Objective:To explore the types and characteristics of the grief reactions of adolescents to friends'death repeatedly,so as to provide reference for effective psychological intervention. Methods:Three college students aged nineteen and twenty years who experienced the death of friends at least twice in adolescence participa-ted in the study by means of an open recruitment in a college. They had friends died at the age of 9 and 12. And then it happened again when they were 15 and 17. Data was collected by semi-structured interviews with the three selected,and analyzed by thematic analysis to classify the grief reactions after the loss of their friends. Results:The common grief reactions of a friend's death in the interview are:shocked,regret and angry,denying,disbelieving, fear of the death,feeling the cruelty of death,crying,searching for support,shirking and recognizing the cruelty of death. The special grief reactions in the interview,especially when they experienced the second death of a friend are:caring for the dead loved ones,having a mental shadow over friend's role,reducing social activities,seeking stimulating and venting,revolting against the school,violence,and working harder. Conclusion:The grief reactions of adolescents to friends'death repeatedly are diversity. It presents the characteristics of the psychological develop-ment of adolescence. And the adolescents need to be given special attention and appropriate psychological interven-tion.

Objective To study the relationship of implicit memory and amnesia effect of oral midazolarn premedication and toobserve its anterograde amnesia, the effect on short-term memory and the onset time and out come of retrograde amnesia. Methods60 patients with ASA I - Ⅱ status undergoing abdomen and limb operations were divided into 3 groups with 20 cases each. Group A:oral midazolam 7.5mg;Group B:oral 15mg;Group C:placebo. The patients received combined spinal-epidural anesthesia after oral midazolam. The parameterns of EEG, SEF 95 %, BISwere collected at the same time and the degree and remark of sedation were dome according to OAA/S. The amnesia and implicit memory were investigated with pictures and muddy identified hearing rate 6 hours after operation. Results (1)Twenty min following drug ad dministration the remarks of sedation of group A and B were significantly loWver than that before and that of group C, Which was not significently different between group A and B. ( 2)The amnesia rates tested six hrs after surgery were significantly higher at 30min in group A, 20min in group B than those before treatment and were kept at 70%-80% levels, which in group C was remained zero. (3)The muddy identified hearing rate was not different significantly, among the three groups. (4) The short-term memory was all 100%during the period of drug action. (5)BIS and SEF 95% Were lower 30min after the treatment and all kept at 80 Hz and 20 Hz, which were not different remarkably between group A and B. ConclnsionOral midazolam 7. 5mg has a good effect on anterograde amnesia 30min after treatment, which may not be improved with increament in dosage. It does not lead to retrograde amnesia. The long-term memory, but not short-term memory, was impaired by midazolam. It only affects the explicit memory. Oral premnedication with midazolam can not prevent the awareness during operation totally.

ObjectiveTo compare the efficacy of 3 internal fixations, locking proximal femoral plate(LPFP), ASIAN IMHS and InterTAN, for intertrochanteric femoral fractures in elderly patients.MethodsA retrospective study was done to analyse 185 elderly patients who had been treated for intertrochanteric femoral fractures from February 2008 to December 2009 in our hospital and fully followed up.They were treated with LPFP (group A, 95 cases), ASIAN IMHS (group B, 52 cases) and InterTAN (group C, 38 cases) . Statistical analyses were conducted to compare the 3 groups in operative time, blood loss,fluoroscopy exposure, hospital charges, intrraoperative complications and functional outcome(Harris hip score).Results The average follow-up was 14. 5 months(from 6 to 28 months). Compared with group A, groups B and C showed significant advantages in operative time, blood 1oss and functional outcome but significant disadvantages in fluoroscopy exposure and hospital charges ( P ＜ 0. 05 ). Compared with group A,groups B and C had significant fewer implant failures ( P ＜ 0. 05).There were no significant differences in all the indexes between groups B and C( P ＞ 0. 05) .Conclusions The ASIAN IMHS and InterTAN appear to be more reliable than LPFP for the treatment of intertrochanteric femoral fractures in the elderly.There appear to be no significant differences between ASIAN IMHS and InterTAN.

Objective The objective of this study was to explore the value of enhanced recovery surgery(ERAS)in perioperative period of laparoscopic assisted colorectal cancer surgery.Methods From November 2015 to July 2016,86 patients with colorectal cancer treated with colorectal surgery were divided into ERAS group and routine treatment group.All patients underwent laparoscopic radical resection of colorectal cancer.The operative situation,postoperative recovery and complications were analyzed in this study.Results There was no difference in the operation time and bleeding volume between the operation group and the conventional treatment group(P>0.05).The postoperative ventilation and defecation time in the ERAS group were earlier than those in the routine treatment group.The postoperative hospital stay and the postoperative pain score were lower than those in the routine treatment group.The rate of postoperative complications was lower than that in the routine treatment group(P<0.05).Conclusion The operation of laparoscopic colorectal cancer under the guidance of ERAS can help patients to recover from hospital,shorten the hospitalization time and reduce the cost of hospitalization.The further application of ERAS should be combined with various disciplines.

Objective To study the dynamic change of high-sensitivity C-reactive protein(hCRP),interleukin-1(IL-1?)interleukin-6(IL-6)in acute traumatic brain injury,and the correlation between the dynamic change and the scale of brain injury and the prognosis of the patients.Methods 192 cases patients were divided into different groups according to the Glasgow Coma Scale(GCS)and the Glasgow outcome Scale(GOS)three months later discharged from hospital respectively.The concentration of serum CRP,IL-1?,IL-6 were detected with immunoturbidimetry and ABC-ELISA 24 with in hours after traumatic brain injury and the concentration of serum after iniwn at ond day,three days and seven days was detected as well.Results Serum hCRP levels were remarkably elevated and reached peak value within 24 hours,and then gradually decreased.There were a negative correlation between hCRP,IL-1?,IL-6 and the patient's GCS groups(r=-0.162,P

Objective:To analyze the prognostic factors in patients with metastatic breast cancer (MBC). Methods:A total of 205 patients with pretreated MBC were included in this study. These patients were admitted to the Tianjin Medical University Cancer Insti-tute&Hospital and had undergone radical surgery of breast cancer between January 2008 and December 2010. The clinicopathologic information of the patients was collected in this retrospective analysis. Results: The median overall survival of the patients was 32 months (1 month to 132 months). Luminal A, Luminal B, HER-2 overexpression, and triple-negative patients had a median overall sur-vival of 36 months (4 months to 132 months), 32 months (7 months to 122 months), 29 months (1 month to 85 months), and 24 months (1 month to 98 months), respectively. Univariate analysis showed that lymph node metastases, clinical stage, molecular type, visceral disease, first multiple metastatic sites, and shorter metastasis-free interval were significantly associated with poor outcomes. In multivar-iate analysis, lymph node metastases, clinical stage, molecular type, visceral metastasis, and the number of first metastatic sites were significant predictors of patient survival. Conclusion:Lymph node metastasis, clinical stage, triple-negative breast cancer, and visceral metastasis were used as independent poor prognostic indicators for survival in patients. Results of this study may assist physicians in evaluating the survival potential and determining the appropriate therapeutic strategy for MBC patients.

Objective: Angiosarcoma of the breast is a rare and heterogeneous entity and its overall incidence is reported as 0.04% of primary breast cancer and as 8% of breast sarcoma approximately. To retrospectively analyze the clinical features and prognosis of breast angiosarcoma, 13 patients were identified by mammary pathologists in Tianjin Medical University Cancer Institute and Hospital from October 1975 to June 2009. Methods:Kaplan-Meier method was carried out to analyze different tumor size, tumor margins and histological grade. Prognosis was tested with univariate analysis by Log-rank test. Results: Median and mean age at diagnosis were 48 years and 44 years, respectively. The duration of follow-up ranged from 7 to 98 months (median, 50 months). All patients underwent surgical excision. Two patients received chemotherapy. Eight patients succumbed to recurrence and distant metastasis. Conclusion:Angiosarcoma of the breast has an exceedingly poor prognosis. The median disease-free survival (DFS) and overall survival (OS) were 28 months and 45 months, respectively. Both tumor size and surgical margins were associated with prognosis (P<0.05). Patients with high histological grade had a tendency of short OS (P>0.05) and a high risk of recurrence and metastasis (P<0.05).

Objective To compare the clinical efficacy and adverse effects of photodynamic therapy (PDT) versus pulsed dye laser(PDL)for the treatment of port wine stains(PWS). Methods Forty?five patients with PWS were enrolled in this study. The PWS lesions in each patient were randomly divided into PDT and PDL areas. Hematoporphyrin monomethyl ether of 5 mg/kg was injected intravenously into the PDT area protected from light, followed by 20?minute irradiation with a 532?nm, solid?state, continuous?wave laser(power density:80-100 mw/cm2;spot diameter: 7 cm)10 minutes later. The PDL area was treated with a single session of 595?nm pulsed dye laser radiation(spot diameter:7 mm;pulse width:10 ms;energy density:10-12 J/cm2). The interval between PDT and PDL treatment was no shorter than two months. Follow up visits were scheduled on day 4 and week 8 after each treatment. Adverse reactions were recorded, and photographs were taken before and 8 weeks after the treatment for evaluation of lesion regression. Results In the case of PDT area, 10 cases(22.22%)were nearly cured, 22(48.89%)achieved marked improvement, 9(20.00%)improvement, 4(8.89%)no improvement. As far as the PDL area is concerned, 6 cases(13.33%)were nearly cured, 16(35.56%)achieved marked improvement, 18(40.00%)improvement, and 5 (11.11%)no improvement. The response rate was significantly higher in the PDT area than in the PDL area(Z=2.48, P<0.05). Hyperpigmentation, which spontaneously subsided within 3 to 6 months, was the main adverse reaction. No significant difference was found in the incidence rate of adverse reactions between the PDL and PDT areas(24.44%vs. 15.56%, Z=1.26, P>0.05). Conclusion For the treatment of PWS, both PDT and PDL are effective and safe, and single?session PDT appears to be superior to single?session PDL.

Tendon adhesion easily occurs after the operation.The outcome of tendon repair can be affected by adhesion, in-terfering with their normal gliding function.With increasingly deepened konwledge of the tendon healing process and continuous devel-opment of sciences related to medicine, a variety of effective approaches are provided to prevent tendon adhesion.Antioxidants are new orientations that are provided for prevention of tendon adhesion.Although most researches are only limited to animal experiments, the outcomes are positive.This paper reviews the mechanisms and relevant characteristics of tendon adhesion prevention in order to have a better understanding on the roles of antioxidants for preventing tendon adhesion.

Objective To evaluate the expression and the relativity of PMS2,Akt1 and P-AktS473 protein in A2780,Caov3,C13* and ES2 ovarian cancer cell lines .Methods The expression of PMS2 ,Akt1 and P-Akt S473 protein in A2780 ,Caov3 ,C13*and ES2 ovarian cancer cells was detected by Western Blot .After treated with IGF-1 (Akt1 activator) and API-2 (specific Akt1 in-hibitor) ,Caov3 ,ES2 and A2780 cells were collected and the level of PMS2 was detected by Western Blot .Results PMS2 ,Akt1 and P-Akt S473 proteins were detected in all of the four ovarian cancer cell lines with varied expression levels ,and the activity of Akt1 was inversely related to PMS2 expression in ovarian cancer cells .Exposed to Akt kinase stimulator IGF-1 ,ES2 and Caov3 cells were detected with a dramatically PMS2 decreasing .Meanwhile ,the decreasing of PMS2 protein was time-dependent on IGF-1 .Treated with API-2 ,Akt kinase specific inhibitor ,A2780 was detected with PMS2 dramatically increasing ,and the increasing of PMS2 pro-tein was time-dependent on API-2 .Conclusion In ovarian cancer cells ,PMS2 expression could be directly regulated by activated Akt1 .