This paper discusses the development and actuality of professionalization in psychological counseling,analyzes the existing problems during the professionalization process and puts forward some strategies and solutions to achieve an improvement in the development of professionalization in psychological counseling.

Objective To study endocrine disruptor chemicals causing malformed frogs in an irrigation canal in T city and a pool in CH city. Methods Water samples collected from an irrigation canal in T city and a pool in CH city where malformed frogs were found were concentrated through H103 resin. The concentrated samples were purified and derivated. The endocrine disruptor chemicals in the derivatives were determined by GC/MS and the estrogenic activities in concentrated water samples were assessed by the recombinant yeast estrogen system (RYES). Results Endocrine disruptor chemicals bisphenol_A (5.6?10-3～1.52 ?g/L) and nonylphenol (0.46～0.58 ?g/L) were found in the concentrated water samples of the irrigation canal in T city and the pool in CH city. RYES showed that the estrogenic activities were positive and this result accorded with the data given by GC/MS. Conclusion The results indicated that the cause resulted in malformation of frogs in the irrigation canal in T city and the pool in CH city might be related to endocrine disruptor chemicals.

Objective To establish the recombinant yeast estrogen system(RYES),a reporter vector controlled by estro-gen response elements(ERE)in yeast was constructed.Methods pLacZi-1RER was obtained first by inserting an ERE which was synthesized artificially into the yeast reporter vector pLacZi which had already been lined by SalI and the terminal dephos-phorized by CIAP.Then,pLacZi-zERE.was obtained by inserting another ERE into the XhoI site nearby the ERE in pLacZi-1ERE.Results Sequence analysis indicated that the yeast reporter vector controlled by two tandem copies of ERE was con-structed successfully.Conclusion The yeast reporter vector controlled by ERE,pLacZi-2ERE,was constructed successfully,which was the very important groundwork for further establishment of the recombinant yeast estrogen system(RYES).

Objective　To evaluate the safety and efficiency of percutaneous coronary interventions(PCI) in octogenarian Chinese with coronary artery disease.　Methods　A total of 43 patients aged over 80 years old underwent 45 such procedures at Queen Mary Hospital from October 1994 to May 1998. There were 27 male and 16 female 〔 mean age (82.3±2.5), range (80-89)〕. 55.8% of these patients had multi-vessel lesions. A total of 48 lesions in 43 patients was treated 〔25 LAD(52.1%), 11 LCX(22.9%) , 11 RCA(22.9%), 1 LM (2.1%)〕. 　Results　Thirty-seven (86.1%) patients were successfully performed PCI. Sixteen of them deployed stenting. Among the 6 lesions which failed to cross, 5 of lesions were LAD, 3 of them were total occlusion. The success rate and complication during the procedure were not significant difference compared with the control in 237 patients ＜80 years of age. At 18 months follow up, 78.5% of these patients was free or much improved of chest pain. The restenosis rate was 36.0% confirmed by coronary angiogram performed in 25 patients. 　Conclusions　In octogenarians with coronary artery disease PCI was a safe and effective procedure with a high successful rate, low acceptable complication rate and a favorable immediate and long term outcomes.

Objective To evaluate the effect of PTCA in patients younger than 40 years of age. Methods Patients aged 40 years or less who underwent PTCA were recruited. Clinical and angiographic data were reviewed. Results A total of 82 patients underwent such procedures. Successful PTCA were performed in 80 patients (97.56%), 93 lesions were treated (97.89%), resulting in an improvement in diameter stenosis from 84.5%?11.8% to 4.1%?1.2%. One patient (1.22%) required bypass surgery without death and Q-wave myocardial infarction. During 42.1?6.8 months′ follow-up, 3 patients died (non-cardial cause in two cases), 3 sustained a myocardial infaraction, and 1 required bypass surgery. 87.8% of patients were free of angina. The target vessel revascularisation rate (TVR) was 12.19%. Angiographic follow up were performed in 70 patients (8.4?5.2 months). The total restenosis rate was 31.43%, 13.16% in stent group. Conclusion Coronary angioplasty has a high immediate success rate and good long-term result when performed in young patients who can be treated safely and effectively with coronary interventions.

Objective To improve the cleaning quality of reusable medical instruments continuously through root cause analysis,reduce healthcare-associated infection(HAI)and the wear and tear of instruments.Methods The major factors influencing the cleaning quality of instruments were analyzed and clarified by fishbone diagram,contin-uous quality improvement was carried out based on 5 terminal factors,the rate of rusting,stain,repeated cleaning, damage,and clinical department satisfaction before and after the implementation of continuous improvement were compared.Results The qualified rate of instrument clean increased from 94.24% before implementing measures to 97.60% after implementing measures,the rate of rusting,stain,repeated cleaning,damage decreased from 3.39%, 2.37%,5.76%,and 2.08% to 1 .55%,0.85%,2.40%,and 0.48% respectively,there were significant difference among different groups(all P <0.001 );the score of satisfaction rate to central sterile supply department elevated from(93.87±3.87)before implementing measures to (98.08 ±0.59)after implementing measures(t =6.80,P <0.001).Conclusion Root cause analysis is important in improving cleaning quality of reusable instruments continu-ously,as well as reducing HAI and the wear and tear of instrument,it can save medical cost.

Objective To review the imaging appearances and clinical symptoms of primary hepatic and gallbladder neuroendocrine carcinomas (PHGNC). Methods Five patients (4 females and 1 male) were examined. Long-term diarrhea not controlled by drug was found in four patients, and two of them accompanied by abdominal pain. The liver rupture occurred in one case due to the huge tumor bleeding. Five patients were examined by using ultrasonography (US), four patients by CT, and three patients by hepatic angiography. The tumor originated from liver in three cases, from liver and gallbladder in one case, and from gallbladder in one case. The tumors were diagnosed by surgery in 3 cases, by biopsy and by autopsy in 1 case, respectively. Results Multiple hyperechoic inhomogeneous masses in two cases and hypoechoic inhomogeneous masses in one case were revealed, all with some small fluid areas and abundant vessels. A huge cyst-solid tumor was clearly demonstrated by using US. A small mural nodule along the gallbladder wall was displayed by using US in a gallbladder tumor, and it showed no specific sign in the diagnosis. CT findings included hypodense inhomogeneous masses on plain CT scan, and slightly enhanced masses with some small fluid areas after injection of contrast agent. A huge cyst-solid tumor was clearly displayed by CT due to the hemorrhage, necrosis, and cystic changes in the tumor. Hepatoangiography displayed abundant vessels and stain in the solid part of the tumor, and absent vessel in the cystic region of the cyst-solid tumor accompanied by dislocation of surrounding vessels. Conclusion Imaging appearances of the liver tumor were inhomogeneous mass with abundant vessels and tumor stains. Imaging appearances of the gallbladder tumor were raised mural nodule along the gallbladder wall without specific sign in the diagnosis of the tumor. The tumor may develop hemorrhage, necrosis, and cystic changes if it is large enough. PHGNC was prone to hepatic metastases. The patients often presented with diarrhea and abdominal pain.

Objective To compare the safety and clinical efficiency between minimally invasive percutaneous nephrolithotomy(MPCNL)in supine position and flexible ureteroscopy(FURS)in management of proximal ureteral calculi.Methods From Oct.2010 to May.2012,76 patients with single proximal ureteral calculus between 10-20 mm failed in SWL or other conservative therapy accepted MPCNL (32 cases)or FURS(44 cases).There was no significant difference between the groups in base-line parameters.Stone sizes were(15.6±2.5)mm and(14.9±2.3)mm,P＞0.05.Procedural time,post-operative hospitalization stay,complication rates(Clavien degree Ⅱ or over)and stone free rates were compared.Results In these two groups,procedural time was(49.3± 11.7)and(67.2± 17.3)min,P＜0.05,postoperative hospitalization stay were(4.2±1.1)and(1.8±0.8)days,P＜0.05,complication rates were 12.5％ and 6.8％,P＞0.05 and stone free rates(residual fragments≤3 mm)were 93.7％ and 84.1％,P＞0.05.Conclusions For patients with surgically indicated proximal ureteral calculi,both minimally invasive percutaneous nephrolithotomy in supine position and flexible ureteroscopy are effective and safe therapeutic modalities.Patients treated with flexible ureteroscopy have faster postoperative recovery.

Objective To explore the imaging characteristics and the complementarity of contrast?enhanced cardiac magnetic resonance CMR and nuclear myocardial perfusion/metabolic imaging in the evaluation of myocardial viability in patients with ischemic cardiomyopathy. Methods A total of 111 patients with diagnosed coronary artery disease and left ventricular dysfunction were retrospectively enrolled in this study. All patients underwent CMR and nuclear myocardial imaging within 1 month. Cine CMR was employed to evaluate cardiac function and wall motion. Contrast?enhanced CMR and myocardial perfusion/metabolic images were quantitatively assessed using a standard 17-segment and 5-score system. Dysfunctional segments were classified as viable or non?viable based on contrast?enhanced CMR and myocardial perfusion/metabolic imaging, respectively. No enhancement or sub?endocardial enhancement was defined as viable, while transmural enhancement was defined as non?viable. Severely matched perfusion/metabolism defects on nuclear imaging were assigned as non?viable while other patterns were considered as viable. Kappa index was calculated to evaluate the diagnostic concordance in assessing myocardial viability between contrast?enhanced CMR and myocardial perfusion/metabolic imaging. Results Among 1 887 segments in 111 patients, 80.3%(1 516/1 887) were dysfunctional. Of them, 63.3%(959/1 516) were viable and 36.7%(557/1 516) were non?viable on contrast?enhanced CMR, while 79.7%(1 208/1 516) were viable and 20.3%(308/1 516) were non?viable on nuclear myocardial imaging. The two modalities had a moderate concordance (Kappa=0.46,P<0.01). In segments with normal perfusion and metabolism, 73.9% (431/583) had various extent of enhancement but most of them(84.2%, 363/431) were subendocardial. On the other hand, 21.0%(117/557) segments with transmural enhancement had hibernating myocardium on nuclear imaging. Conclusions Contrast?enhanced CMR and nuclear myocardial imaging have a moderate concordance in the evaluation of myocardial viability in ischemic cardiomyopathy. Combination of the two modalities is expected to improve the diagnostic accuracy in assessing myocardial viability.

Unhealthy dietary habits and a sedentary lifestyle have led to a significant increase in the prevalence rate of non-alcoholic fatty liver disease (NAFLD) in children, adolescents, and adults. In recent years, the biological-psychological-social medical pattern has attracted more and more attention, and internal psychosocial factors have become an important influencing factor for disease progression, treatment, and prognosis. Studies have shown that patients with NAFLD may experience psychosocial disorders, and this article summarizes the common psychosocial problems of these patients.