Objective To investigate the antimicrobial resistance among Acinetobacter baumannii isolated from 7 teaching hospitals at different cities in China from 2004 to 2005.Methods A total of 1 787 nonduplicate A.baumannii isolates were collected.The antimicrobial susceptibility was determined by disk diffusion method in every center.All the data were analyzed by WHONET 5.3 software.Results Imipenem(65.1% susceptible)and meropenem(56.8% susceptible)were the most active agents against A.baumannii,followed by cefoperazone-sulbactam(43.5% susceptible,30.1% intermediate)and ampicillin-sulbactam(39.2% susceptible,16.3% intermediate).The susceptibility rate of A.baumannii to other antimicrobial agents ranged from 2.2% to 34%.Antimicrobial susceptibility pattern varied in different cities.About 52.1% and 76.8% of the imipenem non-susceptible strains were also resistant to cefoperazone-sulbactam or ampicillin-sulbactam,respectively.More than 81% were resistant to any of the other antimicrobial agents.Imipenem-susceptible strains also showed lower resistance to meropenem(11%),cefoperazone-sulbactam(12.5%)and ampicillin-sulbactam(29.1%),but higher resistance to other antimicrobial agents(41.6%-58.4%).Conclusions Carbapenems are still the most active agent against A.baumannii.However,nearly 43.1% of A.baumannii strains are resistant to carbapenems.Such resistant strains are prevalent in some regions.Cefoperazone-sulbactam is the second most active agent against A.baumannii only next to carbapenems,especially for carbapenem-resistant A.baumannii(CRAB).

The development of clinical microbiology laboratory is an essential part in promoting the development of clinical microbiology and the basis rational use of antimicrobial agents.Under the circumstances of national specific rectification of antimicrobials,clinical microbiology laboratory should focus on self-buildup and improvement.The development of clinical microbiology laboratory should focus on development of both software and hardware capabilities for lab examination and diagnosis in an all-round way,enhance the antimicrobial susceptibility surveillance,and emphasize and communication and cooperation between laboratory and other departments e.g.clinical departments,pharmacy department and nosocomial surveillance and control office,making concept translation from past ‘paramedical department' to a ‘platform department',contribute its due share to the rational uses of antimicrobial agents.

Non-cultural laboratory diagnostic methods include fungal antigen detection, anti-fungal antibody detection and molecular methods. Fungal antigen detection aim at ( 1, 3 )-β-D-glucan, galactomannan, cryptococcal capsular polysaccharide antigen and candida mannan antigen.Different antigen is used to diagnose different fungal infection.Antifungal antibody include antibody against Histoplasma capsulatum, Coccidioides immitis/Paracoccidiodes and Blastomyces dermatitidis.Molecular methods include non-amplification nucleic acid detection, nucleic acid amplification test, direct sequencing and matrix-assisted laser desorption/ionization time of flight mass spectrometry ( MALDI-TOF MS ) technology.Even though molecular methods are limited because of no standardization, the future of its usage is promising.

Intestinal infection is one of the most common infectious diseases in children in China, and the intestinal infection is often featured as the diarrhea the main clinical symptom. Systematically understanding the etiological characteristics of intestinal infection in children in China and efficiently detecting the pathogens are crucial on the early treatment and prevention of diseases. The detection technology of clinical pathogenic microorganisms in China is undergoing a revolutionary era from microscopic examination to metagenomic sequencing.

Objective To explore the feasibility of individualized preoperative preparation for thyroid nodular disease concomitant with hyperthyroxinemia. Methods According to different clinical manifestations,traditional preoperative medical preparation, impulse preoperative medical preparation and propranolol preoperative medical preparation were respectively made on 43 cases of thyroid nodular disease concomitant with hyperthyroxinemia and without eye proptosis. Preoperative medical preparation wasn't performed on 12 eases of hyperthyroxinemia without apparent hypermetabolism and basal metabolic rate less than 20%. Hospitalization time and incidence of intraoperative and postoperative complication were observed and recorded. Results Intraoperative and postoperative thyroid crisis or serious complications didn't occur in all 43 cases of thyroid nodular disease concomitant with hyperthyroxinemia and without eye proptosis. Hospitalization time differs for patients with different preoperative preparation. Conclusion It was feasible to make individualized preoperative preparation for thyroid nodular disease concomitant with hyperthyroxinemia.

Objective To study the effects of different inner face status of human venous blood container on platelet activation. Methods The plastic( polyethene terephthalate,PET) and glass tubes were coated with polyalkyleneoxide modified polydimethylsiloxane(L722). The contact angles of L722-coated glass and L722- coated PET tubes, glass tubes, PET tubes, silane coupling agent-coated glass tubes and polypropylene (PP) tubes were analyzed respectively. The blood were drawn into above tubes, and then incubated in a roller bottle at room temperature for 10-60 mira The marker of activated platelete, CD62p, was detected by flow cytometry(FCM). Results The inner face contact angle of the blood collection tubes with different material and surface treatment reflected platelet activation to a certain extent, but was not linear. The percent age of CD62p positive platelets in L722-modified PET tubes reduced from (37.4 ±14. 8) % to(21.9 ± 12. 4) %. The platelet activation by glass tubes was (54.5 ± 18.6 ) %, markedly more than PET tubes. While membrane formed, the platelet activation by glass tubes decreased remarkably, and the percentage of CD62p positive platelet in silane coupling agent-coated glass tubes were ( 28. 3 ± 8.2 ) %,markedly less than that of the L722-coated glass tubes. The platelet activation by PET-based material ectally modified with L722 was obviously less than L722-coated glass tubes and the percentage of CD62p positive platelet in silane coupling agent-coated glass tubes were ( 41.5 ± 15.9 ) % and ( 22. 0 ± 12. 8 ) %,respectively. The time course of platelet activation by different tubes showed that the platelet activation by L722-coated PET tubes and polypropylene tubes in 60 rain was not significantly different from the results in30 mitt Conclusions The diverse surface energy status induced by different material and surface treatment of blood collection tubes have obvious effects on the activation of platelets. The silicic oil surface treatment can effectively improve the blood compatibility of blood collection tubes. CD62p detectod by FCM is a sensitive marker for the evaluation of the activation of platelets induced by the material of blood collection tubes. It is of importance in the establishment of surface treatment model of blood container and screening out the material of clinical application.

The regulation how to deal with unskillful and faulty medical treatment is a policy and legal document.It is a implement to the measure how to deal with unskillful and faulty medical treatment. It will make doctor and patients on an equal basis.

Objective To investigate the protective role of two-step decapping technique for superior parathyroid glands in total thyroidectomy surgery.Methods The clinical data of 136 consecutive cases underwenttwo-step decapping technique in total thyroidectomy plus central compartment dissection from April 2013 to January 2016 were retrospectively analyzed.And the incidences of postoperative hypocalcemia were was compared with conventional consecutive decapping surgical methods containing 113 cases from January 2010 to March 2013.All operations were performed by the same treatment group.Results In the two-step decapping group,28 cases(28/136,20.6％) displayed postoperative temporary hypoparathyroidism and a higher incidence were was observed in 37 cases (37/113,32.7％) in the conventional method group,the difference was statistically significant(x2 =4.737,P =0.03).Whereas,2 cases(2/136,1.5％) suffered permanent hypoparathyroidism in the two-step decapping group and 7 cases (7/113,6.2％) of permanent hypoparathyroidism in the conventional method group,the difference was statistically significant (x2 =3.954,P =0.047).Conclusion Two-step decapping technique can more effectively protect the parathyroid gland function.It is worthy of popularization.

Objective To determine the ESBLs of Klebsiella pneumoniae and ESBL typing by molecular genetic procedures. Methods MIC test and ESBLs confirmation test were taken by agar dilution method in 80 strains of Klebsiella pneumoniae isolated in Beijing area from July 1999 to December 1999. To the 20 ESBLs positive conjugates isoelectric focusing was given. And nucleotide sequencing was analysed to conjugate strain CK23. Results 28 (35%) of the 80 strains of Klebsiella pneumoniae produced ESBLs. In the 28 strains, 20 were successfully done with conjugation of resistant plasmid. Isoelectric focusing results revealed that 13 (65%) of the 20 strains produced an ESBLs protein with a pI of 8.8 with or without additional pI 7.6 and pI 5.4. These ? lactamases were all inhibited by clavulanite acid. The strains with pI=8.8 protein were highly resistant to cefotaxime and ceftriaxone but were susceptible or intermediate to ceftazidime. We picked CK23 strain out from 13 conjugates for gene cloning by the primers designed for bla CTX M and nucleotide sequencing. The results showed that the ESBLs gene in CK23 was CTX M, highly similar to CTX M 3 but had 3 amino acids, which were Glu39Gly, Leu122Pro, Asp278His. Conclusions 28 (35%) of the 80 strains of Klebsiella pneumoniae produced ESBLs. Resistant plasmid successfully conjugated in 20 of the 28 ESBLs producing strains. 13 of the 20 (65%) conjugates pruduced a pI =8.8 ESBLs,which was CTX M ESBLs,with only 3 amino acids different from CTX M 3. This paper indicated that a type of CTX M ESBLs existed in Klebsiella pneumoniae in Beijing, which specifically confers resistance to cefotaxime.

Objective To study the cell metabolism changes of hippocampal region in patients with vascular dementia (VD) after stroke by 1 H-magnetic resonance spectroscopy (1 H-MRS),and to observe the relationship between cell metabolism changes and clinical symptoms after donepezil hydrochloride treatment.Methods Enrolled 18 patients with VD after stroke,16 males and 2 females,with a mean age of (76.9±2.7) years,13 patients without VD after stroke,11 males and 2 females,with a mean age of (76.2±3.6) years and 14 health volunteers as control group,12 males and 2 females,with a mean age of (75.1+2.4) years.The mini-mental state examination (MMSE),activities of daily living (ADL) and Hamilton depression scale (HAMD) were used to assess the effects on cognitive function,ability of daily living and behavior symptoms.1 H-MRS examination of bilateral hippocampus was conducted in all subjects.Metabolisms of N-acetylaspartate (NAA),choline (Cho) and creatine (Cr) were examined and the ratios of NAA/Cr and Cho/Cr were calculated.The patients with VD were prescribed donepezil and given 1 H-MRS assessment half a year later.Results The patients with VD had a significantly lower NAA/Cr ratio in bilateral temporal hippocampus area than did health controls and the patients without VD (F=4.23,4.98,both P＜0.05),and a higher Cho/Cr ratio than did health controls and the patients without VD in left hippocampus (P＜0.05).The NAA/Cr and Cho/Cr ratios in patients without VD had no significant changes compared to health controls.There was a positive relationship between MMSE score and NAA/Cr ratio,and negative relationship between MMSE score and Cho/Cr ratio in the bilateral hippocampus area in patients with VD.After 6 months of treatment of donepezil hydrochloride,the MMSE and ADL scales significantly increased (both P＜0.05),and NAA/Cr ratio had no significant change in hippocampal region (t=-2.02,-2.04,both P＞0.05),whereas Cho/Cr had significant decrease (t=2.86,2.23,both P＜0.05).Conclusions The data suggest that the lower NAA/Cr ratio and higher Cho/Cr ratio in hippocampus area might be helpful in distinguishing VD and no-VD in patients with stroke.Donepezil improves general cognition function in patients with VD,which may be associated with regulating the cholinergic pathogenesis of VD in vivo and in vitro.