OBJECTIVE To explore the clinical features of Acinetobacter baumannii lung infection and drug resistance situation.METHODS An analysis was conducted on clinical features and risk factors of 79 cases of A.baumannii lung infection in elderly patients from Jan 2005 to Jun 2008.Drug resistance of A.baumannii to 12 kinds of antimicrobial drugs such as ciprofloxacin,ceftazidime,ceftriaxone,imipenem and amikacin was tested.RESULTS An onset of A.baumannii infections in the lungs of elderly patients usually appeared during the critical period of some underlying diseases.More clinical manifestations as fever,lung and wet La-hypoxemia existed.Accepting antibiotic therapy,pulmonary diseases,mechanical ventilation,ICU wards,etc were the risk factors.There was a high mortality rate with multi-drug resistant(MDR) A.baumannii.Bacterial resistance to cefoperazone/sulbactam,piperacillin/tazobactam was lower while its resistance to other antibiotics was higher.The detection rate of MDR was 37.97%.CONCLUSIONS Elderly patients with A.baumannii infection have a high incidence of lung infection,but lacking characteristic clinical signs and symptoms.There is an increasing trend in the detection rate of MDR.It is of great significance to reduce the incidence rate of A.baumannii lung infection and prevent the spread of multi-drug resistant strains by strengthening the monitoring of pathogens and their resistance and choosing antibiotics according to susceptibility testing.

OBJECTIVE To understand the pathogens spectrum of tuberculosis patients with lower respiratory tract infection in hospital and the drug resistance,so as to provide guidance of rational drug use.METHODS 576 pathogens isolated from the sputum samples of TB patients with lower respiratory tract infection in hospital from 2005 to 2007 and the drug resistance were analyzed.ESBLs test was conducted on the Gram-negative bacill.RESULTS Gram-negative bacilli accounted for 73.6 percent.The first six ones were: Pseudomonas aeruginosa(19.4%),Acinetobacter baumannii(12.0%),Klebsiella pneumoniae(11.1%),E.coli(9.9%),Staphylococcus aureus(9.2%),Candida albicans(8.2%).They were highly sensitive to impinem,Cefoperazone-sulbactam.The drug resistance rates of ESBLs produceing P.aeruginosa and A.baumannii were respectively 2.7%-30.3% and 8.7%-30.4%.The resistance of MRSA to B-lactamase,Fluoroquinolone and Aminoglycoside was 64.7%-100.0%.ESBLs produceing E.coli and K.pneumoniae strains accounted for 52.6% and 45.3%.CONCLUSIONS Lower respiratory tract infection of tuberculosis patients was mainly caused by Gram-negative bacilli,most of which was portunistic pathogens.The pathogens resistance to antibiotics are increasing E.coli and K.pneumoniae produce a higher proportion of EBSLs.To delay the formation of pathogen resistance and control the hospital infection,it is important to enhance drug monitoring and rational use of antibiotics.

Objective To investigate the epidemiological characteristics of mycoplasma pneumoniae (MP),Epstein-Barr virus (EB virus) and cytomegalovirus (CMV) infection in children with acute upper respiratory tract infections in Hangzhou.Methods Throat swabs and sputum samples were collected from 5942 children with acute upper respiratory tract infections in Hangzhou First People's Hospital during January 2011 and December 2012.MP,EB virus and CMV were detected using quantitative PCR.The distribution and seasonal changes of the above pathogens in children of different ages were analyzed using Chi-square tests.Results MP,EB virus and CMV were positive in 29.91％ (1777/5942),22.92％ (1362/5942) and 8.55％ (508/5942) children,respectively.Mixed infections were found in 556 (9.36％) children.The positive rates of MP varied among different age groups (x2 =113,P =0.000),and the highest one was detected in children ＞ 6-year old (448/1012,44.36％).EB virus infection was rare in age group 0-1 year,and the positive rate was of statistical difference from those in other age groups (x2 =167,181 and 187,P =0.000).The highest positive rate of CMV (23.78％) was found in children aged 0-1 year old.The positive rates of MP varied in different months of the year (x2 =208 and 211,P =0.000),and the highest positive rate was found in July and August.Conclusion The predominant pathogen of acute upper respiratory tract infection in children is MP in Hangzhou,and MP plus EB virus infection is common,particularly in older children;while CMV infection more likely occures in 0-1 year old babies,and usually in summer.

Objective To identify endoscopic and the endoscopic ultrasonography (EUS) features of esophageal tuberculosis.Methods We retrospectively analyzed the data of 39 cases (mean age 50.7) of esophageal tuberculosis diagnosed by endoscopy and EUS in past 6 years.Results A total of 29 lesions were found in the middle part of esophagus,and 5 in upper and lower part,respectively.The lesions under endoscope demonstrated as protrusion in 30 and ulceration in 9.EUS found esophageal wall thickness in 9 cases,intra-wall occupying lesion in 17,mediastinum occupying lesions involving esophagus in 13,and calcified lymph nodes in mediastinum which was integrated with esophageal outer wall in 28 cases.Conclusion The esophageal tuberculosis occurs mainly in the middle part of the esophagus,and appears as protrusion and ulceration under endoscopy.EUS can find occupying lesions intra-or out of the esophageal wall,and full layer thickness,which can accompany calcified lymph nodes in meidastinum,and can be the basis of diagnosis.

Objective To study if tumor retraction assessed by endiscopic uhrasonography (EUS) during radiotherapy has prognostic value in esophageal carcinoma, which may further predict the radiosensi-tivity. Methods The maximal tumor thickness was measured by EUS before radiotherapy and at 40 Gy in patients with esophaged carcinoma. Response was defined as at least 50% reduction in tumor thickness. Re-suits A total of 51 patients were included. The median follow-up time was 28.5 months. The median sur-vival time was 24.3 months. The treatment was radiotherapy alone, concurrent chemoradiotherapy and pre-operative treatment in 35, 10 and 6 patients, respectively. Tumor response was assessed by EUS in 18 pa-tients (34%). The 2-year overall survival (OS) and progression-free survival (PFS) were 69% and 59% for responders, comparing with 37% and 29% for non-responders (χ~2= 5.78, P = 0.016 and χ~2= 3.97, P =0.046, respectively). In radiotherapy alone group, the 2-year OS and PFS were significantly higher in responders (n = 11) comparing with non-responders (n =24)(60% vs 44% ,χ~2 =5.84,P =0.016 and 20% vs 10% ,χ~2 =4.20, P =0. 040). In preoperative radio (chemo) therapy group (n =6), pathological-ly complete response, partial response and minimal response were observed in 4, 1 and 1 patients, respec-tively. EUS detected tumor response in 4 of 5 (80%) patients with tumor regression, and non-response in 1 of 1 patient without tumor regression. Conclusions The prognosis is better in patients with esophageal car-cinoma responding to neoadjuvant treatment identified by EUS than that of non-responders.

With the constant deepening of the study in the genetic factors of eardio-cerebrovascular diseases, the relation between the renin-angiotensin system (RAS) gene polymorphisms and hypertension is increasingly receiving attention. As an important component of RAS, renin has received much concern in the genetic research of cardio-cerebrovascular diseases and its gene polymorphisrns have become the candidate genes of hypertension, coronary heart disease and stroke, etc.

Objective To discuss the diagnostic value of multi-slice spiral CT (MSCT) in distinguishing the severe acute respiratory syndrome (SARS) from community acquired pneumonia (CAP), and to evaluate the prognosis in these two groups. Methods A retrospective study was performed on 64 cases with SARS (28 men, 36 women, aged 18-93 yrs, mean age 42.3 yrs) and 46 inpatients with CAP (29 men,17 women, aged 28-88 yrs, mean age 70.1 yrs). Pathogens of respiratory tract were found in 23 patients of CAP. All of patients underwent MSCT scanning of the chest. Results The sensitivity, specificity, and accuracy for diagnosis of SARS using a combination of 3 factors, including ground-glass opacities of lung parenchyma in chest CT, age, and WBC counts were 93.8%, 60.9% and 80.0%, respectively. The sensitivity, specificity, and accuracy for excluding SARS using a combination of consolidation of lung lesions, fiber stripe components and thicken bronchus wall of lung CT in CAP patients were 91.3%, 82.8%, and 86.4%, respectively. The death in SARS and CAP was 7 (10.9%) and 4 (8.7%), respectively. The late follow-up results indicated that 48.8% (21/43 cases) of SARS cases left abnormal manifestations in the lung. The lung sequela of the patients over 50 yrs tended to be severe with the age. Conclusion In outbreak region of SARS, MSCT plays an important role in early diagnosis, but we need to closely combine the density features of lung lesions and other manifestations of lung with clinical condition of patients to increase the accuracy for the differential diagnosis of SARS from CAP. The prognosis of patients over 50 yrs with SARS is relatively poor.

Objective To investigate the effects and mechanism of magnetic microsphere combination of cisplatin with nano or micron ferric oxide particle on human hepatoma cell(HHC). Methods A human hepatoma cell line BEL-7402 was used in this study, 0.04?g/ml～8?g/ml of cisplatin(CDDP), cisplatin nano-ferric oxide magnetic microsphere(nCDDPmm) and micro-ferric oxide magnetic microsphere(mCDDPmm) were administered to the culture solution for culturing the BEL-7402 cell as the experimental groups,and in the control groups were administered with cisplatin 0?g/ml and magnetic microsphere without cisplatin respectively. The optic density of viable cell, cytotoxity index, growth curve of cell, cell cycle, proliferation index and apoptosis were assayed by MTT method, cell count and flow cytometry respectively. Results (1)The viable cell's optic density decreased and the cytotoxity index increased in human hepatoma cell following increasing dosages of CDDP, nCDDPmm and mCDDPmm in culture solution,presenting a dose-dependent manner(r value of three drugs were 0.95, 0.91 and 0.89 respective, P 0.05)between nCDDPmm and mCDDPmm. (3)Apoptosis rate of hepatoma cell increased ( P

ObjectiveTo evaluate the adequacy of hemodialysis by online clearance monitoring (OCM) and Kt/V of correlation analysis.MethodsThe Kt/V values of 48 maintenance hemodialysis patients in the Department of Nephrology of General Hospital of PLA were accessed by both OCM of Germany BeiLang Dialog + hemodialysis machine and single-pool urea kinetic model.The Kt/V calculation value was also checked by the urea dynamics - room variable volume model.The results generated at different time point were compared,including at the real time,before and after appearing through blood by On - line Clearance Monitoring,and correlation analysis of Kt/V value was performed.ResultsThere was no significant difference on evaluating the level of Kt/v by these two methods.The relationship between the results of the two methods was significantly positive related.(r=0.539,P ＜ 0.01).ConclusionsDuring hemodialysis,the OCM option provides an accurate tool for continuous on-line monitoring of urea clearance.

Objective To investigate the value of multi-slice CT in diagnosis of abdominal cocoon.Methods CT findings of six cases with pathologically proved abdominal cocoon were collected and analyzed retrospectively.The three-dimensional imagines were obtained including multi-planar reconstruction(MPR),maximum intensity projection(MIP)and volume rendering(VR)at workstation,the rela-tionships between the lesions and surrounding structure were observed.Results A group of local small intestine were seen gathered in all six cases,the coiled intestine arranged inaccordionshape orbananashape.The fibrous capsule were seen around them with different thickness,which were low density and slightly enhancement.Mesenteric arteries showed abnormal changes,showing ten-sion,aggregation.Conclusion MSCT can provide a wealth of diagnostic information and is the best method of examination abdomi-nal cocoon.