The diagnosis with unknown pathogens is an important cause of inappropriate use of antimicrobial agents. The microbiology laboratory should intensively cooperate with the clinicians to evaluate the quality of respiratory tract samples. The technicians of microbiology should strengthen the training for basic skills, such as direct smear and a variety of staining. Meanwhile, the laboratory should perform the rapid detection techniques to improve the diagnostic level of pulmonary infections.

Objective To investigate resistance mechanism against erythromycin in Streptococcus pneumoniae from Beijing region. Methods 116 strains of erythromycin resistant Streptococcus pneumoniae were collected from 1998 to 1999 at Peking Union Medical College Hospital Serotyping was done with "capsular swelling" technique erm/mef genes were detected with PCR, pulsed field gel electrophoresis (PFGE) and penicillin binding protein (PBP) fingerprinting technique were used to detect the DNA of resistant strains Results The prevalent serotypes in the 116 erythromycin resistant strains were 23F(30 0%),6A(19 0%),19F(13 8%),15(7 8%),23A(5 2%) 95 7% of penicillin resistant strains were also macrolide resistant, most (85%) expressing the MLS phenotype with co resistance to clindamycin The macrolide resistance determinant in 86 4% of erythromycin resistant strains was the erm gene, both the erm and mef genes were found in 6%, mef alone in 1 7% and no mechanism in 4 2% PFGE identified two clones: one a serotype 23F clone resistant to penicillin; and the other a penicillin susceptible and macrolide resistant serotype 6A clone Conclusions Ribosomal modification (erm gene coded) was the main resistance mechanism against erythromycin in Streptococcus pneumoniae in Beijing region Two resistance clones bear concern

Antimicrobials resistance can be detected by conventional susceptibility testing and genetic method. Most genetic methods are based on PCR, and can be used directly in clinical specimens to guide therapy early and rapidly.Great achievement has made in basic study of antimicrobial resistance genes in China.Applied studies in genetic method of resistance genes are needed.

Objective To explore the treatment and diagnostic value of combined detection of high sensitivity C reactive protein(hs-CRP) and D-dimer (DD) levels for carotid artery plaque (CAS) in patients with acute cerebral infarction(ACI).Methods 48 patients with ACI were selected as the observation group,while 48 healthy people who excluded ACI were selected as the control group.The vascular ultrasonography and serum levels of hs-CRP and DD were detected within 3 days,and the observation group was classified according to TOAST.Results The hs-CRP and DD levels in the observation group were (7.88 ±2.54)mg/L and (1 286.2 ±233.4) μg/L,respectively,which were significantly higher than (1.14 ± 0.32) mg/L and (462.8 ± 147.2) μg/L in the control group (t =15.53,20.67,all P ＜ 0.05).The differences of hs-CRP and DD levels in different TOAST subtypes ACI patients were not statistically significant(P ＞0.05).The hs-CRP level was positively correlated with the number of instability carotid plaque(r =0.465,P =0.000),and DD level had no significant correlation with the number of instability carotid plaque.Conclusion Elevated serum hs-CRP and DD levels in ACI patients confirmed its participation in the acute inflammatory response,and hs-CRP can better reflect the instability of ACI patients with CAS.

Objective To evaluate the value of automatic bacteria identification systems including Phoenix and Vitek2 Compact, as well as blaOXA-51-like gene amplification in the identification of Acinetobacter species compared with amplified ribosomal DNA restriction analysis(ARDRA). Methods A total of 50 non-repeated clinical isolates of Acinetobacter species were collected in PUMCH from 2006 to 2007 and identified by ARDRA, blaOXA-51-like gene amplification, Phoenix and Vitek2 Compact,respectively. Results Compared with ARDRA, the sensitivity and specificity of blaOXA-51-like gene amplification were both 100%. The accuracy rates of Phoenix and Vitek2 Compact were 44% and 56%, respectively. Conclusions The accuracy of phenotypic identification of Acinetobacter species is not ideal, however, blOXA-51-like gene amplification could be used as a fast and reliable method for identification of A. baumannii. ARDRA is recommended in the study of drug resistant mechanisms and homological analysis of Acinetobacter species.

Objective To learn the present pain management quality at tertiary hospitals in China and the application of the quality evaluation system for acute pain management quality recommended by American Pain Society.Methods Analyzing the present pain management at five tertiary hospitals in China by using the evaluation system recommended by American Pain Society,questionnaires and medical records reading.Results The hospitals were found with setbacks in describing pains,recording pains with tools,using the right pain controls,using non-drug pain control measures and pain management outcomes; differences were found between the acute pain service group and non-acute pain service group in pain management quality,as the pain impacts of both groups on activities,emotion and sleep were 3.12±2.82 and 5.16±2.07 (P＜0.05) respectively.Conclusion Setbacks exist in both the process and outcomes of post-surgery pain management at these hospitals; those with acute pain service management are better than those without in terms of post-surgery pain management quality.The evaluation system recommended by American Pain Society is scientific,sensitive,practical and operable,extensively applicable to evaluation of acute pain management quality at hospitals in China.

Objective:To investigate the effects of IL-12p35 small interference RNA on immune functions of Dendritic cells in rats.Methods:DCs were generated by culturing bone marrow progenitor cells of rats with GM-CSF, IL-4 and LPS in vitro. The IL-12p35 siRNA was synthesized and transfected into DCs. The expressions of CD80 and MHCⅡwere examined by flow cytometry. Reverse transcriptase PCR analysis was used to detect IL-12p35 mRNA transcription and ELISA was used to detect IL-12 and IL-10 protein levels, respectively. The antigen presenting by DCs was evaluated by mixed lymphocyte responses.Results:IL-12p35 siRNA silenced DCs expressed lower IL-12, higher IL-10,and exhibited weak activity in stimulating the proliferation of allogenic T cells, but no changes on CD80 and MHCⅡexpressions.Conclusion:IL-12p35 siRNA interference exerts no effects on maturation of DC, but negative effect on immume function of DCs.

Objective To apply accelerated solvent extraction (ASE) technique to extract Achyranthes bidentata and to explore the application of this technique in quality control of Chinese materia medica. Methods Investigation of single factor was used to optimize the conditions that affected the efficiency for ASE from A. bidentata by RP-HPLC using ecdysterone as a quantitative marker. Results The optimized conditions for ASE of A. bidentata were obtained as follows: methanol as solvent, particle size between 0.3 and 0.45 mm, temperature at 100 ℃, pressure under 10.34 MPa, 6 min duration and once extraction. Conclusion ASE technique can be used to extract A. bidentata quickly and effectively.

Objective To investigate the characteristic and diagnosis of left ventricular diverticulum. Meth-ods As one left ventricular diverticulum patient was diagnosed by echocardiography in our hospital,we reviewed and analyzed about published in China. Results Left ventricular diverticulum is a rare disease of congenital heart malfor-marion, Echocardiographic characteristics of the left ventricular diverticulum is the saccular evngination of the left ven-tricular wall with the neck of the diverticula being smaller than the body. Left ventricular diverticulum is classified into contractile muscular type and fibrous type ,The saccular wall of contractile muscular diverticulum remain a normal mo-tion and is thinner than the normal wall The saccular wall of the fibrous diverticulum is due to a loss of myocardial thickness, as thin as aneurysm with a dyskinetic motion. Conclusion Left ventricular diverticulum is a rare disease in clinic, echocardiography is very important for diagnosing classifying.

Objective To investigate the antimicrobial resistance mechanisms and genetic homogeny of Salmonella from community acquired infections in Shenzhen,China.Methods Ninety-three of Salmonella were isolated from 2002 to 2007 at Shenzhen People's Hospital,China.PCR and DNA sequencing were used to investigate the mutation in QRDR of the gyrA,gyrB,parC and parE.Plasmid mediated quinolone resistance genes including qnr and aac(6')-Ib-cr,β-lactamase genes including blaTEM,blaSHV,blaOXA, blaCTX-M, and class 1 integron were detected. All isolates were typed by PFGE. Results S. enterica typhi and S. enterica paratyphi A were susceptible to ampicillin, chloramphenicol, trimethoprim/sulfamethoxazole, ceftriaxone and ciprofloxacin, with the susceptible rate of 96%-100%. Fifty-two percent (13/25) of S. enterica typhi and 95% (61/64) of S. enterica paratyphi A were resistant to nalidixic acid. Twenty-four percent (6/25) of nalidixic acid-resistant S. enterica typhi and 94% (60/64) of nalidixic acid-resistant S. enterica paratyphi A showed decreased susceptibility to ciprofloxacin (MIC of 0. 125-1 μg/ml).All nalidixic acid-resistant (susceptible to ciprofloxacin ) Salmonella (NARS) isolates had a single substitution in the QRDR of GyrA, and 91% (68/75) of these isolates carried the substitution Ser83Phe in GyrA. Two mutations in the QRDR of GyrA were detected in both of two ciprnfloxacin-resistant Salmonella,with the additional one mutation in the QRDR of parC. Plasmid mediated quinolone resistance genes including qnr and aac(6')-lb-cr were not detected in any isolate. The blaCTX-M-14 gene was detected in a ceftriaxoneresistant isolate of S. enterica paratyphi A, with ISEcpl located on the upstream of it. Three muhidrugresistant strains of Salmonella all carried one 1 900 bp classⅠ integron gene cassette dhfrⅫ-orfF-aadA2,with the additional one β-lactamase gene of blaTEM-1, or blaOXA-30. Twenty-two distinct PFGE patterns were observed among twenty-five S. enterica typhi. The PFGE patterns of sixty-four S. enterica paratyphi A showed limited genetic diversity (average similarity of 91% ). Ninety investigated inpatients were infected in the community. Six patients infected by S. enterica paratyphi A had a travel history before infection. Conclusions Nalidixic acid-resistant S. enterica typhi and S. enterica paratyphi A are highly prevalent in Shenzhen,China. The mutation in the QRDR of GyrA is the prevalent mechanism responsible for the resistance to nalidixic acid in Slmonella. The great genetic similarity among S. enterica paratyphi A isolates indicates endemic disease from the presence of a single clone over 6-year period.