Traditionally the cultivation mechanisms of pathological postgraduates can not fully adapt to the demand of research and society in China,to some extent,which impedes the development of pathology.Combining our practical conditions with overseas experiences,we try to make the beneficial thinking and adjustment on the existing cultivation mechanisms.

Objective to analyze the influence obstetric factors of the small for gestational age(SGA)in twins,so as to direct the clinical prenatal supervision in clinic. Methods A retrospective study of the SGA was performed,the general data of 1 514 patients admitted in obstetrics and gyne-cology of Shengjing Hospital during 2001 to 2014 were analyzed by Logistic regression analysis. Results the incidence of the SGA in twins was 10.89%. the protective factors were male fetus,assisted reproductive technology(ARt)and gestational diabetes mellitus(GDM). the risk factors were the female fetus and hypertensive disorders in pregnancy. Conclusion the gender of fetus,assisted reproductive technology(ARt),gestation-al diabetes mellitus(GDM),hypertensive disorder complicating pregnancy are the influential factors of the SGA in twins. We recommend a further pre-pregnancy and pregnancy care which is of significance for the prevention of SGA.

Objective To investigate the histological changes and collagen phenotype of a semitendinosus autograft after reconstruction of posterior cruciate ligament(PCL) in rabbits. Methods Twenty skeletally mature New Zealand white rabbits were divided into two groups. In group 1, the PCL of the right knees of 18 mature New Zealand white rabbits were resected and immediaterly reconstructed with double-band semitendinosus antograft. Then the rabbits were respectively killed at 3, 6, 12, 26 and 52 weeks after the operation, to obtain the the semitendinosus autografts. Group 2 consisting of the other 2 rabbits was served as control group, and semitendinosus tendons and PCL were obtained. All specimens were staining with hematoxylin and eosin, toluidine blue and immunohistochemical methods of type Ⅰ, Ⅲ collagens to analyze the histological changes and collagen phenotype of a semitendinosus autograft, and compare those with normal semitendinosus tendons and PCL. Results Histological results demonstrated that there was obvious difference at the cell formation between normal semitendinosus tendon and PCL. After postoperative 52 weeks the graft was similar to the normal PCL, while the alignment of graft was still different from that of normal PCL through necrosis, cell growing in, collagen formation and remolding. Immunohistochemistry result demonstrated: the staining of type Ⅰ collagen in graft was low at first, then increased gradually; the staining of type Ⅲ collagen was low at first, increased quickly, then decreased, at 52 weeks it was present in local areas. But positive reactions for type Ⅰ collagen were localized in collagen fibers, and those for type Ⅲ collagen were localized in synovium in normal PCL. Conclusion The study showed the semitendinosus autograft was still different in cell formation from normal PCL at 52 weeks after PCL reconstruction with semitendinosus.

Objective To compare the effects of different surgical time for the recovery of elderly patients with acute cholecystitis and provide reference for its clinical treatment. Methods Clinic data of 79 elderly patients with acute cholecystitis from January 2008 to September 2013 were analyzed retrospectively. Patients were divided into two groups according to different surgical time, 42 cases having surgery within 72 h as early surgery group, and 37 cases having surgery later than 72h as delayed surgery group then the curative effects of two groups were compared and analyzed. Results The success rate of early surgery group reached 97.6%, and that of delayed surgery group 91.9%, which showed no statistically significant difference (P > 0.05); with shorter operative time, less blood loss, shorter length of hospital stay and less medical cost, patients recovered better in early surgery group than those in delayed surgery group and there were statistically significant differences between two groups (P<0.05), while the postoperative discharge time of two groups had no significant difference (P>0.05).The complication rate of early surgery group was 2.4%, and that of delayed surgery group 18.9%, which indicated statistically significant difference (P<0.05). Conclusions Early surgical treatment for elderly patients with acute cholecystitis has a good therapeutic effect and is beneficial to the early rehabilitation of patients.

Great difficulties and challenges are existed in the training of clinical type postgraduate of neurosurgery because of the acute onset,server illness and difficult diagnosis of neurosurgical diseases.This paper proposed countermeasures of combing theory with clinical practice and strengthening comprehensive ability after analyzing problems of inadequate professional knowledge,lack of doctor-patient communication and insufficient clinical thinking and innovating ability.The aim was to cultivate the overall quality of postgraduates,making them more qualified for the difficult task of being neurosurgery clinicians.

ObjectiveTo evaluate the effect of early fluid resuscitation in treatment of septic shock.Methods56 patients with septic shock in ICU were divided into two groups by the method of the treatment. Early goal-directed therapy were given in the early fluid resuscitation group except anti-infective treatment, and the traditional therapy were given in the traditional group. The CVP,MAP,ScvO2 ,SaO2 of 6h and 12h of intra-treatment were observed in the two groups, and the incidence of MODS and the mortality rate were observed also. ResultsThe CVP,MAP, ScvO2, SaO2 of the early fluid resuscitation group were improved better than that in the traditional group. The incidence of MODS and the mortality rate in the early fluid resuscitation group were lower than that in the traditional group. ConclusionThe prognosis of septic shock was better for the early fluid resuscitation, and it could lower the incidence of MODS and the mortality rate.

Objective To report the first case of disseminated trichosporonosis in China.Methods A series of clinical,histopatholog ic,and mycologic studies were carried out in a 20year-old-female patien t,who had no definite underlying disease.The causative fungus was identified according to culture,biochemical t est and DNA sequencing.Results Abundant fungal spores,yeasts and h yphae were shown in the specimens tak en from infectious granulomas.The fungal c olonies in the culture of skin lesion s or crusts,liver,oral psedomembra ne,vagina,nasal cavity,urine,and sto ol were the same.The colonies exhibi ted creamy white to yellowish in colo r,rugose on the surface,and hyphae at t he periphery.Under microscopy,there were a lot of rectangular arthrospores,round or oval spores w ith or without buddings,as well as br anched and septate filaments.The isolated fungus was unanimously identified as Trichosporon asahii(No.AS 2.2174)through culture,bio-chemistry and molecular biology tests.The patient's condition was impr oved obviously after the combinatio n treatment of amphotericin B liposom e(Amphotec)and fluconazole.Conclusion The extensive and lasting systemic impairments caused by T.asahii have scarcely been reported at home a nd abroad.Combination therapy with amphotericin B and fluconazole is effective.

Objective To report Trichosporon asahii first isolation and identification of TH chosporon asahii in chain.Methods A clinical infection fungus strain was isolaled from mouth pseudomembrane vaginal,nasal secretions,urine,faces,and live puncture tissue,injured skin tissue of a female patient,who had no clear underlying disease.Through cultured in medium,biochemical assay,identification of the bacterial race molecular biology test and DNA sequencing.Result We demostrated that the fungus strain was unanimously identified as Trichosporon asahii.Conclution The Trichosporon asahii could induce the disseminated Trichosporonosis.

Objective To know the nursing scientific research status in recent years,and to reveal the differences between Chinese nursing scientific researches and foreign nursing scientific researches,in order to promote the rapid development of nursing cause in China.Methods Five Chinese journals of nursing and four foreign nursing journals were analyzed covered China National Knowledge Infrastructure (CNKI),PubMed and Google data ranged from 2008 to 2013.By adopting bibliometrics method,regional distribution,the number of people participation,the cooperation between units,the source of financial funding,research content and nature of Chinese nursing research papers were analyzed,and also compared to research content and nature of foreign nursing journals.Results The amounts of published papers were 1 527 pieces.The geographical distribution of research papers were all spread over 28 provinces,autonomous regions sand municipalities directly under the central government,most of which was Guangdong province [12.64％ (193/1 527)];The majority of research papers were completed by single unit and more than five people,which about [68.4％(1 045/1 527)],[38.6％(589/1 527)],respectively;Provincial level of research papers were more than national level [81.4％(1 243/1 527) vs.18.6％(284/1 527)];The papers focused on the clinical nursing research [37.8％(577/1 527)] and clinical basic nursing research [34.6％(529/1 527)].Almost researches were descriptive research,while 40.7％(622/1527) of which were clinical analysis.Foreign nursing scientific researches paid more attention to psychological research and nursing profession which were related to humanities and investigation was major method used;Compared with the foreign nursing papers at the same time,the number of Chinese nursing research papers increased rapidly (P ＜ 0.05);Papers were completed more than five units rapidly increased compared with the pre-upgrade,as well as the national subjects,the difference was statistically significant (P ＜ 0.05).Conclusions The number of nursing research programs tended to increase year by year and the enthusiasm of nurses participating in scientific research was higher than before.Different units needed to further strengthen cooperation in scientific research.The research content and direction were diversity,which had not yet formed central tendency.The research method was still limited to descriptive studies,and the creativity of the research methods was needed,especially laboratory research.

Objective To evaluate the efficacy of modification and care improvement in endotracheal tubes (ETTs) to prevent ventilator associated pneumonia (VAP) in patients receiving mechanical ventilation (MV).Methods PubMed,China National Knowledge Infrastructure (CNKI) were searched,literature information was extracted and classified according to the inclusion criteria,the data were statistically analyzed.Results Totally 46 clinical research articles and 6 laboratory research articles were involved,the data showed that polyurethane (PU) cuff [23.809％ (35/147)],silver-coated ETTs [4.830％ (37/766)],subglottic drainage duct [19.492％ (759/3 894)],discontinuous subglottic drainage[13.603％ (256/1 882)] were associated with a decreased incidence of VAP compared with polyvinyl (PVC) cuff [40.179％ (45/112)],non-silver-coated ETTs [7.537％ (56/743)],conventional ETTs[45.733％ (1 088/2 379)],continuous subglottic drainage [25.000％ (503/2 012)],the differences in the incidence of VAP were statistically significant,respectively,P＜ 0.05.The incidence of VAP in cylindrical PU cuff was 25.000％ (8/32),the tapered PU cuff was 21.875％ (7/32),the difference in the incidence of VAP was not statistically significant.Conclusions The modification of the ETTs and the care improvement can effectively reduce the incidence of VAP.