Combined with the university graduates'employment situation and aiming at employment problems existing in the university,employers and graduates,this paper,based on the concept of competency and combining students cultivation with their career development,puts forward building a management system that harmonizes university's cultivating talents,employers'fetching in graduates and students'making career plan.

Combined with the concept and content,forming and adjustment of the theory of psychological contract as well as the impact of the breach of psychological contract,this paper analyzed the impact of psychological contract upon employment work,brought forward that enhancing the management of psychological contract and forming reasonable psychological contract had important meaning to enhance employment quality of university graduates and lessen contact breaks.

Objective To evaluate the value of international normalized ratio (INR) in predicting and diagnosing hemorrhagic events in patients with nonvalvular atrial fibrillation (NVAF)receiving wafarin, to determine the optimal cut-off value of INR for predicting hemorrhagic events by receiver operator characteristic (ROC) curve. Methods The data of 231 patients with NVAF receiving wafarin were retrospectively analyzed, including 93 patients with hemorrhagic events and 138cases without hemorrhagic events as control group. The PT and INR were detected by Sysmex CA-500 with Medcalc software plotting ROC curve. Results The area under the ROC curve for INR was 0. 822 (95%CI: 0. 717-0. 900), the analysis of ROC curve revealed the optimal cut-off value of INR was 2.71, which presented a sensitivity of 77.40% and a specificity of 78.30%. Conclusions Through evaluation by ROC curve, the new cut-off value provides substantial improvement in sensitivity, with an acceptable loss of specificity. The value on predicting hemorrhagic events is better, the discriminative power of INR between hemorrhagic events and nonhemorrhagic events is satisfactory. The cut-off value of INR can guide the clinical physicians to predict the risks of hemorrhagic and promote proper use of clinical medications.

Objective To investigate the protective effect of allicin on intestinal mucosal barrier of septic rats so as to explore the possible mechanism.Methods Twenty-four male SD rats were randomly (random number) divided into sham,septic model and allicin treatment group.Septic model was established by cecal ligation and puncture (CLP) in rats.Rats in the treatment group were administered with allicin (30 mg/kg,ip)at 6 h and 12 h after modeling,while those in the model and sham groups were treated with equal amount of saline instead.Rats were sacrificed at 24 h and the serum D-lactic acid,diamine oxidase (DAO) and fluorescence isothiocyanate-dextran (FITC-Dextran,FD-40) were determined to evaluate the intestinal mucosal barrier function.The levels of tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),malondialdehyde (MDA),and the activity of superoxide dismutase (SOD) in intestinal tissue were measured.Histopathological changes of intestinal mucosa injury were assessed by Hematoxylin-eosin staining.Results Compared with the sham group,levels of serum D-lactic acid,DAO and FD-40 increased significantly in the CLP group (D-lactic acid:599.4±101.1 vs.149.2±20.63 nmoL/mL,t=11.84,P＜0.01;DAO:302.1 ±64.5 vs.76.57±14.76 ng/mL,t=9.433,P＜0.01;FD-40:6664.0±1437.0vs.1446.0±205.0 ng/mL,t =9.704,P ＜0.01);intestinal morphology damage occurred in the CLP group;intestinal levels of TNF-α,IL-6 and MDA increased greatly (TNF-αt:186.35 ±20.43 vs.58.76 ±8.94 pg/mL,t=17.23,P＜0.01;IL-6:763.25±85.23vs.125.36±14.37 pg/mL,t=22.54,P＜0.01;MDA:29.36±3.27vs.7.24±0.85 nmol/mg prot,t=16.61,P＜0.01),while SOD activity reduced (35.75±6.53 vs.73.26 ±8.35 U/rmg prot,t =10.57,P ＜0.01) in the CLP group.Allicin treatment greatly inhibited the increase of D-lactic acid,DAO and FD-40 levels in rat plasma caused by CLP (D-lactic acid:330.1 ±81.77 vs.599.4±101.1 nmol/mL,t=7.086,P＜0.01;DAO:171.8±49.70vs.302.1±64.56ng/mL,t=5.45,P＜0.01;FD-40:3349.0±1167.0 vs.6664.0±1437.0 ng/mL,t=6.165,P＜0.01);intestinal morphology damage was improved in the allicin treatment group;allicin treatment greatly inhibited the intestinal levels of TNF-o,IL-6 and MDA and preserved the intestinal SOD activity compared with the CLP group (TNF-α:95.37 ±12.68 vs.186.35 ±20.43 pg/mL,t =12.29,P＜0.01;IL-6:354.27±46.27vs.763.25±85.23pg/mL,t=14.45,P＜0.01;MDA:16.27±3.14vs.29.36±3.27 nmol/mgprot,t=9.831,P＜0.01;SOD:55.35 ±6.23vs.35.75±6.53 U/mgprot,t=5.522,P ＜0.01).Conclusions Allicin could inhibit local inflammation and oxidative stress in the intestine and exerts protective effect on intestinal mucosal barrier of septic rats.

ObjectiveTo observe the effect of Qishen Tongluo Zengzhi decoction on cognitive impairment in patients with acute phase of ischemic stroke.Methods A prospective randomized controlled trial was conducted, and 130 patients with acute phase of ischemic stroke and cognitive impairment accompanied by Qi deficiency and blood stasis and stagnationof phlegm-dampness syndrome admitted into the Neurology and Rehabilitation Departments of Rizhao Hospital of Traditional Chinese Medicine(TCM) Affiliated to Shandong University of TCM were randomly divided into treatment group and control group, 65 cases in each group. In the two groups, conventional internal treatment was given to all patients, and in the treatment group, additionally the Qishen Tongluo Zengzhi decoction was administered orally(composition: astragalus membranaceus 30 g, radix pseudostellariae 30 g, notoginseng 10 g,spatholobus stem 25 g, hirudo 3 g, pberetima 10 g, radix paeoniae rubra 12 g, Chinese angelica 12 g, peach kernel 10 g, carthamus tinctorious 10 g, achyranthes 12 g, radix rhapontici 10 g, rhizoma alismatis 6 g, Acorus gramineus Soland 9 g, polygala root 9 g, rhizoma cyperi 10 g, herba siegesbeckiae 15 g),one dose a day. While in the control group, oxiracetam 4.0 g intravenous drip was given, once a day. The whole course was 21 days in both groups. Before and after treatment, the cognitive function of all the patients in two groups was assessed by Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA) scores, and incubation period and amplitude of P300 wave were recorded.Results Finally 62 cases were in treatment group and 63 cases in control group. Before treatment, the comparisons of the MMSE score, MoCA score and P300 latent period and amplitude between the two groups had no statistically significant differences(allP>0.05). After treatment in the two groups, the MMSE score, MoCA score and P300 wave amplitude were elevated, P300 latency period was shortened compared with those before treatment, and the changes were more prominent in treatment group〔score of MMSE: 25.33±2.32 vs. 21.68±2.29, score of MoCA(score): 26.61±3.06 vs. 22.40±2.93, P300 wave incubation period(ms): 349.62±20.01 vs. 371.87±19.63, P300 wave amplitude(μV): 8.70±2.92 vs. 5.72±2.33,allP<0.01〕.ConclusionQishen Tongluo Zengzhi decoctioncan effectively intervene cognitive impairment in patients with acute phase of ischemic stroke, and improve their cognitive function.

Objective Beta platelet-derived growth factor receptor ( PDGFR-β)-mediated signaling plays a key role in mor-phine tolerance , but its molecular mechanisms are not yet completely understood .The present study aims to investigate whether the ex-tracellular signal-regulated kinase ( ERK) and cyclic AMP response element binding protein ( REB) signaling pathways are involved in the development of PDGFR-βactivation-induced morphine tolerance in rats . Methods Thirty-six adult male SD rats were randomly divided into six groups of equal number:normal saline (20μL), morphine (15μg), morphine +imatinib (morphine 15μg +ima-tinib 10μg), morphine +PDGF-BB (morphine 15μg +PDGF-BB 10 ng), imatinib (10μg), and PDGF-BB (10 ng), all treated intrathecally at 20μL once daily for 7 consecutive days .Paw withdrawal latency ( PWL ) was measured 1 d before and 30 min after medication at 1, 3, 5, and 7 days, respectively, followed by calculation of the maximal possible effect of analgesia (MPE).On the 8th day, PWL was again obtained from all the rats at 30 min after intrathecal injection of morphine (15μg).Then, all the animals were sacrificed and the L4-5 segment of the spinal cord was isolated for determination of the expressions of ERK , phosphorylated ERK ( p-ERK) , CREB, and phosphorylated CREB ( p-CREB) by Western blot. Results At 5 and 7 days after medication, MPE was significant decreased in the morphine group ([52.90 ±8.20] and [15.12 ±3.80] %) and the morphine +PDGF-BB group ([43.51 ±5.42] and [14.81 ±3.60] %) as compared with (100.00 ± 0.00) %in both groups at 1 day (P<0.05), but had no significant changes in the morphine +imatinib group at 1, 3, 5, and 7 days.After intrathecal injection of morphine on the 8th day, MPE was (16.22 ±2.51) %in the morphine group, (15.22 ±3.50) %in the morphine +PDGF-BB group, and (35.21 ±4.51) %in the PDGF-BB group, all remarkably lower than (100.00 ±0.00) %in the control group (P<0.05).There were no significant differences in the expression levels of ERK and CREB among the six groups.The expressions of spinal p-ERK and p-CREB were markedly increased in the morphine , morphine +PDGF-BB, and PDGF-BB groups as compared with the control group (P<0.05), but significantly decreased in the morphine +imatinib group in compari-son with the morphine group, (P<0.05). Conclusion The PDGFR-βsignaling pathway plays an important role in the develop-ment of tolerance to morphine-induced analgesia and its underlying mechanisms may be associated with the activation of the ERK and CREB pathways .

Objective To compare the development of postoperative cognitive dysfunction ( POCD) under total inhalation anesthesia with sevoflurane versus total intravenous anesthesia with propofol in elderly patients. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-77 yr, weighing 43-78 kg, with preoperative Mini?Mental State Examination ( MMSE) score≥25, scheduled for elective surgery for oral and maxillofacial carcinoma, were divided into 2 groups ( n=30 each) using a random number table: total inhalation anesthesia with sevoflurane group ( group S) and total intravenous anesthesia with propofol?based anesthesia group ( group P ) . The patients were tracheally intuba?ted under local infiltration anesthesia. In group S, anesthesia was induced with inhalation of 8% sevoflurane (oxygen flow rate 8 L∕min), rocuronium 0?9 mg∕kg was injected intravenously when the bispectral index ( BIS) value reached 45, and the patients were mechanically ventilated; anesthesia was maintained with inhalation of sevoflurane with the end?tidal concentration of 2%-3%. In group P , anesthesia was induced with iv propofol 2 mg∕kg and sufentanil 0?3μg∕kg, rocuronium 0?9 mg∕kg was injected intravenously when the BIS value reached 45, and the patients were mechanically ventilated; anesthesia was maintained with target?controlled infusion of propofol ( target plasma concentration 3-5μg∕ml) and remifentanil ( target plas?ma concentration 3-5 ng∕ml). In both groups, intermittent iv boluses of cisatracurium 0?04 mg∕kg were given to maintain muscle relaxation during operation, and BIS value was maintained at 40-60 during opera?tion. Before intubation ( T1 ) , immediately after onset of intubation ( T2 ) , at 10 min of intubation ( T3 ) , immediately after begninning of skin incision ( T4 ) , while operating on the base of tongue or sawing the low?er jaw ( T5 ) , at the end of operation ( T6 ) and on the morning of the postoperative day 1 ( T7 ) , blood sam?ples from the elbow vein were collected for determination of plasma norepinephrine and epinephrine concen?trations by high?performance liquid chromatography and electrochemistry. At T1?7 and on the morning of the postoperative day 3 ( T8 ) , blood samples from the elbow vein were collected for measurement of plasma cor?tisol concentrations by radioimmunoassay. MMSE was used to assess the cognitive function on the postopera?tive day 7. MMSE score< 24 was defined as POCD, and the occurrence of POCD was recorded. Results Compared with group S, the plasma concentrations of norepinephrine and epinephrine were significantly de?creased at T4 and T5 , the plasma cortisol concentration was significantly decreased at T4?7 ( P<0?05) , and no significant change was found in the incidence of POCD on the postoperative day 7 in group P ( P>0?05) . Conclusion Although the probability of the development of POCD is low when the two anesthetic methods are used, total intravenous anesthesia with propofol?based anesthesia induces a marked decrease in periop?erative stress responses when compared with total inhalation anesthesia with sevoflurane.

Objective To compare the efficacy of orotracheal intubation after rapid induction and nasotracheal intubation after slow induction assisted by fiberoptic bronchoscope (FOB) in patients with obstructive sleep apnea syndrome (OSAS).Methods Forty ASA Ⅱ patients with OSAS and hypertension, aged 38-64 yr, weighing 82-123 kg, undergoing uvulopalatopharyngoplnsty, were randomly allocated into 2 groups (n = 20 each): group Ⅰ awake nasotracheal intubation through FOB after slow induction and group Ⅱ orotracheal intubation through laryngoscope and FOB after rapid induction. MAP and HR were recorded immediately after anesthesia induction and intubation. The intubation time was recorded, and rate of successful intubation, incidences of tschycardia, hypertension and myocardial ischemia during intubation, and satisfactory rate of otolaryngologists with airway management were calculated. Results The rate of successful intubation were significantly higher, MAP and HR after induction were significantly lower, incidences of tachycardia, hypertension and myocardial ischemia during intubation were significantly lower, and satisfactory rate of otolaryngologists was significantly higher in group Ⅱ than in group Ⅰ ( P < 0.05). Four patients in group Ⅰ had nasal bleeding after extubation. Conclusion Orotracheal intubation after rapid induction assisted by FOB provides less hemodynamic response to endotracheal intubation and higher success rate with less injury to the airway in patients with OSAS than nasotracheal intubation after slow induction assisted by FOB.

Objective To evaluate the efficacy of T-joint endoscopy mask for fiberoptic bronchoscopy (FOB)-guided awake nasotracheal intubation in patients with cervical spinal cord injury.Methods Forty patients of both sexes aged 21-64 yr with fracture of cervical spine complicated by spinal cord injury scheduled for anterior decompression and interbody fusion under general anesthesia were randomly divided into 2 groups according to the technique for awake nasotracheal intubation (n =20 each):group nasal catheter and group T-joint endoscopy mask.Topical anesthesia of nasal cavity,pharynx,larynx and trachea with 2％ lidocaine was conducted and then remifentanil was continuously infused at 0.05-0.15 μg· kg-1 · min-1 in both groups.The incidence of hypoxemia and intubation time were recorded.Arterial blood samples were obtained for determination of PaO2 and PaCO2 before topical anesthesia (baseline),immediately before and 1 min after placement of FOB and immediately after nasotracheal intubation was accomplished.Results The incidence of hypoxemia was significantly lower in group Tjoint endoscopy mask (0) than in group nasal catheter (25％) (P ＜ 0.05).The PaO2 during nasotracheal intubation was significantly higher in group T-joint endoscopy mask than in group nasal catheter (P ＜ 0.05).There was no significant difference in PaCO2 and intubation time between the 2 groups (P ＞ 0.05).Conclusion T-joint endoscopy mask facilitates awake nasotracheal intubation without affecting oxygen inhalation in patients with cervical spinal cord injuries.

Objective To evaluate the efficacy of an airway topical anesthesia catheter for topical anesthesia using a spray-as-you-go technique via the fiberoptic bronchoscope (FOB).Methods Forty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients with obstructive sleep apnea syndrome,aged 20-64 yr,with body mass index of 23-35 kg/m2,with no upper respiratory tract infection within 1 week before operation,scheduled for elective uvulopalatopharyngoplasty,were divided into 2 groups (n =20 each) using a random number table:routine control group (group C) and FOB-airway topical anesthesia catheter group (group F).In group C,the pharynx and larynx were sprayed with lidocaine FOB by using a laryngo-tracheal mucosal atomization device,and cricothyroid membrane puncture was performed and then lidocaine was injected.In group F,airway topical anesthesia was performed using a spray-as-you-go technique via the FOB with an airway topical anesthesia catheter spraying lidocaine via the nose.At 5 min after topical anesthesia of the airway,FOB-guided intubation was performed,and dexmedetomidine was intravenously infused at 0.1 μg · kg-1 · min-1 for sedation in both groups.Ramsay sedation scores were assessed after topical anesthesia and before intubation.The scores for the intubating condition and tolerance of tracheal tube were assessed during FOB-guided intubation.Successful intubation and the development of responses to intubation and hypoxemia were recorded.The patients were followed up one day after the end of operation,and parents' satisfaction with the procedure of intubation was recorded.Results Compared with group C,the intubating condition score,tolerance of tracheal tube score,success rate of intubation at first attempt and rate of parents' satisfaction with the procedure of intubation were significantly increased,and the incidence of responses to intubation was decreased (P＜0.05),and no significant change was found in Ramsay sedation scores before intubation and incidence of hyoxemia in group F (P＞0.05).Conclusion When the FOB is used to guide awake nasotracheal intubation,the airway topical anesthesia catheter provides better efficacy,better intubating conditions,and fewer side effects when applied for topical anesthesia using a spray-as-you-go technique via the FOB,it can be easily accepted by the patients and the efficacy is better that of routine airway topical anesthesia.