This paper discussed that how to cultivate high-quality medical talents by the use of basic education,medical moral education and psychologic education etc.

Objective To explore the causes and risk factors affecting early death in patients with traumatic cervical spinal cord injury (SCI). Methods Clinical data of 553 patients with traumatic cervical SCI were analyzed retrospectively to discuss the related factors affecting early death of patients with traumatic cervical SCI by using univariate analysis and multivariate logistic regression analysis. Results The early mortality of the patients with traumatic cervical SCI was 4.0% ( 22/553 ). The main causes of the early death were respiratory failure in nine patients (40.9%) and electrolyte disorders in five (22.7%). Univariate analysis showed that age, cervical spinal cord injury severity, complications in respiratory, cardiovascular, digestive systems and electrolyte disturbance as well as tracheotomy were considered statistically significant for early death in patients with traumatic cervical SCI ( P < 0, 05 ). Multivariate logistic regression analysis showed that age, cervical SCI severity, complications in respiratory,cardiovascular system and electrolyte disturbance as well as tracheotomy. Conclusion Severe cervical SCI, combined respiratory, cardiovascular system and electrolyte disorder complications as well as tracheotomy are high risk factors for the early death in patients with traumatic cervical SCI.

Objective To investigate the influence of the lymph node micrometastasis and its clinicopathological features on postoperative disease-free survival rate for patients with gastric cancer.Methods The study included 120 patients with pT1-3NoMo gastric cancer. The relationships between clinicopathological features or carcinoembryonic antigen (CEA) positive expression and postoperative disease-free survival rate were analyzed. Results In clinicopathological factors, multivariate analysis identified CEA positive expression was significantly correlated with tumor diameter (P = 0.011 ),depth of tumor invasion (P= 0.027) and lymphatic vessel invasion (P= 0.001 ) in lymph node positively. The average postoperative follow-up was (53.14 ± 16.75) months. There was statistical correlation between the tumor diameter( P = 0.018 ) or depth of tumor invasion ( P = 0.015 ) and postoperative disease-free survival rate. The disease-free survival rate was 90.91% ( 80/88 ), 86.36% ( 19/22 )and 40.00% (4/10) for the lymph node CEA negative,isolated tumor cells (IT Cs) and micrometastasis,respectively. There was significant difference between micrometastasis and the lymph node CEA negative (P= 0.000) or ITCs (P = 0.009), however, the lymph node CEA negative and ITCs was no significant difference (P = 0.438 ). Lymph node micrometastssis of gastric cancer was detected in 10 patients who should belong to stage pN1,the restage rate was 8.33%(10/120). Conclusions If the patients were found micrometastasis in lymph node with high-risk stage pT1-3NoMo gastric cancer for whom chemotherapy may be recommended,because of its high recurrence and poor prognosis.

Objective To explore the clinical features of chronic granulomatous diseases and Mcleod syndrome caused by continuous X chromosome deletion. Methods The clinical data of two children diagnosed as chronic granulomatous disease and Mcleod syndrome by gene detection were retrospectively analyzed. Results Two males, 4 year 1 month and 1 year 9 month old, were both hospitalized due to persistent pulmonary infections. Both of them had a history of repeated severe infections and BCG vaccine associated lymphadenitis, and were diagnosed as X-linked chronic granulomatous disease for respiratory burst defects and deletion of all CYBB exons. Both of them had retarded motor development, and were diagnosed as DMD for detection of DMD gene exons and muscle speciifc promoter region and exon 1-2 deletion by MLPA. One case was found with obvious echinocytes, the other case showed whole exons deletion of XK gene. Both of them were diagnosed as Mcleod syndrome. Conclusion Continuous X chromosome deletion could lead to combination of Mcleod syndrome, DMD, and X-CGD, which may complicate the condition. Due to the lack of Kx antigen, repeated common blood transfusion can produce relative antibody, which lead to severe hemolytic crisis.

Objective To compare and evaluate the clinical efficacy and side effect of vinorelbine plus gemcitabine and vinorelbine plus cisplatin combinations in advanced non-small-cell lung cancer(NSCLC). Methods 56 cases with non-treated advanced NSCLC were unrandomly divided into two groups: the GN group (27patients) treated with vinorelbine plus gemcitabine, the NP group (29 patients) treated with vinorelbine plus cisplatin,1/3 weeks×2～6 cycles. Results For the GN group, the overall response rate was 37.7 %, MTTP was 5.1months,one year survival rate (1-ySR) was 40.7 %. There were no significant difference in the response rates and the survival rates for the GN group compared with the NP group (P ＞0.05); But on the side effect of toxicities, WHO grade anemia and nausea/vomiting and tiredness of the GN group was significantly milder than the NP group (P ＜ 0.05). Conclusion Vinorelbine combined Gemcitabine regimen (GN) is active and well-tolerated. It is worth to investigate GN recommended as the first line chemotherapeutic regimen for the treatment of patients with advanced NSCLC.

Objective To study the relationships of alcohol consumption to the prevalence of metabolic syndrome and its re‐lated components in Yichang professional population and provide decision making basis for lifestyle intervention to MS crowd in the city .Methods We examined baseline data from 3 640 participants (2 285 men and 1 355 women) aged 20 to 70 years who under‐went a careful drinking habits survey ,then physical examination and blood chemical examination .They were divided into three groups by average ethanol intake [non ,occasional (<10 g/day) ,moderate (≥10 and <30 g/day) ,and heavy (≥30 g/day) drink‐ers] .Results Compared with no drinking and occasional drinking group ,the prevalence of MS and abnormal rate of BMI ,DBP ,TG , UA increased significantly (P< 0 .05) while SBP decreased significantly in moderate drinking group;compared with moderate drinking group ,the prevalence of MS and abnormal rate of BMI ,DBP and SBP ,GLU ,TCH ,TG ,LDL C ,UA increased significantly (P<0 .05) in heavy alcohol consumption group;whether moderate or heavy drinking ,abnormal rate of CRP and HDL C did not change significantly(P>0 .05) .Conclusion Even moderate drinking has a significant effect to BMI ,DBP ,TG ,LDL C ,UA ,but not obvious to CRP ,GLU ,TCH ,HDL C .Excessive alcohol consumption has a very bad effect on BMI ,DBP ,SBP ,GLU ,TCH ,TG , HDL C ,LDL C ,UA .Both the prevalence of MS and the abnormal rate of its related components are proportional to the alcohol in‐take .Although moderate drinking could lower SBP and GLU ,but can not reduce the incidence of MS .

Objective To improve the understanding of neonatal-onset pulmonary tuberculosis.Methods The clinical features,laboratory examination and imaging were analyzed in 2 cases with neonatal-onset pulmonary tuberculosis in the Respiratory Department of Beijing Children's Hospital,Capital Medical University.Results The 2 patients were premature twins,were born at 33 +3 weeks of gestation,presented with intermittent cough and transient fever on 26 days after birth.Chest CT scan showed pulmonary multifocal nodules.One case was complicated with pleural effusion,atelectasis and no effectiveness with antibiotics.The untypical pathogen infection was considered.The result of PPD was negative,the result of interferon gamma release array,gastric acid fast staining and mycobacterium tuberculosis culture were positive,finally they were diagnosed with pulmonary tuberculosis.Conclusions The clinical features and imaging of neonatal tuberculosis are always untypical and PPD is negative,which brings difficulties to clinical diagnosis.We should take untypical pathogens into account,such as tuberculosis,when some diseases cannot be explained by common pathogens.

Objective To assess the value of transesophageal echocardiography (TEE) in left atrial appendage (LAA) closer with Amplatzer Cardiac Plug (ACP).Methods Consecutive 32 atrial fibrillation patients (CHADS2≥1) with high risk bleeding underwent LAA occlusion with ACP LAA occlusion device under the guidance of TEE.Measurements of LAA anchoring area diameter (AAD) and LAA anatomical orifice diameter (AOD) including maximum,minimum values,and LAA depth on 2 dimentional TEE (2D TEE) were conducted before closer device implantation.The outcomes of LAA occlusion were analyzed.Results Among 32 patients,27 cases achieved successful LAA occlusion,including 2 cases with peripheral leakage ≤5 mm,and 5 cases failed occlusion.Among 5 failed closed patients,3 cases with LAA AAD≥ 30 mm,1 case with LAA of short depth,and 1 case with anatomical variation of LAA of low position that access sheath could not be positioned in the LAA.LAA AAD maximum,minimum and LAA depth were (25.9±4.9)mm,(20.0±3.8)mm,(31.0±5.6)mm,respectively,and LAA AOD maximum,minimum diameters were (26.2±6.2)mm,(19.4±4.3)mm,respectively.Among 10 cases with LAA AAD≥30 mm,7 cases achieved successful LAA occlusion,but 3 cases failed.The implanted device diameter was (26.4±3.8)mm,and device compression rate was (7.6±5.5)%.The coefficient of correlation between device diameter and large LAA AAD and AOD is 0.770 and 0.717,respectively.There was no complication but 1 case with pericardial effusion.Conclusions Two dimentional TEE measurements of LAA have clinical guiding significance in the selection of proper size of ACP LAA occluder.The AAD of 2D TEE has the good correlation with ACP occluder′s size,the AADs are important factors which affect the success of LAA occlusion.

ObjectiveTo investigate the characteristics of traumatic spinal cord injury (TSCI) urban inpatients of Tianjin in 2007. MethodsInpatients with TSCI of 8 hospitals in Tianjin in 2007 were reviewed. ResultsThere were 73 patients in total. Mean age was (51.34±14.597) years. Male∶Female was 3.56∶1. Falling, motor vehicle accidents （MVC） were the main causes of TSCI. The cervical spinal cord injuries were predominant. 26% were complete injury and 74% were incomplete. 6 cases were dead. Patients with ASIA grade D recover well. ConclusionFor the TSCI, the ages of patients increases and falling is the main cause.

Objective To evaluate the clinical application value of 2-dimentional transesophogeal echocardiography (2D-TEE) ,real-time 3-dimensional transesophogeal echocardiography(RT-3D TEE) and left atrial appendage CT angiography ( LAA CTA ) before percutaneous left atrial appendage closure ( LAAC) with the Watchman occluder . Methods Consecutive 50 atrial fibrillation ( AF) patients underwent 2D-TEE ,RT-3D TEE and LAA CTA examination before LAAC . The number of LAA lobes ,the diameter of landing zone (DLZ) and the depth of LAA were measured by using different methods . The correlation between LAA landing zone diameters measured by different methods and device size were calculated . Results Among 50 patients ,there was no significant difference in lobe nubmers between RT-3D TEE and LAA CTA ( P >0 .05) . The maximum diameter of landing zone(DLZ) from LAA CTA was greater than those from RT-3D TEE and 2D-TEE ( t =3 .977 ,5 .373 ,both P<0 .05) ,and DLZ from RT-3D TEE was greater than that from 2D-TEE ( t=2 .124 , P <0 .05) . The value measured by RT-3D TEE was greater than that by 2D-TEE for the LAA minimum DLZ ( t =2 .142 , P < 0 .05) . LAA depth:CTA value was greater than 2D-TEE and RT-3D TEE values( t =2 .674 ,4 .066 ,both P < 0 .05) ,and 2D-TEE value was greater than RT-3D TEE value( t =2 .114 , P <0 .05) . The correlation coefficient of LAA maximum ,minimum DLZ and LAA depth between 2D-TEE and RT-3D TEE were 0 .638 ,0 .734 ,0 .647 ( all P =0 .000) ,and 0 .517 ,0 .338 and 0 .591 between RT-3D TEE and LAA CTA ,respectively ( all P <0 .05) ,and 0 .503 ,0 .359 and 0 .610 between 2D-TEE and LAA CTA ,respectively ( all P < 0 .05) . LAA DLZ of LAA angiography ( LAA-A) was ( 22 .6 ± 3 .5 ) mm . Fourty-seven AF patients achieved successful LAA occlusion with Watchman device and the size of closure was ( 27 .5 ± 3 .3) mm . Correlation coefficient between the size of device and LAA maximum DLZ by RT-3D TEE ,2D-TEE and LAA CTA were 0 .693 ,0 .647 ,0 .586 , respectively (all P = 0 .000) . Correlation between LAA-A and the size of device was the closest ( r =0 .914 , P =0 .000) .Conclusions The difference in LAA size measured by TEE and LAA CTA could be significant ,and need to be considered before the LAAC . 2D-TEE , RT-3D TEE and CTA LAA measurements all could play important roles in the selection of proper Watchman device size ,and the maximum DLZ of RT-3D TEE has the closest correlation with Watchman device size .