OBJECTIVE:To detect and analyze the drug resistance of the AmpC and the extended-spectrum ?-lactamases(ESBLs)in Escherichia coli(E coli)from urinary infections.METHODS:ESBLs was detected by Phenotypic Confirmatory Test and AmpC was detected by improved three dimensional test.RESULTS:The isolating rates of ESBLs(45 strains),AmpC(8 strains)and AmpC+ESBLs in E.coli(5 strains)were 34.6%,6.2% and 3.8%,respectively.The drug resistance rates of ESBLs and AmpC-producing E.coli was higher than those of the strains without producing ESBLs or AmpC.CONCLUSION:Production of AmpC and ESBLs in ?-lactam antibiotics was the main resistance mechanism against E.coli.Carbopenems should be regarded as the first choice in clinical empirical medication for enzyme-producing strains.

OBJECTIVE:To investigate the characteristics and influential factors of adverse drug reactions(ADRs)of docetax-el in our hospital,and to provide suggestions for clinical rational drug use and individualized administration. METHODS:Medical records of patients receiving anti-tumor chemotherapy were extracted from hospital information system(HIS)of our hospital during Apr. 2014 and Oct. 2015,and Docetaxel related ADR reports were collected and comprehensively analyzed by retrospective classi-fied statistics. RESULTS:Among 417 cases,105 cases of docetaxel related ADR were reported. There were 69 patients aged 50-69 with highest ADR frequency. The ADR incidence of female patients was higher than that of male patients (29.29% vs. 19.66%). The incidence of docetaxel related ADR and arrest of bone marrow increased as the increase of drug dosage;the incidence of breast cancer ADR was the highest (46.03%),followed by lung cancer (37.25%) and gastric cancer (25.00%). The incidence of docetaxel+platinum chemotherapy plan ADR was the highest (35.10%). Main organs/system involved in ADR was hematological system (55.65%). CONCLUSIONS:The individual difference of docetaxal related ADR are great and affected by several factors. Individual physical condition of patients should be taken into consideration as early as possible,which can reduce the incidence of ADR and promote clinical rational drug use.

Objective To investigate the effects of peer education on treatment among patients using 131I with thyroid cancer after surgery.Methods A total of 80 patients using 131I therapy after surgery of thyroid can cerhospitalized from June 2014 to May 2016 were enrolled and randomly divided into two groups.The control group were given routine health care including hospitalized treatment,education,and follow-up examination after discharge from hospital,while the experimental group were given peer education,and the intervention was provided from admission to one month after discharge.Distress level,complication rates and knowledge mastering were compared between two groups.Results The differences of distress level,complication rates and knowledge mastering between two groups were statistically significant(P＜0.05).Conclusion Patients using 131I with thyroid cancer after surgery suffer from significant distress.Peer education can greatly reduce patients' distress,complications after 131I treatment,and improve mastering knowledge.

Objective: To establish a rapid detection method for Salmonella based on the combination of enzymatic recombinase amplification (ERA) and lateral flow chromatography (LF), so as to provide technical support for the on-site detection of Salmonella. Methods: Specific ERA primers and probes were designed based on the highly conserved flagella gene fimY in Salmonella. The primers were screened using capillary electrophoresis, and the probes were designed according to the amplification range of the screened primers. The amplification temperature and time were optimized to establish the amplification method, and the product was detected using LF strips. A standard strain of Salmonella was used to verify the sensitivity, 10 other gut bacteria were used to to verify the specificity and sensitivity, and the nucleic acid of the actual Salmonella strains was amplified to verify the detectability. Results: After screening for Salmonella-specific primers using capillary electrophoresis, the minimum detection concentration was 5 copies/μL under the amplification temperature of 37 ℃ and reaction time of 20 minutes. This method had a positive amplification result for Salmonella nucleic acid, and the amplification results of 10 other gut bacteria were all negative, with good specificity. Conclusion This method provides a possibility for on-site point of care testing of Salmonella infection.

Objective: To determine the rate of lymph node metastases in women with endometrial carci-noma and to compare the pattern of lymphatic spread of endometrial carcinoma with that of cervical carcino-ma. Methods: We retrospectively analyzed the lymphatic spread in 104 patients with endometrial carcinoma and 253 patients with cervical carcinoma. All of the patients underwent a complete pelvic and para-aortic lymphadenectomy from caudal to the median circumflex to the level of renal vessels. Results: The incidence of lymphatic metastases in the endometrial carcinoma group was higher than that in the cervical carcinoma group (22.1% vs 16.2 %). The pathologic grade (G_1: 12.1%; G_2: 21.4%; G_3: 34.5%) and depth of myometrial in-vasion (≤1/2: 11.9%; >1/2: 29%) were correlated with lymph node metastasis. The rates of para-aortic node involvement, pelvic lymph node involvement and involvement of both were 4.3%, 34.8% and 60.9% in the en-dometrial carcinoma group and 0%, 68.3% and 31.7% in the cervical carcinoma group. The rates of obturator node involvement were 73.9% and 70.7%, respectively; the rates of suprainguinal node involvement were 8.7% and 7.3%, respectively. Compared with cervical carcinoma, endometrial carcinoma showed higher rate of para-aortic and sacral node involvement (65.2% vs 31.7%, and 21.7% vs 17.1%) and lower rate of extamal iliac node involvement (17.4% vs 41.5%). Conclusion: Compared with cervical carcinoma, endometrial carcino-ma has a distinct lymphatic spread pattern and can directly metastasize to both pelvic lymph nodes and pa-ra-aortic lymph nodes with pelvic lymph node metastases being dominant. Positive lymph nodes are common-ly seen in cases of all pathological grades.

Objective:To determine the valproate concentration in plasma of epilepsy patients by HPLC, and compare with the re-sults of chemiluminescence microparticle immunoassay ( CMIA) to evaluate the consistency of the two methods. Methods:HPLC and CMIA was respectively applied to determine the plasma concentration of valproate in 230 epileptic patients. The correlation of the two methods was studied by Passing-Bablok regression and Bland-Altman method. Results:The regression equation of the determination re-sults of HPLC (Y) and CMIA (X) was Y=1. 069 7X+2. 338 2 (R2 =0. 969, n=230), which showed promising correlation. Bland-Altman analysis showed that the consistency of the two methods was poor, and the values of HPLC were higher. Conclusion: HPLC and CMIA used for the determination of valproate plasma concentration show good correlation. However, the consistency is poor and there is system error. In the clinical treatment, adjustment and choice should be paid more attention.

Objective To investigate the correlation between the level of serum cortisol and alexithymia in depressive patients with somatic symptoms.Methods The morning level of serum cortisol was measured with radioimmunoassay in 30 depressive patients with somatic symptoms (somatization group) and 30 depressive patients without somatic symptoms (non-somatization group).The severity of alexithymia was evaluated with Toronto alexithymia Scale(TAS-20).Results (1) The level of serum cortisol in somatization group was significantly higher than that in non-somatization group((533.88±144.10) μmol/L vs (458.27±82.87) μmol/L,P＜0.01).(2) The total TAS score and the factor score of Difficulty in identifying feelings and Difficulty in describing feelings in somatization group were obviously higher than those in non-somatization group,respectively ((67.13 ± 6.96) vs (62.03±7.14),(24.50±3.78) vs (21.63±3.63),(15.30±2.69) vs (13.57±2.03),all P＜0.01).(3) The level of serum cortisol in somatization group was positively correlated with the total score of alexithymia (r=0.596,P＜0.01) and the factor score of Difficulty in identifying feelings, Difficulty in describing feelings, externally oriented thinking,respectively (r=0.391,0.435,0.452,all P＜0.05).(4) The level of serum cortisol in non-somatization group was positively related to the total TAS score (r=0.418,P＜0.05) and the factor score of externally oriented thinking(r=0.489,P＜0.01).Conclusions Compared with depressive patients without somatic symptoms,depressive patients with somatic symptoms had more severe alexithymia,especially in Difficulty in identifying feelings and Difficulty in describing feelings.The severity of alexithymia was positively correlated with the level of serum cortisol.

Objective To evaluate the capability of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry ( MALDI-TOF MS) for rapid identification of methicillin-resistant Staphylo-coccus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) strains.Methods Twenty-five MRSA and thirty MSSA isolates were collected from the Second Affiliated Hospital of Zhejiang University School of Medicine as the experiment group .Twelve MRSA and twenty-two MSSA clinical strains were isola-ted as the control .All strains were identified by MALDI-TOF MS and the results were further analyzed by ClinProTools 3.0 software.Results Four algorithms including support vector machine (SVM), genetic al-gorithm ( GA) , supervised neural network ( SNN) and quick classifier ( QC) showed similar results in dis-tinguishing MRSA from MSSA isolates .The sensitivity of GA was 100 .0%and the sensitivities of other algo-rithms were all greater than 95.0%.The specificities of GA, SVM and QC were all greater than 90.0%. The areas under the receiver operating characteristic ( ROC) curves of four characteristic peaks at mass-to-charge ratios (m/z) of 3279, 6485, 6555 and 3299 m/z were all greater than 0.9.The virtual gel view showed that the bands generated by MSSA isolates at 3279 , 6485 and 6555 m/z were obviously deeper in color than those generated by MRSA isolates .However , the bands of MSSA isolates at 3299 m/z were appar-ently lighter in color than those of MRSA isolates .83.3%of MRSA and 90.0%of MSSA isolates from the control group were correctly identified by the GA model .Conclusion MALDI-TOF MS could rapidly and accurately identify MRSA from MSSA isolates under the strictly controlled experimental conditions with the advantages of less time-consuming, high sensitivity and high specificity .The accurate identification of MRSA from MSSA isolates could be applied for the prevention and treatment of MRSA infection .

Objective To evaluate the comprehensive clinical ability of new nurses in hospital of traditional Chinese medicine by the application of obstructive structured clinical examination.Methods New nurses of Nanjing hospital of traditional Chinese medicine (TCM) of the grade 2012 and 2013 were assessed.The examination consisted of four parts including standard patient station,the capacity of the case,the basic nursing skills of medicine and TCM.The scores of the theoretical knowledges and nursing skills were assessed.Results The average score of the nurses was (76.32±6.31)points,complying to the normal distribution;The degree of difficulty of the examination was 0.70-0.85 and the degree of distinguish was 0.28-0.48;The score of the theoretical test was lower than that of nursing skills and there was significant difference between them (P＜0.05).Conclusions The design of the examination is reasonable and the clinical ability of new nurses majored in TCM can be well assessed.

Objective:To provide reference for clinical pharmacists participating in the therapy of idiopathic membranous nephrop-athy patients. Methods:The drug use in 3 cases of idiopathic membranous nephropathy participated by clinical pharmacists was ana-lyzed. Results:When idiopathic membranous nephropathy was treated with glucocorticoid combined with tacrolimus, it was necessary to master the drug selection, dose and blood concentration of the drugs, course and time of the treatment and adverse reactions etc. In addition, the effectiveness and safety should be unified. Conclusion:Clinical pharmacists should pay close attention to the rational drug use, compliance of patients and adverse reactions through participating in the therapy of idiopathic membranous nephropathy.