Objective To explore the effectiveness of sandplay therapy combined with family counseling in children with school phobia and its influence of child′ self-consciousness. Methods Integrative sandplay therary with family consulting were used to treat 28 patients with school phobia regularly for 2 months. Sandplay and family consulting therapy were given once a week for 45 minutes . Clinical outcomes were assessed using CGI-GI and Piers-Harris children′s self-consciousness scale before and after treatment as well as 3 months posttreatment. Results Overall response rate was 85%. In addition, the physical appearance and characteristic factor before and after treatment were no significant difference (P>0.05). The rest of the various factors and total score compared with pre-treatment significantly improved (P<0.05). After treatment for 3 months, every factor in self-consciousness of children and total score were no significant difference (P>0.05). Conclusion Integrative sandplay therapy with family counseling has better and long-lasting treatment effect to self-consciousness of children with school refusal.

BACKGROUND:It has been reported that treatment with granulocyte-colony stimulating factor (G-CSF) increases the abundance of circulating CD34+ cells in rats. Data from the study, more important, suggested that mobilized by G-CSF may enhance rapid reendothelization and reduce neointimal formation after vascular injury.OBJECTIVE: To evaluate whether BM-derived CD34+ cells could enhance rapid reendothelization and reduce neointimal formation after balloon-injured carotid artery in an intact rat model.DESIGN: Randomized control animal study.SETTING: Nanjing First Hospital Affiliated to Nanjing Medical University.MATERIALS: The experiment was carried out in Nanjing First Hospital from December 2005 to April 2006. A total of 40 male Sprague-Dawley rats, weighing 200-250 g and of SPF grade, were purchased from National Rodent Laboratory Animal Resources, Shanghai Branch. The recombinant human G-CSF was purchased from Qilu Pharmaceutical. The 2F Fogarty arterial embolectomy catheters were purchased from Edwards Lifesciences. Anti-human CD34 and anti-human CD45 were purchased from Multi Sciences.METHODS: SD rats were divided randomly into treated group (n =20) and control group (n =20). Subcutaneous injection of recombinant human G-CSF (100 μg/kg/day) once daily for 8 days for treated group. Control group as treated with subcutaneous injection of saline. Five days after initiation of G-CSF treatment or saline, the rats were anesthetized by intraperitoneal injection with ketamine. The left common carotid artery was exposed through a midline incision of the ventral side of the neck. A 2F Fogarty arterial embolectomy catheter was inserted through the external carotid artery,inflated with 200 μL air, and passed 3 times along the length of the segment, which was defined proximally by the carotid bifurcation and distally by the edge of the omohyoid muscle. After removal of the catheter, the proximal ligature of the external carotid artery was tied off. ① An average of 1 mL venous blood per rat was collected for enumeration of the white blood wells (WBCs) and CD34+ cells before and 5 days after initiating G-CSF or saline treatment. ② Ten rats in each group were killed with overdose ketamine at 14 and 28 days after balloon injury and left common carotid arteries were harvested. The luminal surface of carotid arteries (n =5, each group) was exposed to calculate the reendothelialized area, which was manually traced with software (Image ProPlus). Reendothelialized area = non-stained with Evans blue area/the total area of balloon-injuried. The cross sections of carotid arteries (n =5, each group) were stained with hematoxylin and eosin (HE) and calculated intima-to-media area ratio (I/M) with software (Image ProPlus) to assess the extent of neointimal thickening. ③ To evaluate the extent of reendothelialization of arteries injury, sections were stained with CD31 and vWF by immunohistochemistry analysis.MAIN OUTCOME MEASURES: ① The number of WBCs and CD34+ cells; ② the extent of reendothelialization of arteries injury; ③ the extent of neointimal hyperplasia (I/M); ④ CD31 + and vWF+ endothelial cells.RESULTS: A total of 40 rats were involved in the final analysis. ① The number of WBCs and CD34+ cells: After 5 days of treatment, the number of WBCs in the treated rats increased more than 2.7-fold compared with control group [(27.60±2.45) ×109 L-1, (10.11±1.81) ×109 L-1, P ＜ 0.01], CD34+ cells increased more than 12.2-fold compared with control group (38.31×107 L-1, 3.14×107 L-1, P ＜ 0.01). ② The extent of reendothelialization: At 14 and 28 days after balloon injury,carotid artery of reendothelialization in the treated group were (68.3±8.3)％ and (97.6±4.1)％, superior than the control group (33.8±6.3)％ and (76.1±5.2)％ (P ＜ 0.01). ③ The extent of neointimal hyperplasia: At 14 and 28 days after balloon injury, the neointima-media (I/M) ratios in the treated rats were 0.39±0.11 and 0.45±0.09, less than the control group 0.87±0.15,1.26±0.16 (P ＜ 0.01). A highly significant inhibition of neointimal hyperplasia was observed in the treated group. ④ CD31+ and vWF+ endothelial cells: At 28 days after injury, sections from G-CSF treated group showed almost complete and continuous monolayer of CD31 and vWF positive cells.In contrast, a patchy and interrupted CD31 and vWF positive cells were found lining the lumen of control group.CONCLUSION:Treatment with G-CSF significantly increases the number of CD34+ cells and accelerates the rate of reendothelialization of injured vessels, leading to marked inhibition of neointimal formation after vascular injury in rats.

Objective:To study the effect of intraperitoneal hyperthermic perfusion chemotherapy combined with venoclysis on postoperative gastric cancer.Methods:140 postoperative patients with gastric cancer were divided into IPHPC group(n=72) and chemotherapy of venoclysis group(n=68).The intraperitoneal hyperthermic perfusion chemotherapy and chemotherapy of venoclysis were applied for the patients in IPHPC group at one time.Postoperative complications,toxicity,survival rate and peritoneal recurrence rate in two groups were observed.Results:There was no sharp difference in the postoperative complications and toxicity between the two groups.The 3,5 year-survival rate were 86.1%,60.2% and 58.3%,29.4% in IPHPC group and CV group.The 3,5 year-peritoneal cavity recurrence rate were 5.6%,20.6%and 27.8%,53% in IPHPC group and CV group.There were significant differences in survival rate and peritoneal recurrence rate between the two groups.Conclusion:Intraperitoneal hyperthermic perfusion chemotherapy combined with venoclysis can prevent recurrence and metastasis effectively,and improve the survival rate and quality of life of postoperative gastric cancer patients.

Objective To investigate prognostic factors for bloodstream infection in adult patients. Methods Clinical data of 131 adult patients with positive blood cultures during January 2002 to December 2003 in the Hospital were collected and 91 cases of them were retrospectively analyzed to understand their pathogen species and prognostic factors for it.Results Blood samples from 91 patients were cultured positive,53 cases(58.2%)with gram-negative bacteria mainly including Escherichia coli,Salmonella spp. and Klebsiella pneumoniae,28(30.8%)with gram-positive bacteria,mainly including Staphylococcus aureus and coagnlase-negative Staphylococci,eight(8.8%)with fungi and two(2.2%)with multiple infections.Case fatality ratio in this group of patients with septicemia was 30.8% during their hospitalization,and that in those with Pseudomonas aeruginosa,Staphylococcus aureus,Stenotrophomonas maltophilia and E.coli with extended-spectrum beta-lactamase was over 50%.Case fatality ratio was associated with severity of sepsis(OR=1.15)and inappropriately initial empirical treatment with antibiotics (OR=6.77).Conclusions Pathogen causing bloodstream infection in adults were mainly gram-negative bacteria and severity of infection and inappropriate initial antibiotics treatment could increase their fatality.

Objective:To explore the influence of childhood psychological abuse, neglect and alexithymia on the boredom proneness of college students.Methods:The boredom proneness scale for college students(BPS), child psychological abuse and neglect scale (CPANS) and the Toronto alexithymia scale (TAS-20) were used to investigate 1 557 college students, and SPSS 22.0 was used for descriptive statistics, correlation analysis and regression analysis.Results:Childhood psychological abuse (26.540±8.985), neglect (32.665±10.651), recognition emotion in alexithymia dimension (19.359±4.835), description emotion dimension (14.173±3.001), extroverted thinking dimension in alexithymia (20.383±3.429) had positive correlation with the total score of boredom tendency (101.109±19.735) and the dimension of external stimulus (66.022±21.079)( r=0.160-0.559, all P<0.01). And there were negative correlations with the internal stimulus dimension (35.132±8.207)( r=-0.302--0.104, all P<0.01). The hierarchical regression analysis showed that after controlling the effects of gender and age, psychological abuse and neglect were the influencing factors of boredom proneness, internal stimulus and external stimulus, which explained 14.3%, 5.1% and 18.2% of the total variation (△ F=130.561, 41.968, 172.711, all P<0.01). Recognition of emotions, description of emotions and extroverted thinking in alexithymia were the influencing factors of boredom proneness, internal stimulus and external stimulus, which explained 17.5%, 9.9% and 25.5% of the total variation (△ F=134.274, 60.696, 234.383, all P<0.01). Conclusion:Childhood psychological abuse, neglect and alexithymia have significant effect on boredom proneness of college students, and mainly on external stimuli of boredom proneness. Among them, alexithymia has the greatest influence and the highest explanatory power.

Objective To evaluate the value of ultrasound elastography in the diagnosis of breast tumor ,and compared with imaging analysis .Methods To collect the image data of 160 patients ,confirmed by pathology ,a total of 182 ,preoperative ultra-sound elasticity imaging and DWI ,ultra sonic elastography diagnosis by five points method ,DWI on the basis of the measured ADC value in the diagnosis of lesions ,respectively compared with pathology .Results Ultrasound elastography diagnosis of 89 malignant tumors ,of which the correct diagnosis of 78 malignant tumors ,7 misdiagnosis ,11 benign misdiagnosed as malignant diagnosis;93 benign tumors ,86 of correct diagnosis ,11 misdiagnosis ,7 malignant misdiagnosed as benign ,sensitivity was 87 .6% ,specificity of 92 .5% ,the Accuracy was 93 .9% ;ultrasound elastography and DWI combined imaging diagnosis of 86 malignant tumors ,81 correct diagnosis of malignant tumors ,4 misdiagnosis ,5 from the benign misdiagnosed as malignant diagnosis ,96 benign tumors ,92 correct diagnosis ,5 misdiagnosis ,the sensitivity was 94 .1% ,specificity of 95 .8% ,the accuracy was 97 .2% .Conclusion Ultrasound elas-tography in breast benign and malignant tumor diagnosis with higher sensitivity and specificity ,accuracy ,joint DWI can significantly improve the sensitivity and specificity of breast benign and malignant tumor diagnosis ,accuracy .

Objective To establish a method for quality control of xinshuaining mixture. Methods The herbal contents including red ginseng,milk veteh,root of red rooted salvia were identified by thin layer chromatography ( TLC) and the content of ginsenoside Rb1 in xinshuaining mixture was determined by high performance liquid chromatography ( HPLC ) . Results The herbs can be overtly identified by TLC. Ginsenoside Rb1 had a linear relationship in the range of 1. 095-5. 475μg, and the average recovery was 97. 3%(RSD 1. 98%). Conclusion The method is simple and rapid,and can be used for the quality control of xinshuaining mixture.

Objective To explore the association between disrupted in schizophrenia 1(DISC1) genepolymorphism and schizophrenia and different subtype depression.To verify if DISC1 gene is the common predisposing gene for schizophrenia and depression.Methods The genotypes and alleles in 260 cases of schizophrenicpatients,96 cases of depressive patients with psychotic symptoms,124 cases of depressive patients without psychotic symptoms,and 100 normal controls were examined with polymerase chain reaction(PCR),denaturing polyacrylamide gel elcctmphoresis separation technique.The association was analyzed between DISC1 gene single nncleotide polymorphisms(SNP) locus rs821616 and schizophrenia and different subtype depression.Results The frequeneies of the genotypes T/T,A/T,and A/A were 3.5%,28.0%and 69.5%respectively,the frequencies of alleles T and A were 9.6%and 90.4% respectively in schizophrenia group.The frequencies of the genotypes T/T,A/T,and A/A were 3.1%,24.0% and 72.9% respectively,the frequencies of alleles T and A were 15.6% and84.4% respectively in depression 1 group;The frequencies of the genotypes T/T,A/T,and A/A were 2.4%,23.4% and 74.2% respectively,the frequencies of alleles T and A were 15.3% and 84.7% respectively in depression 2 group;The frequencies ofthe genotypes T/T,A/T,and A/A were 1.0%,16.0% and 83.0% respectively,the frequencies of alleles T and A were 17.0% and 83.0% respectively in control group.There were significant differences in the frequencies of the genotypes (Chi-Square=8.072,P=0.045)and alleles(Chi-Square=8.564,P=0.036) of DISC1 gene among the four groups with non-parametric Kruskal-Wallis test.After pairwisecomparison each other in the four groups we found that there were significant differences in the frequencies of thegenotypes(Z=-2.802,P=0.005)and alleles(Z=-2.837,P=0.005) of DISC1 gene between patients withschizophrenia and normal controls with non-parametric Mann-Whitney test(two-tailed),there were no significantdifferences between other groups(P>0.05).Conclusion Our results suggest that DISC1 gene polymorphism is associated with schizophrenia significantly,but it is not associated with different subtype depression.This finding do not support the viewpoint that DISC1 gene is the common predisposing gene for schizophrenia and depression.

Objective To improve the diagnosis and treatment ot adrenocorticotropin-independent macornodular adrenal hyperplasia (AIMAH).Methods The clinical data of 17 cases with AIMAH from 2000 to 2011 were analyzed retrospectively,including 3 subclinical AIMAH,10 clinical AIMAH and 4 highrisk AIMAH patient,with common radiological characteristic of bilaterally enlarged adrenal glands with multiple nodules like ginger.The 3 cases of subclinical AIMAH patients presented with decreased serum ACTH,normal or slightly elevated plasma cortisol and urinary free cortisol level,no suppression following 1 mg overnight dexamethasone suppression test and absence of clinical signs of Cushing syndrome (CS).While clinical AIMAH and high-risk AIMAH presented with clinical signs of CS,elevated plasma cortisol and urinary free cortisol level,suppressed serum ACTH,loss of normal circadian rhythm in cortisol secretion and no suppression following the low-dose and high-dose overnight dexamethasone suppression test.Among the 4 cases of high-risk AIMAH,2 cases presented with osteoporosis,2 cases with hepatic dysfunction,3 cases with cardiopulmonary dysfunction,and 4 cases with severe hypertension.Three cases of subclinical AIMAH were treated with symptomatic treatment,10 cases of clinical AIMAH patients with surgical operation,4 cases of high-risk AIMAH patients with ketoconazole and surgical operation.Results Three subclinical AIMAH patients received symptomatic treatment and discharged from hospital with normal blood pressure and blood glucose.During the period of follow-up from 3 months to 3 years,endocrine results were normal.Seven clinical AIM AH patients underwent unilateral adrenal tumor resection plus ipsilateral partial adrenalectomy or total adrenalectomy.CS disappeared completely after 6 to 9 months.Two clinical AIMAH patients underwent simultaneous bilateral adrenalectomy.One case died of adrenal crisis after operation,and the other case presented with adrenal insufficiency but returned to normal after glucocorticoid replacement therapy,no Nelson's syndrome happened during the follow-up for 5 years.One clinical AIMAH patient undertook unilateral adrenalectomy twice by interval,followed by routine corticosteroid replacement therapy.Followed up for 10 years,no Nelson's syndrome happened.Four high-risk AIMAH patients received ketoconazole and then underwent right total adrenalectomy.Cortisol levels returned to normal after 1 to 2 months and during the follow-up for 1 to 3 years,the laboratory examinations maintained normal.Conclusions Different treatment methods should be adapted to different subtypes of AIMAH.For subclinical AIMAH,the principal treatment is symptomatic,and close follow-up with regular adrenal imaging and endocrine examination is required.Surgical operation should be performed when clinical symptoms of AIMAH appear.Medical management is essential for high-risk AIMAH to inhibit the production of cortisol at first.Once these patients could stand the stimulation caused by operation,the adrenal glands should be resected as soon as possible.The unilateral adrenalectomy is an effective treatment for clinical AIMAH.

Objective To investigate the feasibility of contrast-enhanced ultrasound-directed nosejujunium tube placement.Methods Twenty-four patients hospitalized in ICU who need support from enteral feeding were collected for this study.Flocare spiral nose-jejunium tube was placed into stomach with guide wire.Real-time ultrasound was used after injection of SonoVue for monitoring the passage of feeding tube from pylorus to duodenum-jejunum segment which was pushed down if without strong resistant force.Finnally,the guide wire was drawed out and enteral feeding was conducted with ascertainment of abdominal X-ray photograph for suitable site in intestinal tract.Results Contrast ultrasound -directed nose-jejunum tube placement procedure was conducted in 24 cases.Twenty-one cases (87.5%) was accomplished successfully,and 3 cases (12.5%) was failed.No special change was observed in the procedure of all patients.Conclusions Contrast ultrasound -directed nose-jejunum tube placement procedure can be regarded as a convenient,safe,and reliable insertion technology,which provide an effective means for early enteral nutrition for critical patients.