Occupation career decision-making is affected by personal factors and environmental factors. Medical students should improve individual decision making , maintain physical and mental health , study hard, enhance their comprehensive ability, strengthen ideology cultivation and social prac-tice, recognize themselves and find reasonable fixed position by taking occupation career decision factors into consideration, which lay a solid foundation for success of occupation career decision making.

Neonatal is separated from the maternal by clamping the umbilical cord after delivery.And traditionally,the clinical practice is clamping the umbilical cord immediately after delivery.With the futher study of optimal timing of umbilical cord clamping,the effect of delayed umbilical cord clamping attracts more and more attention.This paper discussed about the subject of the early and late effect of delayed umbilical cord clamping on neonatal.We found that a briefly delay in clamping the umbilical cord increased the placental transfusion and blood volume,decreased the prevalence of anemia,promoted the stability of circulation and internal environment,without adversely affecting health of neonatal.

ObjectiveTo explore the clinical effect of edaravone combined with Shuxuetong in treatment of elderly patients with acute cerebral infarction.Methods120 cases of acute cerebral infarction,according to the different treatment methods,were divided into two groups.The conventional treatment was given in two groups,the control group plus Chuanqiong hydrochloride injection,and the observation group adopted edaravone and Shuxuetong.The clinical efficacy,activities of daily living(ADL) and neurological deficit score were compared between two groups.ResultsThere were 25 cases of basic recovery,18 cases of significant progress,progress in 12 cases in the observation group,total effective rate was 91.7％ (55/60),the control group was 75.0％ (45/60),the difference was statistically significant ( x2 =6.86,P ＜ 0.05 ).Observation group had statistically significant difference than the control group between ADL and neurological deficit scores ( all P ＜ 0.05 ).ConclusionOn the basis of conventional therapy,the use of edaravone combined with Shuxuetong for acute ischemic stroke patients could significantly promote the recovery of neurological function and was worthy of promotion.

Objective To investigate the clinical characteristics of congenital cholangiectasis,the classification of choledochectasia and its complications. Methods Sixty-eight patients with congenital cholangiectasis admitted to Nankai hospital of Tianjin from Jan. 2000 to Dec. 2009 were retrospectively studied. The patients were classified using Todani method. The clinical presentation,complications and development were compared among patients with different types. Results In 68patients, type Ⅰ , Ⅳa and Ⅳb were accounted for 47. 1%, 35.3%, 17.6%,respectively. Wheraes type Ⅱ , Ⅲ and Ⅴ were not found. The complications included cholecystitis (67.6%) and bile duct stone (70. 6%). Biliary stricture and gallbladder atrophy were accounted for 26.5% and 17.6%,respectively. Pancreatitis was found in 8.8% patients, biliary cirrhosis in 5.9% patients,carcinogenesis in 23.5 % patients, fatty liver steatosis in 11.8 % patients, cholecystic polyps in 17.6 %patients, slight spleen enlargement in 14.7% patients, hepatic cyst in 8. 8% patients, renal cyst in 2.9% patients. Conclusions Tyep Ⅰ is commonly found in congenital cholangiectasis, and the next is the type of Ⅳa, but no type of Ⅱ , Ⅲ or Ⅴ is found. The common complications are cholecystitis and bile duct stone. Carcinogenesis is found in 25 % patients.

Objective To study the effect and mechanism of Plantago depressa Willd. extract on rats with chronic nonbacterial prostatitis. Methods Sixty rats were divided into six groups randomly: normal control group, model control group, cernilton group, high-, medium- and low- dose Plantago depressa Willd. extract group, ten rats in each group. Chronic nonbacterial prostatitis rat model was established in the animals except of normal control group. Rats in the cernilton group were administrated with cernilton solution( 100 mg . kg-1 ) . High, middle and low dose Plantago depressa Willd. extract groups were given 150, 300 and 600 mg . kg-1 of Plantago depressa Willd. extract, respectively. The rats in the normal control and model control group were treated with the same volume of purified water.The administration was performed once every day, and lasted for three weeks.Effects of Plantago depressa Willd.extract on prostate index (PI), prostate specific antigen (PSA), tumor necrosis factorα ( TNF-α) , interleukin-1β ( IL-1β) , cycloxygenase 2 ( COX-2) , prostaglandin E2( PEG2 ) , transforming growth factor-β1( TGF-β1 ) , and connective tissue growth factor ( CTGF ) levels and pathological changes of prostate tissue in rats were observed. Results PI and PSA levels of the normal control group were(0.8±0.3)mg.g-1 and(106.5±10.6)pg.mL-1, respectively;those of the model control group were(2.2±0.2)mg.g-1 and(319.4±23.4)pg.mL-1 respectively;Those of the cernilton group were(1.6±0.3)mg.g-1 and(179.5±13.7)pg.mL-1 respectively;Those of the low-, medium- and high- dose Plantago depressa Willd.extract groups were(1.8±0.4),(1.3±0.3),(0.8±0.3)mg.g-1 and(263.4±28.6),(178.5±21.5), (143.5±12.9)pg.mL-1, respectively.Compared with the model control group, PI and PSA were significantly decreased(P<0.01) , TNF-α, IL-1β, COX-2, PEG2 , TGF-β1 and CTGF levels in the prostate tissues were decreased ( P<0. 01 ) , and inflammatory cell infiltration and fibrosis of prostate tissue was significantly alleviated in the model control group. Conclusion This study confirms Plantago depressa Willd.extract exerts effective therapeutical effect on chronic nonbacterial prostatitis in rats.

Vitrectomy combined with internal limiting membrane (ILM) peeling and vitreous tamponade is a conventional method for treating macular hole (MH),but the visual acuity and MH closure rate remains to be further improved.After removal of posterior vitreous cortex,the ILM is grasped with an ILM forceps and peeled off in a circular fashion for approximately 1 disc diameters around the MH.During the circumferential peeling,the ILM is not removed completely from the retina but is left attached to the edges of the MH.The ILM was then massaged gently over the MH from all sides until the ILM became inverted and then peel all other ILM within vascular arcades.Inverted ILM flap technique is one of the important improvement methods in MH vitrectomy,especially for MH with large diameter and unhealed MH after ILM peeling.Compared with conventional vitrectomy combined with ILM peeling,inverted ILM flap technique can enhance MH closure and improve visual acuity.Due to lack of large sample observation in clinical trials of inverted ILM flap technique,we still need more cases and longer follow-up of this technology to more accurately evaluate the effectiveness and safety of this technique.

Objective　To evaluate the diagnostic value of 99Tcm-HL91 in experimental tumor and inflammation models comparing with 99Tcm-MIBI. Methods　Three kinds of solid neoplasm bearing mice (Ehrlich carcinoma bearing mice, H22 carcinoma bearing mice and human ovarian COC1 neoplasm bearing nude mice) and two inflammation models (chemical and bacterial inflammation) underwent static whole body planar imaging at 1 and 4 hours after injection of 99Tcm-HL91. Two kinds of neoplasm bearing mice (Ehrlich carcinoma bearing mice,H22 carcinoma bearing mice) and two inflammation models (chemical and bacterial inflammation) underwent static planar imaging after injection of 99Tcm-MIBI, at early phase (10～20 minutes) and delayed phase (2 h). All of the mice were sacrificed at 4 h. The tumors, or inflammatory lesions, blood and contralateral normal muscles served as controls were removed, weighted and the radioactivity was measured. ROIs were drawn around tumor, inflammatory lesions and contralateral muscles in planar images, and the radioactivity ratios of target (tumor or inflammatory lesions)-to-blood (T/B), target-to non target (contralateral muscles) i.e. T/NT were calculated. Results　Neoplasms were clearly visible in planar images at 1 and 4 h after injection of 99Tcm-HL91 in all tumor models. At the same time inflammatory lesions could not be seen clearly. Neoplasms were seen in delayed phase in 99Tcm-MIBI group, but it was not easy to distinguish them from inflammation. The T/B ratios and T/NT ratios of 99Tcm-HL91 tumor model groups were significantly higher than that of 99Tcm-MIBI tumor model groups. The T/NT ratios of tumors were significantly higher than that of inflammatory lesions in 99Tcm-HL91 groups. Conclusion　Compared with 99Tcm-MIBI imaging, 99Tcm-HL91 is of much more diagnostic value in detection of certain solid neoplasms, and can distinguish neoplasm from inflammation.

Objective To analyze the clinical features of Takayasu′s arteritis (TA) and to evaluate the usefulness of 2D color Doppler flow imaging (2D CDFI) and digital subtraction angiography (DSA) in diagnosing TA.Methods Fifty eight patients with TA were analyzed.In 26 cases,the 2D CDFI findings were compared with that of DSA.Results ① One hundred and eighty two peripheral arteries were involved in 58 patients including 176 arteries with stenosis or occlusion,mainly with aortic arch syndrome and left side involved.② Compared with DSA,2D CDFI had a higher sensitivity (88%) in diagnosing stenosis and occlusion of vessel cavity in aorta and its main branches,and had a positive predictive value of 100% and anegative predictive value of 0% respectively.Conclusion 2D CDFI has some outstaning features as non invading,safety,cheapness and so on in diagnosing TA,compared with DSA that is usually used as "the gold standard" for the definitive diagnosis of this disease.2D CDFI is able to depict vessel wall thickening,which is a major pathologic feature of the disease and it is suitable for long term repeated follow up.

There are several main topics in acute myelogenous leukemia at the 57th American Society of Hematology annual meeting, including the optimization about induction and consolidation chemotherapy for AML, the investigation of targeted drugs in AML first line therapy, the marker for AML MRD monitoring, the differentiation drugs, such as tamibarotene in APL, the definition about refractory AML, the induction therapy for blastic plasmacytoid dendritic cell neoplasm (BPDCN). This article reviewed the research progress of AML in the 57th ASH annual meeting.

Objective To explore the clinical value of prenatal screening by detecting α-fetoprotein(AFP),β-human chorionic gonadotrophin(β-HCG)and free estriol(u-E3)levels in the second trimester of pregnancy.Methods AFP,β-HCG and u-E3 were de-tected in 3 595 second trimester pregnant women by chemiluminescence.The risk value was calculated by combining with the factors of age,pregnant weeks,body weight,etc.Then the high-risk pregnant women were carried out the amniotic fluid cells chromosome karyotype analysis and B-ultrasonic examination.Results Among 3 595 pregnant women,the screening positive rates of Down′s syndrome(DS),Edward′s syndrome(ES)and neural tube defects(NTD)were 3.70%(133/3 595),0.11%(4/3 595)and 1.44%(52/3 595)respectively.In the prenatal screening,there were 189 cases of high risk pregnant women,among them 87 cases were per-formed the prenatal diagnosis of amniotic fluid cells chromosome karyotype analysis and B-ultrasonic examination,6 cases were defi-nitely diagnosed,in which 3 cases were DS,2 cases were NTD and 1 case was ES.Conclusion Prenatal screening is a non-invasive detection method and has the important clinical application value for avoiding the birth of DS,ES and NTD neonates.