Influenza is an acute respiratory infection caused by influenza viruses (IFV), According to the World Health Organization (WHO), seasonal IFV epidemics result in approximately 3-5 million cases of severe illness, leading to about half a million deaths worldwide, along with severe economic losses and social burdens. Unfortunately, frequent mutations in IFV lead to a certain lag in vaccine development as well as resistance to existing antiviral drugs. Therefore, it is of great importance to develop anti-IFV drugs with high efficiency against wild-type and resistant strains, needed in the fight against current and future outbreaks caused by different IFV strains. In this review, we summarize general strategies used for the discovery and development of antiviral agents targeting multiple IFV strains (including those resistant to available drugs). Structure-based drug design, mechanism-based drug design, multivalent interaction-based drug design and drug repurposing are amongst the most relevant strategies that provide a framework for the development of antiviral drugs targeting IFV.

BACKGROUND: Targeted therapy for patients with driver genes positive and immunotherapy for patients with driver gene-negative but high programmed death ligand 1 (PD-L1) expression are the standards of first-line treatment for patients with advanced non-small cell lung cancer (NSCLC). The treatment options for patients with driver gene positive and high PD-L1 expression are still worth exploring. METHODS: The characteristics of 315 patients with NSCLC were identified to analyze the clinicopathological characteristics of patients with driver gene positive and high PD-L1 expression, and the efficacy of targeted therapy. RESULTS: Among the 315 patients, the total positive rate of driver genes was 62.2%, and the high PD-L1 expression rate (≥50.0%) was 11.2%. The proportion of patients with driver gene positive and high PD-L1 expression was 10.7%. PD-L1 was highly expressed in patients with epidermal growth factor receptor (EGFR) mutation, KRAS mutation, ALK fusion, BRAF mutation, and MET 14 exon skip mutation, the proportions were 7.8% (11/141), 18.2% (4/22), and 23.1%, (3/13), 50.0% (2/4) and 100.0% (1/1) respectively. EGFR mutation positive with PD-L1 high expression was mainly in patients with stage IV lung adenocarcinoma. KRAS mutation positive with PD-L1 high expression was mainly in patients with a history of smoking. Among them, two patients were followed in detail for targeted therapy, who with ALK fusion-positive and PD-L1 high expression (90.0%), EGFR L858R mutation and PD-L1 high expression (70.0%) respectively. The total OS of the patients was 5 months, 2 months. CONCLUSIONS The high PD-L1 expression rate in NSCLC patients with different driver gene mutations was variable, which maybe correlated with distinct clinicopathological characteristics. Patients with sensitive mutations and high PD-L1 expression may be less benefit from targeted therapy and have poor prognosis.

Objective:To investigate the influencing factors for prognoses of patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH).Methods:A retrospective analysis was performed on clinical data of 104 patients with aSAH, admitted to our hospital from January 2012 to March 2010. According to the modified Rankin scale (mRS) scores 3 months after discharge, these patients were divided into good prognosis group (mRS scores≤2) and poor prognosis group (mRS scores >2). Clinical data of patients from the 2 groups were compared. Multivariate Logistic regression analysis was used to analyze the influencing factors for prognoses.Results:Forty patients (38.5%) were with good prognosis and 64 (61.5%) were with poor prognosis. As compared with patients in the poor prognosis group, patients in the good prognosis group had significantly lower proportion of patients>60 years old, and significantly lower Graeb scores, cast fourth ventricle (CFV) incidence, Fisher grading, blood glucose content, diastolic blood pressure, systolic blood pressure and mean arterial pressure, and statistically higher serum potassium content ( P<0.05). There were significant differences in treatment methods and incidence of complications between the two groups ( P<0.05). Multivariate Logistic regression analysis showed that age>60 years ( OR=13.470, 95%CI: 2.177-83.347, P=0.005), Fisher grading ( OR=6.649, 95%CI: 1.141-38.736, P=0.035), conservative treatment ( OR=6.348, 95%CI: 1.048-38.742, P=0.044), mean arterial pressure at admission ( OR=29.721, 95%CI: 3.177-278.012, P=0.003), serum potassium ( OR=5.296, 95%CI: 1.138-24.653, P=0.034), CFV ( OR=9.855, 95%CI: 1.785-51.456, P=0.008), and chronic hydrocephalus ( OR=19.298, 95%CI: 3.294-113.069, P=0.001) were influencing factors for prognoses of high-grade aSAH patients. Conclusion:Severe aSAH patients with advanced age, high Fisher grading, high mean arterial pressure, low serum potassium content, fourth ventricle casting and chronic hydrocephalus under conservative treatment are more likely to have poor prognosis.

Objective To study the methods treating talar neck fractures. Methods From Oc-tober 1988 to June 2004, 66 patients with talar neck fractures were treated with different methods. Accord-ing to modified Hawkins classification, there were 14 patients with type Ⅰ fractures treated with plaster exter-nal fixation, 34 with type Ⅱ treated with manipulative reduction plus plaster external fixation, 16 with type Ⅲ treated with open reduction and internal fixation or joint fusion and 2 with type Ⅳ treated with open re-duction and internal fixation or joint fusion. There were four patients with old fractures. Results All pa-tients were followed up for mean 6.28 years and clinical outcomes evaluated according to Hawkins scoring system, which showed that 19 patients (29%) were graded excellent (including 13 type Ⅰ fractures, 5 type Ⅰ and 1 type Ⅲ), 17 good (including 1 type Ⅰ fracture, 12 type Ⅱ and 4 type Ⅲ), 18 fair (including 11 type Ⅱ fractures, 6 type Ⅲ and 1 type Ⅳ) and 12 poor (including 6 type Ⅱ, 5 type Ⅲ and 1 type Ⅳ). There occurred osteonecresis in 25 patients (38%), traumatic arthritis of ankle joint in 20 (30%) and that of subtalar joint in 26 (39%). Conclusions For type Ⅰ and Ⅱ fractures, plaster external fixation should be the choice of treatment. While open reduction and internal fixation should be done for type Ⅲ talar neck fractures and joint fusion for type Ⅳ and old fractures.

[Objective]To study the mid-term outcomes about cementless total hip arthroplasty in the treatment of patients with alcoholic osteonecrosis of the femoral head.[Method]From March 1997 to June 2002,41patients(47 hips) was treatmented by cementless total hip arthroplasty,the mid-term (equal to or more than 5 years) results were evaluated both clinically and radiographically.Clinical outcomes were evaluated according to Harris evaluation score. Components migration,bone changes around the implant were measured radiologically. Kaplan-Meier analysis was performed to evaluate the surviving rate of the femoral and acetabulum components. End point was radiographical loosening or revision of the acetabular and femoral component for any reason.[Result]Forty-seven hips in 41 patients were followed up at least 5 years. The mean Harris hip score increased from preoperation(42.4?6.4)points to (91.8?4.4) points at the time of final follow up. No component was loose,No component was revised. The focal area of pelvic osteolysis in 2 hips and small focal area of femoral osteolysis in 6 hips were found. The surviving rate of the femoral and acetabulum components,was 1.0(95% confidence interval,0.98 to 1.00).[Conclusion]The mid-term outcomes about cementless total hip arthroplasty in the treatment of patients with alcoholic necrosis of femoral head had been satisfactory. Because the wear of component,osteolysis can not be avoided,clinical and radiographical follow-up for cementless total hip arthroplasty must be carried out persistently.

Objective: To investigate the characteristics of etiology and drug resistance of nosocomial infection in the neurosurgery intensive care unit(NICU),and provide useful information for clinical practice.Methods: We analyzed the clinical data of 179 cases of nosocomial infection among 1 163 patients admitted in the NICU from June 2005 to March 2007.Results: From the 179 patients,346 strains of bacteria were obtained,of which Gram's negative bacili accounted for 52.89%,Gram's positive cocci 38.15% and fungi 8.96%.Of the diagnosed nosocomial infections,83.80% involved the lower respiratory tract,10.61% the urinary tract,2.79% the blood vessels,1.68% the central nervous system and 1.12% the hematological system.Conclusion: To reduce nosocomial infections in the NICU,emphasis should be placed on the control of lower respiratory tract infection as well as on the prevention and treatment of Gram's positive coccus infection in the acute stage and Gram's negative bacillus infection in the later stage.Intensified prevention measures based on the standard ones could help to get the drug-resistant strains under control.

To improve the substantial results of continuing medical education in the general hospital of the army,Nanjing General Hospital,starting with the change of the conception,perfected the management mechanism of continuing medical education,adopted multi-leveled and multi-formed training methods and achieved splendid results in both talent training and scientific research.Its success shows that establishing rules and regulations is the effective guarantee,level-based training is the basic principle and turning out high-quality talents is the ultimate goal of continuing medical education.

Objective To develop field medical card based on RFID for storage of casualty information and the sharing in evacuation. Methods Making use of radio frequency identification technology (RFID technology),TEKLOGIX 7527C palm script RFID reader from Canada was adopted with software of Visual Studio 2005 and C# to design and produce the card. Results The basic information of combatants can be entered into the card,and the casualty and cure information could be inquiry,revision and update at any time through the RFID technology. Conclusion After trial in large -scale military exercise,the effect is satisfied.

Objective To resolve the difficulty in controlling the transfusion speed by medical personnel.Methods By using liquid drop sampling module,pulsing signals of liquid drop were obtained,and then they were enlarged,shaped and the wrong signals from the top and bottom surface of every drop were excluded before the standard triggered signals were sent out to SCM processing circuit,from which the real-time liquid drop speed and the average drop speed in every minute were obtained.Results Anti-interference and portable transfusion-drop counter could show the real-time liquid drop value and the average liquid drop value in every minute.Conclusion Anti-interference and portable transfusion-drop counter is convenient with simple structure and has been used in clinic.

The blood reserve bank for preparedness against war,as a store of blood products and a base of blood supply,bears the responsibility of wartime emergency blood supply.Site selection is the basis of the construction of the blood reserve bank and directly related with its capacity of blood supply in both peace and wartime.The decision-making process concerning site selection is complicated and multi-aimed with various factors mutually related and conditioned.This paper proposes some basic principles of selecting the site of the blood reserve bank for preparedness against war,which are hoped to be beneficial for the demonstration of its site selection.