanCement,5 lesions demonstrated whole hyper-enchancement,and 2 lesions appeared hypoenhancement on arterial phase. All lesions demonstrated either hypoenhancing or non-enhancement on portal venous phase and parenchyma phase. Conclusions Low mechanical index contrast-enhanced ultrasound can reveal the blood flow status of hepatic tuberculous lesions and will facilitate the diagnosis of hepatic tuberculosis.

Objective To investigate acquired carbapenemases and prevalence of carbapenem- resistant gram-negative bacill.Methods The antimicrobial susceptibility was determined by agar dilution method.Metallo-B-lactamase(MBLs)were screened by EDTA-disk synergy tesL The encoding genes of MBLs were amplified by PCR followed by sequencing.Strain homology Was investigated by pulsed-field gel electronphoresis(PFGE).Results In 141 carbapenem-resistant Pseudomonas aeruginosa(P.aeruginosa), there were three resistant patterns which were imipenem(IMP)-resistant+meropenem(MEM)-resistant (66.7%),IMP-resistant+MEM-sensitive(32.6%),and IMP-resistant+MEM-sensitive(0.7%).AⅡthe carbapenem-resistan Acinetobacter baumannii(A.baumannii),Acinetobacter lwoffi(A.lwoffi),Citrobactor freundii(C.freundii),Klebsielta pneumoniac(K.pneumoniac)and Serratia were resistant to imipenem and meropenem.Four strains of 141 P.aeruginosa were positive by EDTA-disk synergy test,and they produced VIM-2-type Metallo-B-1actamase.Of 34 carbapenem-resistan A.baumannii,30 strains produced OXA-tllrpe.Among them, OXA23, OXA24 and OXA66 accounted for 79.4%,38.2% and 67.6%,respectively.And 22 of 34 strains(64.7%)produced multiple OXA-carbapenemases.All 7 strains A.lwoffi produced OXA-23-type carbapenemases.A11 11 strains C.freundii,5 strains k pneumoniac and 1 strains Serratia produced KPC-2-type carbapencmases.And 6 of 11 strains C.freundii produced new subtype IMP-8.Of 15 PFGE type in 34 strains A.baumannii,14 strains belonged to A-type,7 strains belonged to B-type.Seven A.lwoffi strains distilbuted in difierent PFGE type.Four strains of P.aeruginosa producing VIM-2.type Metallo-8-lactamase did not have the same PFGE type.Eleven C.freundii strains had the same PFGE type.Five k pneumoniae strains had the sanle PFGE type.Conclusions Drug resistance to 12 common antibiotics in carbapenem-resistant gram-negative bacill was higher than non-carbapenem-resistant gram-negative.The former produced many kinds of carbaponemases and the strains prducing carbapenemases were prevalent in the C.freundii, A.baumanii, and k pneumoniae.

OBJECTIVE To investigate the oropharyngeal bacterial carriage in hospitalized elderly patients without acute infections and the antimicrobial resistance,and the risk factors for the bacterial carriage.METHODS An oropharyngeal swab was taken from each patient after they rinsed their mouths with sterile saline.Bacteria were cultured and identified with routine methods and the antimicrobial susceptibility testing was carried out with disk diffusion method.RESULTS The oropharyngeal bacterial carriage rate was 55.2% in elderly patients.Sixty two pathogens were isolated including 56(90.3%) strains of Gram-negative bacilli,5(8.1%) Gram-positive cocci and 1 Candida albicans.All of 34 strains of Haemophilus spp were susceptible to antimicrobials tested such as ampicillin and cefaclor,a few strains were resistant to gentamicin and ciprofloxacin.Of 10 strains of Klebsiella pneumoniae,4 strains were extended-spectrum ?-lactamases positive and resistant to cefotaxime.Logistic analysis indicated that denture-wearing was the risk factor for the oropharyngeal bacterial carriage in elderly.CONCLUSIONS Oropharyngeal bacterial carriage rate is high in hospitalized elderly patients.The major colonized bacteria are Gram-negative bacilli.Denture-wearing is the risk factor for the oropharyngeal bacterial carriage in elderly.