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.

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 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 analyze causes of missed diagnosis of hiding post-malleolar fractures in treating ankle joint fractures of pronation-external rotation type according to Lauge-Hansen classification and assess its medium-term outcomes.

METHODSAmong 103 patients with ankle joint fracture of pronation-external rotation type treated from March 2002 to June 2010,9 patients were missed diagnosis,including 6 males and 3 females,with a mean age of 35.2 years old (ranged, 18 to 55 years old) . Four patients were diagnosed during operation, 2 patients were diagnosed 2 or 3 days after first surgery and 3 patients came from other hospital. All the patients were treated remedially with lag screws and lock plates internal fixation. After operation,ankle joint function was evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS).

RESULTSAll the 9 patients were followed up, and the duration ranged from 14 to 30 months (averaged, 17 months). No incision infection was found, and all incision healed at the first stage. At the latest follow-up, AOFAS was 83.0 +/- 4.4, the score of 4 patients diagnosed during operation was 85.0 +/- 2.9, and the score of 5 patients treated by secondary operation was 81.0 +/- 5.3. All the patients got fracture union observed by X-ray at a mean time of 2.2 months after operation. There were no complications such as internal fixation loosing, broken and vascular or nerve injuries.

CONCLUSIONAnkle joint fracture of pronation-external rotation type may be combined with hiding post-malleolar fractures. So to patients with ankle joint fracture of pronation-external rotation type, lateral X-ray should be read carefully, and if necessary, CT or MRI examination should be performed. If adding lateral X-ray examination after reduction of exterior and interior ankle joint fixation, the missed diagnosis may be avoided.

Adolescent ; Adult ; Ankle Fractures ; False Negative Reactions ; Female ; Fractures, Bone ; diagnosis ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Pronation ; Rotation ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

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 evaluate the efficacy and safety of AlumaTM functional aspiration controlled electrothermal stimulation (FACES) radiofrequency in the treatment of skin wrinkles and laxity on the face and neck. Methods A total of 30 volunteers with aging skin were recruited in the study. All volunteers were treated with AlumaTM FACES radiofrequency for 6 times at 2-week interval. Photographs were taken for volunteers before every treatment and 1 month after the last treatment. Improvement in lesions was objectively assessed by two separate physicians based on the photographs of volunteers taken before the first,fourth and sixth treatment, and 1 month after the last treatment. Patient satisfaction was measured by ques-tionnaire. Adverse effects were recorded. Results Totally, 24 volunteers completed the treatment. Improve-ment of lesions was achieved in 66.7% of the volunteers after 3 treatments, 90.5% after 5 treatments, and 94.4% one month after the last treatment. About 50% of the volunteers were satisfied with the effect after 3 treatments, 90.5% after 5 treatments, and 100% one month after the last treatment. Slight purpura was the most common side effect. Conehusion Radiofrequency therapy is effective for skin wrinkles and laxity on the face and neck, without obvious side effect.

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 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 .