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.

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.

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.

Objective To investigate the authors, the institution and endemic distribution of these authors of Chinese Journal of Orthopaedics, and understand the current situation and problems in the field of Orthopaedics. Methods The authors, the co-authors and the core authors of papers published in Chinese Journal of Orthopedics from 2005 to 2009 were quantitatively analyzed using literature search through CMCI.The distribution of institution, region and highly quantitative organization were also analyzed. Results The 1182 papers were published by the Journal within 5 years. There were 1108 papers with one or more co-authors; the cooperative rate and degree were 93.74% and 5.02, respectively. 74 papers were written by single author, which accounted for 6.26% of all papers. 615 authors (75.18% of all first authors) published only one paper. There were 295 (24.96%) papers from 67 (8.19%) core authors. 601 (50.85%) papers were from 20 high-productivity institutes. The top three high-productivity institutes were Tianjin hospital, Beijing Jishuitan hospital and Nanjing Drum Tower hospital of Nanjing University Medical School. The number of papers were 89 (7.53%), 75 (6.35%) and 43 (3.64%), respectively. The number of papers from the teaching hospital,provincial or municipal hospitals, military hospitals were 722 (61.08%), 226 (19.12%) and 157 (13.28%),respectively. According to the distribution of Province, Beijing was the first of place with 264 (22.34%) papers, followed by Shanghai by 160 (13.54%) papers and Tianjin by 136 (11.51%) papers. The distribution range of the authors has been expanded to five countries. Conclusion The influence of the Chinese Journal of Orthopaedics has greatly increased. Authors of the Chinese Journal of Orthopaedics have a highly cooperative rate. There is a group of active and talented core authors who has a great influence on the journal. But the number of core authors and the papers published by core authors need to be expanded.

Nowadays it is generally believed that chronic hepatitis C patients who are treated with interferon combined with ribavirin and achieve sustained virologic response are considered cured,but in clinical practice,some patients develop hepatocellular carcinoma (HCC) after achieving sustained virologic response.This article summarizes and analyzes the studies on chronic hepatitis C patients who developed HCC after achieving sustained virologic response and identifies the risk factors for the development of HCC.It has been proved that some of the risk factors,such as male sex,age,liver cirrhosis,and diabetes,may be related to the development of HCC,but a lot of risk factors still await for further investigation.

This article described the current status of problems in quality and safety in TCM industry. It also emphatically discussed the quality and safety control in TCM production process. In addition, this article used the HACCP (Hazard Analysis and Critical Control Points) system to conduct a hazard analysis on TCM production process and determined the critical control points, and carried out the corresponding control measures, with a purpose to realize effective regulation and control of hazard factors and ensure TCM quality and safety.

OBJECTIVE:To improve the rational compatible use of Chinese patent medicines with western medicines. METHODS:A total of 24 000 prescriptions were randomly sampled from July 10th to July 15th in 2006 for an analysis of the compatibility of Chinese patent medicines containing Salvia miltiorrhiza,Radix et Rhizoma Glycyrrhizae,Radix et Rhizoma Rhei with western medicines.RESULTS:Of the total 24 000 prescriptions analyzed,6 830(or 3 213 patients) involved combined use of Chinese patent medicines with western medicines,of which,the irrational combination for Salvia miltiorrhiza-contained,Radix et Rhizoma Glycyrrhizae-contained and Radix et Rhizoma Rhei-contained Chinese medicines with western medicines totalled 128,118 and 16 cases respectively.CONCLUSION:When the Chinese patent medicines being used in combination with western medicines,their physicochemical and pharmacological properties should be taken into fully consideration so as to achieve rational combination.

Objective To discuss the clinical value of modified laparoscopic lithotomy of common bile duct.Methods Clinical data of 78 patients over the age of 60 with gallstone and choledocholithiasis who underwent modified laparoscopic lithotomy of common bile duct in the past four years were analysed.Results All operations were successful.T-tubes were withdrawn 4 weeks after operation.Of the 78 cases,77 cases hat no complications and only one case had a small incision infection.All patients recovered without complications after with drawal of T-tube.Conclusions Modified laparoscopic lithotomy of common bile duct can allow incision and suture of common bile duct and placement of T-tube under direct vision,and achieves excellent therapeatic results in the treatment of common duct stones,especially in elderly patients who cannot tolerate a long period of pneumoperitoneum.

Objectives To provide outline for the Research & Development department of hospitals making research strategy by analyzing the quantity of publications and their cited status for the top 20 hospitals in SCI and MEDLINE, and the top 100 hospitals in domestic publications in 2008. Methods The number of publications and their cited times for the first 20 hospitals in SCI and MEDLINE, and the top 100hospitals in domestic publications in 2008 were analyzed with bibliometric analysis. Results Compared with 2007, the increased number and ratio of publications in SCI and MEDLINE for the top 20 hospitals were 1050, 51.19% and 658, 15.04%, respectively; for top 100 hospitals, the average decreased number of domestic publications was 2.08, and the number of cited publications was increased 202.52 and the increased ratio was 13.51%. Conclusions The SCI publications from top 20 hospitals increase sharply, the increase of the MEDLINE articles from the top 20 hospitals is slowly. The negative growth is showed in the number of domestic articles for the top 100 hospitals. In addition, the increase of cited articles is slowly and disproportion.

Objective Investigation of satisfaction of clinical nurses and analysis of the influence factors.Methods The ERG theory of Clayton Alderfer is used as the framework to design the questionnaires,for questionnaire investigation of 249 nurses in the hospital in a stratified sampling,Results The score of general satisfaction of nurses for their work is 3.40±0.58;the satisfaction of nurses for the management of their leaders and teamwork is high,as the satisfaction scores are 4.01±0.76 and 3.60±0.71 respectively;their satisfaction for salary,welfare and social identity is low,as the scores are 2.46±0.86 and 2.50±1.02 respectively.Work satisfaction varies with departments,academic levels,monthly income,work shifts,age,seniority,and objectives for their choice of nursing as profession.Conclusion Managers are prompted to enhance their work in view of the satisfaction scores on survival,mutual relations and growth,as well as factors affecting satisfaction,and take various incentives to improve overall satisfaction of nurses.