Morita therapy has been bom for more than 100 years.Inpatient Morita therapy is highly oper-able and easy to master.It can improve many refractory neuroses through four-stage treatment.But more neuroses are treated in outpatient clinics,and Morita therapy cannot be used in hospitalized patients.Therefore,the formula-tion of expert opinions on outpatient operations is particularly important.This paper is based on domestic and for-eign references,and after many discussions by domestic Morita therapy experts,and then drew up the first version of the expert opinions on operation of outpatient Morita therapy.Meanwhile the operation rule of Morita therapy in three stages of outpatient treatment was formulated:in the etiological analysis stage,under the theoretical guidance of Morita therapy,analyze the pathogenic factors,to improve treatment compliance and reduce resistance;during the operating stage,guide patients to engage in constructive and meaningful actions,realizing the achievement of letting nature take its course principle;in the cultivating character and enriching life stage,pay attention to positive infor-mation,expanding the scope and content of actions,improving the ability to adapt to complex life,and preventing recurrence caused by insufficient abilities.It will lay a foundation for the promotion of Morita therapy in domestic outpatient clinics,so that more patients with neurosis and other psychological diseases could receive characteristic Morita therapy treatment in outpatient clinics.

Objective To analyze the occurrence and predictive factors of early death(ED)in elderly(≥60 years old)patients with newly diagnosed acute promyelocytic leukemia(APL)induced by single-agent arsenic trioxide(ATO).Methods The clinical da-ta of 71 consecutive elderly APL patients and 456 consecutive young APL patients were collected.Ten clinical and laboratory parameters,which could be obtained rapidly by clinicians were selected.Chi-square test and Logistic regression analysis were used for statistical a-nalysis.Results The ED rate in elderly patients(22.5％,16/71)was higher than that in young patients(15.1％,69/456),but the difference was not statistically significant(P=0.115).The incidence of infection-related ED(8.5％)and thrombosis-related ED(2.3％)in elderly patients was significantly higher than that in young patients(2.0％and 0.3％,respectively),and the difference was statistically significant(P＜0.01).Peripheral white blood cell count＞10 × 109/L and male were independent risk factors for ED in both the elderly and young patients.And hypoalbuminemia(P＜0.001)and plasma fibrinogen＜1g/L(P=0.001)were still independent risk factors for ED only in young patients.Conclusion When induced by single-agent ATO,the elderly APL patients were significantly different from the young patients in terms of clinical features,incidence and risk factors of ED.Therefore age-stratified study on ED in APL is necessary.

Objective:To investigate the efficacy of treatment of Sanders Ⅱ & Ⅲ calcaneal fractures with an absorbable stick plus Kirschner wire through the tarsal sinus incision.Methods:From July 2017 to May 2020, 37 patients with 42 Sanders Ⅱ & Ⅲ calcaneal fractures were treated with an absorbable stick plus Kirschner wire through the tarsal sinus incision at The Third Ward of Department of Traumatic Orthopeadics, The Sixth Hospital of Ningbo. There were 25 males and 12 females, with an age of (48.2±5.6) years (from 20 to 69 years). The fractures were at the left side in 12 cases, at the right side in 20 and at bilateral sides in 5. By Sanders classification, 20 fractures were type Ⅱ and 22 ones type Ⅲ. Fracture union time and complications were recorded. Their B?hler and Gissane angles were compared between preoperation, postoperation and the last follow-up. The range of motion of the subtalar joint was evaluated by the Morrey method at 6 months postoperation. The functional recovery was evaluated by the American Society of Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at 12 months postoperation.Results:The 37 patients were followed up for (15.2±2.7) months (from 13 to 18 months). There were no such complications as incision skin necrosis, Kirschner wire deformation, loss of fracture reduction or Kirschner wire infection. The anatomical morphology of the calcaneus was restored satisfactorily in the 37 patients. At preoperation, postoperation and the last follow-up, the B?hler angles were 13.3°±1.6°, 32.5°±5.5° and 32.7°±5.4° and the Gissane angles 78.3°±6.7°, 127.2°±6.7° and 128.0°±6.4°, respectively, showing significant differences between the preoperative and postoperative values ( P<0.05) but no significant differences between postoperation and the last follow-up ( P>0.05). The range of motion of the subtalar joint at 6 months postoperation was slightly limited in 25 cases and moderately limited in 12 cases, giving a rate of moderate and above limitation of 32.4% (12/37). By the AOFAS ankle-hindfoot score at 12 months postoperation, 12 cases were excellent, 21 ones good and 4 ones fair, giving a good to excellent rate of 89.2% (33/37). Conclusion:Treatment with an absorbable stick plus Kirschner wire through the tarsal sinus incision may lead to fine clinical efficacy for Sanders Ⅱ & Ⅲ calcaneal fractures.

Objective:Hyperoxia is a necessary therapy in some neonatal diseases, and long-term therapeutic hyperoxia may induce severe damaging effects on intestinal epithelial cells.The aim of this study was to investigate whether hyperoxia could promote the expression of ASK1 and P38 in intestinal epithelial cells through ROS.Methods:The human colon adenocarcinoma cell line Caco-2 cells were treated with different concentrations of H 2O 2(100 μmol/L, 200 μmol/L and 400 μmol/L)and 85% oxygen in vitro.The expression of ASK1 was detected by immunofluorescence, and the expression of P38 and p-P38 were detected by Western Blot and Real-time PCR. Results:With the increase of H 2O 2 concentration, the fluorescence intensity of ASK1 increased.The fluorescence intensity of ASK1 in the hyperoxia group was significantly stronger than that of the control group and the H 2O 2 groups.With the increase of H 2O 2 concentration(100 μmol/L、200 μmol/L、400 μmol/L), the expression of P38 protein(0.21±0.02, 0.28±0.13, 0.44±0.07)and p-P38 protein(0.09±0.02, 0.19±0.03, 0.37±0.07)gradually increased.The expression of P38 mRNA in 200 μmol/L and 400 μmol/L H 2O 2 groups(4.03±0.68、3.94±0.71)was significantly higher than that in 100 μmol/L H 2O 2 group(3.05±0.47)( P<0.01). The expressions of P38 protein, p-P38 protein and P38 mRNA in the hyperoxia group were significantly higher than those in the H 2O 2 group( P<0.01). Compared with the control group, the expressions of P38 protein, p-P38 protein and p38 mRNA in the hyperoxia group and H 2O 2 groups increased significantly( P<0.01). Conclusion:The expression of ASK1 and P38 in intestinal epithelial cells increased significantly under hyperoxia, which indicated that hyperoxia might activate ASK1 and thereby regulate the expression of downstream P38 through ROS, resulting in intestinal epithelial cells damage.

To explore the effects of intrauterine infection on early growth and neurobehavioral development in neonatal rats. (E. coli) was inoculated into uterine cervix of pregnant rats with gestation of 15 d to establish the intrauterine infection model, and the effect on the delivery of pregnant rats was observed. The neonatal rat brain tissue was stained with Hematoxylin-Eosin and the cerebral white matter damage was assessed. Immunohistochemical staining and Western blot analysis were performed to evaluate the expression of glial fibrillary acidic protein (GFAP), 2', 3'-cyclic nucleotide 3'-phosphodiesterase (CNPase) and neurofilament (NF) in pup brains. Birth weight and early growth development indices were monitored,and neurobehavioral tests were performed to access the change of neurobehavioral development in neonatal rats. The white blood cell count increased significantly in the uterus and placenta of the pregnant rats after intrauterine E. coli infection and no significant impact was observed on the delivery of pregnant rats. Weak staining and focal rarefaction of cerebral white matter from rats at P7 in intrauterine infection group were observed. The expression of GFAP markedly increased (<0.05) in infection group, while the level of CNPase and NF in pup brains at P7 significantly decreased (<0.05 or <0.01). Compared with control group, the neonatal rats in infection group had lower birth weight and slower weight gain during the suckling period (<0.05 or <0.01), and the completion times of ear opening, eye opening, surface righting, negative geotaxis, acoustic startle and swimming test in infection group were significantly delayed (<0.05 or <0.01). Intrauterine infection in pregnant rats can induce cerebral white matter damage and retardation of early growth and neurobehavioral development in neonatal rats.
Animals ; Animals, Newborn ; Behavior, Animal ; Body Weight ; Disease Models, Animal ; Escherichia coli ; Escherichia coli Infections ; complications ; physiopathology ; Female ; Glial Fibrillary Acidic Protein ; genetics ; Growth Disorders ; etiology ; Leukoencephalopathies ; etiology ; Pregnancy ; Pregnancy Complications, Infectious ; physiopathology ; Rats ; Rats, Sprague-Dawley

Objective To assess whether degrees of leukoaraiosis (LA) severity is associated with prognoses of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy.Methods Clinical data of patients with acute anterior circulation large-artery occlusive stroke who underwent mechanical thrombectomy in our hospital from January 2016 to August 2017 were collected. The subjects were divided into non-to-moderate LA group and severe LA group according to preoperative degrees of LA severity; the baseline data, successful reperfusion rate, and symptomatic intracranial hemorrhage rate within 24 h of surgery, good prognosis rate 90 d after surgery (modified Rankin scale [mRS] scores≤2) and mortality 90 d after surgery were analyzed. According to the prognoses, the patients were divided into good prognosis group and poor prognosis group; univariate regression analysis and multivariate Logistic regression analysis were used to evaluate the relations of degrees of LA severity with prognoses 90 d after surgery.Results In these 146 patients, 100 patients were into the non-to-moderate LA group and 46 patients were into the severe LA group. As compared with patients in the non-to-moderate LA group, patients in the severe LA group had significantly older age (70.50 [59.75, 79.75] yearsvs. 79 [73, 82] years), significantly higher baseline NIHSS scores (20 [16, 25])vs. 22 [18, 28]), significantly higher rate of symptomatic intracranial hemorrhage 24 h after surgery (11.0％ [11/100])vs. 26.1％ [12/46]), statistically higher mortality rate 90 d after surgery (14.0％[14/100]) vs. 14.0％ [14/46]), significantly lower successful reperfusion rate (97.0％ [97/100]vs. 84.8％ [39/46]), and statistically lower good prognosis rate (54.0％ [54/100]vs. 21.7％ [10/46],P<0.05). Among the 146 patients, 64 had good prognosis and 82 had poor prognosis; univariate analysis showed that as compared with than those from the good prognosis group, patients from the poor prognosis group had significantly older age (70.50 [59.75, 79.75] years oldvs. 79 [73, 82] years old) and statistically higher baseline NIHSS scores (20 [16, 25]vs. 22 [18, 28]), and significantly higher proportion of central source embolism by TOAST etiology classification (68.8％ [44/64]vs. 76.8％[63/82]) and proportion of severe LA (15.6％ [10/64]vs. 43.9％ [36/82],P<0.05); multivariate Logistic regression analysis showed that severe LA (OR=3.109, 95％CI: 1.241-7.788,P=0.015), age, baseline NIHSS scores, and TOAST etiology classification were all independent risk factors for poor prognosis 90 d after surgery (P<0.05). ConclusionSevere LA may be associated with poor prognosis of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy.

Objective To evaluate the effect of anesthesia selection on endovascular treatment for anterior circulation major vessel occlusion stroke. Methods The clinical data of patients undergoing endovascular treatment in our hospital from January 2016 to August 2016 were retrospectively reviewed. The patients were divided into general anesthesia group and conscious sedation group. Comparison of the differences in time, symptomatic intracranial hemorrhage, and 90-day functional outcome between the two groups was made. Results A total of 73 patients were included in the analysis, 34 (46.6％) in the general anesthesia group, and 39 (53.4％) in the conscious sedation group. The baseline clinical data were balanced in both groups. There was no statistically significant difference in door-to-puncture time, puncture-to-recanalization time and onset-to-recanalization time between the two groups. The postoperative systolic blood pressure was significantly decreased in the general anesthesia group ((126.29 ± 20.07) vs (139.95 ± 21.22) mmHg (1 mmHg=0.133 kPa), t=2.81, P=0.01), whereas the rate of successful reperfusion (modified thrombolysis in cerebral infarction ≥ 2b) (94.1％(32/34) vs 87.2％(34/39), χ2=0.33, P=0.57), symptomatic intracranial hemorrhage rate (17.6％(6/34) vs 10.3％(4/39), χ2=0.33, P=0.57) and good outcome (modified Rankin Scale (mRS) score≤2) at 90 days (41.2％(14/34) vs 53.8％(21/39),χ2=1.17, P=0.28) did not show statistically significant difference between the two groups. Conclusions The selection of general anesthesia or conscious sedation had no significant effect on the outcome of endovascular treatment for anterior circulation major vascular occlusion stroke. The results of the study still need to be verified by large-scale randomized controlled trial.

Objective To evaluate the efficacy and safety of endovascular thrombectomy for acute ischemic stroke due to basilar artery occlusion,and analyze the correlation between baseline clinical features and prognoses.Methods The clinical data of 27 patients with acute stroke due to basilar artery occlusion,admitted to and underwent emergency endovascular thrombectomy in our hospital from February 2016 to March 2017,were analyzed retrospectively.The re-canalization rate and complications were determined and the clinical outcomes were assessed.The correlation between clinical features and prognoses were analyzed.Results Successful re-canalization was achieved in 24 out of 27 patients (88.9 ％),and the mean time from onset to re-canalization was (418.92±223.96) min.Symptomatic intracerebral hemorrhage (SICH) was observed in 2 patients (7.4 ％) and mortality in the first 3 months was 29.6％ (8/27).At 3-month follow up,14 patients (51.8 ％) showed good prognosis (modified Rankin scale [mRS] scores≤＜2) and 13 had poor prognosis.Baseline NIHSS scores (23[12.5,33.8] vs.35[23,39]) and posterior circulation-Alberta Stroke Program Early CT Scale scores (9 [8,10] vs.7 [4,9]) between patients with good prognosis and poor prognosis were significantly different (Z=-2.043,P=0.041;Z=-2.387,P=0.017).Conclusions Endovascular thrombectomy can contribute to a high re-canalization rate and safety.Baseline clinical severity and collateral circulation compensation are associated with clinical prognosis.

Objective To compare the efficacy and safety of direct thrombectomy and bridging therapy for acute large-vessel occlusion in anterior circulation stroke.Methods A retrospective study was performed on clinical data of 146 patients with anterior circulation large-vessel occlusion stroke who accepted direct thrombectomy in our hospital from March 2016 to July 2017;85 patients were in direct thrombectomy group and 61 patients were in bridging therapy group.The clinical characteristics,procedural complications and clinical outcomes between the two groups were compared.Results There were no significant differences between the two groups in age,gender,baseline National Institutes of Health Stroke Scale (NIHSS) scores,percentages of patients with hypertension,diabetes and atrial fibrillation,baseline blood glucose,platelet count,creatinine level,baseline systolic blood pressure,stroke etiology,occlusion site,and anesthesia methods (P＞0.05).There were no significant differences between the two groups in admission-to-CT time,admission-to-puncture time,puncture-to-re-canalization time,and admission-to-re-canalization time (P＞0.05).The successful reperfusion rate (91.8％ vs.95.1％),incidence of symptomatic intracranial hemorrhage (11.8％ vs.21.3％),favorable outcome rate 90 d after treatment (41.2％ vs.47.5％),and mortality (20.0％ vs.18.0％) were not significantly different between the two groups (P＞0.05).Conclusion The efficacy and safety of direct thrombectomy and bridging therapy are similar for acute large-vessel occlusion in anterior circulation stroke.

Objective To clarify the relationship between the basivertebral foramen (BF) and the retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF) and further explain the mechanism of RBF formation.Methods From June 2013 to June 2016,Sixty-two patients suffering from TLBF with RBF were collected.The characteristics of RBF as well as the parameters of vertebral body were studied using CT reconstruction imaging.In the transverse images,the lengths of RBF (RL) and vertebral body (VL) were measured.In median sagittal images,the heights and widths of RBF (RH,RW) and vertebral body (VH,VW) were also obtained.The ratios of different parameters of RBF and vertebral body (RL/VL,RW/VW,RH/VH) were calculated,and then defined the location relationship of RBF and BF.Eight frozen cadaveric spine were selected and evaluated by Micro-CT scans.Each vertebral body was divided into three layers (Superior,Middle,Inferior).Each layer was further divided into 9 regions (R1-R9),named as SR1-SR9,MR1-MR9,IR1-IR9.Microarchitecture parameters of each region in each layer,including bone volume fraction (BV/TV),bone mineral density (BMD),trabecular connectivity (Corn.D),and trabecular number (Tb.N) and thickness (Tb.Th) were calculated,and their differences were also analyzed to see if the trabecular bone distribution would be affected by BF.In vitro study,burst fractures were simulated on cadaveric spines by using bursting fracture simulator,aiming to observe the RBF morphology and imaging findings to future investigate the relationship between RBF and BF.Results The length and height of RBF were close to half of vertebral body length and height (RL/VL:0.497±0.059,RH/VH:0.485±0.036).The width of RBF was usually one-third of vertebral body width (RW/VW:0.319±0.025),which indicated that the fracture block was often located in the posterior of vertebral body above the BF.BV/TV,Tb.N in the MR2 and MR5 regions were lowest than other regions and the SMI of MR2 and MR5 was largest than others.SR5 was the lowest region in superior lawyer that was corresponded to regions most affected by burst fracture.In simulated burst fractures,the fracture line of RBF went across the vertex or upper surface of the BF and the lower boundaries of RBF were also the upper bound of the BF.Moreover,the damage sites of posterior longitudinal ligament were mainly located at the edge of the BF.Conclusion At the bone defect region,the BF is the weakest area in the vertebral body which may affect the distribution of trabecular bone surrounding it.When subjected to vertical violence,these regions undergo fracture first which impact the anterior and lower boundaries of RBF.Ultimately,RBF was produced upon the BF,involving all or part of the upper bound of the BF.