Objective To explore the distribution characteristics of intra/extracranial large-artery disturbance in patients with ischemic stroke (IS)/transient ischemic attack (TIA).Methods The medical history information of 169 IS/TIA patients was recorded.The results of laboratory examination,electrocardiogram,echocardiography,abdominal ultrasound and chest radiography were analyzed.At the same time,the intra/extra-cranial large arteries were examined to analyze the degree,distribution and pattern of their disturbance.Results Among them,there were intra/extra-cranial large-arterial stenosis (n =112,66.3％) and small-arterial disturbance (n =57,33.7％).Multiple vascular disturbance pattern was more common in patients with intra/extra-cranial large-arterial stenosis (n =71,63.4％).The incidence of intracranial large-arterial stenosis was significantly higher than that of extracranial large-arterial stenosis (53.8％ vs.35.5％,P ＜ 0.05).And middle cerebral artery was the most commonly affected artery,36 of those were culprit vessels accounting for 73.5％ (36/49).Conclusions The IS/TIA patients have a high incidence of intra/extra-cranial large-arterial stenosis.Multiple vascular disturbance is a more common pattern.The incidence of intracranial large-arterial stenosis is greater than that of extracranial and middle cerebral artery is the most common affected artery.

OBJECTIVE:To study the effects of combined use of cefoperazone/sulbactam(CFS),meropenem(MRP)with le-vofloxacin (LVX) on mutant prevention concentration for Acinetobacter baumannii so as to provide a experimental foundation for preventing bacterial drug resistance. METHODS:In the test,there were groups of single use of CFS,MRP and LVX,and groups of combined use of CFS+LVX and MRP+LVX. Double dilution agar method was used to respectively detect minimal inhibitory con-centration (MIC) for standard Acinetobacter baumannii strains ATCC 19606 and 36 clinically isolated strains in all groups,and then the index of fraction inhibitory concentration(FIC)was calculated. Agar dilution method on plates was employed to detect mu-tant prevention concentration (MPC) for Acinetobacter baumannii in all groups,and then corresponding selection index (SI) was calculated. RESULTS:After combined use of CFS or MRP with LVX,synergistic effect accounted for 55%(20/36)and 50%(18/36). For standard strain ATCC 19606,after combined use of CFS+LVX and MRP+LVX,MPC reduced from 32.0 and 4.0 mg/L to 1.8 and 0.8 mg/L;For 36 clinically isolated strains,after combined use of CFS+LVX and MRP+LVX,MPC reduced from 8.0-32.0 and 1.0-2.0 mg/L to 0.25-1.0 and 0.25-0.5 mg/L. SI were all obviously reduced after combination. CONCLUSIONS:The combina-tion of CFS or MRP with LVX can reduce MPC for Acinetobacter baumannii more significantly than the single use,and narrow mu-tant selection window.

Objective To investigate the distribution and resistant pattern of Enterobacter cloacae to antimicrobial agents for reasonable use of antibiotics .Methods E .cloacae strains were isolated from patients from January 2009 to December 2013 .The strains were identified by VITEK‐2 Compact System of BioMerieux and tested for antimicrobial susceptibility by Kirby‐Bauer disk diffusion method .The results were analyzed .Results A total of 397 nonduplicate E .cloacae strains were isolated during 5 years ,accounting for 5 % of the total gram‐negative isolates . The strains were mainly isolated from sputum (48 .9% ) , followed by secretions (30 .5% )and urine (7 .3% ) .The percentage of E .cloacae strains resistant to all the antibiotics tested was on decline except carbapenems ,cefoxitin and amoxicillin‐clavulanic acid .Carbapenems were relatively more active against E .cloacae strains .The E .cloacae strains showed higher resistance rate toβ‐lactams .Conclusions It is necessary to strengthen the monitoring of clinical isolates to guide rational use of antimicrobial agents .

Objective To evaluate the ability of Vitek 2 Compact YST identification cards and pyrosequencing analysis for identifying the clinical isolates of yeast-like fungi.Methods Vitek 2 Compact YST identification cams and ITS1 region pyrosequencing analysis were used to identify the clinical isolates of yeast-like fungi at Jinan Military General Hospital in 2011.The strains which could not be identified to species by pyrosequencing analysis were identified again by the method of ITS1 region Sanger sequencing.The strains with inconsistent identified results by YST and pyrosequencing were identified again using API 20C.Results A total of 282 srtains were isolated from various clinical specimens for culturing in 2011.In addition to the three which could only be identified to similar species,other strains could be clearly identified to species by the method of ITS1 reverse pyrosequencing.Three strains which failed identified to species by pyrosequencing couldn't be distinguished fully by the method of Sanger sequencing.There were 7 strains unidentified,14 strains low discrimination(％ id ＜ 80％),and 6 strains misidentification using YST cams.The identification coincidence rate was 90.4％.The identification coincidence rates were various in different species of yeast-like fungi using YST cards.Conclusions The vast majority of clinical isolates of yeast-like fungi could be identified by ITS1 reverse pyrosequencing analysis.Vitek 2 Compact YST caRD basically meets the needs.But attention should be paid to the standard operating and regular internal quality control.For some rare species it is also needed to combine the source of specimen,colonies and characteristics to determine the identification results for the rare stains.

Aim To study the change of mutant pre- vention concentration (MPC) in carbapenem-resistant Acinetobacter baumannii (CRAB) treated with moxi- floxacin ( MFX ) and/ or cefoperazone/ sulbactam (CFS) in vitro, and provide a theoretical support for preventing the bacterial resistance. Methods To cal- culate the fractional inhibitory concentration (FIC) in- dex, the minimum inhibitory concentration (MIC) of 20 clinical isolates of CRAB treated with MFX and/ or CFS was determined by checkerboard microdilution as- say. In addition, to calculate the selection index (SI), the MPC of 20 clinical isolates of CRAB treated with MFX and/ or CFS was determined by agar plate di- lution assay. Results Our study showed that there was synergistic/ addictive action, rather than antago- nism action against clinical isolates of CRAB when treated with MFX + CFS. The SI of the 20 isolates trea- ted with MFX or CFS alone was 4 ~128 and 8 ~64 re- spectively, but reduced to 1 ~8 and 4 ~16 when trea- ted with MFX + CFS, which decreased by 2 ~16 and 2 ~4 times respectively compared with the single treat- ment. Conclusion These results suggest that the combination treatment of MFX + CFS against clinical isolates of CRAB might lower the MPC of the isolates treated with MFX/ CFS alone, narrow the mutant selec- tion window, and prevent the generation of drug - re- sistant mutants.

OBJECTIVE To discuss the best scheme for fungemia detection by analyzing and comparing the ability and performance characteristics of the BACTEC 9120 automated blood culture system and 4 kinds of blood culture bottles in the detection of simulated fungemia.METHODS Simulated blood culture was produced using 65 fungi isolates from clinical specimens and BACTEC Plus Aerobic/F,Plus Anaerobic/F,Peds Plus/F and Myco/F Lytic blood culture bottles and detected by BACTEC 9120 automated blood culture system.The final inoculum densities were 1-5 CFU/ml blood.The(time to detection TTD) of simulated blood culture with different concentrations of suspension produced using 2 kinds of standard strains and 4 kinds of blood culture bottles was compared.RESULTS From the 260 bottles in this study 216 had growth detected by the BACTEC 9120 blood culture system.The positive rates of BACTEC Plus Aerobic/F and Anaerobic/F,which were 90.77%and 41.54%,respectively,were significantly(P

Objective To summarize the perioperative nursing experience of microsurgical denervation of the spermatic cord to treat idiopathic chronic orthialgia.Methods We retrospectively analyzed the clinical record data of two patients with idiopathic chronic orthialgia,who received microsurgical denervation of the spermatic cord in our hospital,including pre-and postoperative symptom scores,evaluation of mental state and wound nursing.Results Both patients got complete pain relief and were discharged one week after operation.No would infection and mental fluctuation was noted.Conclusions The reasonable individual perioperative nursing is an elemental component of recovery for patients with chronic orthialgia who experienced microsurgical management.

Objective To investigate the pathogenic mutations of BRCA1 and BRCA2 in patients with early-onset breast cancer(≤35 years) and explore the relationships between BRCA1/2 mutations and clinical features.Methods Seventy-four patients with early-onset breast cancer were enrolled,who were treated in Hospital 307 between September 2014 and June 2016.High-throughput sequencing was used to test the 49 exon sequences and adjacent sequences of BRCA1 and BRCA2.χ2 test was used to analyze the distribution of BRCA1/2 pathogenic mutations in each group that was set up according to clinical features.Results Fifteen mutations(20.27%) were identified,including 5(6.76%) in BRCA1 and 10(13.51%) in BRCA2.Eleven new pathogenic mutations were discovered,and BRCA1:c.5470_5477delTGCCCAAT was found in one patient.The frequency of BRCA1/2 mutations in the group with a family history of breast cancer or ovarian cancer was higher than in the group without a family history (40.91% vs 11.54%) (χ2=6.534,P=0.011).Conclusion BRCA1/2 pathogenic mutation is significant for early-onset breast cancer,especially for those with a family history of breast or ovarian cancer.The new mutations may be specific to Chinese people.BRCA1:c.5470_5477delTGCCCAAT may be the ancestor mutation among the Chinese.