Goal To research the major factors affecting medical undergraduates' employment.Method In combination with quantity and quality,we reasonably analyzed the factors affecting the employment of Grade 2006 undergraduates in a Medical University in Chongqing.Result The major factors consist of the inadequate knowledge、the increased condition admission、hidden rule and the unreasonable objects.Conclusion Medical universities should try their best to adapt to the development of the society and medical students should try to become the useful talents.

Objective To evaluate the image quality of dynamic three-dimensional contrast enhanced ultrasonography(3D-CEUS) in liver tumors.Methods Twenty-five patients were examed with 2D-CEUS and dynamic 3D-CEUS.Contrast-enhanced computed tomography or magnetic resonance imaging(CECT/MRI) were performed early or late.Two readers reviewed the images of both modalities and graded the images according to diagnostic criteria as follows:tumor blood fusion in arterial phase(unclear-score 0,moderate-score 1,clear-score 2),tumor boundry and relationship with periphery tissues (unclear score 0,moderate-score 1,clear-score 2).The concordance between the two modalities for showing liver tumors was evaluated by Kappa test.Results Twenty-three of 25 danymic 3D-CEUS were displayed successfully versus total objects in CECT/ MRI.Among them,for showing blood fusion,16 lesions scored 2,7 lesions scored 1,2 lesions scored 0 in danymic 3D-CEUS,meanwhile 18 lesions scored 2,7 lesions scored 1,0 lesion scored 0 in CECT/MRI,the Kappa value was 0.65.For showing tumor boundry and relationship with peripherytissues,16 lesions scored 2,7 lesions scored 1,2 lesions scored 0 in danymic 3D-CEUS,meanwhile 21 lesions scored 2,4 lesions scored 1,0 lesion scored 0 in CECT/MRI,the Kappa value was 0.52.Conclusions Danymic 3D-CEUS was shown to be useful for displaying tumor blood fusion,boundry and relationship with periphery tissues in single liver tuomor,the concordance between dynamic CEUS and CECT/MRI for single liver tuomor was fair.For huge liver tumor and multi-tumors,3D-CEUS can not give overall information.

Objective:To discuss the role of clinical pharmacists in avoiding, eliminating and alleviating the effect of medical dis-putes caused by adverse drug reaction ( ADR) and provide reflections and suggestions for the disputes. Methods:Clinical pharmacist participation in the treatment of one case of dispute caused by serious adverse drug reaction was described and analyzed. Results:Clini-cal pharmacists provided opinions and suggestions for the dispute, and promising effect was obtained. Conclusion: Clinical pharma-cists should have excellent medical knowledge and good communication skills, and medical personnel should closely monitor patients in order to avoid medical disputes caused by ADR.

Objective To observe the efficacy and safety of arginine vasopressin receptor antagonist tolvaptan for treating hyponatremia caused by syndrome of inappropriate secretion of antidiuretic hormone (SIADH).Methods Six patients diagnosed with SIADH were enrolled in this study.Four cases were allocated to tolvaptan group (oral tolvaptan 15-60 mg/d,the dosage was adjusted based on the level of serum sodium).Two cases were allocated to regular treatment group (liquid was limited 1 000 ml/d,intravenous drip was less than 3％ sodium chloride and/or oral salt capsule 10-15 g/d several times was adjusted based on the level of serum sodium).Data of the level of serum sodium at 4,7 d,baseline value of serum sodium,serum sodium at the first normal time,24 h urine and weight change were collected.Safety assessment was given before and after treatment,including medical history,physical examination,electrocardiogram,laboratory tests,and incidence of adverse events.Results The level of serum sodium in tolvaptan group increased from the first day of the treatment.During the period of treatment,serum sodium at 4 d increased 22,16,14,11 mmol/L compared with the baseline value respectively.No obvious change of sodium was observed in regular treatment group compared with the baseline value.For 7 d treatment,serum sodium level increased 14,13,14,13 mmol/L in tolvaptan group compared with the baseline level respectively.Only 2 cases in regular treatment group increased 4 mmol/L,and sodium level in regular treatment group did not reach the lower limit of normal level of serum sodium.In tolvaptan group,all patients urine output increased after 1 d treatment and began to stabilize in 3 d.24 h urine putouts were much more than 1 500 ml during treatment.Urine putouts 780-1 400 ml were observed in regular treatment group.There was no difference before and after treatment.Although weight dropped after treatment in the two groups,weight in tolvaptan group fell obviously.In the two groups,there was no difference in blood pressure and heart rate before and after treatment.There were no serious complications and adverse events.Conclusions Compare with regular treatment,arginine vasopressin receptor antagonist is more effective therapy because it can correct the SIADH in patients with hyponatremia and reduce water retention.It also has a good security.

Objective To explore the ultrasonographic characteristics in craniocerebral gunshot injured areas and the value of ultrasound technology for judging the activity of wound tissues. Methods After establishment of the model of penetrated craniocerebral gunshot wound, the ultrasonographic characteristics of the tissues in the injured areas were observed by conventional ultrasound and contrastenhanced ultrasonography(CEUS) ,and compared with the pathological changes of the wound area. Results ①A straight-looking, irregular-edged, easily distinguishable pipe-shaped high-level echo can be seen by conventional ultrasound in craniocerebral gunshot injured areas. ②The pipe-shaped strong echo usually shows non-enhancement by the CEUS,or shows homogeneous hypo-enhancement in some areas. ③Tissues around the pipe-shaped echo usually appears that the homogeneous hypo-enhancing area and non-enhancing area exist together. ④Around the above-mentioned the hypo-enhancing area and non-enhancing area, a hyper-enhancing area can be seen, and appears to be a typical ring-shaped high-level echo in short-axis section of the pipe-shaped echo. ConclusionsConventional ultrasound can easily shows the distribution of craniocerebral gunshot injured areas characterized by pipe-shaped high-level echo, and CEUS can precisely demonstrate necrotic tissues in the gunshot injured areas,distinguish them from the degenerative tissues and normal tissues. The application of ultrasound technology will greatly improve the therapeutic and treatmental level of the craniocerebral gunshot wound.

Objective To explore the significance of serum cystatin C (Cys C)and β2-microglobulin (β2-MG) levels in blood and urine samples in hypertension grading and risk stratifying. Methods One hundred and thirty six cases with primary hypertension were enrolled into the study and classified into three grades and four risk stratifications. The serum Cys C levels were determined by ELISA assay. The blood and urine β2-MG were measured by radioimmunoassay. The serum BUN, Cr concentration were measured by the automatic biochemical analyzer. Results The positive rates of urine β2-MG were the highest index in patients with grade 1 (32%) and low risk hypertension( 8% ) ,followed by serum Cys C levels( grade 1 hypertension 24% ) ,compared with other indices( Ps ＜ 0. 05 ). With the blood pressure elevating, as well as the risk stratification increasing,serum Cys C level and the blood, urine β2-MG levels increased gradually by grading and stratifications (Ps ＜0. 05 or Ps ＜0. 01 ). We also found linear regression relationship between serum Cys C ,urine β2-MG levels and the risk stratifications of hypertension( r =0. 851 and r =0. 469 respectively,Ps ＜0. 01 ). The significant changes of serum BUN,Cr were only found in patients with grade 3 or very high-risk hypertension. Conclusion Joint detection of serum Cys C and urine β2-MG may help to detect early glomerular and tubular dysfunction in primary hypertension patients. Serum Cys C and blood, urine β2-MG levels are also related with the occurrence and development of hypertension,which show clinical significance in hypertension prognosis.

Objective:To explore the correlation between serum cystatin C (Cys C)content and renal function in aged patients with benign prostatic hyperplasia (BPH).Methods:Clinical data of 237 aged BPH patients were retro-spectively analyzed.According to international prostate symptom score (IPSS),they were divided into mild group (n=25),moderate group (n=67)and severe group (n= 145);another 110 patients without prostatic hyperplasia were enrolled as normal control group in the same period.Levels of serum Cys C,blood urea nitrogen (BUN),ser-um creatinine (Scr),fasting blood glucose (FBG),blood lipids and prostate-specific antigen (PSA)were measured in all groups,and prostate volume (PV)was calculated.Results:Compared with normal control group,PV signifi-cantly rose [(18.94±4.62)ml vs.(40.09±12.72)ml],maximum urinary flow rate (Qmax)significantly reduced [(18.67±4.60)ml/s vs.(9.93±3.54)ml/s],and serum Cys C level significantly increased [(1.03±0.23)mg/L vs.(1.53±0.61)mg/L]in BPH group,P <0.01 all.Subgroup analysis indicated that serum Cys C levels in mild, moderate and severe group [(1.32±0.45)mg/L,(1.42±0.32)mg/L,(1.61 ±0.64)mg/L]were significantly higher than that of normal control group,P <0.01 all;and that of severe group was significantly higher than those of mild group and moderate group (P <0.01 or P <0.05).Pearson correlation analysis indicated that serum Cys C level was positively correlated with of age,SBP,DBP,FBG,BUN,Scr,PV and IPSS (r=0.179~0.580,P <0.05 or P <0.01),and inversely correlated with Qmax (r=-0.243,P <0.05)in BPH patients.Conclusion:Serum Cys C level significantly rise,and related with BPH degree,correlated with renal function in aged BPH patients,which can be used to predict renal function of these patients.

OBJECTIVE To find out the situation of the use of antimicrobials in our hospital and to evaluate the rationality of use.METHODS To make a survey of the use of antimicrobials in our hospital among inpatients during Jan-Jun 2007,the data of reasonable use of antibacterial were obtained after evaluation and analysis.RESULTS The pay for antimicrobials among inpatients occupied for 14.16% of total consumption,mainly for cephalosporins.CONCLUSIONS The medical workers should administer antimicrobials in a more reasonable way to fight for a safe,effective,economical goal in our work.

Objective To explore optimized procedures and science decision-making methods for the triage in sanitary train and improve efficiency. Methods The work condition of triage was evaluated with queuing theory and mathematical models. Results The work of triage needs to be further optimized. The M/M/n model of queuing theory can improve efficiency, and then waiting-time that from triage site to specifically sickbed can be shorten consumedly. Conclusion The application and assistance decision on queuing theory in the triage can optimize organization plan and enhance work efficiency.

OBJECTIVE To find out the situation of antimicrobial usage in cardiac surgical perioperative period.METHODS The use of antimicrobials in cardiac surgical perioperative patients during Jan-Jun 2007,and the data of reasonable use of antibacterial were surveyed and evaluated.RESULTS Of the 276 patients,100.00% of them had received antimicrobials involving 12 kinds,59.78% of them used one kind only and 34.78% used two kinds antibiotics and 5.43% used more three kinds.CONCLUSIONS The use of antimicrobials in cardiac surgical perioperative period is reasonable and scientific.