Drug resistance is becoming a serious issue worldwide.Obtaining accurate antimicrobial susceptibility results requires refined standard operation procedures,thus achieving the goal of individual therapy.The interpretive criteria CLSI revised annually causes widespread concern of clinical microbiologists.The major changes in CLSI M100-S25 are described in this article,focusing on the introduction of Carba NP confirmatory test for suspected carbapenemase production and epidemiological cutoff values.

Individualized therapy is dependent on rapid and accurate diagnosis of pathogens,and refined susceptibility reporting.The annually revised interpretive criteria of Clinical and Laboratory Standards Institute (CLSI) causes widespread concern of microbiologists.The major changes in CLSI M100-S24 are described in this article.The document mainly changed the Cefepime breakpoint for Enterobacteriaceae and introduced a new concept-- susceptible-dose dependent interpretive category.Optimizing the use of antimicrobial agents requires clinical microbiologists and clinicians to have a good knowledge of the new breakpoints.

Objective To investigate the features of kidney transplantation in patients over 60 years old.Methods From May 1998 to Oct. 2001,the clinical data of 81 cases over 60 post kidney transplantation were retrospectively analysed and compared with those of 432 patients below 60 age. Results The dialysis time of senile group was longer and the hypoproteinemia was sever than that of control group (P 0.05). The postoperative incidence of pulmonary infection was higher(P

Objective To summarize the experiences of kidney retransplantation from 1978 to Dec. 2002.Methods The clinical data of 86 cases subject to first renal transplantation and 86 cases to second renal transplantation were retrospectively analyzed. The main causes of failure of the first renal transplantation were CAN, while those of the second renal transplantation were HAR, and other complications such as AR, graft rupture and serious graft T.B. PRA or CDC in 31 cases was positive before retransplantation. The clinical data such as antibody-inducing therapy, the protocols of immunosuppression and the survival rates of patients and grafts in these patients were analyzed.Results Survival rates at 1, 3, 5 year of the patient/graft of retransplantation group were 84.8 %/61.6 %, 79.1 %/45.3 % and 58.1 %/41.9 % respectively, while those at 1, 3, 5 years of the patient/graft with the first renal transplantation were 89.5 %/79.1 %, 81.4 %/74.4 % and 67.4 %/58.1 % respectively. No significant difference in the patient survival rates and graft survival rates was observed (P

Objective To investigate the technical features, postoperative complication and therapeutic regimen of immunosuppressant in pediatric and adolescent renal transplantation. Methods From February 1998 to December 2004, clinical data of 46 pediatric and adolescent patients who underwent renal transplantation were retrospectively analyzed to observe the patient and graft survival rate, growth and development of recipients and postoperative complication. Results Ten episodes of acute rejection (AR) were diagnosed in 46 cases. Four cases suffered delayed graft function (DGF), one urinary leakage and 8 drug-induced hepatic injury occurred. Eight cases suffered pulmonary infection, 3 cases suffered bone marrow depression and 2 granulocytopenia. One allograft artery stenosis and one ureteral necrosis occurred. Renal functions were returned to normal in all recipients 4 weeks after operation. The 1-year patient and graft survival rates were all 100 %, and the 3-year patient and graft survival rates were 100 % and 97.4 % respectively. Conclusions Renal transplantation is an effective treatment for pediatric and adolescent patients with end-stage renal disease. In addition to its higher AR incidence than adult, pediatric renal transplantation has especial treatment in the operation process and therapeutic regimen of immunosuppressant.

Objective To evaluate the effects of fructose-1,6-diphosphate (FDP) on the preservation and high-energy phosphate metabolism of hypothermic SD rat hearts. Methods Sixteen SD rats were randomly divided into 2 groups. Their hearts were harvested and preserved in UW solution at 4℃ for 12 hours. In the study group (n=8), FDP (5mmol/L) was added to the UW solution, whereas in the control group, FDP was not added. Langendorff perfusion was established with the isolated hearts, and cardiac functions were examined, as well as the activities of lactate dehydrogenase (LDH) and creatine kinase (CK) in the perfusion fluid collected from coronary. Then the high-energy phosphate concentration, ATP, ADP, and AMP contents in the myocardium were determined with HPLC. Results The high-energy phosphate concentration was remarkably higher in the study group than that in the control group (P

0.05).The acute rejection rates in non-dialysis group was significantly lower than that of dialysis group(19.53% vs 34.27%,P0.05).The 1 year survival rates of patient/graft were 98.44% in non-dialysis and(97.72%/)95.96% in dialysis group(no significance);the 3 year survival rates of patient/graft were 96.23% in nondialysis and(94.4%/88%) in dialysis group(no significance).Conclusion:Renal transplantation without dialysis can avoid the dialysis complications and transfusion-induced sensitization,and reduce the risk of hepatitis infection as well as the acute rejection rate;while its patient/graft survival rate is similar to that of dialysis renal transplantation,making it feasible for clinical application.

ObjectiveTo observe the relativity between cerebral infarction and dyslipidemia in patients with diabetes mellitus (DM).MethodsThe blood glucose and lipid of 66 DM cases and 30 normal healthy persons (as control group) were tested.ResultsIn the blood lipids of the diabetes group without vascular disease, only densities of triglyceride (TG), apolipoprotein A-Ⅰ (apoA-Ⅰ), apolipoprotein B (apoB), apoA-Ⅰ/apoB changed significantly compared with the control group (P<0.05), others without significant change. But blood lipids level of cerebral infarction group was significantly higher than that of the control group (P<0.01). In DM group, the patients with cerebral infarction had higher fasting blood glucose (FBG), glycosylated hemoglobin A1c (HbA1c), TG, low density lipoprotein cholesterol (LDL-ch), apoB, α-lipoprotein (LPα), but lower apolipoprotein A1 (apoA1) and apoA-Ⅰ/apoB than those of the without vascular disease group (P<0.05 or P<0.01).ConclusionDyslipidemia has some relativity with the cerebral infarction of DM.

Objective To explore the relationship between preoperative serum pro-adrenomedullin (pro-ADM) in the patients with closed rupture of small intestine,and postoperative secondary abdominal infection,and to study the value of postoperative serum pro-ADM in assessment of severity of postoperative secondary abdominal infection of this patients.Methods Eighty-five patients with closed rupture of small intestine treated in the emergency surgery from June 2014 to May 2015 were selected.According to the presence of postoperative abdominal infection or not,these patients were divided into infection group and non-infection group.The infection group was further divided into SIRS,sepsis,severe sepsis,septic shock subgroups as per the severity of infection.The levels of serum pro-ADM,interleukin-6 (IL-6),C-reactive protein (CRP) were determined and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was calculated at admission and the first day、the second day and the third day after operation.Comparisons of these biomarkers were carried out to find out the factors associated with postoperative abdominal infection.In addition,ROC curve was used to verify the factors for predicting the abdominal infection of these patients after operation.The relationship between serum levels of pro-ADM and APACHE Ⅱ score after operation was analyzed.The severity of abdominal infection after operation was assessed with laboratory findings.Results Compared with non-infection group,preoperative and postoperative serum pro-ADM (P =0.03,P ＜ 0.01),IL-6 (P =0.02,P ＜0.01) levels and APACHE Ⅱ scores (P ＜ 0.01,P ＜ 0.01) were significantly higher in infection group (P ＜ 0.05).In the infection groups,the postoperative levels of serum pro-ADM and APACHE Ⅱ scores were increased with the severity of infection increased (r =0.924),and the difference between the groups was statistically significant (P ＜ 0.05),but there were no significant differences in IL-6 and CRP levels between two groups.Conclusion (1) The serum levels of pro-ADM before operation has value in predicting the genesis of abdominal infection in these patients after operation.(2) The serum levels of pro-ADM after operation has value in severity assessment of abdominal infection in these patients after operation.

Objective To evaluate the diagnosis value of urodynamics in patients with benign prostate hypertrophy(BPH).Method With urodynamic device,the full set of urodynamic exam was administrated in 427 patients with BPH,and the externalsphincter urethral myogram was monitored simultaneously in pressure-flow studies(PFS).The umdynamic finding such as Q_(max),P_(det)-Q_(max),DS(descending slope)and post-voiding residual(PVR)were recorded,as well as the situation of bladder detrusor constraction and bladder compliance and urethral sphincter coodination.The bladder outflow obstruction was diagnosed by A-G nomogram,P-Q plot and DS.The IPSS score and prostate volume were also acquired.Results The diagnostic rate of BOO is 81.5%,among them concomitantly detrusor muscle impair in 117 cases (27.4%),decreased bladder compliance in 162 case(37.9%),urethral sphincter dyssynergia in 148 cases(34.7%),and unstable bladder in 164 cases(38.4%).The increase degree of BOO show an increasing tendency with urodynamic finding such as Q_(max),P_(det)-Q_(max),P_(open),DS,IPSS score and prostatic volume respectively,but a decreasing tendency with Q_(max) and bladder compliance.Conclusions The urodynamic exam plays an important role in diagnosis of BOO.There is a positive relation among degree of BOO with urodynamic findings such as P_(det)-Q_(max),P_(open),DS and IPSS score and prostatic volume,however,a negative relation with Qmax and bladder compliance respectively.