Two-way choice is the main way for the seven-year-program clinical medical students and postgraduate supervisors.This article analyzes the influence factors and shortages of two-way choice for postgraduate supervisors and seven-year-program clinical medical students.This investigation discovers that the supervisor's abilities of research,teaching and clinical and their personal magnetism are important and key factors.The students' gender,character,hobbies and interests and the familiarity to profession are the secondary factors.The other factors that include employment status,the level of income and the advice of parents and friends also have influence on two-way choice for postgraduate supervisors and seven-year-program clinical medical students.In order to further improve the tow-way choice,the author gives some suggestions,including introducing profession and the scientific researches of supervisors in advance,encouraging the face-to-face communication between students and supervisors,promoting multiple profession choices and giving some aids to the students for choosing the supervisors.

Objective　This study was To investigate the incidence rate of Cockett syndrome and relationship between Cockett syndrome and varicose veins and deep venous incompetence of the left lower extremities.Methods　73 patients(100 legs) with varicose veins of the lower extremities were investigated by descending deep venography and iliography preoperatively.Results　There were 35(47.9%) cases with abnormalities of the left common iliac vein (ALCIV)in all the cases.There were 31 cases with this conditions in the patients with varicose veins of the left or both lower extremity.While in the patients with varicose veins of the only right lower extremity,there were only 4 cases with ALCIV.In contrast,there was a significant difference between groups(χ2=9.8641,P=0.0017).In the patients with ALCIV,14 cases with Ⅲ or Ⅳ grade of deep venous incomptence were found, and only 6 cases with deep venous incompetence in the patients without ALCIV.There was a significant difference(χ2=5.3688,P=0.0205).Conclusion　Cockett's syndrome frequently occurs in varicose veins of the left lower extremity.There is a relationship between them.Cockett's syndrome might be one of the causes for the deep venous incompetence of the left leg.

Pedicle screw fixation is widely used in spine surgery, which allows 3?dimensional fixation with a more rigid construct and permits a shorter fusion length. However, conventional pedicle screw fixation has some drawbacks, including signifi?cant muscle dissection for the exposure of bone marks. Although percutaneous pedicle screw technique can compensate for above defects, it requires an additional approach for decompression and bone graft insertion. Besides, the percutaneous pedicle screw technique depends on intraoperative multiplanar fluoroscopy, which results in high risk of radiation exposure of the surgeons and patients. Screw loosening is a well?known complication, especially in osteoporosis patients. Several methods can enhance screw stability, for example, modifying screw design and augmenting vertebral bodies with reinforcing materials that can improve the structural capacity of the deteriorated tissue, however, they also have some disadvantages. Although we can enhance bone?screw by modifying screw design, it is not useful in severe osteoporosis patients. At the same time, bone cement can increase pedicle screw axial pullout strength and fatigue resistance, however, it is associated with a number of inherent disadvantages such as its high exothermic polymerizing temperature, toxicity of the monomer, and risk of leakage to the spinal canal. Santoni et al. intro?duced cortical bone trajectory (CBT) for lumbar pedicle screw with a new screw design that is shorter and smaller in diameter which has been proposed to maximize the thread contact with this higher density bone surface. In addition, the CBT technique fol?lows a caudocephalad path sagittally and a laterally directed path in the transverse plane, engaging only cortical bone in the pedi?cle without the involvement of the vertebral body trabecular space. Finally, the screw insertion point of this technique locates around lateral pars, enabling less tissue dissection. Therefore, it can be an alternative approach to enhance screw fixation strength, and it may rescue failed pedicle screw and be used in minimally invasive spine surgery.

Objective To investigate the alkaloidal constituents of Nauclea officinalis, an anti-inflammatory and antibacterial traditional Chinese herb. Methods The alkaloids were isolated and purified by silica gel, Sephadex LH20, and C-18 ODS column chromatography repeatedly, and their structures were identified by spectral analysis. Results Eleven alkaloids were isolated from the stems of N. officinalis and their structures were identified as angustoline (Ⅰ), 19-O-ethylangustoline (Ⅱ), 3-S-3, 4-dihydroangustoline (Ⅲ), 3-R-3, 4-dihydroangustoline (Ⅳ), naucleamide A (Ⅴ), strictosamide (Ⅵ), vincosamide (Ⅶ), 6′-acetyl-strictosamide (Ⅷ), 2′-acetyl-strictosamide (Ⅸ), pumiloside (Ⅹ), 3-epi-pumiloside (Ⅺ). Conclusion Compounds Ⅰ-Ⅺ are isolated from this plant for the first time.

The necessity to apply medical devices properly was introduced, and the present situation of the application of hospital medical devices were discussed from the aspects of overuse, abuse, operation and supervision. Some countermeasures were put forward to solve the problems in the application of hospital medical devices. It's pointed out that the application of hospital medical devices tends to be standardized with the progress of medical reformation, the attention on medical devices management, the supervision and etc.

Objective To investigate the effect and safety of Tongqiaoxingnao soup applied in elder severe craniocerebral injury stasis resistance qing qiao patients.Methods 40 cases with severe craniocerebral injury stasis resistance qing qiao were enrolled in the study,and they were divided into two groups randomly,each group had 20 cases.Patients in the monotherapy group received routine western medicine treatment,while the combination group was added the treatment of Tongqiaoxingnao soup,200mL per day for 4 weeks.GCS scores and the persistent time of coma were analyzed.After treatment for 4,8,14 days of intracranial pressure and cerebral edema were recorded and analyzed,the total effective rate and the incidence of adverse reactions were compared between two groups.Results GCS score of the combination group was (13.7 ±4.2)points,and it was obviously higher than the monotherapy (9.2 ±3.5)points (t =2.86,P <0.05).The coma duration of the combination group was (6.5 ±1.4)d,and it was obviously shorter than the monotherapy group (10.2 ±2.5 )d (t =2.86,P <0.05 ).The amount of intracranial pressure increased of combination group were 10 cases and 8 cases,which were significantly less than the monotherapy after 8 and 14 days with 16 cases and 15 cases (χ2 =3.96,5.01,all P <0.05).Total effective rate of combination treatment group was 75.0%,which was significantly higher than 40.0% of monotherapy group (χ2 =5.01,P <0.05).The occurrence of adverse reactions such as bleeding,electrolyte imbalance,hypoxemia,and the acid -base imbalance had no significant differences between the two groups (P >0.05 ).Conclusion Tongqiaoxingnao soup applied in elder severe craniocerebral injury stasis resistance qing qiao patients has clinical curative effect,can shorten the coma time,reduce intracranial pressure and relieve cerebral edema,and has high security,it is worthy of populari-zation and application.

Cardiac surgery carried out on cardiopulmonary bypass(CPB) in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women.Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB.The CPB is associated with utero-placental hypoperfusion due to a number of factors,which may translate into low fetal cardiac output,hypoxia and even death.Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status,use of perioperative fetal monitoring,optimization of CPB,delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

Objective To prove that valve sparing aortic root reconstruction may have an impact on the outcome and longevity of the repair for patients with acute type A aortic dissection.Methods Clinical data of 98 consecutive AAAD patients undergoing the valve sparing aortic root reconstruction were analyzed.The postoperative follow-up and the clinical effect of the procedure were retrospectively analyzed.Results Pre-operative grade of aortic insufficiency was(2.3 ± 0.5), CPB-time was (217.8 ± 43.1)min, aortic cross clamp time was(142.7 ± 37.4)min and stay on ICU (11.1 ± 5.7) days, while hospitalisation was(14.3 ± 3.2) days.8 patients(8.2％) died peri-operatively.None of the early deaths were valve-related.Rethoracotomy rate was 3.1％.All patients followed up(19.3 ± 7.6) (6-68) months.Survival at 1 year was 90.8％.Freedom from valvular reoperation was 97.9％ at 3 years.At last investigation, mean grade of aortic insufficiency for AADA was 0.5 ± 0.3 (0-3).Conclusion Regardless of the underlying indication, the aortic valve preserving reimplantation technique can be performed with favourable functional results.

Objective The purpose was to compare the biomechanical characteristics of new percutaneous guide wire and conventional wire in cadaveric spines,and to evaluate the new percutaneous guide wire's efficacy and safety in a clinical trial.Methods Compared the push-out and penetration forces of the new percutaneous guide wire and conventional wire in fresh cadaveric lumbar spines from L1 to L5.And analyzed the related complications of new percutaneous guide wire by clinical experiment.Results Push-out forces caused the spiral part of the new percutaneous guide wire to bend or spread,so as to resist the anterior migration of the guide wire.The mean push-out forces of the new percutaneous guide wire and conventional wire were (15.5-+ 1.9) N and (5.7 ± 0.8) N respectively (P ＜ 0.01),and the mean penetration forces were (69.1 ±4.2) N and (37.1 ±4.8) N respectively (P ＜0.01).There was no wire breakage or anterior-wall penetration in the clinical trial of 222 new percutaneous guide wire.Conclusion The mean push-out and penetration forces of the new percutaneous guide wire were approximately 2 to 3 times greater than those of conventional wire.The new percutaneous guide wire effectively prevented guide-wire anterior migration and penetration of the anterior vertebral-body wall.The new percutaneous guide wire device could effectively improve the safety of percutaneous pedicle screw insertion procedures for patient with osteoporosis.