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.

Antimicrobial susceptibility testing is an important tool for guiding rational use of antimicrobial agents in clinical settings.Proper use of antimicrobial susceptibility testing results requires clinicians and clinical microbiologists to have the knowledge of antimicrobial susceptibility testing and breakpoints,and have the ability to use pharmacokinetic and pharmacodynamic (PK/PD) principles to optimize antimicrobial therapy regimen.(Chin J Lab Med,2013,36:289-291)

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.

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 determine in vitro susceptibility of itroconazole,voriconazole,caspofungi,and amphotericin B against 82 clinical strains of filamentous fungi.Methods Etest method was used to test the in vitro susceptibilities of itroconazole,voriconazole,caspofungi,and amphoteriin B against aspergillus fumigatus,A.flavus,A.niger,A.terreus,A.nidulans,et al.Results The MIC range of 4 antifungal agents were 0.03~2.00 mg/L and 0.01~32.00 mg/L against A.fumigatus and A.flavus,respectively.But amphotericin B had higher MIC90 value which was 16mg/L against A.flavus than A.terreus(MIC90 3.00 mg/L),A.fumigatus(MIC90 0.75 mg/L),and A.niger(MIC90 0.25 mg/L).Conclusion Itroconazole,voriconazole,caspofungi,and amphotericin B have different susceptibility patterns against various types of filamentous fungi.It's necessary to identify fungi to level of species and perform antifungal susceptibility test in serious patients.

Objective The aim of this study was to evaluate the in vitro activity of Ciprofloxacin(CIP)or Amikacin(AK)combined with four clinically-used antipseudomonas ?-lactams against multidrug-resistant Pseudomonas aeruginosa strains.Methods Determining the MICs of six antibiotics to 35 clinically isolated Pseudomonas aeruginosa strains which have different resistance patterns by 2-fold broth dilution method;determining the in vitro activity of Ciprofloxacin or Amikacin combined with Ceftazidime(CAZ),Imipenem(IMP),Meropenem(MEM)and Piperacillin/Tazobactam(TZP)by broth checkerboard method.Results The combinations of Ciprofloxacin or Amikacin with four ?-lactams have mainly synergistic or additive effect,the synergistic rate of AK-group(AK+CAZ:71.43%;AK+IMP:42.86%;AK+MEM:54.29%;AK+TZP:85.71%)was higher than that of CIP-group(CIP+CAZ:20%;CIP+IMP:25.71%;CIP+MEM:14.29%;CIP+TZP:31.43%).The combination of CIP+TZP has the highest synergistic rate in CIP-group;the combination of AK+TZP has the highest synergistic rate in AK-group.None of the combinations had an antagonistic effect.Conclusion the combination of ciprofloxacin or amikacin with ?-lactams have good in vitro activity to multidrug-resistant Pseudomonas aeruginosa strains.