Currently the employment situation of graduates in China tend to be grim.This article attempts to describe several representative psycological problems faced by graduate students during job hunting and to analyze their possible causes.On this basis,the author proposes some educational countermeasures against such job-hunting psycological problems.

Ischemic stroke is one of the most important complications of malignant tumors. The etiology and pathogenesis of ischemic stroke in patients with cancer are very complicated, it includes either traditional vascular risk factors such as hypertension, diabetes and hyperlipidemia or the risk factors associated with the pathophysiological state of tumors such as hypercoagulable state, tumor emboli, and thrombotic endocarditis. In addition, various treatment methods associated with tumors, such as radiotherapy, chemotherapy and endocrine therapy, can also increase the risk of ischemic stroke. Because of the complexity of the etiology and pathogenesis, the treatment methods for ischemic stroke in patients with cancer are also different with common practice. Identification of the causes and selection of targeted therapies are crucial for the prevention ad treatment of tumor-associated ischemic stroke. With the increase of the survival rate in patients with cancer, ischemic stroke in patients with cancer is also receiving increasing attention. This article reviews advances in etiology, pathogenesis and treatment of ischemic stroke in patients with cancer.

Objective To investigate the role of A2B adenosine receptor(A2BAR)in 6% HES 130/0.4-induced reduction of pulmonary capillary permeability in a rat model of sepsis.Methods Fifty male SD rats weighing 250-300 g were randomly divided into 5 groups(n = 10 each): group Ⅰ sham operation(group S);group Ⅱ sepsis(group CLP);group Ⅲ ,Ⅳ,Ⅴ low,medium,high dose HES(group H1,2,3).The animals were anesthetized with intraperitoneal pentobarbital sodium 50 mg/kg.Left carotid artery and left femoral vein were cannulated for MAP and HR monitoring and fluid and drug administration.Sepsis was induced by cecal ligation and puncture (CLP).6% HES 130/0.4 7.5,15.0 and 30.0 ml/kg were infused iv over 2 h in group H1,2,3 respectively at 4 h after CLP.The animals were sacrificed at 6 h after CLP.The lungs were isolated for determination of pulmonary capillary permeability(by iv Evans blue injection),the expression of A2BAR and the contents of cAMP,protein kinase A(PKA),TNF-α,IL-6 and IL-10 in the lung tissue.Results CLP significantly increased pulmonary capillary permeability,A2BAR expression and cAMP,IL-6 and TNF-α contents in the lung tissue in group Ⅱ as compared with group S.0.6% HES 130/0.4 significantly reduced pulmonary capillary permeability,increased A2BAR expression,cAMP,PKA and IL-10 and decreased IL-6 and TNF-αcontents in the lung tissue in group H1,2,3 as compared with group CLP.6% HES 130/0.4 decreased pulmonary capillary permeability and up-regulated A2BAR expression in a dose-dependent manner.6% HES 130/0.4 15.0 ml/kg was most effective in increasing cAMP and PKA contents in the lung and depressing inflammatory response.Conclusion 6% HES 130/0.4 decreases pulmonary capillary permeability in a rat model of sepsis by up-regulating A2BAR expression in lung tissue.

Objective To detect radiation-induced changes of temporal lobe normal-appearing white matter on conventional MRI following radiation therapy (RT) for nasopharyngeal carcinoma (NPC).Methods The clinical and imaging features of 75 patients with nasopharyngeal carcinoma were retrospectively analyzed,all patients were confirmed by biopsy.All patients performed conventional MRI and Diffusion-tensor imaging (DTI) examinations,and there was no abnormal finding on conventional MRI.Eighteen patients without radiotherapy were selected as the control group and fifty-seven patients with radiotherapy were as the experimental group.We divided the experimental group into five subgroups based on completion time of RT:group 1 (less than 3 months,n =16),group 2 (3 to 6 months,n =12),group 3 (6 to 9 months; n =10),group 4 (9 to12 months,n =8),and group 5 ( more than 12 months,n =11 ).The mean diffusivity ( MD),apparent diffusion coefficient ( ADC ),fractional anisotropy ( FA),radial diffusivity ( λ⊥ ) and axial diffusivity ( k ‖ ) were calculated in bilateral temporal lobe.One-way analysis of variance (one-way ANOVA) test was used for comparison among groups.Results The mean λ⊥ values of the control group and experimental groups ( group1-5 ) after radiotherapy were ( 6.075 ± 0.341 ) × 10 -4 (6.700±0.379) × 10-4,(6.976 ±0.527) ×10-4,(6.621 ±0.388) ×10-4,(6.751 ±0.460) ×10-4,(6.222 ±0.256) × 10-4 mm2/s,respectively.The mean λ ‖ values of the control group and experimental groups were (12.524±0.713) ×10-4,(11.764 ±0.574) ×l0-4,(11.842±0.471) ×10-4,(11.569 ± 0.552) × 10-4,( 12.050 ±0.614) × 10-4,( 12.100 ±0.529) × 10-4 mm2/s,respectively.The mean FA values of the control group and experimental groups were 0.452 ± 0.030,0.379 ± 0.028,0.382 ± 0.028,0.389 ± 0.032,0.388 ± 0.022,0.423 ± 0.232,respectively.The three indicators were significantly different among groups ( F =10.485,4.625,16.539,respectively,P ＜ 0.05 ). Multiple comparisons showed that λ⊥ increased significantly in group 1-4 compared with that in the control group.In group 5,λ ⊥ was not significantly different from that in the control group,λ ‖ decreased in group 1-3 compared with that in the control group,but was not significantly different in the control group and group 4-5. In all experimental groups,FA decreased significantly. MD and ADC values in experimental groups were not significantly different from those in the control group. Conclusion Diffusion tensor imaging is a noninvasive and quantitative method to detect the structural changes in WM after RT and can provide scientific evidence for the early diagnosis and intervention treatment of radiation-induced changes.

Objective:To evaluate the clinical significance of our self-designed three-column scoring system for postoperative X-ray stability of intertrochanteric fracture after intramedullary nailing.Methods:A retrospective study was conducted of the 378 patients with intertrochanteric fracture who had been treated between January 2015 and June 2019 at Department of Orthopaedics, Linyi People's Hospital by internal fixation with proximal femoral nail antirotation (PFNA). They were 161 males and 217 females, aged from 60 to 97 years (average, 72.5 years). By the AO classification, there were 109 cases of type 31-A1, 188 cases of type 31-A2 and 81 cases of type 31-A3. Anteroposterior and lateral X-ray examinations of the hip were performed immediately after internal fixation to evaluate the fracture stability using our self-designed three-column scoring system by which the medial column is given 4 points, middle column 2 points and lateral column 2 points. A single column scoring full points is rated as stable, 3-column stability as excellent, 2-column stability as good, one-column stability as fair, and 3-column unstability as poor. Rehabilitation programs were carried out according to the results of stability evaluation: full weight bearing at an early stage was indicated for excellent patients, partial weight bearing at an early stage for good patients and weight bearing at an early stage contraindicated for fair or poor patients. Fracture union time and failure of internal fixation were recorded. The relationship between internal fixation failure and our three-column scoring system was calculated.Results:The 378 patients were followed up for 6 to 24 months (mean, 10.4 months). Of them, 365 obtained fracture union after an average time of 4.3 months (from 3 to 7 months). Internal fixation failure occurred in 13 patients, giving a failure rate of 3.4%(13/378).Of the 129 excellent patients by our three-column scoring system for post-operative X-ray stability of intertrochanteric fracture, none failed in internal fixation; of the 193 good patients, 4 failed; of the 56 fair patients, 9 failed. Internal fixation failure was closely related to our three-column scoring system for postoperative X-ray stability of intertrochanteric fracture ( r=-0.986, P=0.006), as well as to the column stability ( r=-1.000, P=0.033). Conclusion:Our self-designed three-column scoring system for postoperative X-ray stability of intertrochanteric fracture after intramedullary nailing can accurately reflect the fracture stability so that it can be used to guide rehabilitation programs for the patients and judge their prognosis.

Objective:In order to compare the effect of ascending medial open-wedge high tibial osteotomy and descending medial open-wedge high tibial osteotomy on patellar height.Methods:Our group analyzed 77 patients of medical cases which were closely associated with medial open-wedge high tibial osteotomy for the treatment of knee varus deformity and medial compartment osteoarthritis from May 2011 to December 2018 and 77 cases were effectively followed up, including 36 males and 41 females with an average age of 59.4±10.5. By the way, there are 51 cases of ascending osteotomy and 26 cases of descending osteotomy. During these treatment, we adopted some scientific methods full-length standing anteroposterior radiograph,Miniaci method, Insall-Salvati index (ISI), Caton-Deschamps index (CDI) and Blackburne-Peel Index (BPI) to measure the corresponding parameters and changes in patellar height (PH) at different stages.Results:77 patients were enrolled, the mean follow-up time was 20.6 months (range, 12-60 months), ascending and descending high tibial osteotomy (HTO) show the average degree of varus correction (10.43°±2.67° and 11.16°± 2.80°) respectively. And at the same time, in these cases of ascending HTO, PH decreased by 8.1% (CDI method), 2 cases of low PH (the patellar height decreased by 10%, which is the low patellar) were measured (ISI method), 7 cases of low PH occurred (CDI and BPI). Instead, PH decreased by 4.5% (CDI method) in descending HTO,the difference was significant ( t=2.101, P=0.040). 22 cases of ascending HTO with varus correction less than 10 degrees, the PH decreased by 6.9%. By the way, the ISI method did not detect the occurrence of low PH, but we found one by CDI and BPI. The 29 cases with varus correction of more than 10 degrees in ascending HTO, and PH decreased by 10.4%. There were 2 low PH (ISI method), and 6 low PH (CDI and BPI), the difference was significant ( t=2.310, P=0.028). Conclusion:In ascending HTO, the low PH is closely related to the degree of varus correction. Conversely, The descending HTO did not influence PH.

Objective To investigate the effects of on-pump and off-pump coronary artery bypass grafting on plasma adrenomedullin (ADM) and endothelin-1 (ET-1) levels before and after operation in elderly patients. Methods Elderly patients aged 60 years and over with coronary artery bypass grafting were enrolled in the study and divided into off-pump group and on-pump group, each group had 20 cases. Blood samples were collected before surgery, immediately after operation and 6,24 hours, 3 days after operation. The plasma levels of ADM and ET-1 were dectecded by radio immunoassay. Results The levels of ADM and ET-1 were significantly increased immediately after operation in 2 groups of on-and off-pump. The levels of ET-1 in on-pump group and off-pump group were (67.59±10.18) ng/L and (58.73±9.64) ng/L respectively. The levels of ADM in on-and off-groups were (284.90±36.24) ng/L and (243.25±25.70) ng/L. This showed that in on-pump group, the plasma levels of ADM and ET-1 increased more significantly(P＜0.05). The plasma levels of ADM and ET-1 began to decline at 6 hours after operation, and continued to 24 hours after operation. On 3 days after operation, the plasma levels of ADM and ET-1 in off-pump group returned to the preoperative level, but they were still maintained at a high level in on-pump group.Conclusions For elderly patients, both on-pump and off-pump coronary artery bypass grafting can cause endothelial dysfunction, increasing plasma levels of ET-1 and ADM. But compared with the on-pump coronary artery bypass grafting, the off-pump coronary artery bypass grafting has less influence.

Objective To research the effects of neural stem cells (NSCs) transplantation on the neurological function improvement and neural survive and axonal regeneration in traumatic rat brain. Methods NSCs were cultured in vitro, labeled with hochest and transplanted into rat brain injured area by weight-dropping. Neurological severity scores(NSS) tested the functions at the 0,3,7,14 day post-injury. Immunofluorescence was used to detect the expressions of NeuN cells and GAP-43. Results There was significant difference in NSS between NSCs transplantion group and brain injury group(4.38 ±0.74 vs 5.50 ± 1.07, P＜0.01) at 7th day. There were a significant increase in neural number (51.46 ± 3. 303 vs 42.83 ± 5. 401, P ＜ 0.01 ) ), and GAP-positive axons ( 13.3 ± 1.7 vs 8.7 ± 1.1, P＜0.01 ) in NSCs transplantion group than in control group. Conclusion NSCs have an effects on the neurological improvement in brain injured rat. This may be associated to the increase in number of the neurons and local axons.

Objective To observe olfactory ensheathing cells transplantation on brain injury recovery nerve function and to explore its mechanism. Methods After purification of the olfactory ensheathing cells cultured for NGFRp75 immunocytochemical identification and preparation of cell suspension for transplantation, some cells were pre-labeled for bservation of survival after transplantation. 48 adult SD rats were randomly divided into three groups:sham operation without injury group (A group),cerebral cortex motor area injury group (B group) , the same brain injury and the olfactory ensheathing cell transplantation group (C group). At postoperative day,3 d, 7 d,14 d the neurological severity score (NSS) of rats were assessed; 14 d after injury of brain tissues were taken for NeuN immunohistochemistry host the number of neurons change. The data were statistically analyzed using SPSS17.0 software. Results (1) Cultured olfactory ensheathing cells showed NCFRp75 positive,the positive rate was 90%. (2) 14 d after transplantation of nuclear fluorescence labeling of olfactory ensheathing cells survived well in the host body. (3) 14 d after NSS score of B group( 2.00 ± 0.53) and C group ( 1.25 ± 0.46) were significantly better than the B group (P<0.05). (4) NeuN positive cells in B group (39.2 ±7. 1) and C group(45, 8 ± 6.0) were significantly better than B group (P<0.05). Conclusions Olfactory ensheathing cell transplantation can promote the recovery of neurological function in rats brain injury,which may be related with olfactory ensheathing cells to promote neuron survival in the host.

Objective To investigate changes of spontaneous brain activity in patients with type 2 diabetes mellitus (T2DM) by fractional amplitude of low-frequency fluctuations (fALFF) on subbands, and the possible relationship between these changes and cognitive impairment caused by T2DM.Methods Twenty-two T2DM patients and twenty-three healthy control subjects were involved in this study between December 2013 and June 2014 and the demographic and clinical data (fasting plasma glucose and HbA1c level) were obtained in all subjects.General cognition was assessed by MMSE in all subjects, and memory performance was assessed by Auditory Verbal Learning Test (AVLT) in T2DM group.3D-T1 structural and resting-state functional MRI data were collected by MR scanner.Then fALFF value on slow-5 (0.010-0.027 Hz) and slow-4 (0.027-0.073 Hz) were calculated respectively using DPARSF V2.3.Intra-group and inter-group t-tests were conducted by REST V1.8.Partial correlation among fALFF values extracted from significantly different brain regions, clinical data and AVLT score of T2DM patients were calculated , using age as covariate.Results Compared to the healthy controls, T2DM patients showed increased fALFF values in bilateral anterior cingulate gyrus (cluster=130, t=4.4487, P＜0.05) and partial left cerebelum areas (cluster=89, t=3.8409, P＜0.05) in frequency band slow-5.Moreover, the T2DM patients showed decreased fALFF values in bilateral middle occipital gyrus and precuneus (Left: cluster=102, t=-3.4806.Right: cluster=151, t=-5.1355.All P＜0.05) in frequency band slow-5.While in frequency band slow-4, the T2DM patients showed increased fALFF values in left inferior temporal gyrus (cluster=104, t=4.8631, P＜0.05), and decreased fALFF values in right lingual gyrus (cluster=91, t=-3.7146, P＜0.05).There was positive correlation between fALFF values of middle occipital gyrus and precuneus and AVLT immediate memory score (r=0.456, P=0.038).Conclusions T2DM patients exhibit abnormal spontaneous activity among brain regions associated with cognition, including brain regions related to default mode network on slow-5, and brain regions related to semantic cognition and visual information processing on slow-4.The abnormal regions exhibit different spatial patterns depending on the subbands of low-frequency fluctuations.