Objective To identify the spectrum of pathogenic microorganisms of urinary tract infection and the drug resistance in a hospital setting. Methods The pathogenic microorganisms isolated from 3117 mid-stream urine samples of patients admitted in Hangzhou First People's Hospital from 2005 to 2007 and their drug resistance results were retrospectively analyzed. Results Bacteria were the most prevalent microorganisms in the urinary tract infection, and followed by fungus, mycoplasma and chlamydia. Escherichia eoli accounted for the largest proportion of gram-negative bacteria, in which the ESBLs positive strains accounted for 51.2%, and their drug resistance rate was much higher than that of ESBLs negative strains. Main gram-positive coccobacteria was all sensitive to vancomycin, and relatively sensitive to nitrofurantnin and ampicillin. Conclusions Escherichia coli continue to prevail upon the spectrum of pathogenic microorganism of the urinary tract infection, and the fungus, mycoplasma and chlamydia infections are rising. Antibacterial agents should be used under the guidance of drug sensitivity test, and the combined use should be avoidd.

Objective To find out the weak points of students through analyzing the scores of medical licensing examination, to explore the causes and to put forwards some advices. Methods Excel 2007 was used to statistically analyze the average scores, average passing rate and the mastering rate of 3 060 candidates who took the exam from 2006 to 2011. Literatures were reviewed to find out reforming measures taken by other schools. Results The average scores changed lightly. The master-ing rate changed differently. The average passing rate declined from 83.6% in 2006 to 71.65% in 2011. Conclusions Score of medical licensing examination is an important index of the teaching quality of medical universities, which should be emphasized on. Some practicable methods are put forward taken into all related factors:adjusting course setting, strengthening teaching of practical skills, reforming teaching methods and examination systems, placing more emphasis on examination work.

Objective To investigate the effects of different upper limb abduction angles on the occurrence of malposition of PICC into internal jugular vein. Methods Totally 210 cases of patients treated with PICCs for unilateral breast cancer of our hospital from August,2015 to January,2017 were randomly assigned to three groups with 70 cases in each group. The abduction angle of the upper limb for placement was set at 45° ,90° and 160° , respectively. We chose the basilic vein of the uninfected arm using modified Seldinger technique under the guidance of ultrasound for PICC,and malposition was confirmed by detecting the tip of PICC in internal jugular vein. Results The incidence rate of internal jugular venous dislocation in 45° group was 7.14%(5 cases) and 8.57% in 90° group (6 cases),and no internal jugular venous dislocation in 160° group. There was no statistically significant difference among 45°,90° and 160° groups(χ2=5.95,P>0.05). Significant differences of group comparisons for 45° v.s. 160° and 160° v.s. 90° were found (P<0.05). There was no statistically significant difference between 45° and 90° groups (P>0.05). Conclusion Abduction angles of 45° ,90° and 160° can all be used for PICC placement. The abduction angle can be selected according to specific situation of patients instead of being limited to the standard abduction angle of 90°.

Objective To investigate the distribution and drug resistance of the gram positive bacteria isolates from hospital in Chongqing during 2006-2011 .Methods Non-repetitive gram positive bacterias were collected retrospectively from ten hospitals in Chongqing .Antimicrobial susceptibility testing of all clinical isolates were carried out using Kirby-Bauer(KB) .Results 14 473 strains were isolated .There were 4 840 strains of Staphylococcus aureus (33 .4% ) ,2 566 strains of Staphylococcus epidermidis (17 .7% ) ,1 822 strains of Staphylococcus haemolyticus (12 .6% ) ,1 325 strains of Enterococcus (E .faecalis/E .faecium )(9 .2% ) . Staphylococcus was highly sensitive to nitrofurantoin ,rifampicin ,piperacillin/tazobactam ,linezolid ,teicoplanin and vancomycin ,but their resistance rate to ampicillin/sulbactam ,oxacillin ,penicillin and clarithromycin was high .The resistance rate of E .faecium to the majority of antimicrobial agents was obviously higher than that of E .faecalis ,excluding imipenem ,chloramphenicol and tetracy-cline .Vancomycin and linezolid still remain the strongest antibacterial activity to Enterococcus .Conclusion The distribution and drug resistance of pathogenic bacteria in Chongqing present regional particularity ,and antibiotic resistance is severe .It is significant to strengthen the epidemiology study of pathogenic bacteria and to develop policies to intervene in the use of antimicrobial agents .

OBJECTIVE To investigate the distribution of pathogens and their antibiotic resistance in lower respiratory tract infection(LRTI) from intensive care unit(ICU) in our hospital,and provide basis for rational selection of clinical drugs.METHODS Pathogens were detected from qualified sputum specimens in LRTI from ICU and identified by VITEK-AMS60 automatic microbial analyzing system.Drug susceptibility was determined by KB test.RESULTS From 320 sputum specimens 367 pathogens were detected between from Jan 2007 to Mar 2008,including 261 strains(71.1%) of Gram-negative bacilli,70 strains(19.1%) of fungi,and 36 strains(9.8%) of Gram-positive cocci.21.8% Of the isolated pathogens were Acinetobacter baumannii,with 16.7% of drug-resistant rate to cefoperazone/sulbactam and over 71% to other 13 antibiotic agents.The rate of extended spectrum ?-lactamases(ESBLs) producing Escherichia coli isolates and Klebsiella pneumoniae ones were 65.2% and 72.0%,respectively,comparing to 84.6% for meticillin-resistant Staphylococcus aureus(MRSA).CONCLUSIONS Gram-negative bacilli are the major pathogens of LRTI in ICU,in which A.baumannii shows with a high rate of drug-resistance,followed by fungi,which should attract the clinician′s more attention.

Objectives To investigate the properties and distributions of ampC gene among different drug-resistant strains of Serratia marcescens,and the relationship of control gene ampR with AmpC enzymes′ expressions.Methods According to the results of inducting experiment with 1/2 MIC of beta-lactam antibiotics (CTX),three-dimensional testing and isoelectric focusing electrophoresis testing,143 strains of S.marcescens were classified into three groups:including induction group, continuous low-production group and hyperproduction group. In each group, the sequences of ampC and ampR genes were amplified using the method of PCR. The products of PCR were analyzed. The plasmid-mediated beta-lactamases were detected using the method of conjugation experiment.Results Among 143 strains of S.marcescens, the continuous low -production strains, induction strains and hyperproduction strains were 14,103,and 18, respectively.125 and 99 strains were ampC and ampR gene positive, respectively.The detection rate of ampR in hyperproduction group was lower than other groups.5 sites of ampC genes and 4 sites in the Open Reading Frame (ORF) of ampR gene were easily mutated in 5 induction strains and 2 hyperproduction strains.Conclusions The production of inducing drug-resistance of some S.marcescens might be related to mutation of ampC gene encoding AmpC beta-lactamases and the ORF mutation in ampR. The continuous hyperproduction drug-resistance had something to do with deletion mutation in ampR in segmental hyperproduction strains.The plasmid-mediated AmpC enzymes hadn′t been found in S.marcescens.

Objective To explore the mechanism of protection role of ambroxol against acute lung injury (ALI)by studying the change of cytokine mRNA expression during the course of ALI.Method The study was composed of experiments both in vivo and in vitro. (1)Experiments in vivo were as follows.Twenty-four sprague-Dawley rats were randomly divide into 3 groups,namely,control group(n=8),acute lung injury group(LPS group,n=8)and ambroxol group(LPS+A group,n=8).The rat model of acute lung injury was induced by intraperitoneal injection of 10 mmol/L lipoopolysaccharide(LPS).The pathological alteration of lung tissue and arterial partial pressure of oxygen(PaO2)were observed.Expressions of TNF-α,IL-10 and IL-24 mRNA were determined by using RT-PCR assay. (2)Experiments in vitro were the followings.Alveolar macrophage cells were collected and divided into 3 groups as above mentioned.Cells were treated with normal saline,with LPS,and with LPS plus ambroxolin dose of 180 μmol/L at 0,6,12 and 24 hours after exposure of LPS,respectively,in 3 groups as above stated.The expressions of TNF-α,IL-10 and IL-24 mRNA were also determine by using RT-PCR.Results The pathological changes of could be parially ameliorated by giving ambroxol.Massive hemorrhage along with vascular edema and infiltration occurred in the lungs of ALT rats.The pathological alterations in ALI rats treated with ambroxol were less severe.The expressions of TNF-α,IL-10 and IL-24 mRNA were dramatically increased in ALI rats,and were partially attenuated after treatment of ambroxol.Macrophages oxposed to LPS for 6 hours showed dramatical increase in expressions of TNF-α,IL-10 and IL-24mRNA those remained at high levels afterwards.The expressions of TNF-α,IL-10 and IL-24 mRNA in macrophages after exposure to both LPS and ambroxol were increased less than those exposed to LPS alone.Conclusions Ambroxol can partially ameliorate the expressions of TNF-α,IL-10 and IL-24 mRNA in alveolar macrophage induced by LPS.

duodenum.Conclution Nattokinase could be absorbed into blood plasm in small intestine.

To report the process of diagnosis and treatment of 1 case with SRY gene mutation of 46, XY complete gonadal dysplasia, and to discuss the clinical characteristics, diagnosis and treatment of the disease.Due to clitoral enlargement for 8 months, a 9 years old girl was admitted to the Children′s Hospital Affiliated to Zhejiang University School of Medicine.Previously, she had early breast development, and suffered from high gonadotropin expression when she was 6 years and 4 months old.Physical examination: breast B3 stage, female vulva, clitoris hypertrophy, normal urethra, normal vaginal opening, slightly thick hymen ring, the development of pubic hair was 2 stages, and Prader score level 1.Laboratory data showed elevated levels of estradiol, testosterone, and human chorionic gonadotrophin.Genetic examination revealed that the chromosome karyotype was 46, XY and SRY gene detection was positive.Therefore, the patient was diagnosed with 46, XY complete gonadal dysplasia.Bilateral gonadectomy was performed, and the posto-perative pathological diagnosis was bilateral gonadoblastoma with left dysgerminoma.The tumor did not recur after che-motherapy.The etiology of early breast development needs to be carefully identified.Patients with sexual characteristics dysplasia need to accept the chromosome karyotype analysis and gene detection, and surgical exploration should be performed when necessary for a correct diagnosis as soon as possible.

ObjectiveTo explore the influence of washable type subglottic attract on incidence of ventilator-associated pneumonia (VAP) in patients with mechanical ventilation. Methods356 cases in need of mechanical ventilation from July 2009 to July 2010 in our hospital were chosen as the research object.They were randomly divided into the observation group and the control group with 178 cases in each group.The control group was treated with conventional endotracheal tube for mechanical ventilation.The observation group used washable type subglottic endotracheal tube to attract for mechanical ventilation.The VAP rate for the two groups occurred during mechanical ventilation in ventilator was compared.Migration of the dominant bacteria of the subglottic secretion was detected,underwent pathogenic examination and drug sensitivity test. ResultsThe VAP rate was significantly lower in the observation group than that of the control group.186 bacteria strains were detected from subglottic secretion,and 169 were detected from lower respiratory tract. ConclusionsWashable type subglottic attract for mechanical ventilation can reduce the risk of ventilator-associated pneumonia for patients with mechanical ventilation significantly,and it is worthy of clinical application.