Abacterial strain A25, isolated from activated sludge and identified as Bacillius megaterium, could produce flocculant, The optimum carbon and nitrogen sources are maltose and yeast extract, respectively. The optimum pH range is 7.0～10.0. The flocculant was synthesized during the cell growth. The flocculant mainly exists in the supermatant. The partial purified flocculant could be kept in 60C for 1 hour without losing activity.

The present paper consults the concept of clinical competence, cultivation actuality, examination and assessment system of master of nursing specialist (MNS) at home and aboard based on literature analysis.Currently there is neither unified concept of master nursing specialist clinical competence, nor a unique clinical ability training mode of MNS.This paper mainly expounds the differences of the nursing professional master degree graduate students clinical ability evaluation system at home and abroad in the assessment methods, assessment tools, assessment agencies and assessment index, pointing out that our country should make a unified concept of the clinical competence.We should develop a flexible, diverse clinical competency assessment method, establish specialized evaluation agencies which are independent of the government, and implement 3 level quality monitoring system-graduate school of the university, clinical college graduate school and nursing department of, to ensure the training quality.

spectrum beta-lactamase genes:blaOXA-128 and blaOXA-129.

Objective To investigate the health-related quality of life and its relative factors in children with leukemia during maintenance treatment period. Therefore, the basis for effective individualization intervention can be provided. Methods A total of 224 leukemia children in maintenance treatment were collected in Affiliated Children′s Hospital of Chongqing Medical University from October 2015 to January 2016 by convenience sampling methods, questionnaire was used to assess the physical status, emotional status, social status, school status of the children. Results Single factor and generalized linear regression analysis were used to conclude that patient′s age (F=5.841-36.343, all P<0.01), parenting pattern (F=4.006-4.288, all P<0.05), family economic status (F=3.277-15.865, P<0.05 or 0.01) and the caregivers′information mastery level household location (F=2.044-2.661, P<0.05 or 0.01) had significant influence on the quality of life of children with leukemia in maintenance treatment. Conclusions The health-related quality of life and its relative factors in children with leukemia during maintenance treatment period should be analysis comprehensively. At the same time, take intervention should be taken from physiology, psychology, society, and school, to improve the social adaptability of children with leukemia and help them return to society as soon as possible.

Objective A preliminary study on the etiology , the gene typing , the PCR-ribotyping and the clinical features of Clostridium difficile from clinical isolates at Xiangya Hospital could improve the isolation rate and provide the basis for effectively prevention of C.difficile.Methods A prospective observational study was performed.A total of 452 stool samples were collected during June to December 2012 at Xiangya Hospital.All stools were anaerobic cultured by selective medium and identified by API 20A for C.difficile.The positive isolates were detected the toxin genes ( tcdA, tcdB, cdtA, cdtB ) and ribotyping (16S-23S internal spacer region ) by PCR.The clinical data of all patients were collected and analyzed through Logistic regression to discover the risk factors for the development of C.difficile infection ( CDI ) . Results The rate of CDI occurrence was 13.94%(63/452), among them, 42.86%(36/63) were A-B+strains and only 14.29%(9/63) were obtained from community acquired-CDI.No binary toxin was detected in any of the isolates.Eleven different PCR ribotypes were identified , the dominant ribotype CD017 accounted for 22.22%(14/63).Logistic regression analysis showed that the risk factors for CDI included age>55(P=0.016;OR=4.45;95%CI:1.33-14.91), diarrhea frequency(P=0.007, OR=0.03;95%CI:0.002 -0.38 ) and the duration of diarrhea ( P =0.015; OR =7.86; 95%CI: 1.50 -41.16 ) . Conclusions C.difficile is the main pathogens of diarrhea patients and is mainly from hospital infections with higher detection rate of A -B+ in Xiangya Hospital.Ribotyping exist comparative advantages type CD017.No evidence suggests outbreak of C.difficile infection.

objective To compare the technical survival between Tenckhoff double-cuffed straight catheter (TC)and swan-neck curled tip catheter (SNC) in peritoneal dialysis (PD). Methods Clinical data of 208 patients received PD in the Peritoneal Dialysis Center of Peking Union Medical College Hospital from January 1999 to December 2007 were analyzed retrospectively. All the patients were divided into two groups according to indwelling catheter. Technical survival and complications associated with the catheter between two groups were compared. Results Demographics and basic information were similar in both groups. The exit-site infection (ESI) rates of TC and SNC were 22.1% and 19.8% (P=0.786), and peritonitis rates of TC and SNC were 31.1% and 22.1% (P=0.159), which were slightly lower in SNC group, but the difference was not significant. Removal of the catheter was found in 27 (13.0%)patients, including 17 cases in TC group (13.9%) and 10 cases in SNC group (11.6%)(P=0.680).The median survival times of catheter in TC group and SNC group were 25 months and 22 months respectively without significant difference (P=0.103). Conclusions There are no significant differences of ESI rate, peritonitis rate and catheter survival between these two catheters in PD. The expensive swan-neck catheter offers no additional advantage. Doctors should choose the catheter according to the economic status of patients.

OBJECTIVE: To explore the correlation between peripheral blood cytomegalovirus (CMV) DNA level and cyclosporine A (CsA) plasma concentration among allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients who received immunosuppressant treatment, and to evaluate the potential clinical value. METHODS: A total of 32 allo-HSCT patients were enrolled and their data were analyzed retrospectively. Ganciclovir was used to prevent CMV infection before the transplantation. Routine fluorescence PCR was admitted to test the blood CMV DNA level. The patients were divided into 2 groups: a CMV DNA positive group and a CMV DNA negative group. Enzyme multiplied immunoassay technique was adopted regularly to monitor the blood CsA concentration. The correlation between CMV DNA level and CsA concentration was analyzed. RESULTS: The CMV infection rate in patients who received allo-HSCT was 53.13%. The blood CsA concentration in the CMV DNA positive group was significantly higher than that in the CMV DNA negative group (P<0.05). Through the ROC curve, the area under the curve on Day 1, 7, and 14 had statistical significance compared with 0.5, and the corresponding blood CsA concentration was 203.15, 215.55, and 302.65 ng/mL, respectively. CONCLUSION Immunosuppressive drug concentration can affect the dynamic changes of CMV DNA. High blood CsA concentration may be one of the reasons for CMV infection. Monitoring the blood CsA concentration may provide guidance for clinical treatment.
Adolescent ; Adult ; Cyclosporine ; adverse effects ; blood ; therapeutic use ; Cytomegalovirus ; isolation & purification ; Cytomegalovirus Infections ; prevention & control ; DNA, Viral ; blood ; Female ; Ganciclovir ; therapeutic use ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Immunosuppressive Agents ; adverse effects ; blood ; therapeutic use ; Leukemia ; therapy ; Male ; Retrospective Studies ; Young Adult

The 2nd round of the third-party evaluation of the National Healthcare Improvement Initiative was made during Dec 2016 and Jan 2017.The methods, organization and implementation of the survey and the technical roadmap were the same as those of the 1st round of evaluation.The total number of respondents was 94 218,including 19 773 doctors,24 315 nurses,29 105 outpatients and 21 025 inpatients. 142 typical cases were collected from sample hospitals.The key findings showed that, the National Healthcare Improvement Initiative has been implemented quite well in the 2nd year, achievements and challenges exist side by side.The overall satisfaction rate of both outpatients and inpatients was good, both were about 90%.Further improvement is expected.Hospital staff have been actively involved in this Initiative,but they are not satisfied with their working environments and compensations.

Objective To analyze impacts of the referral system on outpatient satisfaction with the background of developing a hierarchical medical system, and to provide recommendations for further improvements of the referral system.Methods Based on the outpatient satisfaction survey results of the National Healthcare Improvement Initiative Third Party Assessment(2016-2017),the propensity matching method was used to analyze the satisfaction of outpatients who were referred and not referred.Results Compared with the overall satisfaction score of the non-referred outpatients, that of the referred outpatients was 0.11 points lower(P<0.01,95%CI=-0.17, -0.06).The patient experience satisfaction score of the referred outpatients was 0.06 points lower than that of the non-referred(P=0.03,95%CI=-0.11,-0.01).Conclusions Under the policy background of the hierarchical medical system in China, the current referral system has failed to positively improve patient satisfaction.To further improve the referral system and to raise patient satisfaction,there is a need to take following actions,to link the referral system construction with the public hospital reforms, in order to motivate the tertiary hospitals to be more actively involved in the strengthening of the referral system,to strengthen the medical capacity of the primary health care institutions, to standardize the referral criteria and procedure, and to formulate a more rational and effective health insurance payment method and reimbursement system.In addition, it is critical to further regulate and optimize the referral procedures,so as to set up reasonable and effective insurance payment and reimbursement for the referred patients, to promote the dissemination and to raise public awareness of the referral policy.Finally,it is necessary to enhance the diagnostic and treatment skills of the primary level of the health care delivery system.