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.

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.

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.

Objective To investigate the effects of recombinant human growth hormone (rhGH) on tumor growth and vascular endothelial growth factor (VEGF) expression of human gastric carcinoma xenografts in nude mice with different expressions of growth hormone receptor (GHR). Methods Immunocytochemical method was used to pick out one GHR-positive and one GHR-negative cell line. Then the cells were subcutaneously injected into 24 nude mice separately. The nude mice bearing two different kinds of human gastric caicinoma were equalges of body weight and tumor volume of nude mice were recorded. Serum concentrations of VEGF in peripheral blood were analyzed by ELISA. VEGF protein and mRNA expression in tumor tissue were detected by immunohistochemistry and RT-PCR, respectively. Results We chose SGC-7901 as GHR positive group, and MKN-45 as the negative one. For nude mice bearing GHR + SGC-7901 xenografts, the tumor volumes were significantly larger in rhGH groups than in control group (P ＜ 0.05), and the high-dose rhGH group revealed greater effect (P ＜ 0. 05).Body weights were not significantly different among three groups (P ＞ 0. 05). Serum VEGF concentration was (252.94 ± 15.32) ng/L in the high-dose rhGH group, which was significantly higher than that in control group [(49.94 ± 5.73) ng/L] and low-dose rhGH group [(167.60 ± 9.54) ng/L] (P ＜ 0.05). Moderate positive staining with VEGF was observed in the control group, while VEGF staining was strong in rhGH administration groups. The relative expression of VEGF mRNA for the high-dose rhGH group was 0. 6470 ± 0. 0447, which was significantly higher than that in control group (0. 3230 ± 0. 0258)and low-dose rhGH group (0. 412 ± 0. 0351)(P ＜ 0.05). While for nude mice bearing GHR-MKN-45 xenografts, the body weights of the rhGH-administrated groups were significantly higher than that of control group (P ＜ 0.05), while tumor growth, serum VEGF concentration, and the expressions of VEGF mRNA and protein in tumor tissue were not significantly different (P ＞ 0.05).Conclusions rhGH can promote tumor growth and increase the expression of VEGF in the GHR-highly-expressed SGC-7901 xenograft tumor model. However, such effects do not exist in GHR-negatively-expressed MKN-45 xenograft tumor model. The existence of GHR may be a key target where rhGH influences the secretion of VEGF.

Objective To evaluate the relationship between aberrant crypt foci(ACF) and colon cancer by observing the sequential development of ACF in cancer models of rats. Methods The colon cancer models in 60 Wistar rats were established by subcutaneously injection of dimethylhydrasine (DMH) once a week for 18 weeks. The rats were sacrificed and the colon tissues stained by methylene blue were observed with a stereomicroscope. Results There were two types of ACF, named cACF and dACF. The microscopic findings in dACF were similar with that in early colon cancer, while those in cACF were not. The expression of β-catenin in cACF and dACF were 4. 84% and 100% (P =0. 000) , respectively, and the expression of MMP-7 were 7. 87% and 81.82% (P =0. 000), respectively. There was no significant difference in expression of β-catenin and MMP-7 between dACF and colon cancer ( P ＞ 0. 05 ). Conclusion The microscopic and molecular changes in dACF is similar with that in colon cancer, and dACF may progress to cancer through Wnt pathway.

Objective To determine whether LTB4 could indirectly stimulate human osteoclast differentiation in RA through increasing RANKL expression of RAFLs. Methods We utilize the coculture model of RAFLs and monocyte which were stimulated in the presence of 2.5 ng/ml M-CSF in the control group, 2.5 ng/ml M-CSF +10-8 mol/L LTB4 in the experimental group A, 2.5 ng/ml M-CSF+10-8 mol/L LTB4+100 ng/ml OPG in the experimental group B. After culture for 3 weeks, through TRAP staining we counted the number of multinucleated TRAP staining positive osteoclast-like cells stained with TRAP to evaluate the differentiation effect in each group. Results There was almost no osteoclast-like cell in the control group and the experimental group B. Whereas there were many osteoclast-like cells in the experimental group A. Conclusion LTB4 can indirectly stimulate human osteoclast differentiation in RA through increasing RANKL expression of RAFLs.

AIM: To investigate the activation dynamics and the intracellular localization of p38 protein kinase in Raw264.7 cells after lipopolysaccharide (LPS) stimulation.METHODS: Protein kinase assay and immunogold electron microscope technique were used to check the activation dynamics and distribution of p38 MAPK in Raw264.7 cells before and after LPS stimulation. RESULTS: The kinase assay results showed that a marked increase in p38 activity was detected 15 min after LPS treatment, and reached maximal activity 30 min post stimulation, then dropped down and got closed to the pre-stimulated level 2 h later. The optimal LPS concentration for treatment was 100 ?g/L. The immunogold electron microscope data showed that p38 spread evenly in every part of the cytosol of the non-stimulated and EGF stimulated Raw264.7 cells, such as endoplasmic reticulum, mitochondria, lysosome, while the golden granules intensity in the cytosol area decreased and in the nuclear area increased significantly after LPS stimulation.CONCLUSION: p38 MAPK moves to the nuclei of Raw264.7 cells on account of stimulation by LPS.

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.