Staphylococcus aureus continues to be a major pathogen in both community and healthcare associated infections.The pathogenicity of staphylococcus aureus is a complex process involving a variety of extracellular and cell wall components that are coordinately expressed during different stages of infection.Accessory gene regulator (agr)-mediated quorum sensing plays a major role in staphylococcal pathogenesis.However,agr dysfunction strains exist extensively in staphylococcus aureus clinical isolates.This review will mainly focus on the influence of agr dysfunction on staphylococcus aureus biofilm formation,clinical course and outcome of infectious diseases,and antibiotic resistance.

Sepsis is a complex systemic inflammatory response syndrome caused by infection.Sepsis can deteriorate to severe sepsis,septic shock,and multiple organ dysfunction syndrome.Due to the use of antimicrobial agents,fluid resuscitation and the developments of all kinds of support life,the treatment of sepsis has greatly improved over the past years.However,the mortality rates of sepsis still remain high.Rapid,accurate and early diagnosis of sepsis is a key factor to lower the high mortality rate of sepsis.Recently,it has been found that some biomarkers are closely associated with early diagnosis of sepsis and are helpful for the treatment.These biomarkers for early diagnosis include presepsin(sCD14-subtype),neutrophil CD64,soluble triggering receptor expressed on myeloid cells-1 (sTREM-1),soluble CD163,microRNAs,copeptin,and so on.Examining these biomarkers alone or in combination will bring new opportunities for the early diagnosis of sepsis,and hopefully provide new ideas for the treatment of sepsis.This article reviews the progress on the current emerging biomarkers for early diagnosis of sepsis.

Diabetes-related macular exudation is a common fundus change associated with diabetes mellitus,charactered by hard exudates of macular area.It is one of main causes of lowing vision in diabetic patients.The incidence of diabetes-related macular exudation is increasing recent years,and therefore the diabetic maculopathy is also a matter of urgent concern.Domestic and international studies suggested that many systemic factors,such as blood glucose level,blood pressure,hypertension,higher blood lipid,inflammatory factors and genetic predisposition,exert impacts in the pathogenesis and development of diabetic retinopathy.However,whether the hard exudates of macular area also is associated with systemic factors mentioned above is unclear up to now.Since the hard exudates of diabetic maculopathy may leads to permanent loss of visual function,it is very important for us to find the effective prevent and managing approaches.This paper aimed to review the progress in this field and summarize the relevant risk factors that must be strictly controlled.

Objective To evaluate the application value of the VATS combined with artificial pneumothorax in extended thymectomy. Methods From March 2013 to November 2014, we completed 45 cases of expanded thymectomy in patients with myasthenia gravis .According to the choice of patients , the surgeries were divided into two groups .The artificial pneumothorax group (24 cases) was given thoracoscopic expanded resection under artificial pneumothorax , while the conventional surgery group (21 cases) was given conventional thoracoscopic surgery .The operation time , intraoperative bleeding , operative field show ( to expose the offside mediastinal fat and cardiophrenic angle fat fully ) and symptom relief were compared between the two groups . Results The operations were successful in all the 45 cases.As compared with the conventional surgery group , the artificial pneumothorax group had shorter operation time [(93.8 ±16.8) min vs.(119.5 ±23.3) min, t=-4.293, P=0.000], less intraoperative hemorrhage [(54.2 ±43.7) ml vs.(92.9 ±41.0) ml, t=-3.048, P=0.004] and better operation exposure [91.7% (22/24) vs.57.1%(12/21),χ2 =7.228, P=0.007].However, there was no significant difference in symptom remission rate between the two groups . Conclusion VATS under artificial pneumothorax for thymus expanded resection can fully expose the operation field , with shorter operation time and less blood loss .

Objective To observe the effect of moxibustion and ear acupoint pressing method in treating dry eye syndrome.Methods Will meet the inclusion criteria of 63 patients were randomly divided into a treatment group (n=31) , treated with moxibustion and ear acupoint pressing method, and a control group (n=32) who were given with sodium hyaluronate eye drops. After 4 weeks' treatment, clinic symptom,break-up time of tear film(BUT), fluorescence staining(FL) and tear meniscus height(TMH) were measured and compared respectively.Results After treatment, the BUT (8.28 ± 1.73 svs.5.00 ± 1.51 s,t=11.948) in the treatment group was longer than the control group (P<0.01), FL score (1.00 ± 0.90vs.1.85 ± 1.45,t=4.057) in the treatment group were lower than the control group; TMH(0.28 ± 0.06 mm vs.0.20 ± 0.06 mm,t=6.768) in the treatment group were higher than the control group (P<0.01). After treatment, dry sense (1.61 ± 0.67 vs.2.60 ± 0.89,t=6.053), foreign body(1.00 ± 0.45 vs.1.85 ± 1.45,t=10.460), burning(0. 39 ± 0.67 vs.1.59 ± 0.87, t=6.142), visual fatigue (0.61 ± 0.67 vs.1.50 ± 1.16,t=3.725), eye expansion (0.29 ± 0.46 vs.1.28 ± 1.02, t=4.980), Photophobia (0.77 ± 0.76 vs.1.67 ± 0.90,t=4.092), cry (0.29 ± 0.46 vs.0.59 ± 0.91,t=2.038) integral in the treatment group were lower than those in the control group (P<0.05,P<0.01).Conclusion The effect of moxibustion and ear acupoint pressing method in treating dry eye syndrome is more effective than sodium hyaluronate eye drops.

Objective: To explore the relationship between ERCC 1, Ki67, PCNA expression with anthracycline chemotherapeutic drugs′sensitivities in breast cancer tissues.Methods:The ERCC1,Ki67,PCNA expression in 93 breast cancer tissue was detected by immunohistochemical staining.The efficacy of chemotherapy was observed and the difference of anthracycline chemotherapy effect among patients with different ERCC 1,Ki67,PCNA expression was compared.Results:The positive rate of ERCC1 was 65.59%,the positive rate of Ki67 was 69.89%,the positive rate of PCNA was 64.52%.The total effective rate of ERCC 1-positive group was 50.82%,and ERCC1-negative group was 84.38%.In Ki67-positive group,the effective rate of patients in 25%-50%intensity was 73.68%, the effective rate of patients in 50%-75% intensity was 85.71%, the effective rate of patients in >75%intensity was 88.89%, and Ki67-negative group was 60.71%.In PCNA-positive group , the effective rate of patients in 25%-50%intensity was 52.94%, the effective rate of patients in 50%-75% intensity was 62.07%, the effective rate of patients in >75%intensity was 71.43%, and PCNA-negative group was 81.82%.These differences were all statistically significant ( P<0.01 ,P<0.05 , P<0.05).Conclusion: There are correlations between ERCC1,Ki67,PCNA expression with anthracycline chemotherapeutic drugs′sensitivity of patients with breast cancer.Combined detection of multi-factor in clinical is more helpful for the selection of chemotherapy drugs and the formulation of chemotherapy regimen.

Objective To investigate the expressions of excision repair cross complementation group 1 ( ERCC1) and Ki67 in patients with breast cancer, and the relationships between their expressions and sensitivity of platinum-based chemotherapy. Methods Totally, 129 cases were pathologically diagnosed as breast cancer.Paclitaxel and carboplatin were used simultaneously. Chemotherapy regimen was as follows:Gemcitabine 1 000 mg??( m2 )-1 , IV drop on day 1 and 8;cisplatin 25 mg??( m2 )-1 , IV drop on day 1-3, for six cycles ( 21 days a cycle ) . ERCC1 and Ki67 expression in tumor tissue was observed by immunohistochemical analysis.Platinum-based chemotherapy sensitivity and survival of patients with different levels of ERCC1 and Ki67 expression were analyzed. Results In 129 patients, 18 cases were ERCC1 and Ki67 double-negative ( ERCC1-Ki67-) , and the clinical effective rate and 3-year cumulative survival rate were 88.89%and 83.33%, respectively.Twenty-four cases were ERCC1 positive but Ki67 negative ( ERCC1+Ki67-) , and the clinical effective rate and 3-year cumulative survival rate were 50. 00% and 62.50%, respectively.Thirty-three cases were ERCC1 negative but Ki67 positive (ERCC1-Ki67+), and the clinical effective rate and 3-year cumulative survival rate were 54. 55% and 60. 60%, respectively. Fifty-four patients were ERCC1 and Ki67 double-positive ( ERCC1+Ki67+) , and the clinical effective rate and 3-year cumulative survival rate were 22.78% and 31. 48%, respectively.Compared with ERCC1-Ki67- group, the clinical treatment efficiencies of cisplatin-based chemotherapy in ERCC1+Ki67- group, ERCC1-Ki67+ group, and ERCC1+Ki67+ group were significantly decreased ( P<0. 05 ) . The clinical treatment efficiency in patients of ERCC1+Ki67+ group with cisplatin-based chemotherapy was significantly decreased as compared with ERCC1+Ki67- group and ERCC1-Ki67+ group (P<0.05).Compared with ERCC1- Ki67- group, three-year cumulative survival rate in patients of ERCC1+ Ki67- group and ERCC1- Ki67+ group, ERCC1+Ki67+ group was significantly decreased ( P<0. 05 ) . Compared with ERCC1+Ki67-group and ERCC1-Ki67+group, three-year cumulative survival rate in patients of the ERCC1+Ki67+group was significantly decreased ( P<0.05) . Conclusion The expression levels of ERCC1 and Ki67 in breast cancer were high. Their expression levels are closely related with clinical efficiency of platinum-based chemotherapy.

Objective:To analyze and evaluate the effect after the PIVAS workflow optimization in our hospital. Methods: One-for-one grouping preparation was carried out by pharmacists and nurses. The checking of medicines, solvents and empty ampoules be-fore and after the preparation was performed by pharmacists, and the preparation of infusions was operated by nurses according to the operation specification. The preparation workload, error number in each link and damage of ampoules and finished goods before the op-timization and in 5 months after the optimization were compared. Results:The working efficiency was obviously improved with less time of about 0. 5 h for the same workload, the error rate was decreased by 40%, and the ampoule damage was reduced by 60% before and during the preparation. Conclusion:The PIVAS workflow optimization improves the working efficiency and management level.

Objective To investigate the information ability of medical personnel from a large general hospital that integrates medical care,teaching and research under the network environment for providing evidence to improve targeted information service in library.Method A self-designed and self-administered questionnaire was distributed through the questionnaire system on hospital office network.Information ability involved in the questionnaire mainly included the ability to precisely retrieve literature in Chinese and foreign language,commonly used retrieval strategies,and screening,evaluation and English full-text access methods.A total of 1 094 medical personnel voluntarily participated and completed the questionnaire,and complete responses were obtained from 1 065 individuals (effective response rate 97.35％).x2 and trend x2 tests were used for data analysis.Results The overall accuracy of precise retrieval information was only 6.1％,and the accuracies of precise retrieval literature in Chinese and foreign language databases were 14.6％ and 14.6％,respectively.Duty,education and working years of the medical personnel had significantly effects on the ability to precisely retrieve literature and the strategies and methods of information retrieval,screening,evaluation and full-text access.Conclusion Medical personnel had certain information ability,but library should carry out relevant training program to improve the medical personnel's information quality and ability further.

Objective:To analyze the nuclear proliferation in breast cancer tissue related antigen (Ki-67) and proliferating cell nucleus antigen ( PCNA ) expression changes and the relationship between breast cancer and its relationship to breast cancer chemotherapy sensitivity, provide theoretical basis for clinical effective chemotherapy of breast cancer.Methods: Subjects from our hospital in recent years,by clinical examination,84 cases of patients diagnosed with breast cancer,breast cancer tissue were measured with immunohistochemical method of Ki-67 and PCNA content, compared different Ki-67 and PCNA expression levels of patients undergoing chemotherapy curative effect difference.Results:Ki-67 positive cases for 52 cases,PCNA positive cases of 62 cases.Ki-67 positive rate and the patients with lymph node metastasis and tumor classification stage were positively correlated,the difference was sta-tistically significant,P<0.05).The PCNA positive rate and the tumor was closely relative to lymph node metastasis,P<0.05,has nothing to do with tumor clinical classification stage(P>0.05).The total effective rate of Ki-67+was significantly higher than that of Ki-67-(80.8%and 56.2%,P<0.05).Effective rate of PCNA-significantly higher than that of PCNA+(72.7% to 45.2%,P<0.05).Conclusion:Ki-67 clinical data and PCNA expression is closely related to breast cancer and chemotherapy sensitivity.It can be used as a prediction index of curative effect of chemotherapy.