Objective:To analyze the key point of client's change in counseling,and found the cognitive,emotional and other characteristics in the key point of change.Methods:Totally 14 foreign cases and 5 domestic cases with good outcome that came from the published literature in the area of assimilation model were analyzed.The secondary data analysis was used to analyze the cases'data.Results:Analysis revealed that 9 categories were generated from the data,which were understanding the causes of the problems,the accompanying feelings,the emergence of a new awareness,removing the problematic voice's threat,discovering behavior pattern,allowing the coexistence of both original conflicts,directly expressing the problematic voice desired to be expressed,viewing things with different perspectives,finding out the direction of future action.Conclusions:Behind the key point of client's change,changes in cognition could lead to changes in emotion,so that the problematic voice's threat could be removed and the coexistence of original conflict could be allowed,and then bring about the relief of the client's inner conflict.

Objective Establishment of two experimental models for osteoclast differentiation from monocyte in vitro,and to study the potential of osteoclast differentiation induced by cytokines.Methods Direct model of osteoclast differentiation: CD14+ monocyte fraction of peripheral blood mononuclear cell(PBMC) stimulated by(25 ?g/L) M-CSF+(10~(-8)mol/L) LTB4 for two weeks.Indirect model of osteoclast differentiation: Utilize the coculture model of RAFLs and monocyte that were stimulated in the presence of 25 g/L M-CSF+(10~(-8)mol/L) LTB4 for three weeks.In TRAP staining the multinucleated TRAP staining positive osteoclast-like cells were counted as marker of as differentiation effect of each group.Results Osteoclast-like cells can be induced by both direct and indirect models.Conclusion Two experimental models for osteoclast differentiation can be separately used to study the effect of various cytokines for direct and indirect OC differentiation.

Objective To investigate the effects of comprehensive pain management on pains and recovery of knee function of patients who hadundergone total knee arthroplasty(TKA).Methods A total of 50 patients who had undergone single-knee TKA surgery were selected and divided into 2 groups of 25 patients each:the study group and the control group.The control group was given patient-controlled epidural analgesia while the study group was given comprehensive pain management.The two groups were compared in terms of score on pain within 7 days after operation,knee joint activity and the incidence of adverse reaction within 10 days after operation(the 1st,3rd,7th,10th day).Results Within 7 days,the scores on pain in the study were significantly lower than those in the control group(P<0.05).The scores on the knee joint activity in the study group on the 1st,3rd,7th,10th day were significantly higher than those in the control group(P<0.05)and the incidences of adverse reaction were significantly lower as well (P<0.05).Conclusion Comprehensive pain management is effective for post-surgery pain control and the hastened TKA patients, and the improved quality of life.

Objective To investigate the correlation between the level of serum cortisol and alexithymia in depressive patients with somatic symptoms.Methods The morning level of serum cortisol was measured with radioimmunoassay in 30 depressive patients with somatic symptoms (somatization group) and 30 depressive patients without somatic symptoms (non-somatization group).The severity of alexithymia was evaluated with Toronto alexithymia Scale(TAS-20).Results (1) The level of serum cortisol in somatization group was significantly higher than that in non-somatization group((533.88±144.10) μmol/L vs (458.27±82.87) μmol/L,P＜0.01).(2) The total TAS score and the factor score of Difficulty in identifying feelings and Difficulty in describing feelings in somatization group were obviously higher than those in non-somatization group,respectively ((67.13 ± 6.96) vs (62.03±7.14),(24.50±3.78) vs (21.63±3.63),(15.30±2.69) vs (13.57±2.03),all P＜0.01).(3) The level of serum cortisol in somatization group was positively correlated with the total score of alexithymia (r=0.596,P＜0.01) and the factor score of Difficulty in identifying feelings, Difficulty in describing feelings, externally oriented thinking,respectively (r=0.391,0.435,0.452,all P＜0.05).(4) The level of serum cortisol in non-somatization group was positively related to the total TAS score (r=0.418,P＜0.05) and the factor score of externally oriented thinking(r=0.489,P＜0.01).Conclusions Compared with depressive patients without somatic symptoms,depressive patients with somatic symptoms had more severe alexithymia,especially in Difficulty in identifying feelings and Difficulty in describing feelings.The severity of alexithymia was positively correlated with the level of serum cortisol.

Problem-based learning (PBL)was used in resident standardized training in depart-ment of pediatrics of Changhai Hospital. Attending doctors with authority were taken as leaders teach-ing group and 3-5 resident doctors as team members. Cases were set up according to the targets of resident standardization training and common clinical diseases in each system. According to the results of the questionnaire after the teaching , both teachers and students were satisfied with the teaching effect and expected targets were reached. Residents made great progress in handling clinical problems.

This article summarizes the bleaching of pulp by white-rot fungus, including the type of white-rot fungus, the type of pulp, the equipment used to bleach by white-rot fungus, and some problems and prospect in practical application by white-rot fungus.

Objective To evaluate the effectiveness and safety of Shuangyi Qushi Tongluo Capsules ( SQTC) in treating ankylosing spondylitis (AS), and to explore the synergistic action of SQTC combined with sulfasalazine. Methods A randomized and parallel-controlled trial was carried out in 80 AS patients. The enrolled subjects were evenly randomized into testing group and control group. Both groups were given oral use of sulfasalazine enteric-coated tablets, and the testing group was additionally given oral use of SQTC, which is mainly composed of silky ant (Formica Fusca), black-winged Termitidae, Scorpio, Radix Ginseng, Radix Astragali, Rhizoma Atractylodis Macrocephalae, Radix Angelicae Sinensis, Flos Carthami, Radix Salviae Miltiorrhizae, Radix Achyranthis Bidentatae, Caulis Spatholobi, Herba Epimedii, and Radix Morindae Officinalis. The treatment for the two groups covered 24 weeks. On treatment week 4, 12, 24, we recorded the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), visual analog scale (VAS) scores of rachialgia, patients’ general assessment (PGA), VAS scores of night pain, spondylitis scores, Bath Ankylosing Spondylitis Functional Index ( BASFI) , Bath Ankylosing Spondylitis Metrology Index ( BASMI) , scores of the quality of life ( QOL) , erythrocyte sedimentation rate ( ESR) , C-reactive protein ( CRP). Moreover, the adverse reaction of the two groups was also monitored. Results ( 1) Compared with the control group, testing group had high ASAS 20 percentage on treatment week 4, 12 and 24 (P<0.05 or P<0.01). (2) After treatment for 12, 24 weeks, the observation indexes were much improved in the testing group ( P<0.05 or P<0.01 compared with the control group). ( 3) In the control group, one case ( 2.86%) had slight abnormal hepatic function, and one case (2.63%) in the testing group had slight gastrointestinal discomfort, the difference being insignificant (P>0.05). Conclusion SQTC are effective and safe in treating AS, starting an effect shortly and having synergistic effect on salfasalazine for the treatment of AS.

Objective:To analyze influence factors in patients with acute myocardial infarction (AMI) undergoing e‐mergency percutaneous coronary intervention (PCI ) .Methods:Clinical data of 656 patients ,who received emer‐gency PCI because of AMI in our hospital from Jan 2005 to Jan 2015 ,were retrospectively analyzed .Short -term prognosis ,including incidence rates of heart failure (HF) ,cardiogenic shock (CS) ,arrhythmias and mortality , were compared and analyzed among these patients from onset related factors ,coronary disease and vascular reope‐ning time etc .Results:Mean onset age of men was significantly younger than that of women (P<0.05) .Incidence rate of AMI in winter and spring was significantly higher than those in summer and autumn (χ2 = 6.244 , P=0.012) .According to complicated with hypertension ,DM ,dyslipidemia and smoking or not ,patients were divided into corresponding disease group and normal group ;only incidence rates of CS (37.78% vs .29.62% ) and arrhyth‐mia (47.78% vs .38.24% ) in DM group were significantly higher than those of non -DM group ,mortality rate of dyslipidemia group was significantly lower than that of normal blood lipid group (0.73% vs .3.69% ) , P<0.05 or< 0.01 ,there were no significant difference in incidence rates of other events between normal group and disease group (P>0.05 all) .Incidence rate of arrhythmia in RCA group was significantly higher than those of LAD group , LCX group and multi -vessel group (56.36% vs .31.55% ,37.50% ,34.38% ) ,mortality of LM group was signifi‐cantly higher than those of LAD group ,RCA group and LCX group (25.00% vs .1.79% ,0.91% ,0% ) , P<0.05 or <0.01. Incidence rate of HF in 10~12h group was significantly higher than those of 0~3h ,4~6h and 7~9h group (79.46% vs .61.70% ,66.81% ,64.78% ) ,incidence rate of arrhythmia was significantly lower than those of 0~3h ,4~6h and 7~9h group (32.14% vs .55.32% ,43.81% ,44.65% ) ,and incidence rate of CS was significant‐ly higher than that of 0~3h group (35.27% vs .21.28% ) , P<0.05 or <0.01. Conclusion:Onset age ,season and DM ,coronary disease extent ,vascular reopening time are risk factors influencing short‐term prognosis of AMI .

To perform an evaluation of the on-going prospective clinical trials on particle radiation therapy and their impact on the current clinical practice as well as future clinical research and development.Furthermore,to briefly present the results of the registration trial of the IONTRIS particle therapy system at the Shanghai Proton and Heavy Ion Center.We used data from the clinicaltrials,gov and the Particle Therapy Collaborative Organization Group (PTCOG) website.After excluding retrospective and in silico studies,we examined and analyzed the prospective clinical trials for their ion type,targeting disease site,and nature.At the time of this analysis,149 prospective trials were identified on proton and carbon-ion radiation therapy,including 20 were carbon-ion and 129 trials were proton radiation focused,respectively.Except for 15 randomized phase Ⅱ/Ⅲ and Ⅲ trials,134 trials were phase 0-Ⅱ trials.Tumors from nearly all body parts were covered by the on-going trials,but trials on pediatric,GI,lung,prostate,and breast cancer account for the majority.The majority of the currently on-going trials focus on the efficacy and adverse-effects of the new dose/fractionation schemes of particle therapy as well as the use of particle therapy on new indications.Few studies invcstigate the addition of adjuvant therapy or imaging technology used in adjunct with particle therapy.Randomized trials that compare particle radiation therapy versus photon radiation is relatively uncommon.Despite the prevailing use of proton and heavy-ion radiation therapy for cancer treatment,～ 150 prospective clinical trials associated with particle radiation therapy are identified.As the majority of trials aim to investigate more efficacious dose/fractionation and the application of particle therapy on new indications,improved outcome from and expanded utilization of particle radiation therapy can be expected.

BACKGROUND:The position of median and radial nerves corresponding to elbow is usual y estimated by macroscopical measurements, but there are big data errors when the elbow is bent. OBJECTIVE:To measure and analyze the impacts of elbows in different positions on median and radial nerves under X-ray. METHODS:Ten fresh frozen upper limb specimens were selected. The distance of median and radial nerves to the osseous marks inside the elbow was measured when the elbow was in extension, extension-half pronation, bent at flexion 90 degrees and bent at 90 degrees with the injection of normal saline into the joint capsule, respectively. RESULTS AND CONCLUSION:The positions of median and radial nerves were not influenced when the elbow was in extension or in extension-half pronation (P>0.05). The distance of median and radial nerves to the osseous mark of the elbow was significantly lengthened when the elbow was moved from from extension to was bent at 90 degrees (P<0.05). The intra-articular injection of normal saline when the elbow flexion 90 degrees significantly elongated the distance of median and radial nerves to the osseous mark of elbow (P<0.05). These results suggest that the elbow in different positions can induce the displacement of median and radial nerves. In addition, the distance between median, radial nerves and the osseous marks of the elbow is obviously lengthened when the elbow is in flexion with intra-articular injection of normal saline.