Objective To investigate the resistant mechanism of carbapenem-resistant Escherichia coli and its relationship with endogenous infection. Methods Two carbapenem-resistant Escherichia coli strains were isolated from blood and stool of a same patient, respectively. The minimal inhibition concentrations (MIC) of the two isolates against imipenem and meropenem were determined by E-test. The susceptibility against other antimicrobial agents were done by disc diffusion method. Isoelectric focusing electrophoresis (IEF), polymerase chain reaction (PCR) amplification,cloning and sequencing, conjugation, Southern blotting were carried out to analyze the encoding gene of β-lactamases. Homology analysis of the two strains was done by pulsed field gel electrophoresis (PFGE). Results MIC against imipenem and meropenem of the two strains were both≥32 mg/L.Both strains produced KPC-2 (pI 6.7) and SHV-12 (pI 8.2) β-lactamases. blaKPC2gene was located on a 54 kb transferable plasmid. PFGE showed that the two Escherichia coli strains were derived from the same clone. Conclusions The resistance and enzyme digestion map of chromosome DNA of the two Escherichia coli strains are coincident. The Escherichia coli septicemia of this patient is probably an endogenous infection caused by the immigration of Escherichia coli from the gut.

Objective To investigate the effect of Amikacin and prulifloxacin alternate application in the treatment of Lung infections in ICU resistant Acinetobacter Bauman.Methods 82 cases of Lung infections in ICU resistant Acinetobacter Bauman from August 2014 to August 2016 in our hospital were selected and randomLy divided into two groups, 41 cases in control group were given routine treatment, 41 cases in the experimental group were treated with Amikacin and prulifloxacin alternate application, and patients were treated continuous for two weeks.Levels of serum CRP, PCT, WBC, N%, SCR, BUN, AST, ALT, scores of APACHE II and CPIS and clinical efficacy were observed pre-and post-treatment.Results After two weeks, levels of serum CRP, PCT, WBC and N% in experimental group were significantly lower than control group, scores of APACHE II and CPIS were significantly lower than the control group, the total clinical efficiency was higher than the control group(P<0.05), and the levels of serum SCR, BUN, ALT, AST were lower, but had no statistically difference.Conclusion Amikacin and prulifloxacin alternate application in the treatment of Lung infections in ICU resistant Acinetobacter Bauman can reduce the patient's inflammatory reaction and the degree of infection.

Nitrate not only remarkably stimulates the rifamycinbiosynthesis in Amycolatopsis mediterranei, but also influences the primary metabolisms, including the inhibition of fatty acids biosynthesis in the bacterial. This phenomenon has been designated as "Nitrate Stimulating Effect" by the late Prof. J.S. Chiaosince its discovery in the 1970's, and has been found in many other antibiotics-producing actinomycetes subsequently. Based on the research in his laboratory, we have revealed that the nitrate stimulation effect mainly manifests in two aspects over the last two decades. First, nitrate promotes the supply of rifamycin precursors, e.g., UDP-glucose, AHBA, malonyl-CoA and methylmalonyl-CoA. Specifically, the biosynthesis of fatty acids is inhibited by nitrate consequently the acetyl-CoA is shunted into malonyl-CoA. Second, nitrate facilitates the expression of genes in the rifclulsterthat encodes rifamycin biosynthetic enzymes. Following our current understanding, the future research will focus on the signals, the signal transduction pathway and the molecular mechanisms that dictate nitrate-mediated transcriptional and post-translational regulations.
Actinomycetales ; classification ; metabolism ; Acyl Coenzyme A ; chemistry ; Anti-Bacterial Agents ; biosynthesis ; Nitrates ; chemistry ; Rifamycins ; biosynthesis

ObjectiveTo investigate the cell toxicity of a novel macropores calcium phosphate cement (CPC) scaffold and its influence on cell adhesion,growth and proliferation.MethodsA novel CPC material was synthesized by means of adding mannitol porogens and applying sodium solution as the cement liquid.The cell growth and proliferation in the novel CPC material extraction was observed by CCK8 assay.Scanning electron microscopy was used to observe hole diameter of the material,cell adhesion and growth in the material.The experiment of three point bending was used to test the biomechanic performance of the CPC material.ResultsThe novel CPC material reached hole diameter value of (267.43±118.01)μm,microporosity of (66.15±6.91)％.Maximum load,flexural strength and toughness of the novel CPC material was increased about one time compared to the traditional CPC(P＜0.05).CCK8 assay showed there were no significant difference of the light absorption value of cells in the CPC extraction in the 4th,6th,8th day compare to the control group (P＞0.05).ConclusionThe novel CPC material has the strong biomechanics performance,macropores,high microporosity and excellent biocompatibility,which is promising for ideal bone tissue engineering scaffold.

BACKGROUND:Bone mineral density(BMD) is still regarded as the standard of early diagnosis and treatment of osteoporosis(OP) at present.But it is found in detection that different sex,age and skeleton location have different OP detection rate,so it is necessary to analyze the difference. OBJECTIVE:To compare the difference of OP detection rate at different skeleton location between males and females with the increase of age. DESIGN:A cross-sectional study taking patients as the subjects. SETTING:Endocrine department of an artillery general hospital of Chinese PLA. PARTICIPANTS:A total of 147 patients,including 54 males and 93 females, aged from 50 to 78 years old,who were hospitalized in our outpatient clinic from September 2000 to January 2002,were selected and divided into 3 groups according to age,50 to 59 years old group (n=46,13 males and 33 females),60 to 69 years old group (n=66,26 males and 40 females) and 70 to 79 years old group (n=35,15 accordance with the OP diagnostic criteria recommended by WHO[1]. Exclusive criterion: secondary OP patients caused by chronic disease of liver,kidney, heart, and gastrointestinal tract and some endocrine disease such as diabetes,hyperthyroidism and so on. INTERVENTIONS:Every subject filled in the history questionnaire in detail.Height and body mass were measured accurately and body mass index(BMI) was calculated (kg/m2).A new type of Norland Excell plus dual-energy X-ray absorptiometry(DEXA) was used to detect BMD(g/cm2) of L2- 4 and proximate femur(neck of femur, Ward's triangle,greater trochanter).The detected values were compared with the normal data of young adults of the same sex and the T value(SD) was obtained. RESULTS:OP in lumber vertebra was predominant in female climacteric(χ 2=10.14,P< 0.01),and the detection rate of OP in lumber vertebra and neck of femur increased with age(χ 2=7.41, P< 0.05).OP in simple neck of femur increased significantly in males after 60 yeas old(χ 2=9.11,P< 0.05). Females were more liable to suffer from OP in simple lumber vertebra and in both lumber vertebra and neck of femur(χ 2=8.04,P< 0.05;χ 2=14.26,P< 0.01).Age had significant negative correlation with BMD in neck of femur,Ward's triangle and great trochanter of females(r=- 0.364,- 0.389, P< 0.01;r=- 0.504,P< 0.001),while BMI was positively correlated with L2- 4,neck of femur and great trochanter significantly(r=0.306,0.329,0.338,P< 0.05). CONCLUSION:Detection rate of OP changes with skeleton detecting location and age.It is very significant to recognize and evaluate these objective phenomena correctly for the diagnosis and treatment of OP.

Objective To study the characteristics of neutralization antibody in mice induced by DNA vaccines of hemagglutinin(HA) of novel H1N1 influenza A virus(2009H1N1).Methods HA encoding plasmids of 2009H1N1 or 1918H1N1(2009HA or 1918HA)were constructed.25 μg or 200 μg dosage of 2009HA plasmids were used to immunize the mice,the total antibody of anti-20O9HA or cross-reactive antibody were assayed by ELISA using 2009HA or 1918HA protein as capture antigen,and the neutralizing antibody were assayed by two kinds of virus pseudo - particles(pp) of 2009H1N1 and 1918H1N1 .Results During of 4 to 16 weeks after boost immunization,in two groups of mice immunized with 25 μg or 200 μg dosage 2009HA plasmids,both total antibody of anti-2009HA and neutralizing antibody to 2009H1Nlpp reached the similar level(P ＞0.05),and there were cross-reactive antibody to 1918HA protein in two groups of mice serum,with similar titers of cross-neutralizing activity to 1918H1N1 pp(P ＞0.05),Conclusion A low dosage DNA vaccine encoding HA of 2009 H1 N1 virus is able to induce persistent and high level of neutralizing antibody,and may be potential valuable vaccine against the new emerging influenza virus.

Objective:To analyze status quo and trends of VIP services in the tertiary public hospitals of Shang-hai and provide references for health administrative departments. Methods:Health policies of VIP services in tertiary public hospitals were searched and analyzed, and the number of medical institutions, services, prices and service fees were analyzed from 2011 to 2013 . Results:There is a clear demand for VIP services in the tertiary public hospi-tals of Shanghai, and fees for rooms, nursing, and examinations for outpatient and inpatient care are decided by the hospitals. 89. 7% of the tertiary public hospitals in Shanghai offered VIP services, and the trend was steadily grow-ing. The four services that could be decided by hospitals varied greatly, and the service fees for inpatient care in-creased significantly. The total cost of VIP services in the tertiary public hospitals of Shanghai accounted 6. 2% of all costs, and the percentage of income from drugs was lower. Conclusions:VIP services in public hospitals have a his-torical necessity;management should be strengthened in the short term;public hospitals should strengthen their own management and provide VIP services regularly, and health administration departments should strengthen regulation. In the long run, it is suggested that public hospitals should draw lessons from international experiences to form a pat-tern of multi-level medical services and actively carry out cooperation with private medical institutions.

Objective:To study status quo of premium private health services and analyze the trend of its devel-opment. Method:The scope of premium private medical institutions was first defined. Then, seven indicators were used to analyze the allocation of resources;two indicators were used to analyze services;eight indicators were used to analyze costs. The entire situation of different styles of institutions through 2011 to 2013 was compared. Results:The results indicated that in the allocation of resources, the current level of premium private medical institutions is not high enough;large-scale construction is still at its early stages;and the medical personnel structure is not reasonable enough;as for service quantity, the total growth rate of premium private medical institutions is high but the service quantity is still far below that of the VIP services in public hospitals;as for medical expenses, premium private medi-cal institutions are charging high service fees, and the internal structure of the expenses is reasonable. Conclusions:Although the development of premium private health services is at an early stage, development prospects are promis-ing. Premium private health services should strengthen the aspects of medical technology, service levels, management capabilities, human resource building, and brand development.

Objective To study the clinical efficacy of ulinastatin combined with ambroxol hydrochloride in the treatment of acute respiratory distress syndrome (ARDS) complicated with ventilator-associated pneumonia (VAP).Methods One hundred and ten cases of ARDS complicated with VAP were randomly divided into the study group (55 cases) and the control group (55 cases) according to the different treatment method.The two groups accepted symptomatic anti-infective treatment,and the control group was treated with 300mg of ambroxol twice daily,the study group were intravenously infused 200 000U ulinastatin on the basis of the control group,two groups of patients were treated for 1 week.The ventilation indicators,pathogen clearance rate,off-time rate,mechanical ventilation time,respiratory rate,APACHE score,lung injury score and adverse reactions during the treatment were compared between the two groups.Results After treatment,PaO2,PaO2/FiO2,CL,RAW and PIP in the study group were (97.83 ± 12.01)mmHg,(364.25 ±35.77)mmHg,(88.93 ±9.44)mL/cmH2O,(31.45 ±4.87)cmHH2O · L-1 · s-1,(21.43 ± 5.75)cmH2O,respectively,which in the control groupwere (83.25 ± 10.13)mmHg,(238.55 ± 34.29) mmHg,(62.77 ± 8.54) mL/cmH2 O,(37.97 ± 6.54) cmH2 O · L-1 · s-1,(29.12 ± 5.43) cnH2 O,respectively.The P.aO2,PaO2/FiO2,CL in the study group were significantly higher than those in the control group,the RAW,PIP in the study group were significantly lower than those in the control group,the differences were statistically significant (t =6.88,18.81,5.93,7.21,15.42,all P ＜ 0.05).The clearance rate of both Gram-positive lacteria (90.00％)and Gram-negative bacteria (92.00％) in the study group were significantly higher than those in the control group (66.67％ and 70.21％) (x2 =4.81,8.84;P =0.03,0.00).The mean mechanical ventilation time in the study group [(7.15 ± 2.43) days] was significantly shorter than that in the control group [(12.85 ± 3.12) days] (t =10.69,P ＜ 0.05).The respiratory rate,APACHE score and lung injury scores of the two groups were significantly lower than those before treatment (P ＜ 0.05).The respiratory rate,APACHE scores and lung injury scores of the study group [(18.94 ± 6.99) times/min,(12.53 ± 3.14) points,(1.31 ± 0.15) points] were significantly lower than those of the control group [(25.87 ± 6.12) times/min,(16.53 ± 4.42) points,(1.65 ± 0.32) points],the differences were statistically significant (t =5.53,5.47,7.14;P =0.00,0.00,0.00).The off-line success rate and mortality between the two groups had no statistically significant differences (all P ＞ 0.05).Conclusion Ulinastatin combined with ambroxol hydrochloride can significantly improve the respiratory function of ARDS patients complicated with VAP,significantly shorten the duration of mechanical ventilation,improve respiratory function,reduce lung injury and improve pathogens clearance rate,but with no significant impact on mortality.

To establish a simple and sensitive LC-MS/MS method for simultaneous determination of the concentration for L-tryptophan(L-Try)and L-kynurenine(L-Kyn)in rat plasma. The changesin the process of the liver tumors formation may provide a basis for the diagnosis of liver cancer. 3-Nitro-L-tyrosine(3-NT)were added as the internal standard for the determination of two active substances and the chromatographic analysis was performed on a RRHD Eclipse Plus C18 column(3. 0 mm×100 mm, 1. 8 μm). The mobile phase was composed of water and acetonitrile(containing 0. 1%formic acid)(90 ∶10)at a flow rate of 0. 25 mL/min, and the injection volume is 5 μL. Detection and quantification were performed by mass spectrometry in multiple reaction monitoring mode with m/z 205. 12→146. 10(L-Try), m/z 209. 09 →146. 10(L-Kyn), m/z 227. 09→181. 10(3-NT), respectively. The results show that thelinear ranges were 9. 670-9 670 ng/mL for L-Try, and 9. 973-9973 ng/mL for L-Kyn(r2≥0. 9990). The limit of quantitation were 9. 670 ng/mL for L-Try, and 9. 973 ng/mL for L-Kyn, respectively. The intra- and inter-day precisions were all less than15%; the recoveries ofthe two analytes were more than 81. 17% and severe matrix effect was not observed. The ratio of L-Try/L-Kyn determined by LC-MS/MS in rat plasma showed an overall downward trend, which could used effectively for the drug metabolism studies and researches on the action mechanism of medicine on liver cancer. A rapid, simple, sensitive and specific LC-MS/MS method has been successfully developed and could also be used effectively for the drug metabolism studies and researches on the action mechanism of medicine on liver cancer.