Depression is a complex disabling condition that is common in primary care. Mr. X was previously diagnosed with depression but had defaulted treatment. It was through an extended consultation that we could unmask the diagnosis and initiate the therapeutic process. ObjectivesTo use the model of an extended consultation to both diagnose depression and to formulate the psycho-social factors that predispose, precipitate and perpetuate the depression as well as the positive factors that ameliorate it (4 Ps). MethodsAn example of an extended consultation with Mr. X. was videotaped with his permission. Excerpts from the video transcript are reproduced to demonstrate the 4 Ps formulation and how the pattern approach of narrative therapy was employed to help Mr. X. ResultsMr. X. gained insight into his condition. He was hence agreeable to initiate anti-depressant medication and continued to follow up for his depression.ConclusionThe extended consultation can be used to uncover therapeutic opportunities when engaging patients with depression, and to formulate the 4 Ps in order to complement pharmacotherapy for holistic management.

Objective To assess the effects of surgical treatment for patients with blepharochalasis and its associated abnormali- ties. Design Retrospective case series, Participants 35 cases (52 eyes) with blepharochalasis in stable phase. Methods The correction of the abnormalities in upper eyelids: after designing the lid crease incision, the redundant eyelid skin and prolapsed fat were excised, and prolapsed lacrimal glands were sutured back into position in 18 cases (36 eyes) and ptosis was treated in 10 cases (16 eyes). The correction of abnormalities in lower eyelids: lower eyelid retraction was corrected in 4 cases (6 eyes). The correction of lateral canthus malformation: lateral canthus rounding was treated in 7 cases (14 eyes), accompanied with or followed by correction of baggy eyelid or ptosis. Main Outcome Measures The shape, location and movement of bilateral eyelids, the location of lacrimal glands and the cir- cumstance of tear secretion. Results During the follow-up of 6～60 months, the appearance and location of bilateral eyelids and can- thuses were satisfying, the function of eyelids were normal, and no dry eye symptoms were found. Two cases (3 eyes) appeared recurrent lacrimal gland prolapse 29 and 36 months postoperation and received surgeries for correction again. There was no recurrence after the second prolapse correction surgery in the follow-up of 18 and 24 months respectively. Conclusions Surgical treatment for patients with blepharochalasis and its associated abnormalities is safe and effective. Its recurrence rate is low.

Objective:To study the effect of invigorating the kidney and spleen complex prescription on deltamethrin intoxicated pregnant rats. Methods:Pregnant rats were divided into 5 groups. Except the blank group,other groups were orally fed 1/20LD50(6.93mg/kg)DM daily from day 1 to 15 when proved pregrancy. 4 Hours later,rats in model group were given physiological saline,other 3 groups were given high/ median /low dose of Zhuyun Formula. Half pregnant rats were killed on D15. The rest was kept until labour. The abortion rate,survival rate,delivery condition,the level of estradiol,progestogen were observed. Results:With respect to abortion rate,model group showed statistical signifi cance when compared with other groups. Model group also showed low progesterone level. With the treatment Zhuyun Ⅲ,it had desirable effect in decreasing abortion rate,and increasing the level of progesterone. The labour time of all groups was within the normal range. Conclusion:DM had toxicity on reproduction,it could lead to abortion which was related to endocrine function of pregnant rats. Zhuyun Ⅲ could regulate the above condition and relief DM toxicity.

Objective To estimate the impact of universal salt iodization on child intelligence quotient (IQ) development in Hainan province. Methods In this is a cross-section study from September in 2008 to April in 2009,the observation group was historical iodine deficiency ward which includes 2 counties and 6 townships,and the control group was non-historical ward which includes 6 counties and 9 townships. Comparison of child IQ distribution according to different geographical housing position(plain,mountainous area,coast),age and sex based on the result of urine iodine examination and the IQ test of children between 8 and 10 years old. Results The median of urinary iodine of children in the observation group was 196.2μg/L which was 2.13 times of the urinary iodine median in the control group(91.9μg/L). The average IQ of children in the observation group was 94.7 which was 8.5 higher than the control group(86.2) ; IQ≤69 rate in this group was 7.7%(91/1179),and it was 8.9 percentage point lower than the control group[16.6%(253/1520)]; IQ≥ 110 rate of the group was 18.3%(216/1179),and it was 10.0 percentage point higher than the control group[8.3%(126/1520)]. The average IQ of children living in mountainous area(83.1) was the lowest in the control group. It was 3.5 and 5.1 lower than that of the children living in the plain(86.6) and coastal area(88.2) respectively; the IQ≤69 rate of children living in mountainous area [20.5%(91/443)]was the highest,and it was 3.8 and 7.1 percentage point higher than that of the children living in the plain [16.7% (89/533)]and coastal areas [13.4% (73/544)]respectively. The average IQ of children aged 8 (97.4) was similar to those aged 9(95.9) in the observation group which was 6.8 and 5.3 higher than that of the children aged 10(90.6) in the same group respectively; However,the average IQ of children aged 8,9 and 10 was close in the control group(86.8,86.3 and 85.6). The average IQ of boys(96.2) was 3.1 higher than that of the girls(93.1),and their IQ≤69 rate[6.3%(37/590)]was 2.9 percentage point lower than that of the girls[9.2% (54/589)]in the observation group. On the other hand,the average IQ(87.2) of boys was 2.1 higher than that of the girls(85.1),and IQ≤69 rate[14.5%(114/787)]was 4.5 percentage point lower than that of the girls [19.0%(139/733)]in the control group. The average IQ of children with different housing geographical position,age and sex in observation group was 5.0-12.4 higher than that of the control group; their IQ≤69 rate was 7.7-13.2 percentage point lower than that of the control group; their IQ≥110 rate was 5.6-13.0 percentage point higher than that of the control group. Conclusions Supplementing salt iodization can improve child intelligence. Supplementing iodine can increase the child IQ and reduce the child mental retardation.

Background The condition of the sclera is associated with many ocular diseases.The measurement of human scleral thickness in vivo is helpful for us to understand the features of the sclera and related diseases.Objective The present study was to measure the anterior sclera thickness(AST) in patients with senile cataract and to analyze the relationship among AST and other associated ocular parameters.Methods This study was approved by the Ethic Commission of First Hospital of Peking University.Written informed consent was obtained from each individual prior to examination.One hundred and five senile cataract patients were recruited in this study.Central corneal thickness (CCT),corneal curvature (CCV) and axial length were measured using ultrasonic pachymeter,keratometer,and A-scan unit,respectively.The AST was measured at 2 mm posterior to the scleral spur in the temporal meridian using ultrasound biomicroscope (UBM).The differences of CCT,CCV,ocular axial length and AST between bilateral eyes and the different sexes were compared by the Paired test and independent sample t test.The correlations among various parameters were assessed by the Pearson linear correlation analysis.The differences of CCT and AST among different axial length groups were evaluated by one-way ANOVA.Results No significant differences were found in the CCT,CCV,axial length and AST between bilateral eyes (t =0.584,P =0.561 ; t =1.161,P =0.248 ; t =0.140,P =0.889 ; t =0.342,P =0.773).Temporal AST at 2 mm posterior to the sclera spur was (0.589 ±0.051)mm in the right eyes.An insignificant decline in CCT was found in the male group compared with the female group (right eyes:t =0.469,P =0.641 ; left eyes:t =0.465,P =0.643).However,compared with the female group,the increase of axial length,reduction of the mean CCV value and enhancement of the mean AST were observed(right eyes:all P＜0.01 ;left eyes:all P＜0.01).CCV showed a negative correlation with ocular axial length (r =-0.50,P＜0.01),but no significant correlation was found among age,CCT,ocular axial length and AST(P＞0.05).No remarkable differences were found in CCT and AST among the various axial length groups (CCT:F =0.998,P=0.372;AST:F=1.919,P=0.383).Conclusions In senile cataract patients,correlation is not found between AST and CCT;the increase of axial length is not associated with the thinning of the eyeball wall to a certain extent.Differences exist in some ocular parameters between different sexes.

Background A close relation between sclera thickness and glaucoma has been determined.Clinical features vary in different types of glaucoma patients,which hints that the scleral thickness might be distinct among these patients.Objective The aim of this study was to investigate the differences of central corneal thickness(CCT),anterior scleral thickness(AST) and axial length in glaucomatous patients.Methods This study was approved by the Ethic Commission of First Hospital of Peking University.Written informed consent was obtained from each individual prior to the examination.A retrospective descriptive study was designed.One hundred and sixty consecutive patients were recruited from March,2009 to November,2010 in First Hospital of Peking University,including 35 eyes with primary angle closure glaucoma(PACG) (35 cases),34 eyes with primary open-angle glaucoma POAG) (34 cases),37 eyes with normal tension glaucoma(NTG) (37 cases)and 17 eyes of ocular hypertension OHT) (17 cases).Thirty-seven eyes of 37 subjects with incipient cataract served as the control group.CCT and ocular axial length were measured with ultrasonic pachymeter and A-scan unit,respectively,and AST at the temporal quadrant 2 mm posterior to the scleral spur was measured by ultrasonic biomicroscopy (UBM).The measuring parameters among different groups were compared by analysis of covariance,and the correlations of AST,CCT with ocular axial length were analyzed using Pearson linear correlation and linear regression.The differences and correlation of CCT,AST and AL among five groups were analyzed.Results The CCT values in PACG group,POAG group,NTG group,OHT group and control group were (535.54 ± 5.20),(550.47 ± 5.28),(521.61 ± 5.07),(575.75 ± 7.76) and (535.06± 5.06) μm,respectively,showing a significant difference among them (F =9.560,P =0.000),and the CCT value of OHT group was increased in comparison with POAG group,PACG group,NTG group and control group(all P =0.000).The CCT of the POAG group was thicker than that in the PACG group,NTG group and control group(P=0.046,0.000,0.040).No significant difference was found in CCT among NTG group,PACG group and control group(P=0.950,0.060).The AST values of PACG group,POAG group,NTG group,OHT group and control group were(0.593±0.050),(0.600±0.050),(0.592-±0.060),(0.610-±0.060) and(0.604±0.060) mm,respectively,showing a insignificant difference among them (F =0.700,P =0.590).The axial length in the patients with PACG was shorter than that of the POAG group,NTG group,OHT group and control group (all P =0.000).The Pearson correlation analysis showed significantly positive correlation between CCT and AST in POAG group and NTG group(r=0.445,P=0.008;r=0.400,P=0.014).Conclusions This study confirms that there is dissimilarity in CCT but not in AST among different types of glaucomatous patients.The changes of CCT and AST are consistent in POAG and NTG patients.

Objective To study the relationship of abnormal family history in the first degree relatives and the clinical phenotype of patients with polyeystic ovary syndrome(PCOS).Methods Clinical data of first degree relatives of 139 women with PCOS were collected by questionnaires,including body mass index(BMI),waist hip ratio(WHR),and hursutism score.Follicle stimulating hormone(FSH), luteinizing hormone(LH),prolactin(PRL),testosterone(T),androstenedione(A),oral glucose tolerance test(OGTT)and insulin releasing test were measured.Results(1)Compared with patients with a negative family history of diabetes mellitus,for women with a positive family history,WHR(0.99?0.10 vs 0.79?0.08)and score of hirsutism(1.9?1.2 vs 1.8?1.2)were increased,the duration of menstruation was longer[(108?10)vs(92?19)days];A[(11?6)vs(8?5)nmol/L],homeostasis model assessment of insulin resistance(HOMA-IR,3.5?2.0 vs 2.7?1.6),area under curve(AUC) glucose[(836?245)vs(748?139)nmol?L~(-1)?min~(-1)],AUC insulin[(9670?4582)vs(7330?4311) mIU?L~(-1)?min~(-1)],fasting glucose[(5.0?1.1)vs(4.8?0.5)mmol/L]and fasting insulin[(15?8)vs (11?8)mIU/L]were increased,while early insulin secretion function index(?I60/?G60,32?22 vs 52?30),insulin sensitive index(ISI,0.019?0.011 vs 0.033?0.014)and disposition index(DI,18? 10 vs 30?22;P

Total 149 strains of endophytic bacteria were isolated from different healthy organisms of Glycyrrhiza inflata Bat. from Xinjiang. The fermented liquids of these strains were screened by TLC and analysed by HPLC, and the glycyrrhizinic acid monoammonium salt was taken as standard control at the same time. Only one endophtytic bacterial stain of Bacillus subtilis could produce Glycyrrhizinic acid monoammonium salt analogue.

ostic sensitivity and specificity of EUS are high in distinguishing benign and malignant character of upper digestive tract GIMTs. EUS plays an important role in guiding the clinical management of upper digestive tract GIMTs.

OBJECTIVETo study the effects of Chinese materia medica (CMM) combined chemotherapy on the recurrence, metastasis, and the disease free survival (DFS) of stage II and III colorectal cancer (CC) patients after radical cure.

METHODSRecruited were 366 inpatients and outpatients with stage II and III colorectal cancer (CC) from Changhai Hospital, Second Military Medical University, and Tumor Department of Longhua Hospital, Shanghai University of Traditional Chinese Medicine from January 2002 to December 2008. A non-randomized concurrent control method was adopted. Patients were assigned to the combination group (treated by CMM + chemotherapy, 189 cases) and the chemotherapy group (177 cases) according to whether they were willing to receive the CMM treatment for more than 6 successive months. By using follow-ups at clinics, by letter, and by telephone, the DFS, 1-, 2-, 3-, and 5-year DFS ratios were observed. The correlations between DFS and the gender, age, tumor location, staging of clinical pathology, pathological type, chemotherapeutic cycle, radiotherapy, CMM treatment, end point event (recurrence and metastasis) were analyzed.

RESULTSThe recurrence or metastasis occurred in 145 cases (39. 61%) of the 366 patients. Of them, local recurrence occurred in 17 cases (11.72%), liver metastasis in 45 cases (31.03%), lung metastasis in 52 cases (35.86%), and metastasis in other parts in 53 cases (36.55%). Results of one-factor analysis showed six factors such as the tumor location, pathological type, staging of clinical pathology, chemotherapeutic cycle, radiotherapy, and CMM treatment were correlated with the DFS, showing statistical difference (P<0.01, P<0.05). Results of multifactor analysis showed staging of clinical pathology, chemotherapeutic cycle, and CMM treatment were correlated with the DFS, showing statistical difference (P<0.01). Results of stratified study on the staging of clinical pathology indicated that the primary tumor location (P=0.016) and the pathological type (P=0.047) were the independent predictors for DFS of stage II CC. The median DFS of the two groups could not be calculated. Results of stratified study on the stages of clinical pathology indicated that CMM treatment (P=0.000) and chemotherapeutic cycle (P=0.017) were independent predictors for DFS of stage III CC. As for comparing the composition ratio of the two therapeutic cycles, results showed the baselines of the chemotherapeutic cycle of the two groups were balanced. Further comparison showed the median DFS for the chemotherapy group at stage III was 24. 16 months, while it could not be calculated in the combination group. The DFS, 1-, 2-, 3-, and 5-year DFS ratios were 92%, 72%, 61%, and 59%, respectively in the stage III CC combination group, while they were 74%, 50%, 36%, and 20%, respectively in the stage IlI CC chemotherapy group.

CONCLUSIONCMM combined chemotherapy could prolong the DFS of stage III CC patients after radical cure.

Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Colorectal Neoplasms ; drug therapy ; mortality ; pathology ; Combined Modality Therapy ; Disease-Free Survival ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Phytotherapy