In order to summarize the experience in physician recruitment and training process,an investigation was carried out on young physicians recruited from campus from 2007 to 2011.The results showed that the assessments of departments of the young physician's on theirs' medical ethics,professional values,theoretical knowledge,clinical competence and other aspects were higher.This indicated that these young physicians have higher overall quality.In addition,compared with the above-described abilities,the results also showed that the assessments on theirs' foreign language oral communication skills,research capacity,innovation capability,and so on,were lower.Therefore the hospital should continue to increase assessments to the candidates during the campus recruitment stage,and to develop targeted training plans so as to strengthen the ability of young physicians continually.

Objective To investigate the clinical significance of the changes of electrocardiogram (ECG) and cardiac markers for myocardial damage after on-pump coronary artery bypass grafting (CABG) and off-pump coronary artery bypass grafting (OPCABG). Method Monitoring 25 patients of OPCABG (OPCABG group) and 25 patients of CABG (CABG group) R wave amplitude of V4 and V5 on antorior electrocardiographic lead and simultaneously determining cardiac markers for myocardial damage creatine phosphokinase isoenzyme MB (CPK-MB), tropenin I (cTnI) and heat-shock protein 70 (HSPT0) on different lime. Results R wave amplitude of V4 and V5 on anterior electrocardiographic lead had no significant changes on 0, 6, 18 and 24 hours after OPCABG. On the contrary, R wave amplitude of V4 and V5 on anterior electrocardiographic lead decreased significantly on 0, 6 and 18 hours after CABG (P<0.01), and came back to preoperative values 24 hours after operation. The levels of CPK-MB and cTnI reached its peak and higher significantly for CABG than those for OPCABG on 24 hours after operation, 29.29 μg/L vs 5.98 μg/L and 6.74 μg/L vs 1.91 μg/L respectively. HSP70 increased significantly on 6 hours after operation in two groups, but median of HSP70 was higher significantly in CABG group (11044.5 pmol/L vs1702.0 pmol/L). In the first day after operation the HSP70 peak was correlated significantly with the level of CPK-MB(r=0.370, P<0.01) and cTnI (r=0.458,P<0.01). Conclusions Myocardial damage is significantly alleviated for patients of OPCABG comparing with those of CABG. The HSF70 in circulation may indicate the degree of myocardial damage.

Objective To investigate the resistance of Staphylococcus to erythromycin and clindamycin and detect the percentage and gene for inducible resistance. Methods Disk diffusion method was used to test the resistance phenotype of Staphylococcus aureus and coagulase-negative staphylococcus according to the standards of NCCLS. The inducible resistance of erythromycin to clindamycin was checked by D-test and the gene for erythromycin ribosome methylase was detected by polymerase chain reaction.Results Co-resistance to erythromycin and clindamycin accounted for 62.7% and 54.8% in MRSA and MRCNS respectively. D-test positive rate was 17.7% among all Staphylococcus tested. The rate of inducible resistance to clindamycin (D-test positive) was 67.6% and 45.3% in Staphylococcus aureus and coagulase-negative Staphylococcus which possessed erythromycin resistant and clindamycin sensitive by individual disk diffusion test. The predominant gene for inducible resistance was ermC with the percentage of 74.5%.Conclusion The inducible resistance of erythromycin to clindamycin in Staphylococcus should be checked by D-test in clinical microbiology laboratory in order to help physicians to select MLSB antimicrobial agents correctly.

OBJECTIVE To investigate the prevalence and resistance of extended spectram ?-lactamases(ESBLs) producers in Escherichia coli and Klebsiella pneumoniae.METHODS ESBLs producing strains were screened by double disk test and confirmed by the NCCLS confirmatory test.Susceptibility test to antimicrobial agents was performed by disk diffusion method and analyzed by WHONET 5.3 and Excel.RESULTS The isolated ratio of ESBLs producing E.coli and K.pneumoniae increased from 14% and 15% in 1999 to 30.1% and 30.4% in 2002.Bacteremia caused by the two kinds of ESBLs producers accounted for 30.2% and 30.4%,respectively.ESBLs producing K.pneumoniae and(ESBLs) producing E.coli were 19.8% and 14.0% for outpatient and 26.6% and 31.6% for inpatient.The resistance of(E.coli) to 17 kinds of agents was similar,no matter it was isolated from blood,urine or sputum.Susceptibility of(ESBLs) producing E.coli and K.pneumoniae in urine to cefoperazone/sulbactam,and piperacillin/tazobactam were 85% and 65.2%,66.6% and 29.4%,although to other 15 agents there were no difference.None of the(isolates) showed resistance to imipenem.CONCLUSIONS There is an increasing trend of ESBLs producing E.coli and K.pneumoniae(isolated) from various kinds of specimens and from different wards.It is important for clinical physicians to understand the distribution and the resistance characteristics of ESBLs producing E.coli and(K.pneumoniae) to antibiotics.

OBJECTIVE To analyze distribution of the pathogens of catheter-related bloodstream infection ( CRBSI ), and provide doctors with the laboratory evidence of CRBSI diagnosis. METHODS A retrospective analysis of CRBSI pathogens′ distributions from 261 inpatients whose catheter culturing was positive in General Hospital of PLA from Jan 1, 2002 to Aug 31, 2004 was done, and from which true cases of CRBSI were judged and true pathogens or contaminants were identified and counted. RESULTS There were 88 (33.72%) patients diagnosed as CRBSI among 261 cases. They were from intensive care unit (41), surgical department (22), medicine (12), the old patients ward (10), and pediatric ward (3). The first four by rank order of the CRBSI pathogens were Acinetobacter baumannii (15.9%), coagulase-negative staphylococci (14.8%), Pseudomonas aeruginosa ( 11.4% ), and Candida albicans (9.1%). The prominent contaminants were as follows: coagulase-negative staphylococci , Streptococcus pyogenes, Micrococcus and Gram-positive rods. CONCLUSIONS To get a better understanding about distribution of CRBSI pathogens will help its diagnosing as early as possible.

The nutrition and food hygienic character of the degreased castor protein in Neimeng autonomous region were studied by chemical analysis and rat experiment. Using casein as reference protein and soy flour as comparable substance, the contents of major nutrients and composition of essential amino acids in the degreased castor cake and its protein efficiency ratio (PER) and other indicators related to nitrogen metabolism in the animal experiment were studied by the recommended method of AOAC. Some harmful substances in the samples were examined quantitatively. The results showed that the protein content, the PER, the true digestibility, the biological value, and NPU of the degreased castor cake were 35.80%, 1.75-1.76, 62.51%, 91.16 and 57.04 respectively. The blood indicators and pathological observation of tested rats were normal. The content of several harmful substances in the product was allowable. The essential amino acid composition of the degreased castor protein was similar to soy protein. So the detoxified degreased castor cake protein could be used in food or feed industry.

Objective To explore the activity of Elemene for glioma cell from the cellular and molecular level. Methods The human glioma cell U251 was cultured. The effect of Elemene for human glioma cell proliferation was studied by MTT assay. Cell cycle, Fas, PCNA, bcl-2, intracellular Ca~(2+) and apoptosis were evaluated by flow cytometry analysis. Results Elemene exhibited antiproliferative effect on human glioma cell U251 markedly. The fifty percent inhibition on concentration (IC_(50)) of Elemene against glioma cells at different time points. 24 h was 40.60 μg/ml, the 48 h 38.14 μg/ml and the 72 h 34.35 μg/ml.Cell cycle was blocked in the S and G_2/M phases. The apoptosis ratio was increased by Annexin V staining markedly. Elemene decreased the gene expressions of PCNA and Fas, increased the intracellular Ca~(2+). There was no significant effect on the bcl -2 gene expression. Conclusion Elemene exhibits a marked antiproliferative effect on glioma cells and induces apoptosis by decreasing the expression of PCNA and increasing intracellular Ca~(2+). It also influences the expression of Fas. It might have no relationship with bcl-2 gene expression.

Objective To analyze the present situation of the dental instrument cleaning and disinfection in Hainan province and to explore the management mode of dental instrument cleaning and disinfection which is suitable for the provincial situation .Meth-ods By adopting the stratified random sampling method according to the hospital grades ,24 hospitals in Hainan province were per-formed the questionnaire survey on the cleaning mode of oral instruments ,layout of cleaning and disinfection room ,cleaning method and facilities ,protection measures and training of cleaning staff .Results 14 hospitals (58 .33% ) had the sterilization and supply center for conducting the centralized processing on the dental instruments .The tertiary hospitals and the second-grade hospitals had the independent cleaning and disinfection rooms with the rational layout and professional cleaning staff ;the safeguard facilities had the application in place ,the training of the related cleaning and disinfection work and the cleaning process conformed the require-ment of the standards .Among 10 first-grade and below hospitals ,only 1 hospital(10 .00% ) had the rational layout of cleaning and disinfection rooms ;3 hospitals(30 .00% ) had the professional cleaning staff ;the related training of the cleaning staff was not basi-cally carried out and the safeguard was not in place ,most of the cleaning and disinfection instruments and the cleaning process were not in accordance with the requirements .The qualification rates of instruments cleaning and disinfection in different grades of hospi-tals by the ATP bioluminescence assay were 100 .00% ,90 .00% and 80 .00% .Conclusion The existing problems are general and prominent in the hospitals of the first-grade and below .It is suggested that the regionalized disinfection and supply management mode is implemented for maximally realizing the optimized resource configuration in the disinfection and supply center .

For medical student, diagnostic practice is the first step of clinical study. To penetrate the humanities education in diagnostic teaching,the combination with practice from the following steps as physical examination, laboratory examination and interrogation, would cultivate medical students' humane quality imperceptibly and play an important role in creating noble medical ethics of them.

Hepatocellular carcinoma has a high morbidity and mortality, which has seriously harmed human health. Several targeted therapies have been approved for the first- and second-line treatment of advanced hepatocellular carcinoma. The emergence of immunotherapy has brought the treatment of hepatocellular carcinoma into a new era. Targeted and immunotherapeutic agents have synergistic effects in mechanism, also the combination of these two therapies has been clinically beneficial to patients with advanced hepatocellular carcinoma. At the same time, in addition to the systemic therapy of targeted combined immunological, applying appropriate local therapy can provide a longer survival period or even a chance of cure for that some patients. The authors introduce the diagnosis and treatment of a case of advanced hepatocellular carcinoma who achieved pathological complete remission by first-line immunotherapy combined with anti-angiogenesis targeted therapy.