With the rapid development of medical and health sciences,the pressure on the new skills learning for health professionals has also increased.Advanced training has become important opportunity for the career development of the health professionals.This study takes a third—grade class —A hospital to conduct a case study,using the questionnaire to collect information and analyzed the factors that might affect the pressure for advanced training.This paper also discussed how to improve the quality of advanced training by reduce the pressure of the medical staff from the view point of hospital and individuals.

BACKGROUND:The effect of body mass index (BMI) on the outcomes ofin vitrofertilization (IVF) is controversial. Some scholars suggested that the higher BMI, the lower rate of pregnancy, and the higher rate of abortion. However, some others got the different results. To data, the effects of BMI on the pregnancy outcomes in females at different ages are rarely reported.
OBJECTIVE:To explore the effect of BMI on the pregnancy outcomes of IVF for infertile women atdifferent ages.
METHODS:A total of 902 cycles undergoing IVF were divided into two groups according to the age:≤ or> 35 years old groups. The patients in each group were then divided into four subgroups according to BMI: low weight, normal weight, excess weight, and obesity subgroups, respectively.
RESULTS AND CONCLUSION: With increasing BMI, the average dosage of gonadotropins was increased gradualy in two both of age groups (P < 0.05). In the≤ 35 years old, the levels of estrogens on the day of injecting human chorionic gonadotropin was significantly lower in obesity group than the other subgroups (P < 0.05); the rates of empty folicle in excess weight and obesity subgroups were significantly higher than that in normal weight subgroup (P < 0.008 23). The fertilization rate and clinical pregnancy rate of in obesity subgroup were significantly lower than those in the other subgroups (P < 0.05). In the > 35 years old group, the empty folicle rate in obesity subgroup was significantly higher than that in normal weight subgroup (P < 0.008 23). Fertilization rate in excess weight and obesity subgroups was significantly lower than that in the normal weight subgroup (P< 0.008 23). There were no significant differences in cleavage rate, cycle cancelation rate, implantation rate, biochemical pregnancy rate and abortion rate between four subgroups (P> 0.05). These findings suggest that in the females at the younger age, BMI not only affects the quality of folicles and fertilization rate; but with increasing BMI, clinical pregnancy rate is decreased obviously. However in the females at the older age, BMI only affects the folicular quality, embryo quality and fertilization rates; there are no significant differences in the outcomes of pregnancy in the four subgroups. BMI have effects on pregnancy outcomes of IVF, and the effects are much greater in the younger female group.

Lung adenocarcinoma accounted for about 70％ of non-small cell lung cancer,and now a higher risk of detected.Early diagnosis and early treatment can significantly improve lung adenocarcinoma patients after operation and improve the survival rate of patients.Bronchoscope clinical diagnosis of lung cancer and chest wall puncture in pathology has problem in that it is an operation and specimen is not easy to get,compared to tumor markers that are easy to obtain.A series of studies in recent years have shown that the joint detection of tumor markers has important value in early detection and diagnosis,prognosis assessment,and tumor recurrence of lung adenocarcinoma.

Objective To evaluate the safety of CT guided percutaneous lung biopsy in the elderly,and to analyze the risk factors for its complications.Methods Totally 204 elderly patients aged ≥65 years underwent transthoracic needle biopsy under CT guidance.Clinical data,complication and its risk factors were analyzed retrospectively.Results The complications included pneumothorax accounting for 15.2％ (31/204),hemoptysis 21.6％ (44/204),and no mortality was found.Logistic regression analysis showed that needle path ≥5.00 cm,lesion size ≤2.00 cm and emphysema around the lesion were the independent risk factors for postoperative pneumothorax (OR=4.05,2.54 and 3.97,all P＜0.05).Meanwhile,the enhancement degree by CT ＞40 HU,needle path ≥5.00 cm and lesion size ≤2.00 cm were the independent risk factors for postoperative bleeding (OR=2.27,2.82 and 2.33,all P＜0.05) in elderly patients undergoing lung biopsy.The sensitivity and specificity for postoperative pneumothorax and bleeding obtained by forecasting equation were 87.1％ and 49.1％,54.5％ and 80.8％ respectively.Conclusions The length of needle path,lesion size and emphysema around the lesion are correlated with pneumothroax,and length of needle path,lesion size and the CT enhancement degree are correlated with bleeding after percutaneous lung biopsy in the elderly.

CD19-targeted chimeric antigen receptor T-cell (CAR-T) therapy is effective in refractory/relapsed (R/R) B-cell acute lymphoblastic leukemia (B-ALL).This review focuses on achievements,current obstacles,and future directions in CAR-T research.A high complete remission rate of 68 ％ to 93％ could be achieved after and-CD19 CAR-T treatment for B-ALL Cytokine release syndrome and CAR-T-related neurotoxicity could be managed.In view of difficulties collecting autologous lymphocytes,universal CAR-T is a direction to explore.Regarding the high relapse rate after anti-CD19 CAR-T therapy,the main solutions have been developing new targets including CD22 CAR-T,or CD19/CD22 dual CAR-T.Additionally,some studies showed that bridging into transplant postCAR-T could improve leukemia-free survival.Some patients who did not respond to CAR-T therapy were found to have an abnormal conformation of the CD 19 exon or trogocytosis.Anti-CD19 CAR-T therapy for R/R B-ALL is effective.From individual to universal CAR-T,from one target to multi-targets,CAR-T-cell has a chance to be off the shelf in the future.

In the current situation,how to adapt to the new medical reform and determine its development goal has become the primary concern of the managers of No.1 Affiliated Hospital of Hebei North University.The internal and external conditions were analyzed by the method of SWOT and the advantages,disadvantages,opportunities and challenges facing the hospital were also observed.Finally,a series of countermeasures were put forward in accordance with the strategies by SWOT.

Objective To observe the antioxidative capability and the mRNA expression of sodium pump αl-subunit in kidney of hypothyroid rats by iodine deficiency and illuminate the pathogenesis of kidney damage.Methods Wistar rats were randomly divided into two groups as control group (NT) and hypothyroid group (HT).The rats were all fed with low-iodine diet derived from an endemic goiter area and drank deionized water containing different potassium iodide to duplicate hypothyriod animal models.We determined the morphometric parameters of kidney by routine histology method.The contents of malondialdehyde and free radical scavengers (GSH-PX and SOD) in kid-ney,as well as the activity of Na~+-K~+ ATPase were measured in two groups.The mRNA expression of sodium pump α1 subunit was determined by reverse transcription-polymerase chain reaction.Results Compared with that in the control group,in hypothyroid group (1) serum free T3,free T4,total T3 and total T4 were markedly lower.(2) mean glomerular area and volum diminished markedly.(3)the content of MDA and activity of PGx increased markedly,but the activity of SOD decreased significantly,as well as the one of Na~+-K~+-ATPase.(4)the mRNA expression level of sodium pump α1 subunit was lower.Conclusion In a hypothyroid state,the decrease of antiox-idative capability of kidney resulted in lipid peroxidative damage,atrophy of kidney,decreased activity of Na~+-K~+ -ATPase and degression of sodium pump α1 subunit mRNA expression.

Animals ; Endothelium, Vascular ; metabolism ; ultrastructure ; Environmental Exposure ; Male ; Rats ; Rats, Sprague-Dawley ; Sound ; Vascular Endothelial Growth Factor A ; metabolism

Objective To summarize the experiences in clinical diagnosis and surgical treatment of chest cancers invading the superior vena cava (SVC). Method Retrospective study of 12 cases with chest cancers invading the SVC, SVC and innominate vein were reconstructed with prosthesis in 3 cases, the side wall of the SVC was excised and repaired in 9 cases. Results Complete resection was performed in 10cases,2 cases had incomplete resection. There was no death associated with operation in these patients. All patients were followed up for 1 - 7 years after operation,and 3 cases were lost to follow up,5 of remaining 9cases were dead because of relapse and metastasis, their median survival time was 8 months,other 4 cases lived, their median survival time was 42 months. Conclusions Patients with chest cancers invading the SVC should have surgical treatment of not only tumor resection but also the vessel reconstruction,the prognosis would be better than without surgical treatment. These patients have a high quality of life and live with long-term survival.

There are many progresses in the therapy of MM with ASCT. ASCT improves the ratio of CR,EFS and OS,compared with conventional chemotherapy.Myeloma patients with renal failure or old age also can be candidate for ASCT.Tandem autologous transplantation improves the ratio of CR. Its impact to long-term EFS and OS still need to be judged.To improve conditional project,to choose suitable time,and- toselect consolidation schedule can boost therapeutic effect.