555 medical vocational students were surveyed with questionnaire to data regarding their employment intentions. The study showed that the employment rate in basic-level medical organizations and the degree of job satisfaction of college students were low. The main factors were economic benefits, living environment, hospital equipment status, self-awareness. Therefore, in order to encourage medical vocational students to choose basic-level medical organizations, it is important to train health talents which is suitable for the grass-roots level, develop basic-level medical organization service qualities and pays more attention to the employment guidance in higher vocational schools, which can help medical vocational students cultivate proper views of employment.

Objective To investigate the effect of high uric acid(HUA) on insulin sensitivity (IS) in 3T3-L1 adipocytes and its mechanism. Methods 3T3-L1 adipocytes were pretreated with HUA with or without NAC,and then stimulated by insulin. The cell viability of 3T3-L1 adipocytes was detected by CCK-8 assay. The glucose consumption was measured by glucose oxidase method. The levels of phospho-IRS-1,phospho-Akt and GluT4 protein were tested by western blot. Results HUA could inhibit insulin-induced glucose consumption,phosphorylation of Akt (Thr308),dephosphorylation of IRS-1 (Ser307) and the GluT4 protein expression (P<0.05). All the above could be blocked by NAC(P<0.05). Conclusion HUA can inhibit inulin stimulated IRS-1/Akt signaling and GluT4 expression,and thus induced insulin resistance in 3T3-L1 adipocytes.

OBJECTIVE:To find out the situation of antidiabetic drugs used in 47 hospitals of Shanghai and to make objective evaluation as reference for production,sale and consumption departments.METHODS:To investigate the hypoglycemic drugs used in 47 hospitals of Shanghai during the period 1998～2001 in respect to the sum of money of consumption,kinds of drugs,DDDs and DDC.RESULTS:In recent 4 years,the annual rate of growth of antidiabetic drugs were 11.98% in DDDs?6.32% in DDC and 19.05% in sum.Among the increasing ranges of antidiabetic drugs in DDDs,joint venture drugs occupied the first place,imported drugs came second,and domestic drugs got the least.CONCLUSION:Antidiabetic drug is a kind of common drug which has developmental future.

Objective Evaluate the efficiency of scientific research output of the 54 departments in a hospital,to put forward improvement suggestions based on the evaluation results.Methods Select appropriate indicators of scientific input and output,use the Data Envelopment Analysis method to evaluate and analyze the efficiency.Results According to the analysis of DEA,calculate the values of overall efficiency,technical efficiency,scale efficiency and scale income.Then compare and analyze the relative efficiency of different units scientific output,to identify the relatively superior department a mong the various categories.Conclusions According to the evaluation results,to find out the input surplus and insufficient output of each decision units.Then we will put forward suggestions on hospital resource allocation to optimize the scientific input and output,to improve the competitiveness of the hospital,and to activate the potential of each department's scientific research.

Objective:To examine clinic pathological features of mucinous cystic neoplasms (MCN) of the pancreas and explore the prognosis factors associated with malignant transformation of MCN of the pancreas.Methods:This multicenter retrospective study included all patients with pancreatic MCN underwent surgery at Department of Pancreatic Surgery, Zhongshan Hospital of Fudan University between January 2008 and December 2018 and patients with MCN who confirmed by postoperative pathology from Multicenter Pancreatic Cystic Tumor Database. There were 50 males (14.4%) and 297 females (85.6%) and the mean age was 48.6 years (range: 24-77 years). According to the pathological results, all patients were divided into benign lesion group (including MCN and which associated with low/medium grade dysplasia) and malignant lesion group (including MCN with high-grade dysplasia or invasive carcinoma) . The preoperative clinical pathology and imaging features of the two groups were analyzed, and the risk factors associated with malignant transformation of MCN were statistically analyzed.Results:This multicenter retrospective study included 347 patients. Twenty-four of the 347 patients were malignant, including 7 males and 17 females. Univariate analysis showed that age, gender, carcino-embryonic antigen (CEA) , CA19-9, CA125, tumor maximum diameter, and tumor location were remarkably different in the two groups ( P<0.05) . Logistic regression analysis found that the preoperative tumor maximum diameter ( OR=1.023, 95 % CI: 1.002-1.045, P=0.035) was an independent risk factor for MCN malignant transformation. Conclusions:Age, gender, CEA, CA19-9, CA125, tumor maximum diameter, and tumor location are important features of MCN malignant lesions.The maximum diameter of the preoperative tumor is an independent risk factor for MCN malignant transformation.

Objective:To examine clinic pathological features of mucinous cystic neoplasms (MCN) of the pancreas and explore the prognosis factors associated with malignant transformation of MCN of the pancreas.Methods:This multicenter retrospective study included all patients with pancreatic MCN underwent surgery at Department of Pancreatic Surgery, Zhongshan Hospital of Fudan University between January 2008 and December 2018 and patients with MCN who confirmed by postoperative pathology from Multicenter Pancreatic Cystic Tumor Database. There were 50 males (14.4%) and 297 females (85.6%) and the mean age was 48.6 years (range: 24-77 years). According to the pathological results, all patients were divided into benign lesion group (including MCN and which associated with low/medium grade dysplasia) and malignant lesion group (including MCN with high-grade dysplasia or invasive carcinoma) . The preoperative clinical pathology and imaging features of the two groups were analyzed, and the risk factors associated with malignant transformation of MCN were statistically analyzed.Results:This multicenter retrospective study included 347 patients. Twenty-four of the 347 patients were malignant, including 7 males and 17 females. Univariate analysis showed that age, gender, carcino-embryonic antigen (CEA) , CA19-9, CA125, tumor maximum diameter, and tumor location were remarkably different in the two groups ( P<0.05) . Logistic regression analysis found that the preoperative tumor maximum diameter ( OR=1.023, 95 % CI: 1.002-1.045, P=0.035) was an independent risk factor for MCN malignant transformation. Conclusions:Age, gender, CEA, CA19-9, CA125, tumor maximum diameter, and tumor location are important features of MCN malignant lesions.The maximum diameter of the preoperative tumor is an independent risk factor for MCN malignant transformation.

Objective To analyze the effects of quality supervision and continuous improvement system on optimizing in-hospital diagnosis and treatment process in patients with acute ischemic stroke (AIS).Methods From September 2013 to May 2016,424 consecutive patients with AIS treated with intravenous thrombolysis and/or endovascular therapy in Changhai Hospital,the Second Military Medical University were enrolled retrospectively.They were analyzed according to the annual running process (the first year[from September 2013 to August 2014],the second year[from September 2014 to August 2015],and the third year[from September 2015 to May 2016]).The spend time and delay (DTN>60 min,DTP>90 min) rate of each treatment process in the first,second,and third year (time from door-to-imaging[DTI],door-to-needle[DTN],imaging-to-needle (ITN),door-to-groin puncture (DTP) and imaging-to-groin puncture (ITP) were compared.Taking the time periods (>median) of having significant differences of the spend time of the treatment processes as the dependent variables in the first,second,and third year,the influence of the years and treatment modalities on delay was observed.The difference of constituent ratio of the reasons for delay in intravenous thrombolysis and endovascular therapy (objective reasons/other reasons) in different years were analyzed.Results (1) DTIs were 23.0 (11.0,42.0) min,22.0 (10.1,39.0) min,and 13.0 (6.0,27.0) min,respectively,and DTNs were 50.0 (30.0,77.1) min,45.0 (30.0,70.2) min,and 36.0 (24.0,57.0) min,respectively in the first,second,and third year.The spending time was shortened year by year.There were significant differences among the different years (all P<0.01).The spending time of DTP had a tendency to be shortened,but there were significant differences among different years (P=0.06).There were no significant differences between the spending time of ITN and ITP (all P>0.05).(2) The DTN delay rates were 33.3% (40/120),20.7% (29/140),and 8.1% (9/111),respectively in the first,second,and third year.There were significant differences among the 3 years (x2=22.111,P<0.01).There were no significant differences among the DTP delay rates (P=0.08).(3) Multivariate Logistic regression analysis showed that taking the first years as a reference,the risk of DTI delay was reduced in the third year (OR,0.174,95%CI 0.101-0.298,P<0.01),the risks of DTN delay were reduced in the second and third year (OR,0.564,95%CI 0.338-0.941;OR,0.180,95%CI 0.101-0.320,all P<0.05).For simple intravenous thrombolysis,bridging therapy was a protective factor for the improvement of treatment efficiency in the DTI process (OR,0.530,95%CI 0.297-0.943,P=0.031).Compared with the bridging therapy,the direct endovascular therapy was a protective factor for DTP treatment (OR,0.427,95%CI 0.202-0.901,P=0.025).The remaining independent variables were not associated with the occurrence of DTN and DTP delay (all P>0.05).(4) During the three years,the delay of intravenous thrombolysis was mainly due to objective reasons.The constituent ratio of other reasons caused delay of intravenous thrombolysis was decreased year by year.There was no other reasons for delay in the third year).There was no significant difference in the constituent ratio of the delay reasons in endovascular treatment (x2=3.622,P=0.164).Conclusion Under the existing process and resource allocation,setting the DTN target time and implementing continuous quality improvement are conducive to the effective implementation of brain CT scan and continuous optimization of intravenous thrombolysis in the processes in AIS patients with the first diagnosis.

Objective Discussion on the methods of retrospectively selecting peer review experts based on the results of review.Methods Based on the review data of peer reviewers,peer review experts are retrospectively selected based on the voting,rating and comprehensive evaluations,as well as their variations and errors during the review.Results Through the retrospective selection of peer reviewers,there is a better convergence of reviews,which assures the quality of future peer reviews.This method is superior to the prospective selection of peer reviewers.Conclusions Based on the results of the review,retrospective selection of peer review experts is feasible and helpful for the selection of high-level peer review experts,which can improve the quality of peer review and standardize peer review.

Objective Based on the three years' peer review data of a project fund,the results of fund peer review were analyzed and evaluated,to provide references for further improvement of the peer review and management.Methods Based on the fund's peer review results of 2145 projects in three years,descriptive statistics,single-item identification index were adopted,as well as RJ normality test,t-test and other statistical methods,to analyze and assess the overall data of fund,project categories,individual scores,etc.Results The score distribution of the three year peer review project of the fund is almost normal distribution,and the overall consistency of peer review shows a better trend.The analysis shows that the peer review experts of the fund have better consistency in terms of project innovation,rationality and characteristics.While there were differences in the peer review of applicability.Conclusions The three year peer review data of the fund show that three years' evaluation results are reliable,reasonable,and the quality of evaluation is good,showing a better development trend in both project quality and expert consistency.

Objective To enhance the understanding of the quality control of rubber closures and to promote pharmaceutical manufacturers'reasonable selection and effective management of rubber closures.Methods According to the performance needs of drug products for rubber closures,the impacts of the ingredients and manufacturing processes of rubber closures with other possible influence on drug products were analyzed.Complied with the requirements of pharmaceutical lifecycle management,the processes of selection and utilization of rubber closures were divided into three periods,including screening,validation and maintenance,and suggestions on the tasks and goals for these three periods were given.Results Though the actual performance of rubber closures was affected by multiple factors,the processability in the pharmaceutical manufacturing processes and the suitability in the periods of storage,transportation and clinical application could be confirmed by reasonable screening and scientific validation of rubber closures.And by the effective quality control of rubber closures,the suitability could be maintained across the lifecycle of drug products.Conclusion By means of the reasonable selection and effective quality control of rubber closures,it would be benefit for keeping drug safety,efficacy and quality controllability throughout the lifecycle.