Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty.Currently,PJI is the main cause for knee revision and the third reason for hip revision.Accurate diagnosis is of quite importance for patients with potential in revision surgery.However,there is no test alone can achieve both perfect sensitivity and specificity in diagnosis of PJI.The following diagnostic methods still have irreplaceable role,including erythrocyte sedimentation rate (ESR),C reactive protein (CRP) test,synovial white blood cell count and polymorphonuclear percentage,bacteria culture and histology analysis.Some novel diagnostic techniques,such as leucocytes esterase strip test,show advantages in diagnosing as fast,convenient and cost-saving.Synovial biomarkers,such as α-defensin,have promising prospect with both high sensitivity and specificity.Among various diagnostic methods,bacteria culture and drug sensitivity test can guide the therapy of PJI.Thus,it is crucial to improve the positive rate of bacteria culture.With the development of technology,sonication and polymerase chain reaction (PCR) will be the future research highlights.Although the imaging technologies,such as labeled leukocyte imaging and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET),have been progressed in the past years,most of them are still in controversy.Further researches are still needed in the future.

Howtodevelop promotional strategies ofnetwork teachingplatform in medical colleges has laid a good foundation for the network teaching platform for successful application in medical institutions. These issues are currently facing the construction of digital campus teaching element that must be addressed. Through the research of the promotion process of Chongqing Medical University's network teaching platform,we have described effective promotion strategies of network teaching platform at the "pre-publicity," "functions of the departments," "development of policies and measures",etc.

Objective To analyze the correlation between health quotient and quality of life by investigated and studied the relationship between the two. Methods One hundred and ninty three caregivers of cancer patients were investigated by the general situation questionnaire, Health Quotient Questionnaire and Health Survey Short Form (SF-36). Results Different age, gender, education, marriage status, income, occupation, whether suffering from chronic diseases, physical examination frequency, care time and care relationship had a significant differences on quality of life of caregivers ( t/F=7.618-21.043, P < 0.05 or 0.01); the dimension scores of health quotient of caregivers were self-care (4.87±1.65) points, health knowledge (4.53±1.50) points, life style (4.47±1.65) points, state of mind (4.66± 1.87) points, life skills (4.73±1.78) points, were all on the alert value;caregiver′s level influenced by age, income, education level, occupation, whether suffering from chronic diseases and other factors (F=5.227-11.143, P<0.05);the dimension of health quotientand quality of life of caregivers were significantly correlated (r=0.506-0.771, P<0.01). Conclusions The status on quality of life and health quotient of caregivers are poor, and there is a positive correlation between the two, the level of health quotient is higher, the quality of life is better. Therefore, as for improving the quality of nursing care, clinical nursing staff should pay more attention to improve their health quotient level so as to improve the quality of life better.

Objective To evaluate the value of the color Doppler ultrasonography in assessing the changes of the superficial palmar arch arteries and the proper palmar digital arteries in patients with Raynaud's phenomenon.Methods The color Doppler ultrasonography was used to check the left superficial palmar arch arteries and the left middle finger proper palmar digital arteries in 42 patients with Raynaud's phenomenon (case group).The blood vessel flow,blood flow filling and hemodynamic parameters were recorded.The hemodynamic parameters include peak systolic velocity (PSV),end diastolic velocity (EDV),resistance index (RI) and pulsatility index (PI).The control group was 35 healthy adults who received physical examination.The above parameters were measured,and the difference of the parameters between the case group and the control group were compared.Results The blood flow signal dispayed rate of the left superficial palmar arch arteries of case group was good,almost 100％ (42/42);the blood flow of the middle finger proper palmar digital arteries was poor,the blood vessel was thinner and even occluded,the blood flow signal displayed rate was 92.86％ (39/42).Compared with the control group,the PSV and EDV of the left middle finger proper palmar digital arteries decreased,the EDV of the superficial palmar arch arteries decreased also,but the RI and PI increased in case group (all P＜0.05),The PSV of the left superficial palmar arch arteries of the case group was lower than that of the control group,and there was no significant difference between both groups (P＞0.05).Conclusion The color Doppler ultrasonography can evaluate the hemodynamic changes of the proper palmar digital arteries and the superficial palmar arch arteries in patients with Raynaud's phenomenon,and provide effective evidence for the diagnosis and treatment of Raynaud's phenomenon.

AIM: To investigate the situation of patients with mechanical ocular trauma and the possible influencing factors related to the prognosis.METHODS: Totally 260 patients(286 eyes) with mechanical ocular trauma from January 2011 to January 2016 in Xiaogan Central Hospital were selected and retrospective studied.Sociology and clinical data including gender,age,career,injury causes,injury nature,treatment time and visual acuity on admission in these patients were univariate analyzed,then the positive factors were analyzed using Logistic regression.RESULTS: The middle-aged and young males were domain in 260 patients.The causes were mainly sharp instrument injury,while perforating injury of eyeball was the majority in injury nature.Univariate analysis showed that injury causes,injury nature,treatment time and eyesight on admission were influencing factors,while multivariate analysis by Logistic regression showed that visual acuity on admission and orbital contusion were independent influencing factors for patients ocular trauma.CONCLUSION: Ocular trauma is a majoy cause of monocular blind,there are close associations between prognosis of ocular trauma and orbital contusion and visual acuity on admission.But the majority of ocular trauma is preventable and treatable,the relevant measures should be developed to prevent the ocular trauma.

AlM: To analyze the correlation between tear film changes of allergic conjunctivitis and dry eye, then provide clinical references for better treatment.
METHODS: Fifty patients with allergic conjunctivitis were taken as the observation group, the control group was selected based on 1:1 case control theory, and we chose 50 health volunteers without ocular surface diseases, xerophthalmia and systematic diseases randomly, then fluorescein ( FL) staining, break-up time ( BUT) , Schirner l test ( SⅠt) , tear meniscus high ( TMH) and slit-lamp examinations were performed in the two groups.
RESULTS: ln the observation group, FL, BUT, Slt, TMH of right eyes and left eyes were statistically significant correlated ( P < 0. 05 ). FL and BUT were statistically significant between control group and observation group (P<0. 05). TMH and Slt has positive correlation, while FL and BUT has negative correlation and the differences were statistically significant (P<0. 05). CONCLUSlON: Due to inflammatory mediators participation, allergic conjunctivitis could lead to the stability changes of tear film which cause in dry eye. The stability changes of allergic conjunctivitis correlate to the damage degree of epithelium.

Objective To analyze the clinical characteristics and nursing measures of infection in hospital ICU,and to provide the refer-ence for clinical nursing. Methods From January 2010 to June 2013,116 patients with nosocomial infection in surgical ICU were collected as observation group,and 72 patients with nosocomial infection in the surgery were as the control group. The risk factors of nosocomial infec-tion were retrospectively analyzed,and the problems related to nursing were discussed. Results The nosocomial infection rate was 8. 44% in ICU,which was significantly higher than the surgical infection rate(4. 43%) in general ward (P<0. 05). Whether patients in ICU or surgery ward,respiratory and urinary tract infections were the most common site of nosocomial infection. The mortality rate in ICU was 9. 48%,which was higher than that of nosocomial infection in surgical ward (4. 17%),P<0. 05. The nosocomial infections were obviously related to the age of patients,duration of hospitalization,the invasive operation,antibiotic and immunosuppressive agents and disturbance of consciousness in ICU and general wards (P<0. 01). Conclusion The ICU nosocomial infection rate was significantly higher than that in general ward,the main infection sites are respiratory tract and urinary tract,with a variety of factors,the key is to establish the mechanism of prevention and ef-fective nursing strategy.

BACKGROUND: Cigarette smoking has been recognized as one of the high risk factors in carcinogenesis of lung cancer. Early diagnosis of lung cancer may be of clinical therapy value.OBJECTIVE: To explore the mutation of K-ras oncogene in bronchoalveolar lavage fluid(BALF) in order to reveal its relationship with cigarette smoking in lung cancer patients.DESIGN: Randomized controlled trial based on the patients.SETTING: Department of Toxicology, College of Radiology and Public Health of a university, and Department of Respiratory Medicine of a university hospital.PARTICIPANTS: The out-patients and inpatients in the Second Affiliated Hospital of Soochow University between June 1999 and September 2001 were included. The patients were confirmed to have lung cancer or innocuous diseases by fiber bronchoscopy through bronchoalveolar lavage(BAL) and cytological or pathological examination.METHODS: BALF samples were obtained from 37 smoking patients with lung cancer and 25 nonsmoking patients with lung cancer, and 20 with benign pulmonary diseases in the Second Affiliated Hospital of Soochow University. They were detected for K-ras codon 12 mutations using polymerase chain reaction with restriction fragment length polymorphism(PCR-RFLP).MAIN OUTCOME MEASURES: Codon 12 mutations of K-ras gene.RESULTS: K-ras mutation in patients with lung cancer was found to have an average frequency of 36% (22/62)but no K-ras gene mutation was detected in patients with benign pulmonary diseases. The mutation frequency in heavy smokers(69% ) was higher than that in moderate smokers(31%), mild smokers (25%) and nonsmokers (20%). The mutation was related to age and history of smoking, but not to sex and TNM classification.CONCLUSION: Cigarette smoking may be correlated with the mutation of K-ras gene. Early detection of K-ras mutation in BALF may be of clinical value, which helps the identification and diagnosis of smoking-related lung cancer.

Objective To investigate the effects of soluble CD40 ligand combined with LY294002,a specific inhibitor of phosphatidylinositol 3-kinase,on proliferation and invasion of gastric cancer cells (AGS ) and its potential mechanisms. Methods The effect of gradient concentration of sCD40L and its combination with LY294002 on cellular proliferation was determined using MTT assay. The ability of cellular invasion and migration was evaluated by wound healing and Transwell invasion assay. The protein expression of PI3K, p-Akt and vascular endothelia growth factor (VEGF) was tested by Western blotting. Results The inhibitory effect of cellular proliferation in sCD40L, LY294002 and sCD40L + LY294002 groups was 70. 1%, 65. 7% and 41. 3%, respectively, with significant difference (P<0. 05). And wound healing was also delayed in cells treated with sCD40L plus LY294002 when compared with those treated with sCD40L or LY294002. These results indicated that the inhibitory effect of cellular proliferation, migration and invasion was enhanced when cells were treated with sCD40L plus LY294002. The protein expression of PI3K,p-Akt and VEGF increased in cells treated with sCD40L, but reduced drastically in cells treated with sCD40L plus LY294002. Conclusion Inhibiting PI3K/Akt signaling pathway may enhance the inhibitory effect of proliferation, migration and invasion by sCD40L on AGS cells, which provide a new way for biochemical therapy of gastric cancer.

Small interfering RNAs (siRNAs) are an emerging class of RNA interference (RNAi) therapeutics with unique pharmacokinetic properties. Five siRNA drugs based on two delivery systems have been approved, and an increasing number of siRNA drugs have already moved to the clinical study phase. Physiologically-based pharmacokinetic (PBPK) modeling is a useful tool and has been demonstrated to have wide ranging utility in drug development and regulatory review. However, PBPK modeling is still in its infancy in guiding the development of siRNA-based drugs in the context of its widespread use in small and large molecule areas. This article reviews the pharmacokinetic profiles of siRNA drugs, outlines the current state of PBPK model building in siRNA drug development, and describes the key parameters required for model building. This article provides insights into the future applications of PBPK models and for optimizing the key parameters when building the model for siRNA drug development.