Humans ; Physicians ; Professional-Patient Relations

Good standardized training of resident physicians is indispensable for high quality medical personnel building.This paper gives a brief introduction to the experiences of endocrinology fellowship trainings in three top hospitals in USA.On the basis of current simation in China,a new and improve the quality'is proposed,and a new approach is explored,which is a valuable reference for the endocrine resident trainings in China.

OBJECTIVE To establish a convenient method for detecting plasmid-mediated AmpC beta-lactamases in Enterobacteriaceae lacking chromosomal AmpC beta-lactamases and to investigqte their genotype.METHODS Fifteen isolates of Klebsiella pneumoniae were collected and the diameters of inhibitory zone of cefoxitin in combination with or without cloxacillin were measured separately by standard disc diffusion test.The M3D assay was used as control method.And the activity of AmpC beta-lactamases of all isolates was simultaneously assayed.Multiplex PCR was performed to determine the genotype of AmpC beta-lactamases.RESULTS Among 15 isolates,8 isolates were identified to have plasmid-mediated AmpC beta-lactamases.The sensitivity and specificity of AmpC beta-lactamases phenotypic confirmatory test were 100%.Eight of 15 isolates were identified to be DHA-1 beta-lactamases by multiplex PCR.CONCLUSIONS The new AmpC beta-lactamases phenotypic confirmatory test is a reliable method for detecting plasmidmediated AmpC beta-lactamases in Enterobacteriaceae lacking chromosomal AmpC beta-lactamases.DHA-1 beta-lactamases are the main genotypes of plasmid-mediated AmpC beta-lactamases in Hubei Province of China.

Objective To investigate the clinical Results of microwave heliotherapy on the malignant bone tumors of scapula. Methods Form June 1998 to February 2008, 17 patients with malignant bone tu-mors of scapula were treated with microwave heliotherapy. There were 12 males and 5 females, 48 years old on the average (ranging from 13 to 59 years). The tumors included: the primary malignant tumor of the scapula (12 cases), the metastases of the scapula (5 cases). Locations of tumors included: the SI region (14 shape or curved nick on the surface of scapula. The lesions were heated at 50 ℃ fur 20 min at 2450 MHz microwave, with surrounding soft tissue protected by copper mesh. The necrotic tumor tissues were excised after the treatment of microwave heliotherapy. Results The axillary nerve of the patient with the metastases of the scapula was cut off, and the broken ends were sewed up after the tumor was excised. The duration of surgery was from 60 minutes to 180 minutes (120 minutes on average). The blood loss was from 300 ml to 1000 ml (460 ml on average). All patients were followed up for 3 months to 10 years (4.2 years on average). Three cases with Ewing sarcoma died due to brain metastases, pulmonary metastases or all body metastases 8 to 24 months postoperatively. Three cases with malignant fibrous histiocytoma died due to pulmonary metastases or all body metastases 10 to 22 months postoperatively. Five cases with the metastases died due to metastases 6 to 14 months postoperatively. Three patient's superduet function of shoulder joint was re-stricted. Conclusion The clinical Results demonstrated that the advantages of microwave heliotherapy in-cluded quick increase of temperature, sensitive responses, easy control of temperature, and effective inacti-vation of tumor cells in the malignant bone tumors of scapula.

Drug-Related Side Effects and Adverse Reactions ; Humans

Objectives:To evaluate the role of percutaneous endoscopic gastrostomy and jejunostomy in postoperative critical patients. Methods:Percutaneous endoscopic gastrostomy and jejunostomy procedures were performed in 22 postoperative critical patients.Indication, procedure-related complication, technical success and clinical outcome were reviewed. Results:The technical success was 100% and there were no death and serious complication.PEG/J feeding tubes was used for enteral nutrition for more than 30 days in 21(95%) of 22 patients. In 3 patients (14%) , local cleansing, drainage and intravenous antibiotics were used for the infection of PEG site. PEG/J tube dysfunction occurred in 6 patients (27%). Conclusions:PEG/J is a safe, minimal invasive, and effective procedure for enteral nutrition in postoperative critical patients.

Carcinoma, Squamous Cell ; metabolism ; pathology ; Chemokine CCL2 ; metabolism ; Fibroblast Growth Factor 7 ; metabolism ; Fibroblasts ; metabolism ; pathology ; Gelatinases ; metabolism ; Humans ; Membrane Proteins ; metabolism ; Mouth Neoplasms ; metabolism ; pathology ; Neoplasm Invasiveness ; Neoplasm Metastasis ; Serine Endopeptidases ; metabolism

Objective To determine sonographic features of thyroid follicular carcinoma ( FC) in comparison with thyroid follicular adenoma ( FA ).Methods This retrospective study included 36 pathologically proven FCs (5 widely invasive FCs and 31 minimally invasive FCs)and 52 FAs in 88 patients who underwent thyroid surgery .We analyzed clinical features of each patient ,including patient gender,age, and sonographic features of each tumor , including maximum diameter, peripheral halo, echogenicity, echotexture,calcifications and nodule number .These clinical and sonographic findings were compared by using t test ( age and diameter ) or the χ2 test (sex ratio,halo,echogenicity,echotexture,calcifications and nodularity)between FAs and FCs.Results For sonographic features,predominantly solid content(100.0%, 36/36),hypoechoic echogenicity (69.4%,25/36),inhomogeneous echotexture (83.9%,26/32),presence of calcifications(55.6%, 20/36) and without or with irregular halo (69.4%,25/36) were more commonly found in FCs.In comparison,FAs were more likely to present with mixed or predominantly cystic content (61.5%,32/52),isoechoic echogenicity (63.5%,33/52),homogeneous echotexture (80.8%,42/52), absence of calcifications (7.7%,4/52) and thin halo (86.5%,45/52) ( χ2 =34.813,28.596,35.256, 25.052,28.811,all P<0.01).The maximum diameter and mean age did not show statistically significant difference between FCs and FAs (t=0.222,-1.228,P=0.825,0.223).The proportions of tumor larger than 40 mm(22.2%,8/36 vs 17.3%,9/52),solitary nodule(31.3%,12/24 vs 21.2%,11/41),male sex (25.0%,9/27 vs 23.1%,12/40)and patient older than 45 years(66.7%,24/36 vs 71.2%,37/52)did not show statistically significant difference between FCs and FAs ( χ2 =0.330,1.635,0.043,0.201,all P>0.05).Conclusion Sonographic features,including predominantly solid content ,hypoechoic echogenicity, inhomogeneous echotexture ,presence of calcifications and without or with irregular halo were more commonly seen in FCs.

Objective To infer its transmission origin and route through studying the feature of molecular epidemiology of an HCV outbreak in Guangzhou.Methods Serum samples 192 cases in an HCV outbreak incident were analyzed for 2a and 6a subtypes.Appropriate genotypes were selected as control group.Informatics software were used in the evolutionary analysis to construct time scale trees and infer the origin time of HCV infection.Results Of 119 patients in the HCV outbreak,66 cases were 2a and 110 cases were 6a subtype.No other genotypes were found.The evolutionary analysis indicated the isolates of 2a group and 6a group both originated from 2 ～ 5 years ago.Both of 2a group and 6a group were in line with the characteristics of iatrogenic infection.Conclusion 2a and 6a were the main sub-genotypes in the Guangdong HCV outbreak investigation and they were originated from 2 to 5 years ago,which were in line with the characteristics of iatrogenic transmission.With the extension of time,a large number of cases accumulated and led to outbreak.