Considering the difficult reality of clinical medical graduates employment,the authors,according to their practice experiences,proposed that medical higher schools should enhance graduates employment guidance to increase their employment rate from such aspects as following market rules,making clear cultivation orientation,carrying out employment guidance,helping graduates changing their employment conception,holding special campus job interviews and so on.

Objective To investigate the antimicrobial resistance of clinical isolated acinetobacter baumannii against the common antimicrobial agents in Huainan and to direct rational medication in clinical.Methods 160 acinetobacter baumannii strains were isolated from 3 hospitals in Huainan from Oct.2010 to Jun.2012.Bacteria identification and antimicrobial susceptibility testing were detected by VITEK32 of BioMérieux company.Cefoperazone sulbactam susceptibility was detected by Kirby-Bauer method.Results The drug resistant rate of acinetobacter baumannii against 10 antimicrobial agents was beyond 50.0％ and resistant rate of aztreonam was up to 90.1％.The drug resistant rate of only 4 antimicrobial agents was lower than 50.0％.In these 4 drugs,the lowest drug resistant rate was cefoperazone sulbactam (23.4％) and antimicrobial resistant rate of imipenem and meropenem was 26.0％ and 31.2％,respectively.Conclusion The antibiotic resistance and multiple resistance of acinetobacter baumannii in Huainan is serious.Cefoperazone sulbactam and imipenem are the first drugs for clinical therapy of acinetobacter baumannii infection.

Objective To study the variation and prognostic value of serum heparin-binding protein (HBP),a potent inducer of vascular leakage in septic shock.Methods A total of 82 sepsis patients admitted to central ICU from August 2011 to July 2012 were enrolled in the prospective study.Eighty-two sepsis patients were divided into septic shock group (group A,n =39) and sepsis without shock group (group B,n =43).At the same time,another 30 shock patients without sepsis were enrolled as group C and 35 patients without sepsis and shock were enrolled as group D.Blood samples obtained within 24 hours after enrollment,and the concentrations of HBP were measured by ELISA and lactate by electrode method.Comparisons of HBP,lactate and APACHE Ⅱ score between groups were carried out by Studers't test,and the early prognostic value in septic shock and mortality was studied by receiver operating characteristic (ROC) curve.Results Patients in group A (t =3.862,P＜0.001) and group B(t =5.193,P＜ 0.001) both had higher HBP level than patients in group D.HBP level in group A patients was also higher than that of group B (t =3.270,P =0.002).Septic shock patients (group A) had higher HBP than patients of group C (t =3.029,P =0.004).The area under curve (AUC) of HBP predicting septic shock patients was 0.834,with sensitivity 0.795,specificity 0.795.The AUC of HBP predicting 28-day mortality of all enrolled patients was was 0.680,and the AUC of predicting 28-day mortality of sepsis patients was 0.784.Conclusions HBP levels were increased in septic patients,especially in septic shock patients.HBP is a better predictor than traditional predictors like lactate and APACHE Ⅱ score for predicting septic shock.HBP is a good and specific evaluation marker for predicting septic shock and the mortality of sepsis patients.The measurement of HBP during the early stage of disease presents valuable information about diagnosis and treatment.

Diaphragm is the principal respiratory muscle.Diaphragm dysfunction resulting from mechanical ventilation,chronic cardiopulmonary disease,medicine,cardio-thoracic surgery,septic shock and chronic malnutrition predisposes to weaning failure from mechanical ventilation and prolongs intensive care unit (ICU) stay.Traditionally,the method of assessment of diaphragm structure and function was invasive,lacking specific,and was difficult to be used bedside.A number of recent studies have been suggested that ultrasonographic evaluation has been proposed as an accurate,safe and noninvasive method of quantification of diaphragm structure and function.This article reviews the related researches of technique and the clinical applications of ultrasonography in the evaluation of diaphragmatic structure and function,which may possibly result in timely identification of patients with diaphragm dysfunction and improve the assessment of recovery from diaphragm weakness.

Objective To observe the clinical efficacy of auricular point sticking plus basic nursing for constipation of excessive syndrome in acute stage of stroke.Method Ninety patients with constipation of excessive syndrome in acute stage of stroke were randomized into a treatment group and a control group, 45 cases in each group. The treatment group was intervened by auricular point sticking plus basic nursing, while the control group was by basic nursing alone. The major symptom scores were observed before intervention and after 2-treatment courses, and the clinical efficacies were compared between the two groups.Result Respectively after 1 and 2 treatment courses, there were significant differences in comparing the major symptom scores between the two groups (P<0.05). The total effective rates were respectively 60.0% and 67.5% in the treatment group respectively after 1 and 2 treatment courses, versus 37.5% and 45.0% in the control group, and the differences were statistically significant (P<0.05). Conclusion Auricular point sticking is an effective approach in treating constipation of excessive syndrome in acute stage of stroke.

Objective To evaluate the clinical significance and value of MRI for the diagnosis of the meniscus and ligament injury of the knee joint. Methods 27 patients were put under MRI examinations with 1.5 T unit(Magnetom Vision plus, SIEMENS)and confirmed by surgery or arthroscopy. In all patients, the sagittal and coronal multiplane scan was performed with 4mm section thickness. The posterior cruciate ligament (PCL) angle and PCL curvature index were measured in 8 patients with anterior cruciate ligament (ACL) tears and in 22 patients with ACL normal. The results of measuring were statistically analyzed. Results The accurate diagnosis of MRI was 18 of 24 patients (62.07%) and 24 of 31 cases with meniscus injury (77.42%). On MRI, the signs of meniscus injury were as follows: firstly, the linear high signal intensity inside meniscus was abnormal. Secondly, the size of meniscus diminished and the inner edge was pointless. The third, the triangle configuration of meniscus disappeared.The fourth, the lower or superior margin of meniscus appeared as wavelike configuration. The fifth,the distance from outer side of meniscus to articular capsule increased. Only 5 in 9 patients with ACL tears were exactly diagnosed and the accuracy ratio was 55.56%. There were remarkable statistical differences between the ACL tears group and ACL normal group in the results of (PCL) angle and PCL curvature index(P

Objective To measure intrapulmonary tumor motion due to breathing and analyze the impact factors and characteristics of the respiratory movement of large lung tumors.Methods CT sean was conducted in 30 patients with pulmonary cancer,in the calm inspiratory breath-holding and calm breath after breath-holding state.The tumor GTV in the two phases was recorded.The motion range in the left-right and antero-postefior directions in the GTV center level during the respiratory cyele was measured.The motion range of uppermost and lowermost layer of the tumor from top to bottom was also recorded.The clinical variables and anatomical factors assoeiated with the degree of motion were analyzed.Results The position of large lung tumor was relatively fixed,and the motion range was 3-5 mm,but 2 patients movement was found more than 5 mm.The two tumors were located in the lower part and the rear of the chest with low adhesion coefficient and smaller vertical direction of movement.95 ％ of motion range of the intrapulmonary tumors were under 3.8 mm in the vertical direction,under 5.8 mm in the front-rear direction,and under 1.1 mm in the left-right direction.Conclusion The movement of lung tumors caused by respiratory are influenced by tumor location,volume,and other factors such as the degree of adhesion,but the motion ranges are lower.The motion of lower rear tumors mainly occur in the vertical direction with the maximum range.

ObjectiveTo investigate the characteristics of personality in patients with depression. Methods24 patients with depression and 24 normal controls were measured with Minnesota Multiphasic Personality Inventory (MMPI) software. ResultsCompared with the control, patient with depression showed significantly difference in neuroticism, extraversionn-introversion, anxiety, repression, manifest anxiety scale, ego strength, dependency, dominance (P<0.05). the T score of N and repression is higher than the Chinese usual score. ConclusionThe depression patients show their personality as repression, inferiority, melancholy, anxiety, bad tolerance, overstrung and dependent.

Objective To study the role of heparin-binding protein (HBP) in sepsis-associated acute respiratory distress syndrome (ARDS),and to evaluate the prognostic value of HBP in ARDS.Method Sixty seven sepsis patients were enrolled in the prospective study.According to whether present ARDS,patients were divided into two groups:ARDS group and non-ARDS group.Blood samples were obtained within 2 hours after patients were diagnosed with sepsis.We measured the level of interleukin-6,interleukin8 and HBP by ELISA,counted the number of polymorphonuclear neutrophils (PMN),and calculated Acute Physiology and Chronic Health Evaluation Ⅱ score.We compared interleukin-6,interleukin-8,PMN and HBP between two groups by Student's t test.Correlation analysis was studied between HBP and other indicators by Spearman rank correlation coefficient.We also studied the early prognostic value on sepsisassociated ARDS by establishing receiver operating characteristic (ROC) curve.Results Interleukin-6 (t=4.25,P＜0.01),interleukin-8 (t=10.10,P＜0.01),PMN (t=3.47,P=0.0009) and HBP (t =0.0225,P =2.336,all showed significant difference between ARDS group and non-ARDS group.Interleukin-6 (r=0.535,P=0.002),interleukin-8 (r=0.419,P=0.017) and PMN (r=0.419,P =0.017) all had positive correlation with HBP.The area under curve (AUC) of HBP predicting ARDS was 0.796.Conclusions HBP level elevated in sepsis-associated ARDS patients and were correlated with interleuki-6,interleuki-8 and PMN.HBP show a high value on predicting emergence of sepsis-associated ARDS.HBP may play an important role in sepsis-associated ARDS pathological process.From this study we can conclude one of possible ARDS pathogenesis:inflammatory mediators,such as interleuki-6,interleuki8,activate PMN.Subseqoently PMN releases HBP.Then HBP resolts in vascolar leakage,which is one of the basic ARDS pathology.

Objective To evaluate the role of MR imaging and MR cholangiopancreatography(MRCP) for the diagnosis of hepatic hilar cholangiocarcinoma and assessment of tumor resectability.Methods MR imagings were analyzed retrospectively and compared with surgical result in 20 patients with hepatic hilar cholangiocarcinoma.Results The tumor masses were found in the hilar regions on the MR images for 18 patients. It was found that only dilatation of the intrahepatic biliary tree and thickness of the bile duct wall for the other 2 patients. According to the Bismuth classifying, classification of MR was: typeⅠ (n=3), typeⅡ(n=4), type Ⅲ(n=6),type Ⅳ(n=7). Compared with the operative findings, the accurate ratio of classification was 80%, sensitivity specificity and coincidence was 75%, 75%,80% for the assessment of tumor resectablility by MR. Conclusion MRCP combined with MRI is very useful for diagnosis and classification of the hepatic hilar cholangiocarcinoma and assessment of tumor respectability.