With the change of modern medical model and the rapid development of medical technology,medical humanities education in higher medical education has obviously been weakened and has obvious deficiencies.We should fully understand the importance and the necessity of medical humanities education during cultivating medical students.We should also improve medical humanities curriculum system,construct teaching staff combining with different majors,intensify the cultivation of humanistic quality in practice and organically combine ideological and political with humanistic education,and perfect evaluation system,etc.Inall We should explore the effective way of medical humanities education in many aspects.

Noninfectious diarrhea is a kind of digestive disease caused by many factors and the main clinical features are increased frequency of defecation and change of character of stool,most of the patients have intestinal microecological imbalance. Improving the intestinal microecological balance is very important in the treatment of noninfectious diarrhea. Microbial ecological agent(MEA)has definite efficacy for the treatment of noninfectious diarrhea,and gradually becomes the commonly used drug for noninfectious diarrhea in clinical practice. This article reviewed the use of MEA in the treatment of noninfectious diarrhea.

Objective To explore the relationship among structural empowerment,psychological empowerment and nurses' job burnout,and to provide new approach for relieving nurses' job burnout.Methods Conditions for Work Effectiveness Questionnaire-Ⅱ (CWEQ-Ⅱ),Psychological Empowerment Scale (PES),and Maslach Burnout Inventory (MBI) were used to investigate 233 nurses working at three general tertiary-level hospitals in Tianjin.Results The total scores of structural empowerment,psychological empowerment,and burnout were (43.498 ±9.977),(38.871 ±7.052) and (45.489 ± 11.331),respectively.Relevant Analysis results showed that structural empowerment,psychological empowerment and nurses' job burnout had significant correlation,and the absolute value of coefficient of correlation between 0.358-0.560.The structural equation modeling results showed that fit indexes for fully mediating effect model were excellent(x2 =57.703,x2/df =1.202,GFI =0.965,AGFI =0.933,NFI =0.948,RFI =0.916,IFI =0.991,TLI =0.985,CFI =0.991,RMSEA =0.030,CN =263).Structural empowerment had a positive significant influence on psychological empowerment; structural empowerment and psychological empowerment had a negative significant influence on nurses' job burnout; psychological empowerment played a fully mediating role between structural empowerment and nurses' job burnout.Conclusion Nurse psychological empowerment has direct effect on job burnout.Nurse structrual empowerment affects job burnout via the full effects of psychological empowerment.

Diabetic cognitive dysfunction is one of the important complications of diabetes mellitus .Insulin plays an important protective role in cognitive function through MAPK and PI 3-K/Akt signaling pathway .Insulin resistance may give rise to excessive tau protein phosphorylation , formation of neurofibrillary tangles inhibits insulin degrading enzyme , reduces the degradation of amyloid β;enhances oxidative stress , further damages the integrity of the neu-ronal structure and function and eventually leads to cognitive dysfunction .

The growing number of cognitive dysfunction patients is bringing heavy mental and financial burdens to the society and families.Voltage-gated potassium channels (Kv), which consist of delayed rectifier potassium channels and transient outward po -tassium channels , are involved in the incidence of cognitive dysfunction .This review summarized the role of Kv channels in cognitive dysfunction and their relationship with N-methyl-D-aspartic acid receptors ( NMDARs) that play an important role in the process of learning and memory .

Crohn’s disease( CD)is a gastrointestinal progressive granulomatous disease with unknown etiology. It is characterized as active stage alternating with remission stage,long-term course with many complications,sometimes needing surgery and having the tendency of relapse in patient ’s whole life. Therefore,it is important to define an effective therapeutic endpoint to ameliorate the natural course of CD. This article reviewed the progress in defining treatment endpoint of CD.

Inflammatory bowel disease( IBD)includes ulcerative colitis( UC)and Crohn’s disease( CD),its incidence is increasing yearly in our country. With the progress of molecular biology,genetics,the understanding of IBD is deepen,however,the exact pathogenesis of IBD is still not fully clear,and it may be related to gene,environment, immunity,microorganism. Studies have shown that smoking,vitamin D,sex hormones,emotions,diet may be related with the occurrence of IBD. This article reviewed the role of environmental factors in IBD.

Objective To compare the effectiveness and safety of radiofrenquency ablation(RFA) with other therapeutic methods for patients with early hepatocelluar carcinoma(HCC). Methods Randomized clinical trials(RCTs)which compared the efficacy or safety of RFA with other therapeutic methods for primary hepatocellular carcinoma in Cochrane library,EMBASE,PubMed,OVID and CBM were searched.Trials were considered of high quality if methodological quality score was 3 or more according to Jadad standard.Statistical heterogeneity between trials was evaluated bv STATA 9.0 and considered to exist when P＜0.1.Heterogeneity of the included articles was tested and used to select proper effective model for calculation.Sensitivity analysis was performed and publication bias was investigated through visual inspection of funnel plots and Egger regression model.Results Six RCTs including 862 cases were analyzed.As compared with other therapeutic approaches,RFA significandy increased 3-year overall survival rate and reduced local recurrence rate of early hepatocelluar carcinoma:the total OR were 2.06(95%CI being 1.54-2.77,P=0.000)and 0.40(95%CI being 0.28-0.57,P=0.000)respectively.As compared with other therapeutic approaches,the total OR of new HCC recurrence rates,extrahepatic metastasis rate and major complications in patients with HCC treated with RFA were 0.92 (95%CI being 0.68-1.24),0.98(95%CI being 0.30-3.22),1.35(95%CI being 0.49-3.77)respectively,showing no significant differences(P＞0.05).Inspection of the funnel plots for all outcome measures did not reveal evidence of publication bias(P=0.670,0.160,0.884,0.087,0.317,respectively,by Egger regression model).Conclusions RFA is superior to other treatment methods with respect to local recurrence and 3 year overall survival in early HCC and is the preferred tberapeutic method for small HCC because it is minimally invasive,simple and convenient.

Objective To evaluate the efficacy and safety of preoperative colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction based on literature. Methods The randomized clinical trials (RCT) on the subject were retrieved from PubMed,OVID,EMBASE,Cochrane library,CNKI,Wanfang data and VIP Chinese Scientific and Technologic Periodical Database.Statistical heterogeneity between trials was evaluated by Revman 5.0 and was considered to exist when P ＜ 0.1.Heterogeneity of the included articles was tested,which was used to select proper effect model.Publication bias was investigated through visual inspection of funnel plots.Results Five RCT including 283 cases were analyzed,in which 145 patients received preoperative colonic stenting and 138 received emergency surgery.Compared with those of emergency surgery groups,the total OR of permanent stoma,one-stage operation,and infection of preoperative colonic stenting group were 0.28 (95％ CI:0.12 - 0.62,P =0.002),2.13 (95 ％ CI:1.28 - 3.55,P =0.004) and 0.25 (95％ CI:0.08 - 0.80,P =0.02),respectively.There were no significant differences between 2 groups in anastomotic leakage,mortality,intra-abdominal infection,or overall morbidity.OR were 0.70 (95％ CI:0.29 - 1.71,P =0.44),1.17 (95％ CI:0.49 -2.79,P=0.72),0.27 (95％CI:0.03-2.65,P=0.26) and 0.32 (95％CI:0.07-1.42,P=0.13),respectively.Inspection of the funnel plots for all outcome measures did not reveal evidence of publication bias.Conclusion Preoperative colonic stenting significantly improves one-stage operation and decrease the rates of permanent stoma and wound infection.However,large-scale and high-quality RCTs are further needed.

Objective To evaluate the efficacy and safety of itopride in the treatment of functional dyspepsia (FD) according to the data of published clinical studies.Methods The papers about randomized controlled trials (RCT) of itopride in treatment of FD were searched from Cochrane library,EMBASE,PubMed,Elsevier,web of science (ISI),China national knonledge internet (CNKI),VIP Chinese Scientific and Technologic Periodical Database and Wanfang data,and the feature information in the studies were extracted.The relative risk (RR) value was used for count data and the weighted mean difference (WMD) was used for measurement data.The proper effect model was selected according to the results of heterogeneity test and the publication bias was investigated through visual inspection of funnel plots.Results A total of nine RCT met the inclusion standard.Of 2620 FD cases,1372 received itopride treatment and 1248 cases received placebo or other medicine as control treatment.The RR value of total effective rates,postprandial fullness and early satiety effective rates in itopride treated FD patients was 1.11 (95％CI:1.01,1.21; P=0.02),1.18 (95％CI:1.04,1.33; P=0.009),1.24 (95％CI:1.01,1.53; P=0.04),which showed the curative effects of itropride group were all better than those of control group.However there was no statistical significance in epigastric discomfort.The WMD of effective rates evaluated with the leeds dyspepsia questionnaire (LDQ) score was-1.38 (95％CI:-1.75,-1.01; P＜0.01),which showed the curative effect of itropride group was better than that of control group.For safety,the adverse effects rates of itopride groups were similar with control groups.The funnel plots of each inspection index presented wide bottom,narrow up and symmetrical graphics,which indicated that there was no publication bias.Conclusion Itopride has better efficacy in general symptoms,postprandial fullness,early satiety and LDQ score in FD patients,and few effects are detected.