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China Population Today 1997年第2期14卷 17-17页

The annual college graduate job assignment season has arrived But the news for gir1 graduates is not so en-couraging.

关键词： Girl Graduates So It to Get difficult

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easy与difficult的用法说明

第二课堂(B) 2008年第9期 14-14页

作者：周云波

从语义上看,easy与difficult是一对反义词,前者表示"容易的",后者表示"困难的";但在用法上,两者却有很多共同点,所以本文将它们放在一起来分析和讲解。表示做某事很容易(困难),英语通常用be easy(difficult)(for sb)to do sth,注意该结... 详细信息

从语义上看,easy与difficult是一对反义词,前者表示"容易的",后者表示"困难的";但在用法上,两者却有很多共同点,所以本文将它们放在一起来分析和讲解。表示做某事很容易(困难),英语通常用be easy(difficult)(for sb)to do sth,注意该结构通常要用it作形式主语,而不直接以人或物作主

关键词：反义词 difficult

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“分层”让英语学习不再difficult

校园英语 2019年第9期 145-145页

作者：史延胜王乾楠天祝县城关第二小学天祝县松山镇教育辅导站

在实际教学中我们发现:随着年级的增长,学习难度的不断增加,学习任务的不断增大,学困生的数量急剧增加,严重影响着教育教学质量的提高。教育学家布卢姆认为:只要给学生充分的学习时间,95%的学生可以达到教学规定的要求,其差异仅在于掌... 详细信息

在实际教学中我们发现:随着年级的增长,学习难度的不断增加,学习任务的不断增大,学困生的数量急剧增加,严重影响着教育教学质量的提高。教育学家布卢姆认为:只要给学生充分的学习时间,95%的学生可以达到教学规定的要求,其差异仅在于掌握的快慢,而不在于能否学会。这一理论告诉我们,每个学生,包括学习有困难的学生,都具有学习潜能,教师的教学要有利于发展和开发学生的潜能。基于这种情况,少数民族地区的英语教学必须以学生为本,根据学生的实际水平和学习接受能

关键词：期末成绩 difficult 学困生分层教学

Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology

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Hepatobiliary & Pancreatic Diseases International 2019年第1期18卷 73-78页

作者： Jun Wen Tao Li Yi Lu Li-Ke Bie Biao Gong Digestive Endoscopy Center Department of Gastroenterology Ruijin Hospital Shanghai Jiaotong University School of Medicine Digestive Endoscopy Center The Sixth Affiliated Hospital of Sun Yat-sen University

Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.

关键词： difficult biliary cannulation Endoscopic retrograde cholangiopancreatography Needle-knife fistulotomy Precut techniques Transpancreatic septotomy

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儿童学习困难相关家庭环境因素分析

中华医学写作杂志 2005年第13期12卷 1123-1124页

作者：蒋汝刚咸宁学院预防医学教研室，湖北咸宁437100

目的：探讨相关家庭环境因素对儿童学习的影响。方法：随机抽取580名小学生，按(提高学习能力因素诊断测验>方法进行学习能力等级评定，采用自行设计的调查表对调查对象登门访谈调查。结果：儿童学习困难检出率为6．90％，其中男生为8... 详细信息

目的：探讨相关家庭环境因素对儿童学习的影响。方法：随机抽取580名小学生，按(提高学习能力因素诊断测验>方法进行学习能力等级评定，采用自行设计的调查表对调查对象登门访谈调查。结果：儿童学习困难检出率为6．90％，其中男生为8．72％，女生为4．96％。两者差异无显著性(P>0．05)。父母教育态度不一致，采用惩罚管教，认为早期教育不重要，不要求成绩名列前茅，父子相处时间短，父母文化程度低，母孕期情绪不好等因素与儿童学习困难有关。结论：提高父母素质，改善教育方式，消除不利生长因素，可减少儿童学习困难的发生。

关键词：儿童学习困难分析(child study difficult analysis)

Characteristics of Patients with Decreased Cognitive Function Undergoing Treatment for Acute Exacerbation of Chronic Heart Failure—Basic Survey for Standardization of Nursing to Prevent Discontinuation of Treatment

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Health 2018年第5期10卷 667-690页

作者： Haruka Otsu Toshiko Inoguchi Michiko Moriyama Shigeko Takayama Yoko Watanabe Masayo Kume Graduate School of Health Sciences Hirosaki University Hirosaki Japan Division of Nursing Science Institute of Biomedical & Health Sciences Hiroshima University Hiroshima Japan Faculty of Nursing Kinjo University Hakusan Japan School of Health and Welfare Prefectural University of Hiroshima Hiroshima Japan

The purpose of this study is to clarify the characteristics of patients with decreased cognitive function undergoing treatment for acute exacerbation phase of chronic heart failure as a basic survey with a view to the standardization of nursing to prevent discontinuation of treatment of patients with declining cognitive function in the acute exacerbation phase of chronic heart failure. As the first stage of the research, using the interview guide created based on the background of discontinuation of treatment and symptomatic monitoring from 33 target literature sources, seven certified chronic heart failure nurses and 15 certified dementia nurses were given semi-structured interviews. Data obtained from the interviews was analyzed by qualitative induction. As a result, we obtained opinions/views on 8 situations namely, “cognitive function at hospitalization”, “characteristics at hospitalization, “characteristics when receiving examinations, procedures or treatment”, “characteristics of course of treatment”, “characteristics related to difficulties in grasping the symptoms of chronic heart failure and indices of deterioration”, “characteristics when using diuretics”, “characteristics concerning compliance with dietary restrictions” and “support required for discharge from hospital” concerning patients with declining cognitive function. In the future, it is necessary to prepare nursing protocols incorporating these contents for standardization of nursing.

关键词： Heart Failure Acute Exacerbation Acute Phase Dementia Physical Disorder difficult to Respond difficult Care Nursing Behavioral and Psychological Symptoms of Dementia (BPSD)

High Frequency Transcricoid Jet Ventilation Prior to Neck Surgery—A 10-Year Retrospective Case Series Analysis

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Open Journal of Anesthesiology 2020年第1期10卷 38-45页

作者： Hille Kisch-Wedel Hannelore Ledderose Kathrin Reise Bernhard Zwissler Department of Anesthesiology University Hospital LMU Munich Marchioninistr Munich Germany

difficult airway is still a challenging field in anesthesia, emergency departments and intensive care unit and is the cause of severe patient injury such as irreversible hypoxic brain damage or even death. Therefore, safer techniques are needed to maintain the airway in patients, who are difficult to intubate. The aim was to analyze the safety of the technique of transcricoid high frequency jetventilation (TCHFJV) by the investigation of complications. We performed a 10-year retrospective analysis (1/2009-1/2019) of patients subjected to TCHFJV at the hospital of the Ludwigs-Maximilians-University, Munich, Germany. TCHFJV was applied before anesthesia induction in awake, spontaneously breathing patients, with suspected or known difficult airway, scheduled for head and neck surgery. During the 10-year study period, we identified 39,477 patients, who underwent neck surgery. Of these, 1489 (3.8%) patients were managed with TCHFJV (1090 males, 399 females;62 ± 13 years, BMI 25 ± 0.2 kg?m-2, ASA class 3 ± 0.5). TCHFJV was successful in 1479 (99%) patients. Subsequent endotracheal intubation was performed in most cases (93%). Occasionally, emergency cricothyroidotomy (n = 2) or tracheotomy (n = 6) was necessary following TCHFJV. TCHFJV-related complications occurred in 1.5% of the cases. A majority (83%) of the complications were judged to be non-severe (grade 1, 2A) and 17% were severe (grade 3B), while there were none that were very severeC or lethalD. This retrospective study indicates that TCHFJV in experienced hands is a relatively safe alternative airway management strategy for patients undergoing neck surgery.

关键词： Jetventilation Transcricoid difficult Airway

Laparoscopic Choledochoduodenostomy for Biliary Alleviation

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Surgical Science 2017年第2期8卷 65-72页

作者： Hirotaka Okamoto Suguru Maruyama Kazunori Takahashi Kenji Kawashima Toshio Fukasawa Hideki Fujii Department of Surgery Tsuru Municipal Hospital Tsuru Japan Gastrointestinal & Breast Endocrine Surgery Faculty of Medicine University of Yamanashi Yamanashi Japan

Choledochoduodenostomy (CDD) was very useful alternatives for treatment for patients with common bile duct (CBD) stones, especially recurrent stones, giant stones with choledochal dilatation, and difficult or failed cases by endoscopic treatment. Furthermore, CDD was also applied to biliary bypass by malignant obstruction. In these days, minimal invasive laparoscopic approach is adapted in these disorders. We have conducted to perform a laparoscopic CDD for biliary alleviation for patients with endoscopic management of difficult CBD stone with choledochal dilatation. A side-to-side CDD was created intra-corporeally using water-tight running absorbable suture by handmade 4-0 monofilament with double side needles, starting from the right side of choledochus, and continued along posterior wall until the left side of the choledochus followed by anterior-wall anastomosis as the same manner. Five patients were treated successfully by this laparoscopic procedure and remained well without bile leakage and reflux cholangitis for the short-term follow-up. The median operative time and intracorporeally anastomosis time were 182 (167 - 209) min and 33 (30 - 38) min, respectively. Median blood loss was 32 (little-90) ml, median hospital stay was 7 (5 - 14) days, and median follow-up time was 18 months. Although this series was relatively small, this laparoscopic technique is feasible and safe for biliary alleviation, especially for endoscopic management of difficult or failed CBD stones, and would also potentially adapt to biliary bypass by malignant obstruction.

关键词： Laparoscopic Choledochoduodenostomy Biliary Alleviation Endoscopic Management difficult Choledocholithiasis

Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders

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World Journal of Gastrointestinal Endoscopy 2019年第1期11卷 31-40页

作者： Petko Karagyozov Irina Boeva Ivan Tishkov Department of Interventional Gastroenterology Clinic of Gastroenterology Acibadem City Clinic Tokuda Hopsital

Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an important diagnostic and therapeutic tool leading to avoidance of aggressive and unnecessary surgery in many clinical scenarios. This paper focuses on the newly developed SpyGlass DS technology, its advantages, and the technique of single-operator cholangioscopy(SOC), biliary indications and possible adverse events. We also review the available literature; discuss the limitations and future *** SOC(D-SOC) is a useful technique, which provides endoscopic imaging of the biliary tree, optical diagnosis, biopsy under direct vision and therapeutic interventions. The implementations are diagnostic and therapeutic. Diagnostic indications are indeterminate biliary strictures, unclear filling defects, staging of cholangiocarcinoma, staging of ampullary tumors(extension into the common bile duct), unclear bile duct dilation, exploring cystic lesions of the biliary tree,unexplained hemobilia, posttransplant biliary complications. Therapeutic indications are lithotripsy of difficult stones, retrieval of migrated stents, foreign body removal, guide wire placement, transpapillary gallbladder drainage and endoscopic tumor ablative therapy. Most studied and established indications are the diagnosis of indeterminate biliary stricture and intraductal lithotripsy of difficult stones. The adverse events are not different and more common compared to those of Endoscopic retrograde cholangiopancreatography(ERCP)alone. D-SOC is a safe and effective procedure, adjunct to the standard ERCP and the newly available digital technology overcomes many of the limitations of the previous generations of cholangioscopes.

关键词： Per-oral cholangioscopy Digital single-operator cholangioscopy difficult stones Indeterminate strictures Endoscopic retrograde cholangiopancreatography Biliary interventions

The Feasibility of Endotracheal Intubation with Subcutaneous Dissociative Conscious Sedation versus General Anesthesia: A Prospective Randomized Trial

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Open Journal of Anesthesiology 2014年第2期4卷 41-45页

作者： Sanaz Shabani Mihan J. Javid Jayran Zebardast Department of Anesthesiology and Intensive Care Imam Khomaini Medical Center Tehran University of Medical Sciences Tehran Iran Registered Nurse Tehran University of Medical Sciences Tehran Iran

Despite outstanding improvements in anesthesia techniques and anesthetics, difficult airway is still a dilemma and is accompanied by morbidity and mortality. The aim of this study is to compare the feasibility of endotracheal intubation with the traditional method of general anesthesia by using muscle relaxants, and “sDCS” (Subcutaneous Dissociative Conscious Sedation) which has been recently reported as an efficient method of anesthesia with the capability of maintaining spontaneous ventilation and providing an appropriate situation for larynxgoscopy and endotracheal intubation. Material and Methods: This randomized clinical trial was conducted on 100 patients who were scheduled for elective laparotomy. Patients were randomly divided into two groups: group A and group B. In group A, patients underwent general anesthesia with thiopental sodium and relaxant. In group B, patients underwent “subcutaneous Dissociative Conscious Sedation” and received low dose subcutaneous ketamine and intravenous narcotic with no relaxant. The feasibility of direct laryngoscopy and tracheal intubation, hemodynamic changes, desaturation (SpO2 < 90%), patient cooperation, patient comfort, hallucination, nausea and vomiting, nystagmus and salivation were evaluated in two groups. Adverse events including apnea and need for positive pressure mask ventilation, additional dose of fentanyl were recorded in group B. The anesthesiologist who performed the procedure was asked about the patient calmness and cooperation during the procedure and the feasibility of laryngoscopy and tracheal intubation. The incidence of nausea and vomiting in post-operative care unit was recorded too. Results: Hemodynamic variables were comparable in two groups. No event of irreversible respiratory depression, desaturation, need for positive pressure ventilation and hallucination was observed in group B. All patients were cooperative and obedient during the laryngoscopy and tracheal intubation. The incidence of nausea

关键词： difficult Airway Ketamine Laryngoscopy Subcutaneous Dissociative Conscious Sedation Tracheal Intubation