Clinical medical postgraduate education is an important part of higher education in China.We analyzed the current status,major problems existed,direction of the reform and the prospect in the training system.Unifying cultivation criterion,diversifying form of academic degree system,making selection standard strict for advisors and decreasing the proportion of research work for doctors were considered as the effective measures to address these issues.

Objective To explore the hospitalization expenses and its related factors of injury cases in Shenzhen city in 2006,and to provide basis for the expense control in future.Methods The medical expense proportion was calculated on 7 180 injury cases with hospitalization data from Shenzhen injury surveillance system,ANOVA and multivariate regression analysis were used to determine the influencing factors for the expenses.Result The medical expenses of injury inpatients in Shenzhen were 3 835.65 RMB/case and 437.86 RMB/case/day.36.10% and 20.27% of the total expenses were attributed to medication and therapy,respectively.The expense per day was correlated strongly with the level of hospital,length of stay,age,method of payment and injury location.Conclusions The disease burden of injury was higher than that of other diseases,Hospitalization expenses can be effectively controlled by taking strategies,such as enhancing the care and treatment before hospitalization,shortening the duration of hospitalization,avoiding infection in hospital and so on.

Objective To investigate the epidemiologic characteristics of injuries of children aged 0 ~14 yrs. Methods Described analysis was used to analyze the epidemiologic characteristics about the age, gender, injury type and cause in children 0~14 years old who visited in emergency department of hospitals form 2006 to 2007. Results During the study period, 16 124 injured children were collected. the rank of injuries type were contused/abrased wound (44.41%), open injury (36.10%), sprain (12.81%), bone fracture (3.25%) and burn/scald injury (1.49%); the cause of injuries were fall down (55.24%), animal injury (21.49%) , blunt injury (8.47%) and traffic injury (6.96%); The common place of injury occurred were at home (53.66%), public and resident place (18.01%), road/street (11.73%) and school (10.70%). The gender ratio was 1.94, the median age was 6 years, the male injury was decrease with the age increase, but so wasn't the female. Conclusion Injury gradually becomes the key health problem and influences the children health. The effective measures should be taken in term of the epidemiology characteristics of the injuries among children at 0-14 to prevent and control injury occurring. The health education of preventing injury occurring and behavior drawback should be conducted as early as possible to raise awareness of injury issues among children in the kindergartens and promote them growing healthily.

Objective:To explore the relationship between college students' online game addiction tendency and learning burnout,and find the differences between online game addicts and other types of addicts.Method:With the Learning Burnout Scale,revised Chinese Internet Addiction Scale's Revision,Questionnaire of Internet Addiction Tendency,and 420 college Students as the subjects,analysis of correlation and stepwise regression analysis were employed to analyze the related factors of learning burnout.Result:There were significant difference in the gender(?2=21.855,P

ObjectiveTo evaluate the efficacy and safety of Sirolimus (SRL) in immunosuppression following liver transplantation. Methods SRL was applied in 21 patients totally.Indication for adoption was Tac-related nephrotoxicity (4/21), suspiciously Tac-related hepatoxicity (8/21), Tac overdose (3/21), renal insufficiency pre-operation (2/21), or cancer (4/21). Median follow-up was 25. 4 months. Results SRL provided an adequate prophylaxis against rejection in all study patients, with one case of acute rejection. Sirolimus was Withdrawn in 2 cases due to its sideeffect. Tat-induced hepatoxicity in 6 cases and nephrotoxicity in 3 cases were relieved significantly.Conclusions SRL given alone appears to be an effective primary immunosuppressant regimen fororthotopic liver transplantation patients. Early conversion contributes to significant improvement of Tac-related hepatoxicity and nephrotoxicity.

Objective To investigate the relationship between serum prealbumin (PA) and inflammation in acute myocardial infarction (AMI) patients. Methods A prospective observational study was conducted. AMI patients hospitalized in the cardiovascular department of the General Hospital of Chinese People's Armed Police Forces from June 2014 to June 2016 were enrolled in the study. At the same time, healthy cases were enrolled as control. Venous blood was taken from patients at admission. Serum PA was detected by immune projection turbidimetry method and high-sensitivity C-reactive protein (hs-CRP) was measured by latex enhanced immune turbidimetry. High-sensitivity cardiac troponin T (hs-cTnT), and interleukin (IL-6, IL-8) was measured by electrochemical luminescence method. Creatine kinase-MB isoenzyme (CK-MB) was detected by rate method. PA, inflammatory factor and myocardial enzyme were compared between two groups. The correlation between PA and inflammatory factors was analyzed by Pearson linear correlation; The diagnostic value of PA was analyzed by receiver operating characteristic (ROC) curve. Results 173 AMI patients and 86 healthy controls were enrolled in the study. There were no significant differences in gender, age, history of smoking, hypertension and diabetes. Compared with the control, the levels of serum PA in AMI patients was lower [PA (g/L): 0.215±0.056 vs. 0.280±0.057], hs-CRP, IL-6, IL-8, hs-cTnT and CK-MB were higher [hs-CRP (mg/L): 6.63±3.52 vs. 2.25±1.45, IL-6 (ng/L): 38.03±22.43 vs. 6.13±3.38, IL-8 (ng/L): 295.61±98.70 vs. 17.24±7.31, hs-cTnT (μg/L): 4.789±2.874 vs. 0.009±0.008, CK-MB (U/L): 244.48±165.54 vs. 12.20±5.24], the difference was statistical significant (all P < 0.01). It was shown by Pearson correlation analysis that the levels of PA were negatively related to hs-CRP, IL-6 and IL-8 (r = -0.562, -0.591, -0.548, all P <0.05). The PA level had no correlation with hs-cTnT and CK-MB (r = -0.018, -0.149, both P > 0.05). It was shown by ROC curve analysis that area under ROC curve (AUC) of PA for diagnosis of AMI was 0.783±0.039, and the 95% confidence interval (95%CI) was 0.706-0.860 (P < 0.05). When the cut-off value was 0.190 g/L, the sensitivity was 29.63%, and the specificity was 62.22%. Conclusion PA may be involved in the inflammatory process of AMI and had a diagnostic value for AMI.

Currently,there is a worldwide increase in the incidence and mortality of intrahepatic cholangiocarcinoma (ICC),but the etiology of ICC remains unclear.Recent efforts suggest an etiological role of hepatitis B virus (HBV)infection in ICC,and this article reviews the relationship between chronic HBV infection and the risk and prognosis of ICC.

Objective To investigate the expression of MTSS1 in cholangiocarcinoma tissue and its relationship with the prognosis of patients.Methods The specimens of bile duct of 49 patients with hilar cholangiocarcinoma who received surgical excision at the Eastern Hepatobiliary Surgery Hospital from January 2003 to December 2005 were collected.Tissue microarrays of the 49 samples of hilar cholangiocarcinomas and the 10samples of adjancent normal bile duct epithelial tissue were constructed.The expression of MTSS1 was detected by the immunohistochemical staining.The pcDNA3.1-MTSS1 was transferred into the RBE cells and the abilities of proliferation of REB cells were measured by MTT assay.The patients were followed up via out-patient examination and telephone till May 2012.The measurement data were analyzed using the t test,and the count data were analyzed using the chi-square test,the survival curve was drawn by the Kaplan-Meier method,the survival was analyzed using the Log-rank test,and multivariate analysis was done using the COX regression model.Results The results of immunohistochemical staining showed that the expression rate of MTSS1 was 10/10 in the adjacent normal epithelial tissue of bile duct,while 59.2％ (29/49) in the cholangiocarcinoma tissues.The proliferative rate of cholangiocarcinoma cells transfected with MTSS1 was 1.55 ±0.05,which was significantly lower than 2.32 ±0.08 of cholangiocarcinoma cells without transfection of MTSS1 (t =4.454,P ＜ 0.05).Gender,age,TNM stage,T stage,differentiation,neural invasion and diameter of tumor did not influence the expression of MTSS1 (x2=0.211,3.471,0.507,0.507,0.368,0.882,0.660,P ＜ 0.05),while lymph node metastasis influenced the expression of MTSS1 (x2=10.436,P ＜ 0.05).All the patients were followed up for 1-59 months,and the median time for follow-up was 16 months.The median tumor-free survival time was 17.9 months in patients with positive expression of MTSSI,and 11.3 months of patients with negative expression of MTSS1,with no significant difference (Log-rank value =3.707,P ＞ 0.05).The median survival time was 34.9 months in patients with positive expression of MTSS1,which was significantly longer than 18.7 months of patients with negative expression of MTSS1 (Log-rank value =5.671,P ＜0.05).Multivariate analysis showed that MTSS1 was not the independent risk factor influencing the prognosis of patients (x2 =0.406,P ＞ 0.05).Conclusions The expression of MTSS1 is decreased in cholangiocarcinoma tissue,which negatively correlates with lymph node metastasis.MTSS1 could be used as a biomarker in predicting the prognosis of patients with cholangiocarcinoma.

Due to the air-filled alveoli and delicate vascular structure,the lung is the most easily damaged organ when human or animal is subjected to a shock wave.Primary pulmonary blast injury resulting from shock wave is an important cause of trauma not only in military conflicts but also in terrorism or accidents involving civilians.The physiological,pathological and biochemical changes after blast injury may lead to inflammatory response,cell apoptosis in the lung,boost the activation of cytokines including TNF-α,IL-6,IL-8 and IL-1β,and finally result in acute respiratory distress syndrome (ARDS).This paper presents the evolution and characteristics of pulmonary blast injury,and demonstrates four relevant experimental setups including biological shock tube,segmented shock wave generator,mini blast wave generator and laser-induced stress wave generator.Besides,this paper reviews the scoring system of pulmonary blast injury,pathological and biochemical measurement aiming to provide helpful reference to establish pulmonary blast injury models.

BACKGROUND:There are many reports on the clinical effect of total knee arthroplasty in the treatment of advanced rheumatoid arthritis, but the reports on the effect of total knee arthroplasty on the disease activity in patients with rheumatoid arthritis are rare. Therefore, the more clinical evidences are needed for supporting.
OBJECTIVE:To explore the effect of total knee arthroplasty on disease activity in patients with rheumatoid arthritis.
METHODS:109 patients with rheumatoid arthritis were included;48 cases in the replacement group, and received total knee arthroplasty combined with internal medicine medications;the 61 cases in the drug treatment group were treated with simple internal medicine medications. The rheumatoid factor, blood sedimentation rate and C-reactive protein levels of the patients in two groups were measured before treatment, 1 and 2 years after treatment, and the Ishikawa joint function scoring criteria was used to assess the functions.
RESULTS AND CONCLUSION:There were no significant differences in the rheumatoid factor, blood sedimentation rate and C-reactive protein levels between two groups before treatment (P>0.05). At 1 and 2 years after treatment, the indicators in the drug treatment group were higher than those in the replacement group (P<0.05);the indicators in the two groups at 2 years after treatment were significantly lower than those before treatment (P<0.05). The rheumatoid arthritis symptom scores of the affected joints of the patients in two groups were significantly improved, especial y the pain, swel and subjective attitudes, and the replacement group was better than the drug treatment group (P<0.05). The total knee arthroplasty can affect the disease activity of rheumatoid arthritis in short-term, and the effect of total knee arthroplasty is better than simple drug treatment.