Objective:Combining the reality of school, to explore the method of training on the implementation of the outstanding doctor education.Methods: Deepening the reform of teaching, curriculum integration, constructing reasonable curriculum system, strengthen the innovation ability and practice ability, build a outstanding doctor training system, revision of the talent training scheme, the implementation of outstanding physician education program.Results:in our school outstanding doctor the actual situation of the education training, and further analysis and research, explore the method of training on the implementation of the outstanding doctor education.Conclusion: by deepening the reform of teaching, constructing curriculum system, strengthen the innovation ability and practice ability, build a outstanding doctor training system, revision of the talent training scheme, the implementation of outstanding physician training plan, so the method of training on the implementation of the outstanding doctor education is feasible.

Objective To evaluate clinical efficacy of tigecycline alone or in combination with other antimicrobials in treating infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB).Methods Patients with hos-pital-acquired pneumonia (HAP)and/or bloodstream infection in the intensive care unit of a hospital between Janu-ary 2013 and June 2014 were selected,efficacy of tigecycline treatment was analyzed.Results Of 25 patients with CRAB infection,21 were with HAP,2 with bloodstream infection,and 2 with both HAP and bloodstream infec-tion.13 cases were multidrug-resistant Acinetobacter baumannii (MDRAB), 10 cases were extensively drug-resistant Acinetobacter baumannii (XDRAB).The susceptibility rate of 25 CRAB isolates to tigecycline was 84%. After treated with tigecycline,white blood cell count(WBC),C-reactive protein (CRP),and procalcitonin (PCT) all significantly decreased (all P<0.01).The clinical effective rate,bacterial clearance rate,and 30-day mortality were 68.00% (17/25),66.67%(14/21),and 28.00% (7/25)respectively;effective rate of 21 cases of HAP was 76.19% (16/21),1 case of bloodstream infection was effective,2 cases of HAP combined bloodstream infection died.Conclusion Tigecycline is effective in the treatment of HAP caused by CRAB,but the therapeutic effect on bloodstream remains uncertain,further research is needed.

Objective To explore the efficacy of transurethral resection of bladder neck(female)and urinary sphincter(male)to treat neurogenic urinary dysfunction. Methods Forty-one patients(28 women and 13 men)with neurogenic urinary dysfunction(dysuria)were retrospectively analyzed.All patients had sacral neurological damage.The mean patient age was 27(12-43)years.All patients had urinary retention and ureter dilation.Twenty-nine patients had renal function damage.Residual urine volume was 151-700 ml(mean 420 m1).MFR was 4-14 ml/s.After local anesthesia,bladder neck(female)was incised at 5,6,7 o'clock to the circle fiber.Urinary sphincter(male) was cut off at 11,1 o'clock and was dilated using sound(F24-F27).The catheterization time was 1-2 weeks. Results All 41 patients were followed up,from 2 months to 252 months,average 85 months.Thirty-six patients(88%)were completely recovered with no residual urine,no dilation of ureter and pelvis,no renal function damage.of these 36 cases,surgery was carried out once for 1 patient,twice for 20 and 3 times for 15.Five patients(12%)were not improved. Conclusion Transurethral resection of bladder neck(female)and urinary sphincter(reale)to treat neurogenic urinary dysfunction could be an effective method.

Objective:To analyze the differences and similarities of pre-treatment and post-treatment lung microbiome of acute respiratory distress syndrome (ARDS) and find out the change rules of the lung microbiome in the progression of ARDS according to different prognosis.Methods:A retrospective study was conducted. Patients with ARDS caused by severe pneumonia admitted to intensive care unit (ICU) of Jiangmen Central Hospital from February 2019 to January 2020 were enrolled as the study subjects. The patients were divided into pre-treatment (ARDS-preT) group (24 cases), post-treatment survival (ARDS-poT-Survival) group (17 cases), and post-treatment death (ARDS-poT-Dead) group (7 cases). ICU patients with mild pulmonary infection and non-ARDS admitted to ICU during the same period were enrolled as control group (25 cases). The similarities and differences of lung microbiome in four groups were analyzed and compared, and the possible pathogenic bacteria (potential risk factors for death) and probiotics (potential survival and protective factors) related to death caused by ARDS were screened.Results:In terms of pathogenic microorganisms, the positive rates of Escherichia coli and Candida albicans in the ARDS-poT-Dead group were significantly higher than those in the ARDS-poT-Survival group [57.1% (4/7) vs. 5.9% (1/17) and 57.1% (4/7) vs. 0% (0/7), both P < 0.05]. In the screening of background bacteria, the decrease of bacteria in the ARDS-preT group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the control group, the reduced bacteria might be pulmonary probiotics (potential protective factor for ARDS). The screening result was Hydrobacter [ARDS-preT group vs. ARDS-poT-Survival group: 62.5% (15/24) vs. 94.1% (16/17); ARDS-poT-Dead group vs. ARDS-poT-Survival group: 14.3% (1/7) vs. 94.1% (16/17); ARDS-poT-Dead vs. control: 14.3% (1/7) vs. 96.0% (24/25), all P < 0.05]. In the screening of background bacteria, the increase of bacteria in the ARDS-poT-Dead group compared with the ARDS-preT group, the ARDS-poT-Dead group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the control group, and the increased bacteria might be potential pulmonary pathogen (potential risk factor for death of ARDS), which belonged to Enterobacteria: Edwardsiella, Enterobacteriaceae, Escherichia, Klebsiella, Kluyvera, Lelliottia, Pantoea, Raoultella. Conclusions:The results revealed the increase of Escherichia coli or Candida albicans in pulmonary pathogenic microorganisms, or the increase of Enterobacteria in background bacteria may be the risk factors for the death of ARDS. Additionally, background bacteria Hydrobacter probably is a protective factor for the survival of ARDS. Whether it can be used as a novel treatment for ARDS is worth further investigation.