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Objective T he drug resistance detection of carbapenem resistant Klebsiella pneumoniae (CRKP)isolated from 4 intensive care units(intensive care unit,emergency ward,neurology intensive care u-nit and cardiac intensive care unit)in the hospital was conducted,and the detection and homology analysis of resistance gene KPC was carried out.Methods 40 strains of non-repetitive CRKP were isolated from the in-tensive care units in the hospital from January to December 2015.Drug resistance detection was conducted by using minimal inhibitory concentration(MIC)method,The Hodge test was used for the phenotypic test of A type of carbapenems.Polymerase chain reaction(PCR)was used to amplify the KPC gene.The products were sequenced and analyzed.Homology analysis was performed on all strains using ERIC-Ⅱ as primers.Results 40 strains of CRKP showed high drug resistance rate;the positive rate of Hodge test was 100.0%,the resist-ance gene KPC were detected in 29 strains,the positive rate was 72.5%,and the sequencing results was type KPC-2;40 strains of CRKP can be divided into 7 types by homology analysis,including 28 strains of type A, accounting for 70.0%;2 strains of B type.Accounted for 5.0%;1 strains of C type,accounting for 2.5%;1 strains of D type,accounting for 2.5%;2 strains of E type,accounting for 5%;5 strains of F type,accounting for 12.5%;1 strains of G type,accounting for 2.5%.Conclusion The main drug-resistant genotype of CRKP isolated from all intensive care units in the hospital was KPC-2,including 7 types,among which is mainly A type,and there is a trend of epidemic transmission between ICU and emergency wards.
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Objective To investigate the homology of carbapenem-resistant Klebsiella pneumoniae (CR-KPN) isolates by multilocus sequence typing (MLST) method,and profile CR-KPN infections in terms of MLST sequence types (STs).Methods A total of 61 CR-KPN isolates were collected in five hospitals from Liaoning Province from January 2013 to June 2015.The MICs of 14 antimicrobial agents against these isolates were determined by broth microdilution method.The genotypes of carbapenemases were analyzed by PCR and DNA sequencing techniques.The homology of CR-KPN isolates were analyzed by MLST method.The clinical data of patients with CR-KPN infection were reviewed to characterize CR-KPN infections.Results A total of 18 STs were identified among the 61 CR-KPN strains according to MLST data.More than 50 ％ of the isolates belonged to ST11 (53.3 ％).ST11 strains showed higher resistance rate to carbapenems and higher prevalence of KPC-2 type carbapenemase.Univariate analysis indicated that more ST 11-infected patients were treated in ICU and with mechanical ventilation than non-ST11 CR-KPN-infected patients (P＜0.05).ST2033,ST2135,ST2193,ST2194,ST2195 and ST2196 were the STs firstly registered in the world.The eBURST analysis showed that ST2193,ST2194,ST2195 and ST 11 were closely related.Clinical data indicated that the prevalent CR-KPN strains during the same period in the same hospital usually belonged to the same ST clone.Conclusions MLST of CR-KPN showed 18 sequence types,of which ST11 was the predominant type.Clinical data indicated that the prevalent CR-KPN strains during the same period in the same hospital usually belonged to the same ST clone.This suggests the potential of local CR-KPN outbreak.The ICU patients and those receiving mechanical ventilation may be prone to CRKPN (especially ST11) infection.Such patients should be managed appropriately.
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Objective To investigate the antibiotic resistance and resistance genes of carbapenem-resistant Enterobacteriaceaes (CRE) isolated from 5 hospitals in Northeast China.Methods This study collected 85 CRE isolates during January 2013 to June 2015 from five hospitals in Northeast China.Drug sensitivities of 14 antimicrobial agents were determined by the broth microdilution method.The phenotypes of carbapenemases were screened by modified Hodge test and EDTA test respectively.The genotypes of carbapenemases and other extended spectrum β-lactamases (ESBL) were detected by PCR gene amplification and DNA sequencing method.Using the PCR result as gold standard, the performances of other two carbapenemase detection methods were evaluated.Results Among the 85 CRE strains collected in this study, Klebsiella pneumoniae was the most frequently isolated species (61/85,71.8%).The results of antimicrobial agent sensitivity showed that the 85 CRE strains had resistance rate of cephalosporin and β-lactams/enzyme inhibitor (piperacillin-tazobactam) over 80.0%.The resistance rate of carbapenem was high, with ertapenem 100.0% (85/85), meropenem 65.9% (56/85), imipenem 71.8% (61/85).There were 36 isolates resistant to both meropenem and imipenem.For fluoroquinolones, the resistance rates of levofloxacin and ciprofloxacin were 72.9% (62/85) and 65.9% (56/85), respectively.The resistance rate to fosfomycin and amikacin were 65.0% (55/85) and 54.1% (46/85), respectively.The resistance rate of colistin (21.2%, 18/85) and tigecycline (20.5%, 17/85) were low.Forty-nine strains were modified Hodge test positive and 12 strains were EDTA test positive.By PCR gene amplification and DNA sequencing method, 64 strains carried carbapenemase-encoding genes, of which KPC-2 was the main type (53/85, 62.4%), followed by IMP-4 (10/85, 11.8%), NDM-5 (7/85, 8.2%) and NDM-6 (1/85, 1.2%).At the same time, 85 CRE isolates had the ESBL gene detection and 47 isolates were CTX-M type ESBLs (47/85, 55.3%), with no TEM or SHV type.Conclusions Klebsiella pneumoniae is the majority of CRE strains from 5 large hospitals in Northeastern China.The CRE strains are resistant to most of antimicrobials.Most carbapenemases-producing isolates have the KPC-2 type.Nearly half of the carbapenemase-producing strains also carry ESBL genes, which makes the resistance mechanisms more complicated.
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Objective To compare the physical examination results of nephroptosis in the second stage and the final stage, to find the underlying reasons, and to explore better ways to detect nephroptosis.Methods A total of 1334 subjects participated in both the second stage and final stage of PLA air force medical selection of flying cadets, and physical examination results of both stages were compared.Results All the subjects recruited denied a history of abdominal pain or recurrent urinary tract infection, and urine tests were normal.The positive rate of nephroptosis in the second stage was 10.2%, compared to 5.5% in the final stage.The difference of physical examination results in the two stages was significant, and so was that of disqualification rates.Conclusion Results of physical examination of nephroptosis in the second stage are different from those in the final stage.It′s necessary to find better ways of detection of nephroptosis.
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Oncology is extensive in contents,covering a wide range of organs,systems and clinical specialties.Here,we discuss the feasibility and necessity of flipping the classroom teaching through the introduction of Oncology and through the implementation of flip classroom teaching for oncology graduate students,this paper analyzes the evaluation of the classroom teaching by the teachers and students,and compares the assessment results of students under different teaching methods.The results show that the flipped class can promote students' initiative learning,promote students' classroom participation,and help students to internalize and consolidate their knowledge of oncology in the theoretical teaching of graduate oncology.
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Objective To investigate the effect of different medical standards for the urinary system on the enlistment of pilots between PLAAF and USAF , and offer support to amendment .Methods Data on pilots′final enlistment between 2012 and 2015 were analyzed , and results of physical examinations of the urinary system were compared according to differ -ent medical standards .Results One hundred and twenty teenagers enrolled in this examination were disqualifiied due to defects of the urinary system while 97 applicants were qualified after comprehensive assessment of the urinary system .The main problems with the urinary system that affected results of pilots′enlistment were nephroptosia , renal cyst , microscopic hematuria , renal calcified foci and calculus .Conclusion Medical standards for the urinary system are different between PLAAF and USAF, especially those for nephroptosia , renal cyst and microscopic hematuria .The medical standards directo-ry about the urinary system approved by USAF can serve as a reference during our revision of current medical enlistment standards.
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Objective To determine whether the candidates who are disqualified because of arrhythmia during medical selection of flying cadets in China are qualified or not according to United States Air Force ( USAF ) Medical Standards Directory( MSD) , in order to raise suggestions on revising PLAAF medical selection of flying cadets.Methods ECG was performed on all candidates who participated in the final stage of medical selection of flying cadets, and they were considered qualified or not according to USAF MSD.Results Arrhythmia accounted for the largest proportion of cardiovascular diseases( CVDs) in PLAAF medical selection of flying cadets,the constituent ratios of CVDs from 2012 to 2015 were significant different (P<0.01).There were differences between the two countries and the outcome of 81.48%of the candidates disqualified for premature systole in PLAAF was unknown according to USAF MSD.Conclusion There are some differences in medical selection standards of flying cadets between PLAAF and USAF, and we could revise PLAAF standards with reference to USAF standards.
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Objective To investigate correlation between Helicobacter pylori infection and incidence of myocardial infarction and cerebral infarction ,and serum homocysteine(Hcy) level .Methods A total of 72 patients with myocardial infarction ,86 patients with cerebral infarction and 80 healthy subjects were enrolled and detected for Hp‐IgG and serum Hcy by using enzyme‐linked im‐munosorbent assays and enzymatic cycling method .Relationship between Hp infection and serum level of Hcy were analyzed .Results The positive rate of Hp‐IgG and serum Hcy level in patients with myocardial infarction were significantly higher than healthy subjects(P0 .05) .Among patients with cerebral infarction ,serum level of Hcy between Hp‐IgG positive patients and Hp‐IgG negative patients were without significant difference(P>0 .05) .But serum Hcy level in patients with cerebral infarction was significantly higher than that in healthy subjects(P<0 .05) .Conclusion Hp infection might promote the occurrence of myocardial infarction by affecting serum level of Hcy .However ,there might be without obvious correlation between Hp infection and the occurrence of cerebral infarction .And there could be no direct association between high serum level of Hcy in patients with cerebral infarction and Hp infection .
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Objective:To analyze the distribution of UGT1A1 gene polymorphisms in Chinese Han patients with extensive-disease small cell lung cancer(ED-SCLC),and evaluate the correlation between UGT1A1 gene polymorphisms and toxicity and efficacy of irino-tecan(CPT-11) based regimen in the patients with ED-SCLC. Methods: The analysis of UGT1A1?28 and UGT1A1?6 gene poly-morphisms was performed in 67 patients with ED-SCLC admitted in our hospital from June 2011 to January 2013. The 67 cases with ED-SCLC treated with irinotecan(CPT-11) based regimen were enrolled to observe the adverse events and efficacy during the chemo-therapy, including objective responserate rate ( ORR) , progression free survival ( PFS) and overall survival ( OS) . The incidence of different genotypes was compared. Results:The distribution of UGT1A1 genotypes in the 67 patients was follows:UGT1A1?28 wild-type (WT) genotype TA6/6 (56, 83. 6%), heterozygous genotype TA6/7 (11, 16. 4%);UGT1A1?6 wild-type (WT) genotype G/G (45,67. 2%), heterozygous genotype G/A (22,32. 8%). No significant difference of PFS and OS was observed between the differ-ent genotypes. The incidence of grade 3 and 4 delayed diarrhea and neutropenia in the patients carrying UGT1A1?6 G/A was higher than that in those with WT genotype (36. 4% vs. 6. 6%, P<0. 05;27. 2% vs. 4. 4%, P<0. 05, respectively). The incidence of grade 3 and 4 thrombocytopenia in the patients carrying UGT1A1?28 TA6/7 was higher than that in those with WT genotype (27. 2%vs. 1. 8%, P<0. 05). The patients simultaneously carrying UGT1A1?28 TA6/7 and UGT1A1?6 G/A were prone to suffering 3 and 4 delayed diarrhea and neutropenia. Conclusion: UGT1A1 polymorphisms may predict the adverse events of CPT-11 in ED-SCLC, while can not predict the efficacy of CPT-11.