The paper discusses the subject service of clinical medicine in the age of big data , including two aspects:clinical research and clinical medical treatment .It points out that the development and utilization of medical big data require for subject librarians and doc -tors with certain information literacy and proposes suggestion for enhancing the information literacy of subject librarians and doctors .

The concept and technology of Web 3.0 are influencing and changing the study, work and life styles of people, and the library is using Web 3.0 to find out the high confidence UGC resources, improve the knowledge discovery and knowledge service ability of digital library, help library to search the mutually-accepted user groups according to their interests, provide the personal information service, and innovate the displaying methods of digital library.

Objective To evaluate the reliability and validity of Chinese version of Arthritis Self-Efficacy Scale.Methods Arthritis Self-Efficacy Scale was translated and adapted according to Chinese culture,and content validity was evaluated by panel of experts.Then preliminary test was proceeded and revised the scale.90 effective questionnaires were recollected,and 40 patients were tested once again after two weeks randomly.Correlation analysis and factor analysis was conducted.Results The Cronbach's α of Arthritis Self-Efficacy Scale was 0.920 and the Cronbach's α of each subscale was ranged from 0.807 to 0.831.The test-retest reliability was 0.800 to 0.921.The correlations among subscales were ranged from 0.705 to 0.799,the correlations between each subscale and total scale were ranged from 0.875 to 0.921.Component analysis revealed three factors accounting for 56.47％ of the sample variance.Conclusions Chinese version of Arthritis Self-Efficacy Scale is of better reliability and validity,it could be used in the evaluation of self-efficacy for arthritis patients.

Human gastric cancer cell line MKN28 and BGC823 were infected with recombinated retroviruses containing TNF-? gene, The expression and function of TNF were identified in transfected cancer cell line MKN28-TNF and BGC823-TNF. Cancer cells showed lower growth rate after transfection, and the inhibition of growth rate were 71% and 66% in MKN28-TNF and BGC823-TNF in comparison with the control, respectively. Decreased levels of ~3 HTdR incorporation were observed. The tumorigenicity of MKN28-TNF in nude mice was completely lost as compared with the control . The results demonstrate the inhibition of gastric cancer cells growth and tumorigenicity introduced by exogenous TNF gene.

2.0 ?g/L,n=65 cases;Group B(low level):CRP

BACKGROUND: Previous researches indicate that ADp14ARF transfecting positive tumor cell line of p53 can inhibit the proliferation; in addition, the inhibitory effect is superior to transfection negative tumor cell line of p53. Whether simultaneous transfection of p14ARF and p53 genes can increase expression and accumulation of p53 and accelerate apoptosis of tumor cells needs further studies.OBJECTIVE: To construct double plasmid expression vector plRES-p14ARF-p53 by using gene engineering so as to observe the inhibitory effect on proliferation of osteogenic sarcoma cells.DESIGN: Randomized controlled observation.SETTING: Department of Orthopaedics, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: The experiment was carried out in the Public Laboratory Platform, Immune Researching Room, Basic Medical College, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. Human osteogenic sarcoma MG-63 cells were provided by Cell Laboratory, Immune Researching Room, Tongji Medical College, Huazhong University of Science and Technology. plRES-p53 plasmid and plRES vector containing p53total-length gene order were provided by Wuhan Jingsai Biology Company.METHODS: Based on gene engineering, p14DNA (0.5 kb) was amplified from cultured L02 cells of normal human hepatic cells into plRES vector. Recombinant plasmid plRES-p14ARF-p53 was determined with polymerase chain reaction (PCR) and restriction enzyme and transfected into human osteogenic sarcoma MG-63 cells through mediation of liposome to screen positive clones. Otherwise, cells were divided into three groups, including blank control group (MG-63cells), blank vector control group (stably transfecting plRES-neo cells) and p14ARF-p53 group (stably transfecting plRES-p14ARF-p53 cells). ① DNA content and cycle of tumor cells were measured by using flow cytometry before and after transfection. ② Reverse transcription polymerase chain reaction (RT-PCR) and Western blot were used to detect quantitative and semi-quantitative expression of p53 and p14ARF protein in tumor cells after stable transfection. ③Thiazole blue chromatometry and growth curve were used to observe proliferation.MAIN OUTCOME MEASURES: ① DNA content and cycle of osteogenic sarcoma cells; ② expressions of p53 and p14ARF protein in tumor cells; ③ proliferation.RESULTS: Double plasmid expression vector plRES-p14ARF-p53 was constructed successfully. ① DNA content and cycle of osteogenic sarcoma cells: Flow cytometry demonstrated that tumor cells mainly stayed in G1 phase after transfection. ② Protein expression: RT-PCR and Western blot indicated that p14ARF and p53 gene independently expressed in target cell mRNA and protein, respectively. ③ Cell growth: At 24, 48, 72 and 96 hours after MG-63 transfection, inhibitory rates of tumor cells were 33.43%, 69.37%, 66.19% and 75.26%, respectively, which was significant difference as compared with blank vector control group (P ＜ 0.01).CONCLUSION: Wild p53 and p14ARF can synergistically inhibit the proliferation and accelerate the apoptosis of osteogenic sarcoma cells.

Objective To compare the efficacy of different dose esomeprazole-based triplen therapies for Helicobacter pylori (Hp)eradication. Methods Two hundred and forty Hp-infected patients were randomly assigned to undergo high-dose (40 mg) or low-dose (20 mg) esomeprasole combined with clarithromycin (500 mg) and amoxicillin (1g) twice a day for one week. Hp eradication test was performed at 4 weeks after the end of treatment to evaluate the response to therapy. Results One hundred and fourteen patients were followed up in high-dose patients, and 104 were Hp eradication. One hundred and thirteen patients were followed up in low-dose patients, and 101 were Hp eradication. There was no significant difference in eradication rate of intention-to treat analysis and per protocol analysis between high-dose and low-dose patients [86.7%(104/120) vs 84.2% (101/120) and 91.2% (104/114) vs 89.4% (101/113), P>0.05]. There was no significant difference in the rate of adverse effect between high-dose and low-dose patients (8.3%(10/120)vs 6.7%(8/120), P>0.05). Conclusion It demonstrates that low-dose esomeprazole-based triple therapy has a similar Hp eradication rate compared with high-dose esomeprazole-based therapy in China.

Background and purpose:Now 3-dimensional conformal radiotherapy(3DCRT)and intensitymodulated radiotherapy(IMRT)are widely used in the treatment of head and neck tumor.For the parotid,this target area is located on the side of the head and the tumor has a concave shape.What kind of radiation method can be used more eriectively to achieve dose uniformity and protection organs at risk is the topic of much discussion.The postoperative irradiation of parotid tumor is varied in the techniques used.In this study,3-dimensional conformal radiotherapy (3DCRT),intensity-modulated radiotherapy(IMRT)and simplified forward planned multi-segment radiotherapy (MSRT)were compared to conventional planning techniques in order to investigate the potential advantages of these new treatments.Methods:The conventional planning included the large opposed lateral fields with 2 or 3 weight ratio at the target lateral(2F-2D)and the unilateral field with mixture of 6 MV photon and electron beams(X+E).The 3D techniques included 3DCRT,MSRT and IMRT.Their dose distributions were calculated and compared for 8 patients treated in our center.Different beam arrangements were used for 3D techniques.In each case.the dose of PTV was prescribed to 60 Gy.All plans were compared using dose-volume histogram data.The conformity index(CI)and heterogeneity index(HI)of dose were used to evaluate the dose coverage of the target volume.Dose sparing of brain stem.spinal cord and the contra lateral parotid was also compared.To compare IMRT and MS RT,the timing ofplanning and radiation delivery was recorded.Results:Compared to conventional planning,the 3DCRT,MSRT and IMRT plans produced adequate target coverage,and the CI showed 3DCRT plans(0.78)produced poorer target coverage than MSRT(0.81)and IMRT(0.85).MRST and IMRT plans showed a significant reduction in maximum dose to the spinal cord,brainstem and the contra lateral parotid,compared to the conventional plans,while the 3DCRT plan did not show significant sparing of these structures.MSRT and IMRT plans produced better dose coverage among all the techniques.The efficacy of beam delivery comparing between two modulated planning showed MSRT was better.Conclusion:For postoperative irradiation of parotid cancer,3D planning techniques generated better target dose-coverage,without compromising the dose-sparing advantages of important structures.A satisfactory dose distribution can be obtained using MSRT and such a simple technique may be suitable for replacing IMRT.

Objective To explore the clinical features of neonatal septicemia caused by Lester. Methods The clinical features of septicemia caused by Lester bacteria in 9 neonates confirmed by blood culture during from January 2011 to June 2016 were retrospectively analyzed. Results All of the 9 cases were premature and cesarean delivery. The main clinical manifestations were cyanosis (7 cases), fever (5 cases), anhelation (4 cases), hypomyotonia (4 cases), and respiratory distress (3 cases). Blood cultures in 9 cases were detected Lester bacteria with 3 cases found in sputum and 1 case in both sputum and cerebrospinal fluid. Drug sensitivity test showed that Lester bacteria were sensitive to ampicillin, penicillin, and sulfamethoxazole. All of the 9 cases adjusted anti-infective medications after the diagnosis of Lester septicemia by blood culture, and all of them were cured or improved, and discharged. Conclusion Neonatal Lester infection is a serious infectious disease. Fever in pregnant women should alert clinicians to Lester infection. Early detection of pathogens and targeted treatment can help improve prognosis.

Informationization teaching resources contain a large number of information so rea-sonable and effective application of the resources is of great significance to the teaching. The article tries to explore and work out some teaching strategies for effective application of informationization teaching resources through action research combined with literature research , questionnaire survey method , interview and other methods. The research process: the original teaching strategies of infor-mationization teaching resources were implemented , implicated and verified in the first round action research; the problems in the first round were summarized and analyzed and the original teaching strategies were adjusted and optimized in the next round action research; finally, the teaching effec-tiveness between the two rounds action research was evaluated and analyzed by the “classroom teach-ing effectiveness criteria based on the use of information technology teaching resources”. The results show that effective application of informationization teaching resources is of great help to the teaching effect. It can enhance the learners' interest in learning and improve their academic performance. Ap-propriate and rational teaching strategy should be provided flexibly according to the learning back-ground and characteristics of students as well as learning contents.