Objective To analyze the sandtray topics of the children with behavior problems according to the grounded theory method.Methods Collected and described children' s sandtray topics of different types of behavior problems,age and gender.And analyzed them base on a 3 levels coding list compiling according to the ground theory method.Results The frequency of “negative theme” (3.33 ± 1.25 ) was higher than “positive theme” (0.81 ± 1.25 ) with significant difference (P＜0.01) in feature level 1.Age factor had significant effect upon the frequency of “positive theme” in feature level 1 (P ＜ 0.05 ).And also had impact on “harmony”,“ development” in features level 2 (F =3.039,P ＜ 0.05 ).Gender factor,interaction of gender and age had significant effects on frequency of “negative theme” in feature level 1 (F =5.395,P ＜ 0.05 ; F =4.222,P ＜ 0.05 ).Conclusion The characteristics of the children' s sandtay with behavioral problems mainly are “negative theme”.And it shows different features in children with different gender or age.

Objective To summarize the experiences in treating 30 cases of skin soft tissue defects in head and neck by applying repeated expansion, and to explore an effective and satisfactory method of massive defect repair in head and neck. Methods Skin soft tissues were repeatedly expanded for 1 to 3 times after the first expansion. Massive skin defects in head and neck were repaired several times by useing repeated expansion of flap. The size of the skin defects ranged from 29cm?24cm to 10cm?8cm. The indications, complications and experiences in the treatment were discussed. Results A total of 30 cases were treated. Complication incidences of every expansive procedure were 27%, 15%, 14% and 0% respectively . After 6～12 months postoperative follow-up, the appearance and functional restoration was satisfactory. Conclusion Repeated expansion is an excellent method of repairing massive defects in head and neck.

Objective To determine the long-term outcomes of cN0 papillary thyroid carcinoma without elective central compartment neck dissection. Methods The clinical data of 180 patients with clinically lymph node negative papillary thyroid carcinoma who were treated in our center between 2000 and 2005 were retrospectively analyzed. All of these patients did not receive elective central compartment neck dissection. Clinicopathological characteristics including gender,age,surgical range,pathologic type,tumor size,and extrathyroidal extension(ETE)or not were collected. Results After a median follow-up period of 90 months,only one patient died of stroke without tumor. Sixteen patients had tumor recurrence:seven patients had a recurrent disease in residual thyroid tissue,two in the thyroid bed,six in central compartment,eight in lateral cervical compartment,and one in lung. The 10-year overall survival,disease-specific survival,and recurrence-free survival was 99.4%,100%,and 87.9%,respectively. The 10-year accumulative lymph node recurrence rate in central compartment and lateral compartment was 7.8% and 7.0%,respectively. ETE was an independent risk factor for central compartment lymph node recurrence. Male gender(P=0.010)and ETE(P=0.028)were independent risk factors for lateral compartment lymph node recurrence. Conclusions The prognosis of patients with cN0 papillary thyroid carcinoma without elective central compartment neck dissection is good after ten years of follow-up. Male gender and ETE are independent risk factors for lateral compartment lymph node recurrence.

Objective To explore the interaction model of social capital, mental health,occupational burnout, turnover intention and the related influence factors on nurses. Methods By random cluster sampling, investigated 723 nurses with Nurses' Turnover Intention Inventory, the Maslach Burnout Inventory, Social Capital Questionnaire and Chinese Health Questionnaire, then explored the interaction model by path analysis. Results Nurses' position can influence their social capital(the path coefficient was 0. 124), social capital and occupational turnout can influence nurses' mental health(the path coefficient were -0. 231,0. 151), the mental health and occupational turnout both can influence nurses' turnover intention directly(the path coefficient were 0. 088,0. 151 ), the model is acceptable(CMIN/DF 1. 645, GFI 0. 984, AGFI 0. 966, IFI 0. 941, CFI 0. 937, RMSEA 0. 037).Conclusion Social capital can provide a new perspective for nurses' management, developing the social capital resources can relieve nurses' mental problems effectively; relieving the turnout and mental problem can decrease nurses' turnover intention finally.

Objective To investigate the appropriate surgical procedure for unilateral papillary thyroid microcarcinoma (PTMC).Methods Clinical data of 323 patients with unilateral PTMC in Cancer Hospital of Chinese Academy of Medical Sciences from 1999-2007 were retrospectively studied.Survival outcomes and prognostic factors were analyzed.Results After a median follow-up of 102 (range,12-188) months,the 10-year overall and disease-specific survival was 95.3％ and 98.9％.The 10-year recurrence-free survival was 85.5％.The 10-year cumulative recurrence rate of residue glands was 6.5％.Capsular invasion,pT stage and clinical stage were significant predictive factors for recurrence of residue glands (all P ＜ 0.05).Cox regression multivariate analysis showed that pT stage (HR 2.153,95％ CI 1.231-3.767,P =0.007) was independent predictive factor.Of the 311 patients treated with non-total thyroidectomy,the 10-year cumulative recurrence rate of residue glands was 6.8％ Conclusions Unilateral PTMC has a good prognosis and hemithyroidectomy (lobectomy and isthmusectomy) is an appropriate surgical pattern.Extrathyroidal extension is a significant predictor for recurrence.

Objective To determine the expression levels of SOCS2 in the mouse livers under starvation, diabetes and obese conditions and to study the effect of SOCS2 on gluconeogenesis.Methods Animals were divided into 3 groups: C57BL/6J mice, the control group was fed ad libtum and the experimental group was fasted for 24 h.Diabetes model db/db and the control db/m mice were fed ad libitum.Obese model ob/ob and the control C57BL/6J mice were fed ad libitum.All the mice above were sacrificed and total RNA was isolated from mouse livers and reverse transcribed to cDNA.The expression of SOCS2 and gluconeogenesis genes in the mouse livers in the 3 groups above were detected by real-time quantitative PCR.SOCS2 was overexpressed in the primary C57BL/6J mouse hepatocytes by the adenovirus system.The effect of SOCS2 on glucose production was measured by glucose output assay.Results C57BL/6J mouse hepatic SOCS2 expression was suppressed by starvation status.The expression of SOCS2 was decreased in the livers of db/db and ob/ob mice.In contrast, the key regulators of gluconeogenesis, PGC-1α, PEPCK and G6Pase exhibited the opposite expression pattern as SOCS2 in the livers underidentical starvation, diabetes and obese conditions.The protein was Mr 23 000 and glucose production was inhibited after SOCS2 being overexpressed in the primary C57BL/6J mouse hepatocytes by adenovirus system.Conclusions SOCS2 may inhibit gluconeogenesis in the C57BL/6J mouse primary hepatocytes, and SOCS2 may be a potential target for the treatment of type Ⅱ diabetes.

Objective To explore the effect of gender on the concentration of D-dimer between the healthy and the patients with aortic dissection.Methods From January 2015 to January 2016,53 patients with aortic dissection were treated in a hospital and 50 patients of health control group were matched by age,Sysmex CS5100 was used to detect the concentration of D-dimer in the selected population,and the results were analyzed statistically.Results In the same age group,the concentration of D-dimer in healthy control group female was higher than that in male,difference was statistically significant (t=5.357,P<0.05);The concentration of D-dimer in male patients with aortic dissection group was higher than that of female patients,difference was statistically significant(t=-2.041,P<0.05).The concentration of D-dimer in patients with aortic dissection group was higher than that of the healthy control group,difference was statistically significant(t=5.757,P<0.05).Conclusion The concentration of D-dimer between healthy adults and patients with aortic dissection exist gender differences,and it has a certain correlation.

Objective To investigate the rate of termination of pregnancy (TOP) in gravidas with prenatally diagnosed fetal malformation and to analyze the influences of medical and non-medical factors on decision making.Methods This was a prospective cohort study. Gravidas who took part in a multidisciplinary consultation due to fetal malformation and finished a questionnaire after consulting from September 12, 2012 to May 2, 2013 were recruited. Exclusion criteria were chromosomal disorders and isolated abnormal ultrasound soft markers. The questionnaire survey was conducted to understand the patient's backgrounds and to collect their feedbacks on the consultation. Decisions of the gravidas on TOP were followed up by phone in 2014 and 2016. If a gravida chose to continue her pregnancy, her baby's outcome was also recorded.T test,Chi-square test or Fisher's exact test, or rank-sum tests (Mann-Whitney or Wilcoxon) or Logistic regression was used for statistical analysis.Results (1) Altogether 229 gravidas were recruited and 10 of them were lost to follow-up, so 219 cases were finally analyzed. Among the 219 cases, 35.6% (78/219) chose to terminate their pregnancies. (2) Neonatal prognosis was predicted based on the type and severity of the disease and was divided into four levels including good prognosis (122 cases, 55.7%), medium prognosis (20 cases, 9.1%), poor prognosis (17 cases, 7.8%) and unsure prognosis (60 cases, 27.4%). (3) Gravidas who chose to terminate their pregnancies were younger than their counterparts choosing to continue to term (average age: 27.8±4.1 vs 29.0±3.9,t=2.257,P<0.05). Gravidas who went to the consultation before the 24th gestational week carried double risk of TOP than those after the 24th gestational week [termination rate: 52.5% (31/59) vs 29.4% (47/160),χ2=10.089,P<0.01). (4) Gravidas with fetal growth restriction (FGR) were at triple risk of TOP than those without (OR=2.850, 95%CI: 1.323-6.140) after adjusting for maternal age, gestational age at consultation and prognostic evaluation. Comparing with the good prognosis group, in which the rate of TOP was 19%, the unsure (OR=2.354, 95%CI: 1.108-5.004), medium (OR=16.188, 95%CI: 4.732-55.372) and poor (OR=14.515, 95%CI: 3.61-58.359) prognosis groups had higher risk of TOP. (5) There were 63 women informed us their reasons for TOP (multiple choices), among which 57 (90.5%) were due to unsure neonatal outcomes, and 10 (15.9%) were due to emotional factors. (6) Maternal satisfaction with neonatal prognosis was 2 to 5 points (medium score, ten-point system) lower in gravidas choosing to TOP than in those choosing to continue pregnancy regardless of good, unsure, or medium neonatal prognosis. No significant difference in maternal satisfaction was found among gravidas with poor neonatal prognosis.Conclusions The rate of TOP in gravidas with prenatally diagnosed fetal malformation remains high in China. Factors that can negatively influence the rate of TOP are consultation after the 24th gestational week, better perceived neonatal prognosis and higher maternal satisfaction with neonatal prognosis. Uncertainty of the neonatal prognosis is the leading cause of maternal dissatisfaction.

Objective To explore a method for establishing the hamster model of Clostridium difficile-associated diarrhea (CDAD)and the indicators for its evaluation.Methods Clindamycin was administered to hamsters subcutaneously (day 1),and 24 h later infected with C.difficile clinical isolates KH1 (ribotype 027,106-108 CFU/mL)or SH9 (ribotype 001 ,108-1010 CFU/mL)by gavage.Animals were observed for CDAD symptoms such as diarrhea,weight loss and death.At the end of ob-servation period (day 7 or death),the cecum was collected from each animal for histological evaluation of inflammation.Results Following a single dose of 100 mg/kg clindamycin subcutaneously,all the animals challenged with KH1 (108 CFU/mL)devel-oped diarrhea and then died within 5 days.All the hamsters challenged with SH9 (1010 CFU/mL)developed diarrhea as well but only 66.7% died at the end of observation period.Among other groups,only one or none developed diarrhea and then died. The symptoms of hamsters with diarrhea included loose stool,wet tail and weight loss.On histological examination,conges-tion,hemorrhage and neutrophil infiltration of the mucosa were observed in the hamsters died of CDAD.Conclusions We have successfully established a hamster CDAD model that allows for future investigations.

Objective To study the risk factors of prolonged postoperative recovery after the total cavopulmonary connection(TCPC) in the current era.Methods Data on all patients admitted to the cardiac intensive care unit (CICU) after a TCPC between January 2013 and March 2014 were retrospectively analyzed.We excluded all patients who died and required TCPC takedown.The study cohort was further divided into a prolonged recovery group that included patients with 75％ ile for duration of mechanical ventilation or pleural drainage,and a standard recovery group which included all other patients.A multivariable logistic regression model was used to compare demographic,anatomic,and physiological variables between the prolonged and standard recovery groups.Then,the cohort was separated into a high volume resuscitation group and a low volume resuscitation based on the 75％ ile for volume resuscitation(ml/kg) administered on the first three days after the TCPC.Results Totally 118 TCPC operations were performed.Of the study population (n =118),the median age was 3.8 years (3.1 to 4.8 years) and median weight was 14.8 kg(13.3 to 17.1 kg).The most common diagnosis was double outlet of right ventricle (n =47,39.8％).The extracardiac conduit fenestrated TCPC was the most common surgery(n =79,66.9％).Within the study population,43 (39.8％) patients met criteria for prolonged recovery.Univariate risk factors for prolonged recovery included higher preoperative mPAP(P =0.022),atrioventricular valve regurgitation (P =0.000),longer total bypass time (P =0.044),higher postoperative central venous pressure (P =0.000),AST (P =0.001),ALT (P =0.010),NT-proBNP (P =0.000),SaO2 (P =0.012),I n-otropic score (P =0.001),higher incidence of arrhythmia (P =0.000),low cardiac output syndrome (P =0.000),need for peritoneal dialysis (P =0.000),and requirement for greater volume resuscitation during the 72 postoperative hours(75％ for the entire group,P =0.000).In a multivariable Logistic model,need for greater volume resuscitation (OR 10.860,95 ％ CI 2.681,43.987) and the higher postoperative central venous pressure (OR 1.446,95 ％ C I 1.113,1.879) were the only two independent risk factors for prolonged outcome after the TCPC.Conclusion The need for high volume expansion and higher central venous pressure were the risk factors of mediate prolonged recovery.