OBJECTIVE To investigate the variation of in vitro activity,the ?-lactamases,type diversity and the homology of multiple resistances in Acinetobacter isolated.METHODS The multiple resistant Acinetobacter were selected to detect susceptibility test by K-B antimicrobial agents.The resistant rates were analyzed by WHONET 5.4,the isolates ?-lactamases phenotype was detected by three-dimensional test,genomic types were measured by PFGE.The ?-lactamases genotype was determined by PCR assay with specific-primer,and DNA sequencing was also used to analyze resistance-related gene.RESULTS Twenty-eight of 45 strains were OXA producing strains(68.3%),10 strains were IMP producing strains(24.4%),13 strains were TEM producing strains(31.7%),18 strains were CTX-M producing strains(43.9%),6 strains were PER producing strains(14.6%),and 7 strains were AmpC producing strains(17.1%).None produced SHV ?-lactamases.Twenty-four strains were produced 2 or more than 2 kinds of ?-lactamases.CONCLUSIONS The multiple resistance of Acinetobacter can produce kinds of ?-lactamases,but producing ?-lactamases are not the only one mechanism.

Objective To analyze the efficacy and safety of catheter-directed thrombolysis (CDT) for acute lower extremity deep venous thrombosis (DVT) in patients aged 70 years and over.Methods Clinical data of 109 cases who had acute lower extremity DVT and had been treated with CDT from March 2011 to September 2014 were retrospectively analyzed.Results Inferior vena cava filters (IVCF) were implanted in 109 patients.A thrombolytic catheter was inserted from the contralateral femoral vein (21 cases),ipsilateral popliteal vein (44 cases),posterior tibial vein (28 cases) or small saphenous vein (16 cases).The duration of thrombolysis was (5.47±2.13) d.The dosage of urokinase was (3.80 ± 0.56) million units.Forty-two cases underwent balloon dilatation alone,and 67 cases combined balloon dilatation with stent implantation.Gingival bleeding occurred in 7 patients and gross hematuria occurred in 4 patients during thrombolysis,which disappeared after medication adjustment.No symptomatic pulmonary embolism (PE) or other serious complications were found in any patients.There were significant differences in the venous patency score and lower limb circumferences at 10 cm above and below the knee one week after treatment (t=3.874,P=0.031).Ninety-seven cases were followed up for a mean period of (20.76.5) months,and the vein patencyrate was (77.9± 10.5) ％ and (73.1±9.4) ％ at 6 and 18 months after treatment,respectively.Recurrence of deep vein thrombosis was found in 6 cases,of which 2 cases had recurrent stent thrombosis,and treatment with CDT again was successful.No severe deep venous thrombosis syndrome (PTS) was found during the follow-up.Conclusions CDT is a minimally invasive procedure and can rapidly resolve limb venous drainage disorders.CDT is safe,has few complications and usually generates satisfactory outcomes.For very-old elderly patients who have no anticoagulation and thrombolytic contraindications,CDT is a useful option for the treatment of acute lower limb DVT.

OBJECTIVE To explore the disinfection methods for ophthalmology and to strengthen the measures of disinfection.METHODS The disinfection methods of the environment,equipment and operation field in ophthalmology were investigated and analyzed,and the good disinfection methods were summarized.RESULTS Due to strictly control the disinfection measures in ophthalmology,strengthen management,the hospital infection was reduced.In 2006 eye hospital infection rate was 0.CONCLUSIONS Good disinfection methods can effectively prevent eye hospital infection.

Objective To investigate the current status about the knowledge,attitude and practice of medical staff for fast-track surgery (FTS) in third-grade class-A general hospital in Xuzhou,and provide reference for the popularization of the FTS concept.Methods The self-administered questionnaires were employed to survey 130 medical staff in the general surgical department of one third-grade class-A general hospital in Xuzhou.Results The FTS knowledge score was (20±8).The differences of knowledge scores were statistically significant because of different age,degree of education and positional title.The FTS attitude score was (66±20).And the differences of attitude scores were statistically significant because of different age and degree of education.The FTS practice score was (64.50±13.25).There was no statistical significance on the practice scores between the medical staff with different characteristics.Attitude was correlated with knowledge and practice while knowledge was not correlated with practice.Conclusions The FTS knowledge of medical staff was not rich.The FTS attitude was not so positive,and there were also few clinical practice.Medical staff should study the FTS concept and its contents actively.They also should apply FTS in clinic scientifically in order to better control the iatrogenic injury and promote the rehabilitation of patients effectively.

Objective To investigate the structure of Tn1546 like elements,the molecular features and genetic background of VanB phenotype-vanA genotype VREs and to explain the difference between phenotype and genotype. Methods Twenty-one VREs were collected in Beijing Hospital from March 2008 to January 2009. Etest was used to determin MICs of ten antibiotics. PCR product sequencing, PFGE and MLST were performed to study the molecular features and genetic background of the 21 VREs. Results All VREs were vanA genotype, but 3 of them( 14. 3% ) exhibited the VanB phenotype. Based on PFGE analysis, 21 VREs belonged to 9 different patterns. Six STs were identified by MLST analysis. The analysis of the structure of Tn1546 like elements showed the deletion of vanY, vanZ and the insertion of ISEfa4 in orf2-vanR intergenic region may be related to the formation of VanB phenotype-wanA genotype. Conclutions VanB phenotype-vanA genotype VREs were rarely found in China. The results of vanA cluster rearrangements could partly explain the causes of difference between phenotype and genotype.

OBJECTIVE To determine the mutant prevention concentration(MPC) of 3 cephalosporins against clinical isolates of Staphylococcus aureus and Streptococcus pneumoniae.METHODS Agar dilution was used to determine the minimum inhibitory concentration(MICs) and MPCs of cefaclor,cefprozil and cefuroxime against S.aureus and the MICs to Str.pneumoniae.The MPCs against Str.pneumoniae were determined by mixing-bacterium.RESULTS The MPCs and the ratio of MPC90/MIC90 of cefaclor,cefprozil and cefuroxime against S.aureus were 32,16;16,16;2,8;and the MPCs and the ratio of MPC90/MIC90 against Str.pneumoniae were 8,16;4,32;2,8,respectively.CONCLUSIONS The ability of cefuroxime for restricting the selection of resistant mutant of Str.aureus and S.pneumoniae is stronger than cefaclor and cefprozil.

Objective To analyze the antibiotic resistance of clinical isolated bacteria in elderly inpatients in Beijing Hospital from 2006 to 2008.Methods A total of 5710 strains isolated from elderly inpatients received antibiotic sensitivity test (AST) by using K-B method, and the data were analyzed with WHONET 5.4 software.Results During the 3 years, in constituent ratio of bacteria, P.aeruginosa, E.coli and Stenotrophomonas maltophilia were at the top of gram-negative bacteria.And S.aureus, coagulase-negative Staphylococcus (CONS), S.pneumoniae and Enterococcus spp.were at the top of gram-positive bacteria.The results of AST in vitro showed that 19 of 121 strains of S.pneumoniae were penicillin-insensitive S.pneumoniae (PNSP).In 690 strains of S.aureus, the methicillin-resistant S.aureus (MRSA) ratio was 80.2%, and vancomycin-insensitive strains were not found.And 114 strains of Enterococeus faecalis and 95 strains of Enterococcus faecalis were isolated, while the antibiotic resistance of the latter was stronger than the former, and 19 strains were vancomycin-resistant strains.The detection ratios of E.colt producing ESBLs were 41.7%, 55.0% and 56.8%, and the detection ratios of Klebiella pneumonia producing ESBLs were 16.0%, 22.4% and 27.3 %.The antibiotic resistance of ESBL-producing bacteria was much stronger than non-ESBLs producing bacteria.Multi-antibiotic resistant strains of Pseudomonas aeruginosa and Acinetobacter spp.were found.Conclusions It is necessary to detect the drug-resistant strains periodically for understanding the changes in bacterial resistance and providing a theoretical basis for the medication by the clinical experience.

This study aims to investigate the function of two SNPs (rs8904C > T and rs696G >A) in 3' untranslated region (3'UTR) of NFKBIA gene by constructing luciferase reporter gene. A patient's genomic DNA with rs8904 CC and rs696 GA genotype was used as the PCR template. Full-length 3'UTR of NFKBIA gene was amplified by different primers. After sequencing validation, these fragments were inserted to the luciferase reporter vector, pGL3-promoter to construct recombinant plasmids containing four kinds of haplotypes, pGL3-rs8904C/rs696G, pGL3-rs8904C/rs696A, pGL3-rs8904T/rs696G and pGL3-rs8904T/rs696A. Then these plasmids were transfected into LS174T cells and the luciferase activity was detected. Compared with pGL3-vector transfected cells (negative control), the luciferase activity of the four kinds of recombinant plasmids was significantly decreased (P < 0.001). For rs696G > A, the luciferase activity of the recombinant plasmids containing A allele (pGL3-rs8904C/rs696A and pGL3-rs8904T/rs696A) was about 45.1% (P < 0.05) and 56.1% (P < 0.001) lower than those containing G allele (pGL3-rs8904C/rs696G and pGL3-rs8904T/rs696G), respectively. For rs8904C > T, there were no significant differences in the luciferase activity between the recombinant plasmids containing T allele and those with C allele. Together, the luciferase reporter gene vectors containing SNPs in NFKBIA gene 3'UTR were constructed successfully and rs696G > A could decrease the luciferase activity while rs8904C >T didn't have much effect on the luciferase activity.

Objective To study the discrepancy influence of the sulbactam content on susceptibility testing results of cefoperazone/sulbactam combination disks.Methods Agar dilution method was used to determine MICs of cefoperazone,cefoperazone/sulbactam(2:1 and 1:1),and disk diffusion was used to detect the zone diameters of cefoperazone,cefoperazone/sulbactam(75/30 and 75/75μg/disk)disks against 534 clinical gram-negative isolates.The discrepancy within the results of MICs,zore diameters,the method of agar dilution and disk diffusion was analyzed.Results By standard agar dilution method,MIC_(50) of cefoperazone,cefoperazone/sulbactam(2:1 and 1:1)were 32,16,16μg/ml,and MIC_(90) of those were ≥256.128,64 μg/ml respectively.No statistic discrepancy was found for MICs between the ratios of 2:1 and 1:1 combination by Wilcoxon ranks test(Z=-0.248,P=0.804).Susceptibility rate,resistance rate,and intermediate rate with 75/30μg disk were 55.3%,24.5%and 20.2%respectively,which were similar to those determined by agar dilution method.Susceptibility rate,resistance rate,and intermediate rate(I%)with 75/75μg disk were 72.5%,12.4% and 15.1% respectively,compared with the susceptibility rate from 75/30μg disk was 17.2% higher.Statistic discrepancy were tested by paired t-test (t=21.613,P＜0.01)with two groups of whole strains' zone diameters from 75/30μg and 75/75μg disks,and resulting in the difference of susceptibility or resistance rates for ESBL-producing strains,Acinetobacter bauamnnii and Enterobacteriaceae without ESBL tested isolates.On the contrary,for Pseudomonas aeruginosa,Stenotrophomonas maltophilia and ESBL negative isolates,the zone diameters discrepancy was not statistically significant between the results from 75/30μg and 75/75μg disks.Conclusions There is no statistic discrepancy between the susceptibility results from cefoperazone/sulbactam(2:1 or 1:1 ratios)in dilution method and in diffusion method with 75/30μg disk.When the 75/75μg disk is used to be tested for ESBL-producing strains,Acinetobacter bauamnnii and other Enterobacteriaceae,the results should be shown with sulbactam content.

Objective:To investigate the effects of structured group psychotherapy on symptoms and social function of patients with mild to moderate depression.Methods:Sixty patients with mild to moderate depression who received treatment in Department of Psychiatry of the Third People's Hospital of Yongkang from June 2019 to May 2020 were included in this study. They were randomly assigned to receive either conventional antidepressants ( n = 30, control group) or conventional antidepressants combined with structured group psychotherapy ( n = 30, observation group). The Self-rating Anxiety Scale, Self-rating Depression Scale Hamilton Anxiety Scale, Hamilton Depression Scale and the Simplified Coping Style Questionnaire were used to compare the anxiety state, depression state and coping style between the two groups. Results:Self-rating Anxiety Scale, Self-rating Depression Scale, Hamilton Anxiety Scale, Hamilton Depression Scale and Simplified Coping Style Questionnaire scores in the observation group were (44.21 ± 4.15) points, (45.28 ± 5.16) points, (12.41 ± 2.16) points, (9.75 ± 2.83) points, and (10.35 ± 2.23) points, respectively, which were significantly lower than those in the control group [(51.14 ± 4.39) points, (53.64 ± 5.31) points, (16.73 ± 2.54) points, (14.18 ± 2.72) points, (14.73 ± 2.54) points, t = 6.283, 6.184, 7.097, 6.182, 7.375, all P < 0.001]. Simplified Coping Style Questionnaire score in the observation group was significantly higher than that in the control group [(31.42 ± 4.43) points vs. (24.16 ± 4.27) points, t = 7.432, P < 0.001]. Conclusion:Structured group psychotherapy combined with conventional antidepressant therapy for treatment of mild to moderate depression can greatly reduce the symptoms of anxiety and depression and improve the coping style.