Objetive To elucidate the mechanism of antibiotic resistance of Pseudomonas aeruginosa(P.a.) in an effort to provide a basis in clinical combined use of antibiotics against P.a.infection in clinical settings.Methods All P.a.strains were isolated by routine procedures and identified with VITEK-2 automatic bacterial identification console.The minimum inhibitory concentration(MIC) was detected using dilution method on agar plate following the instruction of CLSI.Results Ninety-two strains of P.a.were isolated from clinical infection specimens,most of them were obtained from respiratory tract(88.04%).Of the 92 strains,45(48.91%) were metallo-?-lactmases positive,and 25(27.17%) were AmpC positive.When treated with a combination of meropenem and imipenem,MIC≥1 was found in 17 strains(18.48%).The bacteriostatic rate of polymixin B and meropenem was 95.65% and 80.43%,respectively,that of amikaein,piperacillin/tazohaetam(PIT) and imipenem was 48.91%-71.74%,and that of cefoperazone/sulbactam(SUP) was 36.96%.The synergistic action of PIT,and SUP with amikacin was 60.87% and 58.70%,respectively,and that of PIT,SUP with minocycline were 44.57% and 43.48%,and of PIT,SUP with PLB were 28.26% and 7.61%,respectively.Conclusions P.a.strains in this study are mainly isolated from respiratory tract infection specimens.Multiple drug-resistant mechanisms are involved in the drug resistance of P.a.Enzyme inhibitors,such as PIT or SUP,with amikacin or polymixin B should be first selected for clinical treatment of P.a.caused infection.Meanwhile,antibiotics should be rationally administered in accordance with the seriousness of disease,and with the drug-resistant phenotype of the isolated strains.

Objective:To share the experience of clinical cooperation of physicians and clinical pharmacists in the treatment of one case of rodenticide poisoning. Methods: One case of rodenticide poisoning was early diagnosed by physicians according to the con-sciousness disorder and coagulation dysfunction. Clinical pharmacists participated in the drug treatment actively through providing vita-min K1 at the dose of 30 mg·d-1 as the treatment dose and monitoring the effectiveness. Toxicology analysis was recommended, and 718 ng·ml-1 bromadiolone was found out in the blood samples. According to the long half-life of bromadiolone, the initial duration of treatment was set at 2-3 months, while follow-up plan and final duration of treatment were defined based on coagulation parameters and poison concentration monitoring results. Results:The patient recovered rapidly after hospitalization due to the cooperation of physicians and clinical pharmacists through quickly correcting diagnosis of physicians and actively participating in medication of clinical pharma-cists. After the 3-month treatment, the coagulation parameters of the patient were normal and the patient was discharged with follow-up. Conclusion:The collaboration of physicians and clinical pharmacists leads to the optimal regimen with early, full dose and long course of vitamin K1 therapy.

The methods of diagnostic imaging for pulmonary embolism is diversified. However, the different characteristic features of diagnostic imaging and diagnostic accuracy impressive influenced the choice of selection by clinicians. Furthermore, the principle and indication of interventional therapy would have great impending force on the outcomings. This article presents a comprehension of diagnostic imagings and interventional therapy for pulmonary embolization.

Objective To investigate the imaging features of splenic littoral cell angioma (LCA)and correlate with pathological findings.Methods Ten patients of LCA with pathologically confirmed diagnosis were included in this study.A retrospective review of clinical data and imaging findings on CT and MRI was performed,along with review of the literature.Results Splenic littory cell angiomas presented with multiple nodules of varying sizes with a predoninance of small ones.Nine of 10 patients had clinical symptoms of splenomegalia and hypersplenia.MR T2WI and DWI showed masses with high-signalintensity.The CT and MRI enhancing pattern of LCA was similar to splenic hemangioma.There were many mammiliform structures pointing inside in the wall of the vascular channels,a hallmark feature allowing its differentiation from splenic hemangioma pathologically.Conclusion The CT and MRI findings of LCA can show some of its characteristic signs,especially on DWI,which can assist to identify LCA in clinical practice.

Objective To evaluate the capabilities of disc diffusion and Vitek2-compact GN13 methods for testing antimicrobial susceptibility of screening ESBLs ( extended-spectrumβ-lactamase) in En-terobacteriaceae clinical isolates.Methods A total of 93 Enterobacteriaceae strains were isolated from pa-tients with intra-abdominal infections in 21 hospitals during 2011 to 2012.The in vitro minimum inhibition concentration ( MIC ) values of ampicillin-sulbactam, piperacillin-tazobactam, ertapenem, ceftazidime, ceftriaxone, cefepime, imipenem, amikacin, ciprofloxacin and levofloxacin were determined by disc diffu-sion, Vitek2-compact GN13 and broth microdilution methods, respectively.Categorical agreement ( CA ) rates of disc diffusion and Vitek2-compact GN13 methods were determined by using broth microdilution meth-od as the reference method.The genes encoding ESBLs were screened in Escherichia coli (E.coli), Kleb-siella pneumoniae (K.pneumonia), Klebsiella oxytoca (K.oxytoca) and Proteus mirabilis (P.mirabilis) strains by using PCR analysis and gene sequencing.Disc diffusion and Vitek2-compact GN13 methods were used for the phenotypic confirmatory test of ESBLs and the sensitivity, specificity, positive predictive value and negative predictive value of the two tests were evaluated.Results The CA values of disc diffusion and Vitek2-compact GN13 methods for the 10 antibiotics were all >90% as compared with broth microdilution method.The major error (ME) rate for ertapenem was 3.2%and the very major error (VME) rates for am- picillin-sulbactam, ceftazidime and cefepime tests were all 2.2% by using Vitek2-compact GN13 method. The sensitivity, specificity, positive predictive value and negative predictive value of disc diffusion and Vitek2-compact GN13 methods in the phenotypic confirmatory test of ESBLs were 96.7%(29/30), 100%(20/20), 100%(30/30) and 95%(19/20), respectively.Conclusion Both disc diffusion and Vitek2-compact GN13 methods could be used for testing the antimicrobial susceptibility and the detection of ESBLs in Enterobacteriaceae clinical isolates with the advantage of accuarcy.Attention should be paid to the posibil-lity of oaurance of ME and VME when testing ertapenem, ampicillin-sulbactam, ceftazidime and cefepime by using Vitek2-compact GN13 method.

OBJECTIVE To study the characteristic of nosocomial pulmonary infection to find out the measures for prevention and control.METHODS The patients with radiation brain injuries(RIB) from Oct 2004 to Jun 2007 underwent retrospective investigation.The reasons and sites of pulmoary infection were analyzed.RESULTS The incidence of pulmonary infection of patients with RIB after radiotherapy was 68.5%.Major factors of infection were bulb palsy,invasive treatment and hormone usage.The Gram-negative bacteria were the predominant pathogens.CONCLUSIONS The nosocomial pulmonary infection is related to many factors.Antibiotic usage according to drug susceptibility results and controlling of the risk factors are important measures to reduce the rate of infection.

Asia ; Congresses as Topic ; Nephrology ; Pediatrics

[ ABSTRACT] AIM:To investigate the inhibitory effect of Am80 on neointima hyperplasia in carotid arteries after balloon injury and to observe the interaction between Krüppel-like factor 4 (KLF4) and retinoic acid receptorα(RARα). METHODS:Neointima hyperplasia in carotid arteries was observed by hemotoxylin and eosin staining.The expression of KLF4 and cyclin D1 was examined by immunostaining and Western blotting analysis.To detect the interaction between KLF4 and RARαin the vascular tissue, the injured arteries were harvested, and the protein extracts were prepared and subjected to co-immunoprecipitation assay.RESULTS:Compared with injured group, Am80 significantly reduced neointi-mal hyperplasia and the thickness ratio of intima to media.Am80 not only up-regulated KLF4 or RARαexpression in caro-tid arteries, but also increased the interaction between KLF4 and RARαat tissue levels.CONCLUSION:Am80 inhibits neointima hyperplasia in carotid arteries after balloon injury by promoting the interaction between KLF4 and RARα.

Objective To study the real?time dose verification with 2D array ion chamber array in volumetric modulated arc therapy ( VMAT) with a 2D array ion chamber array. Methods The 2D ion chamber array was fixed on the panel of electronic portal imaging device (EPID). Source?detector distance (SDD) was 140 cm. 8 mm RW3 solid water was added to the 2D array to improve the signal noise ratio. Patient plans for esophageal, prostate and liver cancers were selected to be delivered on the cylindrical Cheese phantom 5 times in order to validate the reproducibility of doses. Real?time patient transit dose measurements were performed at each fraction. Dose distributions were evaluated using gamma index criteria of 3 mm DTA and 3% dose difference referred to the first time result. Results The gamma index pass rate in the Cheese phantom were about 98%;the gamma index pass rate for esophageal, prostate and liver cancer patient were about 92%, 92% and 94%, respectively. Gamma pass rate for all single fraction were more than 90%. Conclusions The 2D array is capable of monitoring the real time transit doses during VMAT delivery. It is helpful to improve the treatment accuracy.

OBJECTIVE To investigate the distribution of fungus infection and risk factor of postoperation patients with tumors. METHODS We analyzed 1 256 postoperation patients in our hospital ICU from Aug 2000 to Aug 2004,and found that there were 88 fungus infection patients(7%),the pathogens were tested and analyzed. RESULTS The fungus infection,which dominated in respiratory tract and digestive tact,had an increasing tendency,the most prevalent fungus of infection was Candida albicans. CONCLUSIONS The risk factors of fungus infection are mechanical ventilation,the useness of antibiotics,radiotherapychemotherapy,and invasive treatment,it is very important to diagnose early and treat in time.