Objective To compare the risk factors of mild hemorrhage and diiferences of TOAST type in patients with acute cerebral infarction (ACI) and transient ischemia attack (TIA).Methods Forty patients with mild hemorrhage were divided into ACI group(24 cases) and TIA group(16 cases) according to disease classification.Risk factors such as age,blood pressure,blood lipid and so on between 2 groups were compared,TOAST subtype differences of 2 groups were compared.Results The age [(73.3 ± 4.1) years],the ratio of hypertension [95.8％(23/24)],leukoaraiosis [70.8％(17/24)] in ACI group was significantly higher than that in TIA group [(65.5 ± 5.6) years,13/16,9/16],there was significant difference (P ＜ 0.05).The ratio of large-artery atherosclerosis and cardioembolism in ACI group [75.0％ (18/24) and 16.7％ (4/24)] was significantly higher than that in TIA group (8/16 and 1/16),there was significant difference (P ＜ 0.05).But the ratio of small artery occlusion in ACI group [8.3％ (2/24)] was significantly lower than that in TIA group (7/16),there was significant difference (P ＜ 0.05).Conclusion Correlative risk factors of milde hemorrhage in ACI and TIA patients have significant differences.

Objective To introduce the method of arthroscopically assisted closed reduction and percutaneous screw fixation for intra-articular calcaneal fractures and to discuss its clinical indications, advantages and disadvantages. Methods From February 2003 to December 2004, 12 unilateral intra-articular calcaneal fractures were treated with the method of arthroscopically assisted closed reduction and percutaneous screw fixation. 7 cases were males and 5 cases were females. The average age was 36.8 years (range, 23-61 years). 8 feet were on right side and 4 feet were on left side. The mechanism of injury was fall from a height in 11 cases and vehicle accident in 1 case. According to Sanders classification, 8 cases were type Ⅱ fractures(1 type ⅡA, 5 type ⅡB, 2 type ⅡC) and 4 cases were type Ⅲ fractures(2 type ⅢAB,1 type ⅢAC,1 type ⅢBC). Results Arthroscopy in the operation showed the fracture space and step were less than 1 mm. The preoperative X-ray film showed that B?觟hler angle was 18.4??5.8?, Gissane angle was 109.1??10.2?, calcaneal width was (35.9?2.2) mm. The postoperative X-ray film demonstrated that B?觟hler angle was 25.4??3.5?, Gissane angle was 118.1??6.4?, calcaneal width was (32.3?1.1) mm. The average follow-up of nine patients was 17.4 months (range, 10-25 months). According to Maryland foot score, all patients had satisfactory results with the mean score of 92.5 score (range, 82-100 score), 6 were excellent and 3 were good. None of the patients had re-displacement of fracture, significant lame or other late complications. They regained normal shape of foot and wore normal footwear. Conclusion Arthroscopically assisted closed reduction and percutaneous screw fixation is an effective and applicable minimal-invasive treatment for Sanders type Ⅱ and selected type Ⅲ intra-articular calcaneus fractures. It can significantly reduce the risk of soft tissue injury and other complications while ensuring satisfactory reduction of the posterior calcaneal facet of the subtalar joint and reliable fixation.

Objective To observe the effect and mechanism of Bush en Tiaojing Decoction (Decocti on for reinforcing the kidney and regulating the menstruation) on ovulation of p olycystic ovary syndrome (PCOS) rats. Methods Eighty fe male SD rats were made PCOS models and randomized into blank group, model group, metformin group, Bushen Tiaojing Decoction high and low dose group s, with 10 ones in each and the remainders removed. The changes of serum leptin, ins ulin and testosterone in each group were observed. Results In Bushen Tiaoji ng Decoction high and low dose groups, serum leptin, insulin and testosteron e were all decreased. The effect of Bushen Tiaojing Decoction high dose group wa s similar with that of metformin group in decreasing leptin, insulin a nd testosterone. Conclusion Bushen Tiaojing Decoction c ould improve the ovulation of PCOS rats through regulating leptin, insulin , and testosterone.

Objective:To explore the effect of behavioral training of creative art therapy(CAT) on interpersonal communication in teenagers.Methods:Eighty teenagers were randomly divided into study group( n=40) and control group( n=40).The study group was received the behavioral training of CAT (12 times, each activity lasts for 120 min), and the control group did not take part in the behavioral training of CAT.The two groups were measured with self-esteem scale(SES), shyness scale(SS) and social anxiety scale for children(SASC) before and after behavior training.SPSS 17.0 software was used for statistical analysis, and t-test variance analysis and Mann-Whitney U test were used to compare the differences between groups or within groups. Results:Before and after behavioral training, changes in the SES total score (7.00(5.00, 9.75) vs 1.00(0, 2.00)), the SS total score (7.00(6.00, 12.75) vs 2.00(1.00, 3.00)), the SASC total score (5.00(2.00, 8.75) vs 0(0, 1.00)) and two factor scores (3.00(0.25, 5.00) vs 1.00(0, 1.00), 2.00(1.00, 4.00) vs 0(0, 1.00))in the study group were obviously higher than those in the control group( Z=-7.347, -7.338, -5.841, -4.122 and -5.393, all P<0.05).The score differences of the SASC total score ((7.19±3.82) vs (3.21±3.04)) and two factor scores ((4.00±2.23) vs (1.68±2.05), 3.00 (1.00, 5.00) vs 2.00 (0, 2.00)) of girls were significantly higher than those of boys in the study group ( t=-3.611, -3.398, Z=-2.111, P=0.001, 0.002, 0.035). Conclusion:Behavioral training of CAT can improve teenagers' self-esteem, relieve their shyness and social anxiety, as well as promote their interpersonal communication.

Twelve cases of colon carcinoid were treated by laparoscopic resection combined with colonoscopy from January 2003 to November 2009 in the First Huai'an Hospital. The tumors presented as submucosal lesions in colonoscopy with the size of 1.5 - 3.0 cm in diameter, which were difficult to be found by laparoscopy. All tumors were locally resected under laparoscopy with the assistance of colonoscopy successfully. Patients were followed up for 6 - 72 months, one case died 30 months after operation due to liver metastases. Colon carcinoid tumors with diameter from 1.5 - 3.0 cm often have muscular invasion and lymph node metastasis. The results indicate that laparoscopic resection combined with colonoscopy is a safe and effective procedure for colon carcinoid tumor.

Objective:From a professional competency-based perspective,this study aimed to explore appro-priate ways for certifying counselors and psychotherapists in China,and focused on improving the evaluation pro-gram for clinical and counseling psychologist of the Clinical and Counseling Psychology Registration System (CCPRS)of Chinese Psychological Society.Method:The theories and methods for certifying counselors and psy-chotherapists in China and overseas were summarized by using the literature method,based on which the design principles for certification in China were determined.Using the expert method,the core competencies of Chinese counselor and psychotherapist were proposed to form the index system of evaluation.A survey was also conducted to obtain a preliminary validity of the improved evaluation program.Result:Design principles for certifying coun-selors and psychotherapists were multi-trait,multi-method,and multi-informant.The core competencies of Chinese counselor and therapist included six domains,which were professional attitudes and conduct,ethics and law,clinical knowledge and skills,science and research,relationship building,cultural diversity and Chinese culture,case man-agement,respectively.Results from the expert judgments indicated that the evaluation materials which formulated by the improved program could assess all six core competencies and had acceptable reliabilities(Cronbach's α=0.74-0.97).And the expert evaluation about the improved program was high.Conclusion:The core competencies of Chinese counselor and therapist,which formulated by the improved evaluation program,reflect the necessary attitudes,knowledge and skills that needed when engaged in the professional practice of counseling and psychothera-py,and also can be used as a reference for counselor and psychotherapist education,training,practice,and compe-tency evaluation in China.The improved evaluation program can be used as a transitional way for certifying coun-selors and psychotherapists in China.

In order to strengthen the clinic medical informatized construction and improve the medical general ensurance,our clinic sets up the hardware network terrace. Making the use of the medical information management system for out-patient service organization,we summarize our experiences of medical informatized management

ObjectiveThe purpose of this study was to analyze the outcomes of surgical treatment of displaced intra-articular calcaneal fractures (ICFs) in children and its characteristics.MethodsBetween January 2004 and October 2008,we review the results of 9 displaced,intra-articular fractures in 8 skeletally immature patients,who were treated with open reduction and internal fixation in our hospital.There were 7 males and 1 female,with the mean age of 13.1 years(range:10 to 15 years).Preoperative radiographs and computed tomographic scans were used to classify fractures.Clinical and radiographic evaluation were performed in postoperative follow-up visits.The functional outcomes were assessed with use of the modified American Orthopaedic Foot and Ankle Society(AOFAS) ankle and hindfoot score.The published literatures of child ICFs treated with ORIF were reviewed.ResultsIn the series,there were 4 tongue-type and 5 joint depression-type fractures according to Essex-Lopresti classification,and according to Sanders classification,we found 5 type-Ⅱ fractures,3 type-Ⅲ and 1 type-Ⅳ fractures.The mean follow-up time was 47.4 months (range:21 to 72 months).All fractures healed within 2 to 4 months.The average preoperative and postoperative Bohler angles were 5.7 and 33.1 degrees respectively,and the mean Gissane angles were 106.5 and 128.0 degrees respectively.The mean modified-AOFAS score was 65.2 points(range:53 to 68 points).Skin necrosis was found in one foot.After the review of literatures,78.6％ (48/61) of displaced ICFs were male in children.Based on the Sanders classification,36 of 67 (53.7％) were type-Ⅱ fractures,25 of 67 (37.3％) were type-Ⅲ and 6 of 67 (9.0％) were type-Ⅳ; And 15 of 37 (40.5％) were tongue-type,22 of 37 (59.5％) were joint depression-type fractures according to Essex-Lopresti classification.ConclusionMost children with displaced ICFs treated with ORIF had a good clinical outcome with few complications.The children and adolescents that were exposed to high-energy trauma suffer calcaneal fractures that were similar to adult fracture patterns.

Objective To explore the treatment strategies for grade Ⅱ supination adduction ankle fracture. Methods From March 2003 to September 2008, 32 patients with grade Ⅱ supination adduction ankle fractures were treated surgically. There were 21 males and 11 females, at a mean age of 44.5 years (range, 21-76 years). Three patients had open ankle fractures. Anteromedial approach to the medial malleolus was taken to expose the vertical medial malleolus fractures and tibial plafond for exploring damage to distal articular surface of the tibia and that to cartilage of the talus. Open reduction and internal fixation with impaction of the articular fragment and possible bone grafting were applied to restore the height of the collapsed tibia. Medial mallcolus fractures were anatomically reduced and the intra-articular cartilage debris removed under direct vision. Repair of the lateral ligament injuries was decided acoording to the stability of the ligament. Different internal fixation was chosen according to fracture displacement of the block size and degree of lateral malleolus fractures. Fracture union, internal fixation and osteoarthritis were detected by X-ray examination. The range of ankle motion was measured. Maryland foot score was taken to assess the ankle function.Results Twenty-three patients were followed up postoperatively for a mean period of 27.9 months ( range, 6-47 months). Two prominent screws were removed from one patient five months after operation because of loosening. Bony fusion was achieved in all patients after an average period of 2.9 months ( range, 2.3-5.1 months). X-ray examination revealed no other internal fixation loosening or osteoarthritis. The average range of motion was 13 degrees of dorsiflexion (range, 6-17 degrees) and 36 degrees of plantarflexion (range, 27-46 degrees). According to Maryland foot score, ankle function was excellent in 19 patients and good in four, with excellence rate of 100%.Conclusions Understanding injury mechanism of supination adduction ankle fracture, strengthening the diagnosis and treatment of damage of tibial plafond articular surface height, cartilage and talar articular surface cartilage can effectively reduce the incidence of complications such as osteoarthritis. Anteromedial incision allows excellent exposure of the medial tibial plafond for clearance of intra-articular cartilage pieces, recovery of distal tibial articular surface height and placement of internal fixation.

Objective To retrospectively assess clinical outcomes of buttress plating in fixation of posterior pilon fractures.Methods The study involved 16 cases of posterior pilon fractures that had undergone buttress plate fixation between January 2005 and December 2009.There were 11 males and 5 females,at mean age of 37.6 years (range,23-62 years).All cases received radiography,CT scan and three-dimensional reconstruction preoperatively.Posterior malleolar fragments were reduced and fixed through posterolateral approach or combined approach (posteromedial plus posterolateral approaches) based on effect area of fracture line on CT films.Clinical and radiographic examinations were performed in postoperative follow-up.Clinical outcomes were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS).Results Posterior pilon fractures were classified into 3 types according to CT scans.Fourteen cases were followed up for average 37.6 months (range,16-52 months).Mean AOFAS score was 86.4 points (range,70-98 points) and mean VAS score was 1.4 points (range,0-3 points).All cases received favorable functional outcomes without hardware failure,except that one patient still suffered from peri-ankle swelling and long term walking discomfort two years after operation.Conclusion Buttress plating is effective in treatment of posterior pilon fractures and can facilitate early weight-bearing functional exercise.