Objective:To test Jiang Guangrong's(2005)three-dimension model on the depth of counseling process.Methods:In this process-outcome research,28 sessions in a university counseling center were videotaped and coded in terms of the model.Structure Equation Model(SEM)was used to examine the relations between the coding and counselors and clients' evaluation of the session depth.Results:(1)Clients and counselors evaluated differently on the session depth,and clients' evaluation was more positive than counselors' [(4.95±1.12)vs.(4.23±0.94),P<0.05];(2)The model was significantly correlated with counselors' session depth evaluation(path coefficient = 0.55,P<0.01),but not with the clients';(3)The session curves describing each dimension changing over time had different patterns in sessions of different depth level,through which more about the counseling process could be known.Conclusion:The three-dimension model on the depth of counseling process has got some empirical evidences.

Objective To study the mechanism and characteristics of calcaneal fracture involving calcaneocuboid joint and its surgical clinical results. Methods 71 cases with 90 calcaneal fractures accompanied calcaneocuboid joint injury were reviewed in our hospital from February 1997 to April 2001, which included 61 ankles of 46 males and 29 ankles of 25 females with an average age of 38.7 years (range, 18 to 67 years). AP, lateral and axial view X-ray of both feet, broaden view X- ray of the affected foot, and CT scan were taken preoperatively. Among them, 45 ankles were examined with three dimensional reconstruction of CT as well. The calcaneocuboid joint injury were divided into 4 types as follows: typeⅠ(46/90) with one articular fracture line but no displacement; type Ⅱ(26/90) with one articular fracture line accompanied the displacement of fragment and the subluxation of calcaneocuboid joint; type Ⅲ (11/90) with two fracture articular lines, and the displacement of fragment as well as the subluxation of calcaneocuboid joint; and type Ⅳ (7/90) with three articular fracture lines and comminuted fracture or the subluxation of calcaneocuboid joint. Of 71 cases, 63 were operated at 3 to 7 days after injury, and 8 delayed at 10 to 14 days. The incision started at the middle point between the fibula and Achilles tendon proximal to the apex of lateral malleolus, and extended distally to the adjacent part of dorsal and plantar skin, then anterior to the base of fifth metatarsus. After the reduction of fractures, type Ⅰcalcaneal plate, designed by authours, was used for type Ⅰ,Ⅱand Ⅲ fractures, the anterior part of calcaneus was fixed with the vertical wing of plate; type Ⅱ calcaneal plate was used for type Ⅳfractures, the horizontal wing of plate was fixed to cuboid to stabilize the comminuted fragments of anterior calcaneus. Results Of 90 ankles, 78 were followed up for an average of 18.7 months (range, 12 to 32 months). The total excellent and good rate was 94.9% according to Marryland foot score. Furthermore, In type Ⅰ, the excellent and good rate was 100%, type Ⅱ 95.7%, type Ⅲ 88.9% and type Ⅳ 60%. Among the types Ⅳ fracture, 7 ankles obtained satisfied internal fixation, but in 4 of them the plates were broken after weight bearing walking. Conclusion The injury of calcaneocuboid joint is related with the severity of calcaneal fracture, attention should be paid and carried out with reliable internal fixation.

Objective To introduce the reconstruction of calcaneal thalamus by bone autograft and subtalar arthrodesis for severe deformities caused by malunion of calcaneal fractures and to discuss the indications and its advantages of the management. Methods From November 1998 to August 2002, 17 cases with 21 malunited calcaneal fractures were treated, which were 13 males and 4 females with an average age of 35.4 years( 25 to 45 years). Unilateral calcaneus was involved in 13 cases, and bilateral calcaneus was affected in 4 cases. The primary treatment was manipulation and immobilization with a cast in all patients. The interval from injury to the operation was on an average of 33.6 months(7 to 50.4 months). The common complaints were painful heels and walking difficulty. Furthermore, there was subluxation of talonavicular joint in 5 cases, protruded osteophyte and fragment from the lateral wall of calcaneus in 12 cases. Lateral, axial, and oblique roentgenograms were taken preoperatively, and three dimensional reconstruction of CT scan as well. Results The modified extended L-shaped approach lateral to calcaneus was used. The bulging lateral wall of calcaneus was excised and reserved for reconstruction of calcaneal thalamus if possible. While in some cases the bone autograft had to be harvested from iliac crest if the excised lateral wall was not available. After the cartilage of subtalar joint was removed completely, the calcaneal thalamus was reconstructed with the bone and fixed with 2 to 3 screws, the contour and position of calcaneus was conformed without valgus or varus by "C" arm intensifier. A short leg cast was used for immobilization one month after operation. Among the patients, 18 feet were followed up on an average of 14.5 months (9 to 22 months). The total excellent and good rate was 88.8% according to Maryland foot score system. Plain radiography showed that B hler angle, Gissane angle, talus inclining angle, width of calcaneus and height of calcaneal thalamus were restored to nearly normal. Conclusion The reconstruction of calcaneal thalamus by bone autograft combined with subtalar arthrodesis is an effective operation for severe malunion of calcaneal fractures, which can improve calcaneal abnormality, and make recovery of the shape of hind foot and functions satisfactorily.

Objective To introduce calcaneal osteotomy without subtalar fusion for calcaneal malunion and to discuss its indications, advantages and disadvantages. Methods From November 1998 to May 2003, 24 cases with 26 calcaneal malunion for 1 to 9 months were treated by calcaneal osteotomy without subtalar fusion. The average age was 32.6 years (range, 28 to 42 years). All patients underwent radiography including plain, axial and lateral views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, 13 cases were of type Ⅱ(9Ⅱb, 4Ⅱc), 13 of type Ⅲ(8 Ⅲac, 5 Ⅲbc). Through the modified lateral L-shaped approach, the protruding lateral wall of calcaneus was resected and the posterior subtalar facet was reduced by elevating the fragment of the posterior subtalar facet upwards and backwards. The defect of calcaneus was filled with bone autografts. Iliac crest bone graft was used in 19 feet and the bone graft resected from the extruding lateral wall of calcaneus in 7 feet. The calcaneus was fixed with plate and screw. Results 21 feet were followed up for an average of 14.5 months (range, 9 to 22 months). No complications such as wound infection, screw breakage and calcaneum varus were found postoperatively. The average time for bone healing was 11.2 weeks (range, 10.5 to 13.3 weeks). The postoperative functional evaluation by Maryland foot score system revealed excellent result in 8 feet, good in 10, fair in 3. The rate of excellent to good results was 86%. Plain radiographs showed the nearly complete restoration of Bhler angle, Gissane angle, talus inclining angle, calcaneal width and height of the calcaneal thalamus. Conclusion Calcaneal osteotomy without subtalar fusion is an effective method for calcaneal malunion with advantages of correcting deformity markedly, restoring the function and the outer aspect of hindfoot satisfactorily.

Objective:To analyze the association between obesity and age at spermarche among Chinese Han boys aged 11-18 years . Methods:The height, weight and status of the spermarche of Chinese Han boys aged 11-18 years were selected from the data of 2010 National Physical Fitness and Health Surveil-lance. The body mass index ( BMI) , prevalence of spermarche in each age group and ages at spermarche by BMI groups were calculated. Chi square test was used to analyze the differences of prevalences of spermarche among the boys with different BMIs across ages. U-test was used to compare the differences of age at spermarche between the boys who were obese and not. Results:In the boys aged 12 and 17 years in urban areas and boys aged 13 years in rural areas, the differences of prevalences of spermarche among the normal weight, overweight and obesity groups were significant (P<0. 05). The age at spermarche in the obesity group (13. 90 years) was 0. 1 years earlier than that in the non-obesity group (14. 00 years) (P<0. 05). Conclusion:Obesity may make the age at spermarche ahead of time.

Objective To investigate the methods and results of lengthened proximal femoral nail antirotation (PFNA) in the treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures. Methods Of the 21 patients with femoral shaft combined with ipsilateral femoral neck fractures treated by lengthened PFNA from 2006 to 2009,16 patients with complete follow-up were retrospectively studied.There were 15 males and 1 female,at mean age of 35 years (range,21-51 years).Injury causes were all high-energy trauma including traffic injuries in 11 patients and fall injuries in five.According to Garden classification,there were seven patients with type Ⅰ femoral neck fractures,six with type Ⅱ and three with type Ⅲ.Femoral shift fractures contained six superior part fractures and nine medial part fractures and one inferior part fracture.According to Winquist classification,there were two patients with type Ⅰ femoral shaft fractures,four with type Ⅱ,six with type Ⅲ and four with type Ⅳ.Two patients had open fractures belonging to type Ⅰ Gustilo-Anderson.Harris hip score was used to evaluate functional outcomes at the last follow-up postoperatively. Result The mean follow-up time was 2.4years (range,1-4 years ).The mean period for healing of femoral neck and shaft fractures was 4.2months ( range,3-6 months) and 5.1 months ( range,3-8 months) respectively.Four patients showed delayed diagnoses of femoral neck fractures ; two patients had delayed union of femoral shaft fractures ; one suffered from avascular necrosis of the femoral head ; one patient presented 3 cm of extension of the affected limb and was accompanied by active pain of the knee joint for over four months.According to Harris score,function of hip joints was excellent in seven patients,good in six and fair in three,with excellence rate of 82％. Conclusions It is relatively few that the femoral shaft fracture is combined with ipsilateral femoral neck fracture.The rate of missed diagnosis of femoral neck fractures is high and the patients with high energy trauma hould be highly paid attention to.Lengthened PFNA conforms to characteristics of biomechanical fixation and presents short operation time and solid fixation. Lengthened PFNA achieves affirmatory effects for treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures.

Objective To evaluate the value of diffusion weighted imaging in differential diagnosis of endometrial carcinoma stagedⅠa.Methods A retrospective analysis of 18 patients with endometrial carcinoma staged Ⅰ a which was confirmed by pathology. Other 22 patients with benign endometrial diseases were also enrolled in the study including endometrial hyperplasia in 9,endometrial polyp in 8 and degenerative submucous myoma in 5.DWI with b value of 0 s/mm2 and 1 000 s/mm2 was performed with single shot sequence of EPI,and the ADC values were measured.Results The mean ADC values of endometrial carcinoma staged Ⅰa,endome-trial hyperplasia,endometrial polyp and degenerative submucous myoma were (0.89±0.21)×10 -3 mm2/s,(1.45±0.19)×10 -3 mm2/s, (1.29±0.32)×10 -3 mm2/s and (1.32 ±0.29)× 10 -3 mm2/s,respectively.There were statistical significant differences between them (F =48.021,P =0.00).Furthermore,statistically significant differences also existed between endometrial carcinoma and other groups (P <0.05).Conclusion ADC value shows a good value in differential diagnosis of endometrial carcinoma staged Ⅰa.

ObjectiveTo evaluate the strain of the weight-bearing metatarsal bone. Methods6 fresh-frozen cadaveric lower extremities were dissected to expose the dorsal aspect of metatarsal. Bone segments were clarified for adherence of strain-gauges while feet kept intact. Then vertical downward axial load was exerted to distal tibia at a 2 mm/min velocity, from 0 N to 1200 N with one minute interval of 200 N leveled loading augment each for sampling. Superficial strain of the metatarsal was measured by resistance strainmeter methods. ResultsThe strain increased gradually with axial loading, and compress force was always found at every marked bone. The strain of every marked bone was significantly different at the same loading (P<0.05). As to the strain of the middle of the metatarsal, the sequence was the second metatarsal＞the third metatarsal＞the fourth metatarsal＞the first metatarsal＞the fifth metatarsal. As to the strain of the second metatarsal, the sequence was the middle＞the neck＞the base. ConclusionThe peak strain was found at the middle of the second and third metatarsal with axial loading, which prompts the stress fractures of the second and third metatarsal are most common, especially the middle of the second metatarsal.

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.

Purpose To investigate the effects and the mechanism of oleum curcumae wenchowensis (OCW) with different concentrations (0, 2.5, 5, 10 and 20 mg/mL) on chronic myeloid leukemia cell line K-562 cells in vitro.Methods The apoptosis of K-562 cells was dyed by Hoechest 33258 and detected by flow cytometry marked with Annexin V/PI. The Expression of Fas/FasL, bcr/abl, bcl-2 and p53 was detected by semi-quantity reverse transcript-polymerase chain reaction (RT-PCR) and Western blot.Results The results showed that the apoptosis rates were gradually elevated. The expression of Fas and FasL protein was increased in a concentration dependent manner, while bcr/abl, bcl-2 and p53 had no significant changes.Conclusion OCW could induce the apoptosis of K-562 cells by up-regulating the expression of Fas/FasL protein.