Objective To investigate the employment status of higher vocational medical col-lege graduates in Hainan province, analyze the existing employment problems, and put forward some effective suggestions. Methods A questionnaire was applied to survey the employment problems of 1 048 medical graduate in 11 medical related field of Grade 2012. A total of 989 valid questionnaires were collected. The questionnaires covered six aspects including graduates' basic information, their employment intention, access to employment information channel, service and satisfaction about school employment agencies, and employment psychology etc. SPSS 13.0 was used to analyze the statistical numbers in each option and the percentage was calculated. Results Only 22.9%(227/989) of the graduates were willing to accept the provincial employment, 49.1%(486/989) of the graduates obtained employment information channels through the school employment sector; 10.6%(105/989) of gradu-ates expressed dissatisfaction with employment services; graduates' entrepreneurial intention reached 26.9%(267/989); only 19.8% of graduates signed employment agreement, and 25.1%(248/989) of gradu-ates face the employment with anxiety and confusion. Conclusion The higher vocational medi-cal graduates in Hainan provinces need to change their employment concept and school employment guidance needs strengthening to link up the employer position requirements and expectations of grad-uates employment. Besides, the school enrollment professional settings and employment market demand also need to be linked up, to guarantee the system interface between career guidance, internship and training base.

Objective To investigate the drug resistance tendency of Klebsiella pneumoniae isolated from the clinical samples during 2012-2014 to provide reliable evidence for clinical treatment .Methods The Klebsiella pneumoniae strains isolated from the submitted specimens were collected and identified according to the national clinical test procedures ,and the drug sensitivity test was performed by using MIC method .The confirmation test of ESBLs was conducted by using K‐B method and the phenotype of carbap‐enemases producing was confirmed by using the improved Hodge test .Results Totally 410 strains of Klebsiella pneumoniae were i‐solated ,55 .87% of which were derived from sputum ,and the rest was derived from pus(9 .53% ) ,secretion(9 .47% ) and blood (8 .78% );Klebsiella pneumoniae was mainly originated from ICU ,respiration department and oncology department ,accounting for 16 .10% ,9 .02% and 7 .80% respectively ;the resistance rates of Klebsiella pneumoniae against imipenem was 0 .74% ,the resist‐ance rates of Klebsiella pneumoniae against ampicillin/sulbactam ,cafazolin ,cefepime ,cefotaxime ,cefatriaxone ,ceftazidine ,compound sulfamethoxazole were decreased year by year ,while which against amoxicillin/clavulanic acid showed the increasing trend as a whole .Conclusion Timely conducting the identification and drug susceptibility analysis on local Klebsiella pneumoniae and tracking its drug resistance trend can guide the rational and standardized use of antibacterial drugs ,reduces the pressure for selecting anti‐bacterial drugs in order to reduce the generation of drug resistant strains .

Objective To investigate the expressions of interferon γ(IFNγ), interferon inducible protein-10(IP-10). chemokine receptor CXCR3 and their significance in infection-associated hemophagocytic syndrome(IAHPS). Methods Forty-three patients with IAHPS, 35 infection patients without HPS and 25 healthy controls were included in the study. The serum IFNγ and IP-10 levels were measured by enzyme linked immunosorbent assay(ELISA). The expression of CXCR3 on cell surface of CD_4~+ and CD_8~+ T cells in peripheral blood was determined by flow cytometry. SPSS 13.0 was used for data processing, and independent-sample t test was performed to compare the differences among the groups. Results The serum IFNγ and IP-10 levels in patients with IAHPS were( 608±135) pmol/L and(939±141) pmol/L respectively, which were significantly higher than those in without HPS group[(154±45) pmol/L and (385±119) pmol/L, t=4.97 and 4.02, P<0.05] and healthy controls[(56±18) pmol/L and (248±98) pmol/L, t=5.27 and 4.77, P<0.05]. The expressions of CXCR3 on CD_4~+ and CD_8~+ T cells in IAHPS group were (35±11)% and (23±8)% respectively, which were significantly higher than those in without HPS group[(24±7)% and (16±7)%, t=3.12 and 3.62, P<0.05] and healthy controls[(20±6)% and (12±5)%, t=4.46 and 4.93, P<0.05]. Conclusion The expressions of IFNγ, IP-10 and CXCR3 are increased significantly in patients with IAHPS, which may be related to the disease pathogenesis.

n of IL-6 and TNF-alpha,alleviate the inflammation of ANP.

Resveratrol is a natural polyphenolic substance with a variety of bioactivities,such as anti-oxidation,anti-tumor and apoptosis induction.This paper summarized the recent research progress of resveratrol induced cancerous cell apoptosis,including human cervical cancer HeLa cells,leukemia cells,hepatoma cells and gastric cancer cells,and analyzed the molecular mechanism behind resveratrol-induced cell apoptosis in tumor.In addition,resveratrol was investigated by blocking the cell cycle,regulating the expressions of related genes and proteins and mitochondria-induced apoptosis pathways as a potential application of cancer drugs to clinical researches.

In this study,the coding region of type O FMDV capsid protein VP1 and a series of codon optimized DNA sequences coding for VP1 amino acid residues 141-160(epitopel),tandem repeat 200-213(epitope2(+2))and the combination of two epitopes(epitope1-2)was genetically cloned into the prokaryotic expression vector pPROExHTb and pGEX4T-1,respectively.VP1 and the fused epitopes GST-E1,GST-E2(+2)and GST-E1-2 were successfully solubly expressed in the cytoplasm of Escherichia coli and Western blot analysis demonstrated they retained antigenicity.Indirect VP1-ELISA and epitope ELISAs were subsequently developed to screen a panel of 80 field pig sera using LPB-ELISA as a standard test.For VP1-ELISA and all the epitope ELISAs,there were clear distinctions between the FMDV-positive and the FMDV-negative samples.Cross-reactions with pig sera positive to the viruses of swine vesicular disease virus that produce clinically indistinguishable syndromes in pigs or guinea pig antisera to FMDV strains of type A,C and Asial did not occur.The relative sensitivity and specificity for the GST-E1 ELISA,GST-E2(+2),GST-E1-2 ELISA and VP1-ELISA in comparison with LPB-ELISA were 93.3% and 85.0%,95.0% and 90%,100% and 81.8%,96.6% and 80.9% respectively.This study shows the potential use of the aforementioned epitopes as alternatives to the complex antigens used in current detection for antibody to FMDV structural proteins.

Objective To explore the current situation and requirements of the health management services among the middle-aged and elderly people in Hainan province for optimizing the health management service pattern. Methods The random sampling method was adopted to perform the survey and analysis on the current situation and requirements of the health management services among 600 middle-aged and elderly people by using the mode of questionnaire combined with interview. Results Totally 575 respondents completed the questionnaire. 43.1% of respondents could correctly understand the concept of health, 40.5% of them thought that "Health is the condition without disease" ;the main ways for getting the health knowledge by these people were mainly joining the intercommunication meeting of health management (97. 2%), phone counseling (94. 4%) and brochures (90.3%) ;the requirements of the health management service mainly focused on the middle age and elderly people aged 45- 59 years old. The most needed health management service items were the mental health service (99.0 %), cultural entertainment service(97.4 %) and health care recovery(84 %). The health management requirements had no statistical difference compared with the gender (x2 = 0. 678, P= 0. 712), cultural degree (x2 = 5. 584, P = 0. 471 ) and medical insurance situation (x2 = 3. 886, P = 0. 420) ;but compared with the age, the difference was statistically significant (x2 = 9. 697, P = 0.04). Conclusion The consciousness of health management among middle age and old people needs to be increased,the health management information platform construction and propaganda promotional efforts should be strengthened, the cooperation between government and enterprise should be strengthened, the pertinence of the health management service should be enhanced and the related policy laws and regulations should be perfected.

Objective To observe the efficacy and safety of different doses of mizoribine to prevent rejection after renal transplantation. Methods Sorted by time of operation and odevity, 206 primary kidney transplant recipients were divided into 3 groups, including MMF group, MZR Ⅰ group and MZR Ⅱ group. All recipients in 3 groups were administrated CsA and Pred, combined with mycophenolate mofitile (MMF) in MMF group and mizoribine (MMF) in MZR Ⅰ and Ⅱ groups.The dosage of MMF was 1. 0 g/day, while dosage of MZR in MZR Ⅰ and Ⅱ groups was 100 and 200 mg/day, respectively. There was no difference in usage of cyclosporine (CsA) and prednisone (Pred) among 3 groups. 100, 60 and 30 recipients were followed up in MMF, MZR Ⅰ and MZR Ⅱ groups respectively in 5 years. During the follow-up period of 5 years, the incidence of acute rejection, patient/graft survival and adverse effects associated with drugs in three groups were observed. Results The patient/graft survival was 88. 3 % (53/60), 85 % (51/60) in MZR Ⅰ group, 90 % (27/30),86.7 % (26/30) in MZR Ⅱ group, and 88% (88/100), 86% (86/100) in MMF group, respectively (P>0. 05). There was no significant difference in incidence of acute rejection among MZR Ⅰ (10 %, 6/60), MZR Ⅱ (6. 7 %, 2/30) and MMF groups (9 %, 9/100). The incidence of severe pulmonary infection in MZR Ⅰ group was 3. 3 % (2/60), and 10 % (3/30) in MZR Ⅱ , and the former was lower than MMF group (15 %, 15/100) significantly. There was significant difference in mortality of severe pulmonary infection between MZR Ⅰ group (0, 0/2) and MMT group (73. 3 %, 11/15). The rate of ACR in MZR Ⅱ group (10 %, 3/30) was lower significantly than MMF group (30 %, 30/100) and MZR Ⅰ group (31.7 %, 19/60). There was significant difference in the incidence of hyperuricacidemia between two MZR groups (30 %, 56. 7 %) and MMF group (10 %)(P<0. 05), while the incidence of diarrhea and myelosuppression was lower significantly in MZR Ⅰ group than in MMF group. Conclusion MZR can prevent acute rejection after kidney transplantation effectively and safely. Immunosuppressive therapy including mizoribine is the best choice especially for high risk group because of susceptibility to infection and those who suffer from tenacious diarrhea owing to the side effect.

Inflammatory bowel disease ( IBD) is a chronic disease including Crohn′s disease ( CD) and ulcerative colitis ( UC ) .There are no single diagnostic criteria for IBD .Biomarkers are an objective measurement and evaluation of physiological and pathological processes .And they have been widely used in the diagnosis and prognosis monitoring of IBD patients .

Objective: To investigate the clinical value of laparoscopic peritoneal dialysis catheter implantation in peritoneal chemotherapy for gastric cancer with peritoneal metastasis. Methods: From January 2019 to June 2019, the clinical data of 6 patients diagnosed as gastric cancer with peritoneal metastasis were retrospectively analyzed in the Gastrointestinal Surgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Five were male and 1 was female. The median age was 69.5 (28-77) years. The median body mass index (BMI) was 22.8 (19.6-23.5). All procedures were performed under general anesthesia with endotracheal intubation. The patient′s body position and facility layout in the operating room were consistent with those of laparoscopic gastrectomy. The operator′s position: the main surgeon was located on the right side of the patient, the first assistant stood on the left side of the patient, and the scopist stood between the patient′s legs. Surgical procedure: (1) trocar location: three abdominal trocars was adopted, with one 12 mm umbilical port for the 30° laparoscope (point A). Location of the other two trocars was dependent on the procedure of exploration or biopsy as well as the two polyester cuff position of the peritoneal dialysis catheter: Usually one 5 mm port in the anterior midline 5 cm inferior to the umbilicus point was selected as point B to ensure that the distal end of the catheter could reach the Douglas pouch. The other 5 mm port was located in the right lower quadrant lateral to the umbilicus to establish the subcutaneous tunnel tract, and the proximal cuff was situated 2 cm away from the desired exit site (point C).(2) exploration of the abdominal cavity: a 30° laparoscope was inserted from 12 mm trocar below the umbilicus to explore the entire peritoneal cavity. The uterus and adnexa should be explored additionally for women. Once peritoneal metastasis was investigated and identified, primary laparoscopic peritoneal dialysis catheter implantation was performed so as to facilitate subsequent peritoneal chemotherapy. Ascites were collected for cytology in patients with ascites. (3) peritoneal dialysis catheter placement: the peritoneal dialysis catheter was introduced into the abdominal cavity from point A. Under the direct vision of laparoscopy, 2-0 absorbable ligature was reserved at the expected fixation point of the proximal cuff (point B) for the final knot closure. Non-traumatic graspers were used to pull the distal cuff of peritoneal dialysis catheter out of the abdominal cavity through point B. The 5-mm trocar was removed simultaneously, and the distal cuff was fixed between bilateral rectus sheaths at the anterior midline port site preperitoneally. To prevent subsequent ascites and chemotherapy fluid extravasation, the reserved crocheted wire was knotted. From point C the subcutaneous tunnel tract was created before the peritoneal steath towards the port site lateral to the umbilicus. Satisfactory catheter irrigation and outflow were then confirmed. Chemotherapy regimen after peritoneal dialysis catheterization: all patients began intraperitoneal chemotherapy on the second day after surgery. On the 1st and 8th day of each 3-weeks cycle, paclitaxel (20 mg/m²) was administered through peritoneal dialysis catheter, and paclitaxel (50 mg/m²) was injected intravenously. Meanwhile, S-1 was orally administered twice daily at a dose of 80 mg·m^-2·d^-1 for 14 consecutive days followed by 7-days rest. To observe the patients′ intraoperative and postoperative conditions. Results: All the procedures were performed successfully without intraoperative complications or conversion to laparotomy. No 30 day postoperative complications were observed. The median operative time was 33.5 (23-38) min. The median time to first flatus was 1(1-2) days, and the median postoperative hospital stay was 3 (3-4) days, without short-term complications within 30 days postoperatively. The last follow-up was up to July 10, 2019, and the patients were followed for 4(1-6) months. No ascites extravasation was observed and no death occurred in the 6 patients. There was no catheter obstruction or peritoneal fluid extravasation during and after chemotherapy. Conclusion Laparoscopic peritoneal dialysis catheter implantation was safe and feasible for patients with peritoneal metastasis of gastric cancer. The abdominal exploration, tumor staging and the abdominal chemotherapy device implantation can be completed simultaneously, which could simplify the surgical approach, improve the quality of life for patients and further propose a new direction for the development of abdominal chemotherapy.