Occupation career decision-making is affected by personal factors and environmental factors. Medical students should improve individual decision making , maintain physical and mental health , study hard, enhance their comprehensive ability, strengthen ideology cultivation and social prac-tice, recognize themselves and find reasonable fixed position by taking occupation career decision factors into consideration, which lay a solid foundation for success of occupation career decision making.

Neonatal is separated from the maternal by clamping the umbilical cord after delivery.And traditionally,the clinical practice is clamping the umbilical cord immediately after delivery.With the futher study of optimal timing of umbilical cord clamping,the effect of delayed umbilical cord clamping attracts more and more attention.This paper discussed about the subject of the early and late effect of delayed umbilical cord clamping on neonatal.We found that a briefly delay in clamping the umbilical cord increased the placental transfusion and blood volume,decreased the prevalence of anemia,promoted the stability of circulation and internal environment,without adversely affecting health of neonatal.

ObjectiveTo explore the clinical effect of edaravone combined with Shuxuetong in treatment of elderly patients with acute cerebral infarction.Methods120 cases of acute cerebral infarction,according to the different treatment methods,were divided into two groups.The conventional treatment was given in two groups,the control group plus Chuanqiong hydrochloride injection,and the observation group adopted edaravone and Shuxuetong.The clinical efficacy,activities of daily living(ADL) and neurological deficit score were compared between two groups.ResultsThere were 25 cases of basic recovery,18 cases of significant progress,progress in 12 cases in the observation group,total effective rate was 91.7％ (55/60),the control group was 75.0％ (45/60),the difference was statistically significant ( x2 =6.86,P ＜ 0.05 ).Observation group had statistically significant difference than the control group between ADL and neurological deficit scores ( all P ＜ 0.05 ).ConclusionOn the basis of conventional therapy,the use of edaravone combined with Shuxuetong for acute ischemic stroke patients could significantly promote the recovery of neurological function and was worthy of promotion.

Objective To investigate the clinical characteristics of congenital cholangiectasis,the classification of choledochectasia and its complications. Methods Sixty-eight patients with congenital cholangiectasis admitted to Nankai hospital of Tianjin from Jan. 2000 to Dec. 2009 were retrospectively studied. The patients were classified using Todani method. The clinical presentation,complications and development were compared among patients with different types. Results In 68patients, type Ⅰ , Ⅳa and Ⅳb were accounted for 47. 1%, 35.3%, 17.6%,respectively. Wheraes type Ⅱ , Ⅲ and Ⅴ were not found. The complications included cholecystitis (67.6%) and bile duct stone (70. 6%). Biliary stricture and gallbladder atrophy were accounted for 26.5% and 17.6%,respectively. Pancreatitis was found in 8.8% patients, biliary cirrhosis in 5.9% patients,carcinogenesis in 23.5 % patients, fatty liver steatosis in 11.8 % patients, cholecystic polyps in 17.6 %patients, slight spleen enlargement in 14.7% patients, hepatic cyst in 8. 8% patients, renal cyst in 2.9% patients. Conclusions Tyep Ⅰ is commonly found in congenital cholangiectasis, and the next is the type of Ⅳa, but no type of Ⅱ , Ⅲ or Ⅴ is found. The common complications are cholecystitis and bile duct stone. Carcinogenesis is found in 25 % patients.

Objective To explore the clinical value of prenatal screening by detecting α-fetoprotein(AFP),β-human chorionic gonadotrophin(β-HCG)and free estriol(u-E3)levels in the second trimester of pregnancy.Methods AFP,β-HCG and u-E3 were de-tected in 3 595 second trimester pregnant women by chemiluminescence.The risk value was calculated by combining with the factors of age,pregnant weeks,body weight,etc.Then the high-risk pregnant women were carried out the amniotic fluid cells chromosome karyotype analysis and B-ultrasonic examination.Results Among 3 595 pregnant women,the screening positive rates of Down′s syndrome(DS),Edward′s syndrome(ES)and neural tube defects(NTD)were 3.70%(133/3 595),0.11%(4/3 595)and 1.44%(52/3 595)respectively.In the prenatal screening,there were 189 cases of high risk pregnant women,among them 87 cases were per-formed the prenatal diagnosis of amniotic fluid cells chromosome karyotype analysis and B-ultrasonic examination,6 cases were defi-nitely diagnosed,in which 3 cases were DS,2 cases were NTD and 1 case was ES.Conclusion Prenatal screening is a non-invasive detection method and has the important clinical application value for avoiding the birth of DS,ES and NTD neonates.

The antimicrobial abuse has become an indisputable fact as well as a global public health concern.At the 2016 G20 summit in Hangzhou,the issue of antimicrobial resistance was also put on the agenda of world leaders.This paper analyzed the status quo of global antimicrobial resistance.With reference to the report Tackling drug-resistant infections globally: final report and recommendation written by British Lord Jim O′Nell published in May 2016,the main influencing factors of antimicrobial resistance were described.In addition,this paper proposed countermeasures for antimicrobial resistance,including carrying out large-scale promotional activities,improving global public health conditions,reducing antimicrobial use in agriculture,strengthening the global surveillance of antimicrobial resistance,developing new treatment products for infectious diseases,and building a new pattern of global response.

Objective To investigate the curative effect of modified Danggui Shaoyao Powder in the treatment of patients with chloasma and the effect on the expression of cyclooxygenase-2 (COX-2) and nuclear factor E2 (Nrf2) in serum.Methods90 cases of patients with chloasma treated in the hospital were selected as the subjects.According to different treatment methods, the patients were divided into the control group (treated with routine western medicine, n=48) and the study group (treated with modified Danggui Shaoyao Powder, n=42).The clinical efficacy, changes of cytokines (serum COX-2 and Nrf2), patch pigment regression.ResultsAfter treatment, the total effective rate of the study group was significantly higher than that of the control group (90.48% vs 72.92%) (P<0.05).After treatment, COX-2, patch pigment regression scores in the two groups were significantly lower than those before treatment, and Nrf2 was significantly higher than that before treatment.The changes were more significant in the observation group than the control group (P<0.05).ConclusionModified Danggui Shaoyao Powder is significant effective in the treatment of chloasma.It can effectively promote the regression of pigment, reduce the skin lesion area and improve the quality of life of patients.The mechanisms may be related to effectively reducing COX-2 and increasing Nrf2.

There are several main topics in acute myelogenous leukemia at the 57th American Society of Hematology annual meeting, including the optimization about induction and consolidation chemotherapy for AML, the investigation of targeted drugs in AML first line therapy, the marker for AML MRD monitoring, the differentiation drugs, such as tamibarotene in APL, the definition about refractory AML, the induction therapy for blastic plasmacytoid dendritic cell neoplasm (BPDCN). This article reviewed the research progress of AML in the 57th ASH annual meeting.

The etiology of pulmonary fibrosis is complex. The occurance and development of this disease involve many cell signal transduction pathways, including MAPK signaling pathway, JAK-STAT signaling pathway, Smad signaling pathway, PI3K-Akt signaling pathway, NF-κB signaling pathway and so on. Numbers of experiments have shown that intervention in signal transduction pathways with TCM can delay the progression of fibrosis, which provides good therapeutic methods for this disease. This article reviewed study on TCM intervention in different signal transduction pathways in the pulmonary fibrosis in China.

Vitrectomy combined with internal limiting membrane (ILM) peeling and vitreous tamponade is a conventional method for treating macular hole (MH),but the visual acuity and MH closure rate remains to be further improved.After removal of posterior vitreous cortex,the ILM is grasped with an ILM forceps and peeled off in a circular fashion for approximately 1 disc diameters around the MH.During the circumferential peeling,the ILM is not removed completely from the retina but is left attached to the edges of the MH.The ILM was then massaged gently over the MH from all sides until the ILM became inverted and then peel all other ILM within vascular arcades.Inverted ILM flap technique is one of the important improvement methods in MH vitrectomy,especially for MH with large diameter and unhealed MH after ILM peeling.Compared with conventional vitrectomy combined with ILM peeling,inverted ILM flap technique can enhance MH closure and improve visual acuity.Due to lack of large sample observation in clinical trials of inverted ILM flap technique,we still need more cases and longer follow-up of this technology to more accurately evaluate the effectiveness and safety of this technique.