Objective To analyze the medical undergraduates'employment intentions and determinants for policy recommendations on how to solve the contraction between the employment and human resources shortage working in the rural place.Methods Descriptive method was used for the employment recognition and unconditional logistic regression was employed for its factors analysis.Results 74.90% interviewees were not high for policy recognition,and only 21.16% undergraduates were willing to work in rural area.Logistic regression analysis found local culture and life environment (OR=2.668),institute performance(OR=0.630)and work challenge(OR=1.509)were key factors to affect their employment.Conclusion To give reform of primary institute performance mainly on pubic health service,take great importance on the medical service,improve work and life environment of rural workers and highly care health workers'career planning and development.

Liver cirrhosis is a common gastrointestinal disease. Portal vein thrombosis( PVT ) can increase the mortality of patients with liver cirrhosis. Studies showed that increased D-dimer level,spleen thickness and Child-Pugh score are independent risk factors of PVT in liver cirrhosis. In addition,increased portal vein diameter,reduced portal vein blood velocity,elevated P-selectin level can predict the development of PVT after portal hypertension surgery. This article reviewed the advances in study on risk factors of PVT in liver cirrhosis.

Objective To compare the difference of procalcitonin (PCT)level between serum and plasma in children so as to in-vestigate whether ethylenediamine tetraacetic acid dipotassium (EDTA-K2 )anti-coagulation plasma could replace serum to be an al-ternative material for PCT testing.Methods The PCT concentrations in the serum and EDTA-K2 anti-coagulation plasma from 90 children patients were detected by using the mini-VIDS-GB automatic enzyme linked fluorescence analyzer and the plasma PCT au-tomatic quantitative detection method.The correlation between the two sets of data was analyzed.And the data were assigned into the 3-level groups for conducting statistic analysis.At the same time the influence of child′s age and gender on the PCT level was al-so discussed.Results The PCT level in serum was well correlated with that in EDTA-K2 anti-coagulation plasma (r=0.812,P <0.05).There were no statistically significant differences in PCT levels between serum and plasma measured in the low level groups (P >0.05).However,the differences of the PCT levels between serum and EDTA-K2 anti-coagulation plasma in the middle level group and high level group were statistically significant (P <0.05).Child′s gender and age have significant effect on the PCT level. Conclusion There is statistically significant difference between serum and plasma PCT detection levels in children,which has an important guiding role for further systematic study of PCT level difference in serum and EDTA-K2 anticoagulation plasma and its clinical significance.

Objective To investigate the change in distribution and antimicrobial resistance of pathogens from blood culture of children,and provide a basis for treatment of bloodstream infection.Methods Pathogens isolated from blood culture of hospitalized children between January 2009 and December 2013 were divided into group 2009-2011 and 2012-2013.Distribution and antimicrobial susceptibility of pathogens were analyzed.Results From 2009 to 2013,a total of 48 455 blood specimens were taken for culture,2 730 pathogenic bacteria were isolated,positive rate was 5.63%.The positive rate of blood culture decreased year-by-year (χ2 =415.30,P <0.01 ).Of 2 730 iso-lates of pathogenic bacteria,gram-positive bacteria,gram-negative bacteria,and fungi accounted for 80.37% (n =2 194),18.68%(n=510),and 0.95%(n=26)respectively.The difference between two groups of pathogenic bacte-ria was significant(χ2 =180.334,P <0.001).Susceptibility rates of gram-positive cocci to vancomycin,linezolid and teicoplanin were all 100%,resistance rates of coagulase-negative Staphylococcus and Staphylococcus aureus to cip-rofloxacin,compound sulfamethoxazole and tetracycline all decreased.Susceptibility rates of gram-negative bacilli to imipenem,meropenem and amikacin were all≥97.50%,susceptibility rate of Klebsiella pneumoniae to levofloxacin was 100%;Of cephalosporins,Escherichia coli and Klebsiella pneumoniae had high resistance except ceftazidime and cefepime.Conclusion Distribution of pathogens from blood culture of children in 2009-2013 changed signifi-cantly,pathogens have high resistance to commonly used antimicrobial agents,more attention should be paid to the monitor of pathogens from blood culture and pathogenic antimicrobial resistance.

Objective To compare the clinical efficacy between standard sequential early enteral nutrition (EEN) plus parenteral nutrition (PN) and PN alone in patients undergoing gastrointestinal surgery. Methods Werandomly divided 126 patients who underwent laparotomy gastrointestinal surgery into EEN + PN group (n = 62) and PN group (n = 64). The levels of blood nutrition-related indicators, biochemical indicators, and inflammatory indicators were determined before surgery and 3 and 7 days after surgery, and the gastrointestinal function recovery time, complications, nutritional support cost, and length of hospital stay were compared between two groups. Results The preoperative nutrition-related indicators, biochemical indicators, and inflammatory indicators showed no significant differences between two groups (P >0. 05). Three days after operation, however, the levels of prealbumin in EEN + PN group were significantly higher than those in PN group [(160. 3 ±23. 0) g/L vs. (137.0±28.7) g/L, P=0.000]. Seven days after operation, the levels of albumin [(33.6±3.8) g/L vs. (31.8±4.7) g/L, P = 0.042], prealbumin [(210.6±34.6) g/L vs. (154.8 ±36.9) g/L, P=0.000], and lymphocyte cell count [(2.33±0.53) x 109/L vs. (1.04±0.36) × 109/L, P = 0. 046] in EEN + PN group were significantly higher than those in PN group, and the levels of serum γ-glutamyltransferase [(48. 12 ± 33.84) U/L vs. (71.54±34.00)U/L, P=0.048], C-reactive protein [(31.15 ± 19.00) mmol/L vs. (45.90 ± 23.21) mmol/L, P=0.042], total cholesterol [(3.09±0.83) mmol/L vs. (3.29±0.91) mmol/L, P = 0. 045] and low density lipoprotein [(2.01 ± 0. 39) mmol/L vs. (2. 31 ± 0. 72 ) mmol/L, P = 0. 049] were significantly lower than those in PN group. The postoperative gastrointestinal function recovery time in EEN + PN group was significantly shorter than that in PN group [(65. 7 ± 15. 6) hours vs. (75. 1 ± 27. 0) hours, P = 0. 036], and the total cost of perioperative nutrition in EEN + PN group was also significantly lower than in PN [(2634. 5 ±1306. 8) RMB vs. (3058. 6 ± 1216. 0) RMB, P= 0.046]. Conclusion Standard sequential EEN plus PN can increase the post-operative prealbumin level, improve the immune function, promote the recovery of gastrointestinal function, and decrease the cost of nutritional support.

Objective To detect heat shock protein 90 (HSP90) expression in the placenta in pregnancy induced hypertension in order to understand its role in the pathophysiology of hypertensive disorders comphcating pregnancy (HDCP).Methods The gene and protein expression of HSP90 in the placenta of normal pregnant women,gestational hypertension patients,mild preeclampsia patients,severe preeclampsia patients,by RT-PCR and Western blotting.Results The gene and protein expression of HSP90 in placenta of gestational hypertension group,mild preeclampsia group,severe preeclampsia group were significantly higher than that of normal pregnant group (P ＜ 0.01),and it showed the increased progressively with the increasing of disease stage.Conclusion HSP90 may be involved in the onset and development of HDCP.Monitoring HSP90 concentration in the placenta which is the initial theoretical basis for the target as HSP90 for the treatment of HDCP.

Objective To explore the efficacy of pulse infusion of gonadorelin (LHRH) on the patients with idiopathic hypogonadotropic hypogonadism (IHH) via a micro infusion pump. Methods The protocol was designed as an open, self-controlled prospective study. 31 patients were enrolled and assigned to 3 groups: 23 males without gonadotropin-releasing hormone ( GnRH ) pulse ( group A), 2 males with GnRH pulse frequency insufficiency ( group B), and 6 females ( group C). All the subjects were admitted LHRH every 90 min via the micro infusion pump for 24 weeks. Sex hormones and related characteristics were compared before and after the treatment. Results After 24-weeks treatment, LH peak value reached ( 6. 92 ±5.66 ), ( 9. 55 ±0. 98 ), and ( 6. 93 ±4. 52 ) IU/L; and FSH peak value reached ( 7.44 ± 3. 80 ), ( 12. 85 ± 12. 80 ), and ( 7.38 ±4. 98 ) IU/L among 3 groups, respectively. The testosterone also reached ( 3.18± 1.81 ) and ( 5.78±4. 65 ) ng/ml in groups A and B ( all P＜0. 01 ). In groups A and B, the testis volumes were increased, seminal fluid production was found in 7 patients and spermatogenesis in 6 patients. In group C, uterus was enlarged 85.4%, as well as the ovaries of both sides. Menarche was reported in 5 patients. 19. 4% of the studied patients complained uncomfortable at the injection sites, all the symptoms were mild. Conclusion Pulse infusion of LHRH in IHH patients via a micro infusion pump is effective, while the medication system needs improving.

Objective To detect the serum level of vitamin D in infants with atopic dermatitis (AD),and to investigate the relationship between the serum level of vitamin D and severity of AD in infants.Methods Clinical data were collected from patients with moderate to severe AD (AD group)through a questionnaire survey in Children's Hospital of Shanxi from February to April in 2016,and the severity of AD was evaluated by the SCORing atopic dermatitis (SCORAD) score.A total of 95 health checkup examinees served as the control group.Enzyme-linked immunosorbent assay (ELISA)was performed to detect the serum level of 25 (OH) D3 in the AD group and control group,as well as the total serum IgE level in the AD group.Blood cell analyzer was used to determine the proportion of blood eosinophils in the AD group.Results A total of 97 patients with AD were enrolled into the study,including 43 (44.3 ％) patients with moderate AD and 54 (55.7％) patients with severe AD.The serum level of 25 (OH) D3 was significantly lower in the AD group than in the healthy control group ([66.71 ± 21.07] nmol/L vs.[85.43 ± 14.87] nmol/L,P ＜ 0.01),as well as in the patients with severe AD than in the patients with moderate AD ([47.54 ± 29.36] nmol/L vs.[63.89 ± 26.67] nmol/L,P =0.006).The proportion of blood eosinophils was significantly higher in the severe AD group than in the moderate AD group (0.124 ± 0.094 vs.0.061 ± 0.060,P ＜ 0.001).There was no significant difference in the total serum IgE level between the moderate AD group and severe AD group (P =0.375).Among the patients with AD,the serum level of 25 (OH) D3 was negatively correlated with the proportion of blood eosinophils (r =-0.336,P ＜ 0.05),but there was no correlation between the serum level of 25 (OH)D3 and total serum IgE level (r =-0.174,P ＞ 0.05).The serum level of 25 (OH)D3 was significantly associated with breastfeeding and vitamin D supplementation (P ＜ 0.05),but unrelated to age,gender,course of disease and acute exudative phase (all P ＞ 0.05).Conclusion The serum level of 25 (OH) D3 is evidently decreased in infants with AD,and vitamin D deficiency is closely related to the severity of AD in infancy.

Objective To determine the value of using B-type natriuretic peptide (BNP) and D-dimer in preliminary recognition of cardioembolic stroke patients.Methods A mutilple-center study was conducted in Foshan Hospital of traditional Chinese Medicine (TCM) and its affiliated hospitals from July 2015 to July 2016.In the emergency departments (EDs),emergency physicians prospectively assessed consecutive adult patients with acute cardioembolic stroke and measured plasma BNP by POCT platform on admission,then followed up.Stroke neurologists evaluated patients' functional outcome at hospital discharge and also made discharge diagnosis and stroke etiologic subtypes according to the TOAST criteria.Results In this study,290 acute ischemic stroke patients met the study criteria [mean age (68.41 ± 12.06) years;53.8％ female].Of the enrolled patients,28.3％ were diagnosed with LAA at discharge,17.9％ with CE,42.8％ with SAO,11.0％ with SOE or SUE.And the mean BNP concentration was significantly higher in the CE group than that in other three subtypes (P ＜ 0.001).After adjustment for multiple clinical predictors like gender,age,coronary artery disease,atrial fibrillation and renal function,BNP and D-dimer were associated with CE [BNP OR:1.044 (95％ CI 1.025,1.064),P ＜ 0.001;D-dimer OR:1.511(95％ CI 1.020,2.238),P =0.039,respectively].Conclusion Through POCT technique in the EDs,cardioembolic stroke patients can be differentiated from other TOAST subtypes.BNP with/without D-dimer has good but different corresponding diagnostic performance in preliminary recognition of cardioembolic stroke patients.

Objective:To investigate the effect and safety of rituximab, programmed death 1 (PD-1) monoclonal antibody, and Bruton tyrosine kinase (BTK) inhibitor on elderly refractory primary central nervous system lymphoma (PCNSL).Methods:The clinical data of an elderly patient with refractory PCNSL treated with the combination of rituximab, PD-1 monoclonal antibody and BTK inhibitor in the First Hospital of Jilin University in February 2020 were retrospectively analyzed. The relevant literature was reviewed.Results:The patient had primary central nervous system diffuse large B-cell lymphoma (high-risk group), and the Memorial Sloan Kettering Cancer Center (MSKCC) score was 2 (estimated overall survival time was 7 months). Disease progressed after 1 course of treatment. Complete remission was achieved after the therapy of rituximab, PD-1 monoclonal antibody combined with BTK inhibitor. PD-1 monoclonal antibody maintenance therapy was performed and patient was followed up until November 17, 2021. The patient's condition was stable. The second progression-free survival (PFS) time was 20 months, and the overall survival time was 21 months. The patient well tolerated the new drug treatment, and no adverse reactions of grade 3 or above occurred.Conclusions:The new targeted combination therapy can be used as a treatment option for elderly PCNSL patients, which can further improve the curative effect and significantly improve the prognosis.