Objective:To investigate learning burnout of undergraduates and its relationship with health-related hardiness.Methods:408 undergraduates were investigated with Undergraduate Learning Burnout Scale and Health-Related Hardiness Scale.Results:Boys scores were significantly higher than those of girls in behavior inadequacy, reduced personal accomplishment and general burnout;significant differences were found between grades in emotion turndown and majors in emotion turndown, reduced personal accomplishment and general burnout.Health-related hardiness has a sig-nificant negative correlation with learning burnout.The results of regression analysis found that control and commitment were the effective precursors.Conclusion:Health-related hardiness has a significant influence on undergraduates' learning burnout.

Objective To explore the effect of Electroacupuncture on anxiety mood and periaqueductal grey (PAG) β-endorphine expression in rats with morphine abstinence syndrome.Methods The model of heroin-addicted rat was firmly established by the subcutaneous injection of gradually-increased dosages of heroin. Rats were randomly divided into control group, herion-addict group, withdrawal group, electroacupuncture group.Anxiety mood of experimental rats were assessed by Elevated Plus Maze test. Expression of β-EP in PAG was detected by immunohistochemstry. The effect of electroacupuncture at bilateral zusanli and sanyinjiao on anxiety mood and expression of β-EP in PAG was observed in rats with herion abstinence symptom.Results The anxiety index in rats with herion abstinence symptom:the value of OT％,OE％and head-dips times was (12.5±4.3) ％, (17.1±6.7)％and (5.7±2.0) times respectively,lower than that in control group [ (26.8±8.7) ％,(32.4±6.0) ％ and (12.2±4.0) times respectively],there existed significant difference(The value of P was 0.003,0.018 and 0.003 respectively).Meanwhile,The expression of β-EP-positive neurons(206.1±23.1)was significantly higher than the control(186.2±15.3). There existed significant difference( P =0.041).Electroacupuncture could increase OT％,OE％,head-dips times[(26.5±8.7)％、(31.8±7.7)％ and (9.9±3.1) times respectively] in rats with herion abstinence symptom,which comparied with control group were not statistically distinctive(The value of P was 0.920,0.816 and 0.122 respectively).The expression of β-EP(185.3±11.4)in PAG increased, which comparied with control group(186.2±15.3)were not statistically distinctive( P =0.891).Conclusion Electroacupuncture could inhibit the abstinence syndrome effectively.And there is obvious promotion of β-EP expression in PAG. This is probably one of underlying mechanisms for electroacupuncture improving withdrawal symptoms.

With the modernization of the medical records and the planning implementation of informationalized strategy,the management of medical records has been extended to the stage of supervising resources electronic and digital,also the informationalized features is more evident.one reason is the integration and storage of medical records information need informationalized technology support,and the other is the socialization of utilizing medical records needs the internet technology as platform,and the third is the exploration and utilization of resources in medical records requires advanced data warehouse and data mining technology as guaranty,at the same time,the management of medical records information have the man-made risk of divulging secrets,the risk of damage to the integrity,the risk may be to deny the fact,as well as the risk of information systems security.The corresponding preventive measures taken to standardize the medical records management processes,improve its management system and the law,will be a long-term and arduous task to the quality manager.

Objective: To determine the sinapine in Semen Raphani(Laifuzi) from different places by measns of RP HPLC. Method: The column empolyed was Alltima Phenyl Collumn(250?4.6mm,5?m). The mobile phase was acetonitrile 0.08 mol/LKH 2PO 4(15∶85). The flow rate was 1.0mL/min and detection was effected at 326nm results. Conclusion: The results show the method is accurate, rapid and reproducible. We found it has marked discrepancy in the content of Semen Raphani(Lai Fuzi) from different places.

Objective To analyze the related factors of congestive heart failure (CHF) in elderly female patients. Methods 39 female patients aged over 60-year-old with chronic CHF were divided into two groups according to the cardiac functional grading. Historical features and data were compared between two groups by single factor and multifactorial regression analysis.Results There were differences between two groups in hemoglobin concentration, serum creatinine, incidence of chronic kidney disease and anemia (P<0.01), but no obvious difference between two groups in morbidity of hypertension and diabetes. And it was n by multifactorial regression analysis showed that hemoglobin concentration, serum creatinine, incidence of chronic kidney disease and anemia could not be in regression equation. Conclusion The hemoglobin concentration, serum creatinine, incidence of chronic kidney disease and anemia may associated with degree of congestive heart failure.

Objective:To evaluate the clinical efficacy and safety of SpyGlass-guided laser lithotripsy for large common bile duct (CBD) stones with diameter>2 cm.Methods:From August 2015 to August 2018, a total of 157 patients with large CBD stones at the First Affiliated Hospital of Shandong First Medical University who met the inclusion criteria were randomly divided into SpyGlass group ( n=78, underwent SpyGlass-guided laser lithotripsy) and laparoscopic common bile duct exploration (LCBDE) group ( n=79, underwent LCBDE) by using random numbers. Non-inferiority test was used for rates of one-time stone removal and total stone removal, and the non-inferiority margin was set to 10%. The transform rate, incidence of short-term complications, hospital stay, and quality of life (assessed by the gastrointestinal quality of life index) were compared between the two groups. Results:The total success rates of stone clearance were 92.3% (72/78) and 96.2% (76/79) in the SpyGlass group and LCBDE group, respectively ( P=0.023), with valid non-inferiority hypothesis. The one-time stone removal rates were 83.3% (65/78) and 96.2% (76/79), respectively ( P=0.124), with invalid non-inferiority hypothesis. There were no significant differences in the incidence of transform [7.7% (6/78) VS 3.8% (3/79), P=0.294] or short-term complications [5.1% (4/78) VS 10.1% (8/79), P=0.246] between the two groups. Compared with the LCBDE group, the SpyGlass group had a shorter hospital stay (5.65±0.94 d VS 8.84±1.54 d, P=0.001) and higher scores of gastrointestinal quality of life index (1 month after operation: 99.85±4.36 VS 91.51±5.47, P=0.001; 3 months after operation: 131.24±3.32 VS 112.32±7.77, P=0.001). Conclusion:For large CBD stones, the efficacy of SpyGlass-guided laser lithotripsy is not inferior to LCBDE, and it is less invasive. In the future, SpyGlass-guided laser lithotripsy could be an important option for the treatment of large CBD stones.

Objective To investigate the efficacy of prophylactic pancreatic stent placement and nonsteroidal antiinflammatory drugs( NSAIDs) for the prevention of post?endoscopic retrograde cholangiopan?creatography(ERCP) pancreatitis(PEP). Methods A total of 623 patients with high risk factors for PEP were treated with prophylactic pancreatic stent placement ( 145 patients, group A) or rectal NSAIDs( 478 pa?tients, group B) for PEP prevention by using the propensity score matching( PSM) analysis. Incidence of PEP, moderate and severe PEP were investigated. According to risk factors of PEP, indications of prophy?lactic pancreatic stent placement were analysed. Results Of 623 patients with high risk factors, 145 pairs were generated after PSM.Pancreatitis occurred in 32 patients,10 (6?9%) in group A and 22 (15?2%) in group B( P<0?05 ) . Moderate?to?severe pancreatitis developed in 5 ( 3?4%) patients in group A and 14 (9?7%) patients in group B(P<0?05).Risk factors of post?ERCP PEP were cannulation attempts duration longer than 10 minutes, precut sphincterotomy, more than one pancreatic guidewire passages and history of ampullectomy. Conclusion Although the NSAIDs represent an easy, inexpensive treatment, prophylactic pancreatic stent placement is still a better prevention strategy for PEP.Prophylactic pancreatic stents should be recommended to those with risk factors including cannulation attempts duration longer than 10 minutes, precut sphincterotomy, more than one pancreatic guidewire passages and ampullectomy.

Objective:To determine the microvessel density (MVD) in laryngeal carcinoma and its clinical significance.Method:Thirty-eight tumor specimens were selected from laryngeal cancer patients from January,1994 to March,1996.Histological sections of the tumors were stained immunohistochemically for factor Ⅷ.Using light microscopy,we counted microvessels per 400×field in the most active areas of tumor angiogenesis.Result:①The tumor blood vessels,composed of only one layer of endothelium were mainly distrbuted heterogenously in the interstitial tissue of laryngeal carcinoma with irregular lumen,poorly developed structure.②The MVD in the cancer tissues were statistically higher than that in peritumoral tissues (P＜0.01).③The MVD in the cancer tissues in group of patients with metastasis to cervical lymphonodes were statistically higher than in group without metastasis (P＜0.01),the MVD in the cancer tissues in group of advanced cases (Ⅲ,Ⅳ stages) were statistically higher than that in group of early cases (Ⅰ,Ⅱ stages,P＜0.01).④There was no statistically difference in MVD in the cancer tissue between supraglottic and glottic laryngeal carcinoma patients (P＞0.05).⑤There was no statistically difference in MVD in the cancer tissue among the G1,G2 and G3 group (P＞0.05).Conclusion:The laryngeal cancer blood vessels have some characteristics that don′t appear in normal vessels.It is suggested that tumor angiogenesis can promote tumor growth and metastasis and MVD may be a new prognostic indicator of laryngeal carcinoma.

Objective:To introduce the experience of repairing the defect of cervical trachea wall by using the sternocleidomastoid myoperiosteal flap after the anterior or posterior wall of cervical trachea was invaded by cervical neoplasm. Method:Between 1989 to 1998 the sternocleidomastoid myoperiosteal flap was applied in 12 patients with different diseases, among which 3 cases were thyroid carcinoma, 5 cases were laryngeal carcinoma, 4 cases were cervical esophageal carcinoma. Result:The operation was successful. 12 patients were decannuated and had normal exercise tolerance. The time from reconstruction to decannulation was ranging from 20 days to 6 months. Conclusion: The sternocleidomastoid myoperiosteal flap is an ideal transplant for cervical tracheal reconstruction.

Objective To evaluate whether small endoscopic sphincterotomy (EST) plus balloon dilation (EPBD) can replace endoscopic sphincterotomy (EST) alone for patients with common bile duct (CBD) stones.Methods From May 2008 to April 2011,462 patients with CBD stones were randomly divided into two groups.The success rate of complete stone removal after the first session,the rate of using mechanical lithotripsy (ML),the short-term complications,the procedure time and fluo roscopy time were compared between the two groups.Results Overall ductal clearance did not differ between the two groups (96.5％ vs 93.5％,P＞0.05).The complication rates at 24 hours were 6.9％ for the small EST plus EPBD group and 11.7％ for the EST group (P＞0.05).However,the rate of complete stone removal after the first session using small EST plus EPBD was significantly higher than EST alone (86.2％ vs 70.4％,P＜0.05).ML was required significantly more often in the EST group when compared with the small EST plus EPBD group (34.8％ vs 12.1％,P＜0.05).The total procedure time and total fluoroscopy time in the small EST plus EPBD group were significantly shorter than the EST group [(38.6±15.5) min vs (47.1±20.2) min,P＜0.05 and (17.3± 7.0) min vs (26.5±10.8) min,P＜0.05].Conclusions Compared with EST,small EST plus EPBD was safe and more efficacious for bile duct stones.In the future,small EST plus EPBD probably can replace EST to be the first treatment of choice for bile duct stones.