Objective To analyze the sandtray topics of the children with behavior problems according to the grounded theory method.Methods Collected and described children' s sandtray topics of different types of behavior problems,age and gender.And analyzed them base on a 3 levels coding list compiling according to the ground theory method.Results The frequency of “negative theme” (3.33 ± 1.25 ) was higher than “positive theme” (0.81 ± 1.25 ) with significant difference (P＜0.01) in feature level 1.Age factor had significant effect upon the frequency of “positive theme” in feature level 1 (P ＜ 0.05 ).And also had impact on “harmony”,“ development” in features level 2 (F =3.039,P ＜ 0.05 ).Gender factor,interaction of gender and age had significant effects on frequency of “negative theme” in feature level 1 (F =5.395,P ＜ 0.05 ; F =4.222,P ＜ 0.05 ).Conclusion The characteristics of the children' s sandtay with behavioral problems mainly are “negative theme”.And it shows different features in children with different gender or age.

Objective To summarize the experiences in treating 30 cases of skin soft tissue defects in head and neck by applying repeated expansion, and to explore an effective and satisfactory method of massive defect repair in head and neck. Methods Skin soft tissues were repeatedly expanded for 1 to 3 times after the first expansion. Massive skin defects in head and neck were repaired several times by useing repeated expansion of flap. The size of the skin defects ranged from 29cm?24cm to 10cm?8cm. The indications, complications and experiences in the treatment were discussed. Results A total of 30 cases were treated. Complication incidences of every expansive procedure were 27%, 15%, 14% and 0% respectively . After 6～12 months postoperative follow-up, the appearance and functional restoration was satisfactory. Conclusion Repeated expansion is an excellent method of repairing massive defects in head and neck.

Objective To determine the long-term outcomes of cN0 papillary thyroid carcinoma without elective central compartment neck dissection. Methods The clinical data of 180 patients with clinically lymph node negative papillary thyroid carcinoma who were treated in our center between 2000 and 2005 were retrospectively analyzed. All of these patients did not receive elective central compartment neck dissection. Clinicopathological characteristics including gender,age,surgical range,pathologic type,tumor size,and extrathyroidal extension(ETE)or not were collected. Results After a median follow-up period of 90 months,only one patient died of stroke without tumor. Sixteen patients had tumor recurrence:seven patients had a recurrent disease in residual thyroid tissue,two in the thyroid bed,six in central compartment,eight in lateral cervical compartment,and one in lung. The 10-year overall survival,disease-specific survival,and recurrence-free survival was 99.4%,100%,and 87.9%,respectively. The 10-year accumulative lymph node recurrence rate in central compartment and lateral compartment was 7.8% and 7.0%,respectively. ETE was an independent risk factor for central compartment lymph node recurrence. Male gender(P=0.010)and ETE(P=0.028)were independent risk factors for lateral compartment lymph node recurrence. Conclusions The prognosis of patients with cN0 papillary thyroid carcinoma without elective central compartment neck dissection is good after ten years of follow-up. Male gender and ETE are independent risk factors for lateral compartment lymph node recurrence.

Objective To explore the interaction model of social capital, mental health,occupational burnout, turnover intention and the related influence factors on nurses. Methods By random cluster sampling, investigated 723 nurses with Nurses' Turnover Intention Inventory, the Maslach Burnout Inventory, Social Capital Questionnaire and Chinese Health Questionnaire, then explored the interaction model by path analysis. Results Nurses' position can influence their social capital(the path coefficient was 0. 124), social capital and occupational turnout can influence nurses' mental health(the path coefficient were -0. 231,0. 151), the mental health and occupational turnout both can influence nurses' turnover intention directly(the path coefficient were 0. 088,0. 151 ), the model is acceptable(CMIN/DF 1. 645, GFI 0. 984, AGFI 0. 966, IFI 0. 941, CFI 0. 937, RMSEA 0. 037).Conclusion Social capital can provide a new perspective for nurses' management, developing the social capital resources can relieve nurses' mental problems effectively; relieving the turnout and mental problem can decrease nurses' turnover intention finally.

Background Magnetic activated cell sorting(MACS)is a new immunomagnetic separation technique.It's principle is based on the specialized recognition between the antibody and antigen.When directed or indirected coupled with the 50 nm magnetic beads,the antibody can linked with the cells which express the corresponding antigen,and then leads to the magnetic cell separation in a high intensity and high-gradient magnetic field.The method has higher separative purity and recovery and been made use of enriching tumor cells and tumor stem cells.It could be also utilized to enrich the rare tumor cells in fluid specimen.Objective To evaluate the enriching efficiency of detecting free cancer cells in analogue malignant ascites using MACS and a panel of tumor-specific markers.Methods Five species of tumor cell lines correlated to the diseases resulting in malignant ascites were selected and the expressions of EpCAM,CAl25,CEA,TAG-72 and their mixture in these tumor cell lines were detected using immunofluorescence reactions and flow cytometry(FCM).The tumor cells were spiked into mononuclear cells by different ratios to analogue the main ingredients of malignant ascites.The efficiency of MACS combinded with mixture antibodies in separating tumor cells was compared with single antibody.Results The FCM revealed that the expression of the mixture antibodies in 5 tumor cancer cell lines was significantly higher than that in single antibody.The mean recovery rates of spiked tumor cells were enhanced by using a panel of monoclonal antibodies combined with MACS than single antibody,especially in two gastric cancer cells and colon cancer cells(69.18%±20.84%VS 45.23%±11.54%,78.75%±15.42%vs 59.73%±16.64%and 85.63%±12.30%VS 76.88%±8.65%,respectively),the ovarian cancer cells was the next(32.49%±3.58%vs31.79%±4.82%),and the liver cancer cells was the lowest(11.78%±0.43%VS 7.16%±0.46%).Conclusions The detection of free cancer cells from malignant ascites by MACS combined with a panel of monoelonal antibodies is more effectively than single antibody.The method has the potencial value of clinical application to the malignant ascites caused by gastroenteric tumor.

Objective To study the role of OIf-1/EBF associated zinc finger protein (OAZ),a transcription factor encoded by a positional systemic lupus erythematosus (SLE) candidate gene,in the function of mesenchymal stem cells (MSC) of SLE patients by silencing this gene.Methods OAZ mRNA levels of bone marrow MSC obtained from 5 SLE patients and 5 healthy controls were detected by real-time PCR.Bone marrow MSC obtained from 6 SLE patients were incubated with specific siRNAs for 3 days,then cells were harvested for OAZ measurement,Idl-3 and CCL2 mRNA levels were tested by real-time PCR,and levels of CCL2 were detected in culture supernatants using ELISA.Differences between groups were analyzed using t-test or MannWhitney test.Results ① OAZ mRNA levels of bone marrow MSC were significantly elevated in SLE patients (0.013±0.016) compared to healthy controls (0.001±0.000,P=0.009).② After OAZ silencing,the expression levels of OAZ,Id1,Id2 and ld3 mRNA were significantly decreased (△Ct 10.3±0.7,15.2±1.6,8.1±1.4,10.5±0.6 vs 8.7±0.7,14.1±1.2,7.1±1.5,9.8±0.6) (P all ＜0.05).③ Both the expression levels of CCL2 mRNA (△Ct 2.2±1.1 vs 3.0±1.1 ) and the levels of CCL2 protein in culture supernatants [(341±29) pg/ml vs (304±19) pg/ml] were significantly increased in OAZ silencing group comparing to those in the control group (P all ＜0.05).Conclusion OAZ gene expression is significantly elevated in bone marrow MSC of SLE patients.OAZ may affect autoantibody production in SLE patients by regulating CCL2 expression.

Objective To investigate the effects of Mailuoning on oxidative stress and ischemic brain injury. Methods A total of 126 healthy male Kunming mice were divided into sham operation (n = 18), normal saline control (n = 54) and Mailuoning (n = 54) groups. A middle cerebral artery occlusion (MCAO) model was induced Two hours after MCAO,Mailuoning injection and equivalent saline were injected via the tail vein in the Mailuoning and normal saline control groups, respectively, and then they were injected every other 24 h.Neurological score was performed, and brain water content, infarct volume, membrane potential,as well as protein oxidative stress metabolites such as 3-nitrotyrosine (3-NT), lipid oxidative stress metabolite 4-hydroxy-2-nonenal (HNE) and nucleic acid oxidative stress metabolite 8-hydroxy-2'-deoxyguanosine (8-OHdG) were detected at 12, 24 and 72 h after MCAO. Results Mailuoning injection could significantly improve the neurological function of cerebral ischemia in mice, decrease brain edema, and reduce infarct volume at different time points after cerebral ischemia Of those, it was most significant at 72 h. Mailuoning injection could reverse the decreased mitochondrial membrane potential in cerebral cortex and internal capsule, and significantly downregulate the increased 3-NT, HNE and 8-OHdG in cerebral cortex, internal capsule and serum after ischemia, of those, the effect of reducing HNE was most significant.Conclusions Mailuoning injection may effectively protect against ischemic brain injury in mice,and its mechanism is associated with inhibiting oxidative stress, particularly anti-lipid oxidation.

Objective To explore a method for establishing the hamster model of Clostridium difficile-associated diarrhea (CDAD)and the indicators for its evaluation.Methods Clindamycin was administered to hamsters subcutaneously (day 1),and 24 h later infected with C.difficile clinical isolates KH1 (ribotype 027,106-108 CFU/mL)or SH9 (ribotype 001 ,108-1010 CFU/mL)by gavage.Animals were observed for CDAD symptoms such as diarrhea,weight loss and death.At the end of ob-servation period (day 7 or death),the cecum was collected from each animal for histological evaluation of inflammation.Results Following a single dose of 100 mg/kg clindamycin subcutaneously,all the animals challenged with KH1 (108 CFU/mL)devel-oped diarrhea and then died within 5 days.All the hamsters challenged with SH9 (1010 CFU/mL)developed diarrhea as well but only 66.7% died at the end of observation period.Among other groups,only one or none developed diarrhea and then died. The symptoms of hamsters with diarrhea included loose stool,wet tail and weight loss.On histological examination,conges-tion,hemorrhage and neutrophil infiltration of the mucosa were observed in the hamsters died of CDAD.Conclusions We have successfully established a hamster CDAD model that allows for future investigations.

Objective To study the risk factors of prolonged postoperative recovery after the total cavopulmonary connection(TCPC) in the current era.Methods Data on all patients admitted to the cardiac intensive care unit (CICU) after a TCPC between January 2013 and March 2014 were retrospectively analyzed.We excluded all patients who died and required TCPC takedown.The study cohort was further divided into a prolonged recovery group that included patients with 75％ ile for duration of mechanical ventilation or pleural drainage,and a standard recovery group which included all other patients.A multivariable logistic regression model was used to compare demographic,anatomic,and physiological variables between the prolonged and standard recovery groups.Then,the cohort was separated into a high volume resuscitation group and a low volume resuscitation based on the 75％ ile for volume resuscitation(ml/kg) administered on the first three days after the TCPC.Results Totally 118 TCPC operations were performed.Of the study population (n =118),the median age was 3.8 years (3.1 to 4.8 years) and median weight was 14.8 kg(13.3 to 17.1 kg).The most common diagnosis was double outlet of right ventricle (n =47,39.8％).The extracardiac conduit fenestrated TCPC was the most common surgery(n =79,66.9％).Within the study population,43 (39.8％) patients met criteria for prolonged recovery.Univariate risk factors for prolonged recovery included higher preoperative mPAP(P =0.022),atrioventricular valve regurgitation (P =0.000),longer total bypass time (P =0.044),higher postoperative central venous pressure (P =0.000),AST (P =0.001),ALT (P =0.010),NT-proBNP (P =0.000),SaO2 (P =0.012),I n-otropic score (P =0.001),higher incidence of arrhythmia (P =0.000),low cardiac output syndrome (P =0.000),need for peritoneal dialysis (P =0.000),and requirement for greater volume resuscitation during the 72 postoperative hours(75％ for the entire group,P =0.000).In a multivariable Logistic model,need for greater volume resuscitation (OR 10.860,95 ％ CI 2.681,43.987) and the higher postoperative central venous pressure (OR 1.446,95 ％ C I 1.113,1.879) were the only two independent risk factors for prolonged outcome after the TCPC.Conclusion The need for high volume expansion and higher central venous pressure were the risk factors of mediate prolonged recovery.

Objective To determine the expression levels of SOCS2 in the mouse livers under starvation, diabetes and obese conditions and to study the effect of SOCS2 on gluconeogenesis.Methods Animals were divided into 3 groups: C57BL/6J mice, the control group was fed ad libtum and the experimental group was fasted for 24 h.Diabetes model db/db and the control db/m mice were fed ad libitum.Obese model ob/ob and the control C57BL/6J mice were fed ad libitum.All the mice above were sacrificed and total RNA was isolated from mouse livers and reverse transcribed to cDNA.The expression of SOCS2 and gluconeogenesis genes in the mouse livers in the 3 groups above were detected by real-time quantitative PCR.SOCS2 was overexpressed in the primary C57BL/6J mouse hepatocytes by the adenovirus system.The effect of SOCS2 on glucose production was measured by glucose output assay.Results C57BL/6J mouse hepatic SOCS2 expression was suppressed by starvation status.The expression of SOCS2 was decreased in the livers of db/db and ob/ob mice.In contrast, the key regulators of gluconeogenesis, PGC-1α, PEPCK and G6Pase exhibited the opposite expression pattern as SOCS2 in the livers underidentical starvation, diabetes and obese conditions.The protein was Mr 23 000 and glucose production was inhibited after SOCS2 being overexpressed in the primary C57BL/6J mouse hepatocytes by adenovirus system.Conclusions SOCS2 may inhibit gluconeogenesis in the C57BL/6J mouse primary hepatocytes, and SOCS2 may be a potential target for the treatment of type Ⅱ diabetes.