OBJECTIVE To study the distribution of pathogens and their antibiotic resistance in systemic lupus erythematosus(SLE)patients with gram-negative bacterial infections,for guiding the rational use of antibiotics therapy.METHODS The identification was analyzed by ATB Expression automatic microbiology analytical instrument system.The bacterial susceptibility test was done by Kirby-Bauer agar diffusion method.RESULTS Among 346 patients included,112(32.4%)had bacterial infections.A total of 181 pathogens strains had been isolated.Among 181 isolates,Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii,Proteus mirabilis,and Enterobacter cloacae were the main pathogens.The ESBLs producing rates in E.coli and K.pneumoniae were 27.5% and 28.1%.Piperacillin/tazobactam and cefepime had less activity against A.baumannii and low resistant to other Gram-negative bacilli(0-46.2% and 13.0-33.3%).Meropenem,imipenem and cefoperazone/sulbactam showed greater activity against Gram-negative bacilli,their resistant rates were 0-17.1%,0-22.9% and 0-38.5%,respectively.CONCLUSIONS The clinical features of SLE patients with bacterial infections are lack of specificity.The data will be useful for reasonably choosing antimicrobial agents in the treatment of SLE patients with bacterial infections.

Objective To explore the clinical effect of continuous infusion of dopamine and furosemide on elderly patients with refractory heart failure.Methods 76 elderly patients with heart failure were selected as the observation subjects,they were randomly divided into observation group and control group,38 cases in each group.The control group was given oxygen inhalation,the expansion of vascular,cardiac and other conventional treatment.The observation group was given conventional treatment and continuous infusion of dopamine and furosemide.Clinical efficacy and cardiac function improvement were compared between the two groups.Restlts The effective rate of observation group was 92.1％,which was higher than that of the control group (73.7％) (x2 =10.29,P ＜ 0.05).After treatment,the improvement of cardiac function between the two groups had significant difference (t =15.94,10.18,all P ＜0.05).Conclusion Continuous infusion of dopamine and furosemide in treatment of elderly patients with refractory heart failure could improve heart function,enhance curative effect.

Objective To explore the effect of combination therapy of aminoglycosides with other antibiotics on reducing the mutant selective window of Acinetobacter baumannii. Methods Three aminoglycoside antibiotics (amikacin, tobramycin, netilmicin)and four frequently used antibiotics against Acinetobacter baumannii in clinical practice (cefoperazone-sulbactam, imipenem-cilastatin,ciprofloxacin and levofloxacin)were studied.The minimum inhibitory concentrations of these antibiotics against Acinetobacter baumannii ATCC1 9606 were determined by E-test.The mutant prevention concentrations of the four antibiotics against Acinetobacter baumannii alone or in combination with aminoglycosides were determined by agar dilution method.The selective index was calculated. The effect of aminoglycosides on mutant selective window of Acinetobacter baumannii was evaluated according to the change of selective index after combination. Results The selective index of cefoperazone-sulbactam,imipenem-cilastatin,ciprofloxacin and levofloxacin against A.baumannii ATCC19606 was 16,>32, 16 and 32.When combined with amikacin,the selective index was 1,2,4 and 4,respectively.When combined with tobramycin,the index was 2,2,8 and 8,respectively.When combined with netilmicin,the index was 2,4,8 and 16, respectively. Conclusions The mutant prevention concentration of the four antibiotics against Acinetobacter baumannii is significantly reduced when combined with any of the three aminoglycosides,which is helpful to decrease the incidence of mutants and control resistant Acinetobacter baumannii. Amikacin-based combination shows the most evident effect on reducing the mutant selective window of Acinetobacterbaumannii.

Objective To evaluate the efficacy and safety of linezolid in empirical treatment of methicillin-resistant Staphylococcus (MRS) pneumonia. Methods One hundred and thirty-five hospitalized patients with MSR pneumonia receiving linezolid from April 2009 to October 2010 were enrolled in this retrospective cohort study, and all subjects were assigned to two groups: 75 cases with empirical treatment (linezolid 0. 6 g by infusion q12h at admission) , and 60 cases with objective treatment (linezolid after the sputum culture). The severity score, clinical effect and adverse effect were observed, and the therapeutic effects in patients with high risk factors were especially evaluated. SPSS13.0 software was used for statistical analysis. Results The scores were decreased significantly after finishing therapeutic causes for 3 and 7 days in both groups (tempirical =12.29 and 16.53, tobjective =9.36 and 11.49, P<0. 05). There were significant differences in severity scores after 3 and 7 days between empirical and objective treatment groups (t =2. 64 and 3. 08, P < 0. 01). There were significant differences in absorption time, length of ICU and total hospital stay between two groups (t =6. 61 , 4. 39 and 10. 25, P <0. 05). In empirical and objective group, the effective rates were 88.0% (66/75) and 83.3% (50/60) (x2 = 0.60, P > 0.05 ). In the patients with high risk factors, the effective rates of two groups were 86. 8% (33/38) and 63. 6% (14/22) , and the difference was significant (x2 =4.42, P<0.05). The rate of adverse effects were 6.7% (5/75) in empirical group and 5.0% (3/60) in objective group, and the difference was not significant (x2 =0. 17, P > 0. 05). Conclusion Linezolid can be used as empirical treatment for MRS pneumonia with rapid symptoms relieve and high efficacy, especially for patients with high risk.

Objective To investigate the efficacy and safety of patients with malignant pleural effusion treated with injecting endostar combined with platinum complexes into pleural cavity.Methods Cochrane systematic review methods were used in the data selection,and data were selected from the PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure (CNKI),WanFang,and VIP database to get all clinical controlled trials.The retrieval time was August 2014.The objects of these randomized controlled trials were malignant pleural effusion patients.Endostar combination with platinum complexes was used for the experimental group.Platinum complexes alone were used for the control group.The efficacy and adverse effects of two groups were compared.The quality of included trials was evaluated by two reviewers independently.The software RevMan 5.3 was used for meta-analyses.Results Nine trials with 488 patients were included according to the including criterion.All trials were randomized controlled trials,one of them had B level in quality and eight had C level.Meta analysis results were as follows:there was significant difference in overall effective rate (OR =3.52,95％ CI =2.37 ～ 5.22),Karnofsky (KPS) score changes rate (OR =2.64,95％ CI =1.67 ～ 4.19),between endostar combination with platinum complexes and platinum complexes alone group.The incidences of severe leucopenia (OR =1.0,95％ CI =0.62 ～ 1.61) and nausea and vomiting (OR =0.77,95％ CI =0.43 ～ 1.38) were similar in the endostar combination with platinum complexes group compared to those in the platinum complexes alone group.Conclusions In the treatment of malignant pleural effusion,injecting endostar in combination with platinum complexes into pleural cavity improves the effective rate without obviously raised side effects.Owing to the small sample size and poor quality of included trials,more well-designed double-blinded randomized controlled trials should be performed.

Aiming at the existing problem of inequality and being unscientific in the evaluation of comprehensive quality of medical students, through literature research and expert opinion method, and from multi angles , the author constructed the evaluation index system of comprehensive quality of scientific medicine, using AHP to determine the weights of evaluation indexes, and established a fuzzy evaluation model of the comprehensive quality of medical students, and on this basis, improved the calculation method of fuzzy evaluation and the maximal subjection degree of the evaluation result. The specific examples of the evaluation results showed that the method was effective and could reflect the comprehensive quality of med-ical students in a comprehensive and objective way, and it had great significance to the comprehensive quality evaluation of medical students.

Objective To identify the most common fungal pathogens and their antifungal drug resistance in autoimmune disease (AD) patients with fungal infection , for guiding the rational use of antifungal therapy. Methods The identification were analyzed by ATB Expression automatic microbiology analytical instrument system. The antifungal susceptibility test was done by ATB FUNGUS strip. Results Of 428 patients studied,36(8.4%) had fungal infections. The most commonly infective sites were lower respiratory tract(53.5%),urinary tract(20.9%), intestinal tract(11.6%). A total of 43 fungi strains were isolated, the most common fungi were Candida albicans (65.1%), Candida glabrata (11.6%), Candida tropicalis (7.0%),and Candida parapsilosis (4.7%).Resistance rates of Candida albicans against ketoconazole, miconazole and econazole were 35. 7% , 46.4% and 32.1% , while resistance rates to fluconazole, amphotericin B, nystain and flucytosine were much lower, being 0, 14.3% , 14.3% and 7.1% . The resistance rates of other fungi were similar to Candida albicans. Conclusion The main pathogens causing fungal infection in patients with AD is Candida albicans. It should as early as possible process the clinical antifungal therapy under the result of antifungal susceptibility test and supportive measure.

Objective:To establish the median databases of serum markers for Down's syndrome screening during the second trimester of pregnancy women in the north-central area of Jiangxi Province.Methods:Time-resolved fluorometry was used to detect the serum contents of AFP free β-hCG and uE3 in 57 548 pregnant women during 15-20 gestational weeks.Risk evaluation was conducted by LifeCycle 4.0.SAS 9.2 software was used to establish a model of the median fitted equation.The newly constructed median system was used to reassess the risk of Down's syndrome development in pregnant women.Results:The medianand built in medianof north-central region in Jiangxi Province are significantly different (Z=2.201,P=0.028).The relationship between the median of the triple index and the gestational age was analyzed by the weight regression model.The relationship between the MoM value and the weight was used to calculate the reciprocal model.The median of the new system was more efficiency than the built in median.In the median of the new system than the reference,the detection rate improved from 62.75％ to 72.55％,false positive rate reduced by 5.84％ to 4.94％.Conclusion:The newly constructed median system is suitable for Down's syndrome screening in the north-central region of Jiangxi Province.

OBJECTIVE To investigate the tendency of bacterial distribution and resistance of hospitial infections,and to provide the reference for the clinical treatment and infection control in hospital.METHODS Bacteria isolated from patients in our hospital from Jan 2004 to Dec 2005 were identified by ATB expression,and bacterial susceptibility tests were performed on strains using Kirby-Bauer method.RESULTS A total of 3066 pathogens strains were isolated,among them 927 strains were Gram-positive cocci(30.2%).The most common pathogens of them were Staphylococcus.Meticillin resistant strains of Staphylococcus aureus and coagulase negative Staphylococcus(CNS) accounted for 69.0% and 77.6%,respectively.In our data,no vancomycin resistant S.aureus were isolated.There were 2134 strains of Gram-negative bacilli(69.6%),the most common pathogens of them were Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii and Enterobacter cloacae.The ESBLs producing strains of E.coli and K.pneumoniae accounted for 30.1% and 40.1%,respectively.The highest susceptible to Gram-negative bacilli was carbapenem,then were cefoperazone/sulbactam,piperacillin /tazobactam and cefepime.Mainly pathogenic bacteria were multi-resistant to some antibiotics.CONCLUSIONS Drug resistance of the nosocomial infection bacteria is a serious problem.It's important and urgent to carry out surveillance of bacterial resistance for appropriate using of antibiotics and effective controlling nosocomial infections.

OBJECTIVE To study the existence of the ?-lactamase gene produced by multidrug-resistant Pseudomonas aeruginosa isolated from respiratory tract. METHODS Antimicrobial susceptibility was tested by K-B method. A modified three-dimensional test was used to detect the ?-lactamase phenotypes. The genotypes were analyzed by PCR amplification and product sequencing. RESULTS ?-Lactamases were detected in 29 out of the 46 isolates. Twenty-one isolates produced AmpC ?-lactamase,two of them harboring CARB-3 gene. Two isolates produced ESBLs harbored TEM gene. Six isolates produced other type of ?-lactamases. Four out of 6 harbored CARB-3 gene and three IMP gene. The oprD2 gene was deleted in 34 isolates. CONCLUSIONS Chromosomal-mediated AmpC ?-lactamase is the major ?-lactamases produced by multidrug-resistant P. aeruginosa and CARB-3 is second. Lack oprD2 gene is popular.