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Objective To study the impact of adjuvant transarterial chemoembolization (TACE)after curative resection for patients with hepatocellular carcinoma (HCC) and microvascular invasion (MVI).Methods PubMed,Cochrane library,Embase,Web of Science,CNKI,VIP,Wanfang were searched for randomized or non-randomized studies which compared recurrence-free survival and overall survival rates with or without postoperative adjuvant TACE after curative resection for patients with HCC and MVI.The limited search time was from January 1st,1999 to May 1st,2019.Statistical analyses were performed with software programs using Stata (version 15.0) and Review Manage (version 5.3).Results Eight studies which included 1 809 patients were studied.There were 815 patients who received and 994 patients who did not receive postoperative adjuvant TACE after radical hepatectomy.Postoperative adjuvant TACE significantly improved recurrence-free survival and overall survival rates in patients with HCC and MVI when compared with the patients who required no adjuvant TACE (HR =0.74,95％ CI:0.65-0.85,P ＜0.05;HR =0.74,95％ CI:0.62-0.89,P ＜ 0.05,respectively).Subgroup analysis demonstrated that patients with tumor diameter ＞ 5 cm benefited from postoperative adjuvant TACE only in recurrence-free survival rate (HR =0.72,95％ CI:0.58-0.90,P ＜ 0.05),but not in overall survival rate.Conclusion Postoperative adjuvant TACE delayed recurrence of microvascular invasion of HCC and improved long-term prognosis,but not for tumors with diameter ＞5 cm.These results need to be validated in further clinical trials.
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Objective@#To investigate the application value of Overlap anastomosis in Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy in gastric cancer.@*Methods@#Clinical data of 68 stage T1-2 gastric cancer patients undergoing laparoscopic distal gastrectomy for D2 radical gastrectomy from January 2015 to January 2016 at China Japan Union Hospital of Jilin University were retrospectively analyzed. Inclusion criteria: (1) no distant metastasis of gastric cancer confirmed by gastroscopy and pathology before surgery; (2) T1-2 tumor with diameter <3 cm; (3) the lesion locating in the antrum of the stomach with distance >1 cm from the pylorus, and no invasion into middle area; (4) R0 resection confirmed by postoperative pathology; (5) no history of abdominal surgery. Among 68 cases,23 cases were in Overlap anastomosis group and 45 cases in Billroth I anastomosis group. D2 lymph node dissection and distal gastrectomy were performed in both groups. In the Overlap anastomosis group, the duodenum and stomach were severed by a linear stapler under endoscopy, and the residual gastric curve anastomotic opening was selected. According to the tension between the duodenum and the remnant stomach, the anastomotic opening was selected at the upper edge of the remnant duodenum, and the anastomosis between the posterior wall of the remnant stomach and the upper wall of the duodenum was completed by placing the stapler under endoscopy. Then the common opening was closed and the remnant duodenum was resected. In the traditional Billroth I anastomosis group, pneumoperitoneum was discontinued after amputation of the duodenum under laparoscopy. The median incision of the upper abdomen was 9-12 cm. The distal stomach was pulled out to complete the excision of specimens, the extraction of specimens and Billroth I digestive tract reconstruction. The intraoperative and postoperative conditions of the two groups were compared with student t test (continuous variable) and chi-square test (categorica variable).@*Results@#Of the 68 patients,39 were males and 29 were females,with age of (65.5±10.2)(51 to 77)years. Differences in baseline data between Overlap group and Billroth I group were not statistically significant (all P>0.05). Laparoscopic surgery was successfully performed in both groups without conversion to open operation. As compared with the Billroth I group, the Overlap group had significantly shorter operation time [(149.8±10.1) minutes vs. (169.8±15.3) minutes, t=5.658,P=0.008], shorter anastomotic time of digestive tract reconstruction [(31.2±3.8) minutes vs. (36.3±3.3) minutes, t=3.389, P=0.003] and shorter abdominal incision length [(4.5±0.9) cm vs.(11.0±2.3) cm, t=13.244,P=0.004]. There were no significant differences between two groups in intraoperative blood loss [(92.9±22.4) ml vs. (87.0±7.3) ml,t=1.186,P=0.366], number of lymph node dissected (28.4±5.7 vs. 27.3±5.2, t=0.838, P=0.383), postoperative flatus time [(4.4±2.1) days vs.(4.2±1.8) days, t=0.391, P=0.563], morbidity of postoperative complication [4.3%(1/23) vs. 6.7%(3/45), χ2=0.148,P=0.701]. All the patients were followed up for 28±10 (10-46) months. There were no long-term complications, recurrence or death in two groups.@*Conclusion@#Overlap anastomosis in Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy is safe and effective, and can reduce the anastomosis time.
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Total mesorectal excision (TME) is the basic principle of surgery in rectal cancer which requires en bloc removal of the tumor and its regional lymph nodes. This conincides with the theory of membrane anatomy that emphasizes en bloc resection and avoids cancer leakage. The basis of membrane anatomy is the fusion of peritoneum and three key pointsare needed to understand the fusion and fusion fascia:(1) the fusion only occursin peritoneum; (2) the inside of fusion fascia cannot be separated; (3) the fusion can be diversiform. Only mastering these key points can we comprehend and apply this theory dialectically. The membrane anatomy in rectum is different from stomach or colon because of its specific location. The posterior space of rectum is filled with the loose connective tissue which is the degeneration of peritoneum fusion. In this space, the anterior lay of presacral fascia fuses with the proper fascia of rectum at the S4 level and separates the space into the retrorectal space and the supralevator space. Denonvilliers fascia is the fusion fascia in front of rectum, which forms the prerectal space and retroprostatic space, and extends to lateral pelvic wall with fusion of the parietal fascia of pelvis, covering the neurovascular bundle (NVB) together. The proper fascia of rectum surrounds the middle rectal artery, the pelvic plexus rectal branch and the adipose tissue to form the lateral rectal pedicle at 10 o′clock and 2 o′clock near the pelvic floor. At the level of levator ani hiatus, the fusion of levator ani muscle fascia and the proper fascia of rectum forms the Hiatal ligament, which fixs the anal canal and closes the levator ani hiatus.This article intends to discuss the above points from the perspective of membrane anatomy, in order to better guide surgeons to complete laparoscopic total mesorectal excision for rectal cancer.
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Objective To evaluate the clinical value of thyroid cancer gene detection and its joint diagnos-tic model in early diagnosis of thyroid nodule. Methods Retrospective study was used to analyze 61 cases of thy-roid nodules. These cases were divided into benign nodules and malignant nodules according to the pathology out-comes. We evaluated the AUC,sensitivity and specificity of preoperative fine needle aspiration biopsy(FNAB), thyroid cancer gene detection and color ultrasonography feature in the early diagnosis of thyroid nodule through lo-gistic regression analysis and ROC working curve. Results Among the 61 patients with thyroid nodules,there were 31 cases of benign thyroid nodules and 30 cases of malignant nodules.Diagnostic indexes significantly related with thyroid nodules and their AUC were listed as following:cancer gene detection 0.915(95% CI:0.814-0.971), FNAB 0.813(95% CI:0.691-0.902),low echo 0.657(95% CI:0.523-0.775),size of nodules 0.623(95% CI:0.488-0.745),joint diagnostic model respectively 0.957(95%CI:0.871-0.993). The value of joint diagnosis was the highest,whose sensitivity was 93.1% and the specificity was 90.3%.Conclusion Preoperative cancer gene de-tection joint FNAB and color ultra-sonography will improve the detection rate of thyroid cancer and reduce unneces-sary operation.
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[Objective]To observe the biological characteristics of CD133 positive cells derived from cutaneous squa-mous cell carcinoma(cSCC),and to investigate the mechanism of self-renewal of cancer stem cells(CSC)and the malig-nant behavior in cSCC.[Methods]The flow cytometry was applied to purify CD133+cells and CD133-from cutaneous squa-mous cell carcinoma cell line Colo-16.The effects of CD133 on the cell proliferative,self renew and migratory activity of two group cells were detected by MTT assay,Sphere formation assay and Transwell assay.Western blot and quantitative flu-orescent PCR were performed to investigate the expression of cancer stem cell associated gene CD44,OCT4 and SOX2 in two groups of cells.Examined the expression level of CD133 in actinic keratosis,squamous cell carcinoma in situ and cSCC by immunohistochemistry.[Result]The CD133+Colo-16 cells exhibited significantly stronger proliferation,self-renewal and metastasis ability(P<0.05)and present higher level protein and mRNA expression on CD44,SOX2 and OCT4(P<0.05). In addition,the expression level of CD133 was dynamic rise during the continuous evolution of actinic keratosis,squamous cell carcinoma in situ and cSCC.[Conclusions]The expression level of CD133 may be related to the tumorigenesis of cSCC and the malignant behavior including proliferative,self renew and migratory activity,and CD133+cSCC cells show the properties of cancer stem cells.The occurrence and development of cSCC may be related to the CSC,which express CD133.
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Objective A highly feasible and reliable ultra-high performance liquid chromatography tandem mass spectrometry(UPLC-MS/MS)method was presented for therapeutic drug monitoring of five anti-schizophrenic drugs (aripiprazole, amisulpride, olanzapine, paliperidone and ziprasidone) simultaneously and the reference range of plasma concentration was investigated.Methods establishment and evaluation.The selectivity,accuracy,precision,stability and linear range of established UPLC-MS/MS method were evaluated according to FDA and CLSI.After a ten-month clinical application, a retrospective analysis of 253 positive samples was carried out to investigate conformance of the AGNP therapeutic reference range for Chinese patients.Results The five anti-schizophrenic drugs could be simultaneously measured by the established UPLC-MS/MS within 6 minutes.The LOQs were 0.1 to 9.0 ng/ml.The correlation coefficients were all higher than 0.997 7.The intra-day and inter-day precisions were less than 11.1%,and the recoveries ranged from 86.2% to 104.8%.The clinical results suggested the good consistency in reference range with AGNP for olanzapine, aripiprazole, paliperidone and ziprasidone.While for amisulpride, the plasma concentration level(445.2 ±231.5)ng/ml was significantly higher than the AGNP-recommended range(100 -320)ng/ml.Conclusion The established UPLC-MS/MS method was very suitable for monitoring anti-schizophrenic drugs.
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Objective To master the situation of iodine deficiency disorders (IDD) and the people's iodine nutritional status after implementation of the new salt iodine standard in Gansu Province in 2012.Methods Totally 30 counties (cities) were selected in Gansu Province by population proportionate to size sampling (PPS) method in 2014,and one primary school was selected in each counties (cities).In each selected school,50 children aged 8-10 years old were selected for thyroid examination by B-ultrasound,urine samples were collected for iodine determination,and salt samples were collected for iodine determination from a subset of children included in the study.Totally 20 pregnant women were selected from the towns with the sampled schools and urine samples were collected for iodine determination.Arsenic and cerium catalysis spectrophotometry (WS/T 107-2006) was used to detect urinary iodine content;direct titration (GB/T 13025.7-2012) was used to detect edible salt iodine content.Urinary iodine of children and pregnant women were compared with 2011 (before implementation of the new salt iodine standard).Results The median of salt iodine was 26.6 mg/kg,the iodized salt coverage rate was 99.5％ (1 492/1 500),the qualified rate of iodized salt was 89.3％ (1 333/1 492),and the consumption rate of qualified iodized salt was 88.9％ (1 333/1 500).The thyroid goiter rate of children was 3.2％ (48/1 500);a total of 1 499 urine samples of children were detected,the urinary iodine median was 169.8 μg/L,it was significantly lower than that in 2011 (216.0 μg/L,Z =-6.813,P ＜ 0.05).A total of 600 urine samples of pregnant women were detected,the urinary iodine median was 161.8 μg/L,it was significantly lower than that in 2011 (168.6 μg/L,Z =-3.590,P ＜ 0.05).Conclusion IDD has been controlled after implementation of the new standard of iodized salt and iodine nutrition condition is good.
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Objective To evaluate risk and the direct economic burden of malignant tumor due to type 2 diabetes mellitus. Methods Combing the data of chronic disease surveillance, follow-up and the fifth health service investigation, we calculated the population attributable risk and the direct economic burden for malignant tumor due to type 2 diabetes mellitus in order to estimate the direct economic burden for tumor caused by type 2 diabetes mellitus. Results The relative risk was 1.68 (95%CI: 1.68-1.70) for people with type 2 diabetes mellitus to develop the malignant tumor than the people without type 2 diabetes mellitus. The proportions of attributable risk (AR%) and population attributable risk (PAR%) were 40.57% and 2.05%, respectively. Moreover, the annual average hospitalization costs for malignant tumor reached 11 billion CNY, which took part 6.48% of total health service costs. And the direct economic burden for malignant tumor due to type 2 diabetes mellitus was 0.228 billion CNY. In addition, the top two highest population attributable risks were colorectal cancer and liver cancer, while the top three greatest direct economic burdens for malignant tumor or malignant tumor due to type 2 diabetes mellitus were lung cancer, colorectal cancer and stomach cancer. Conclusion From this study, we found that type 2 diabetes mellitus increased the risks of tumor and therefore lead to sharply increasing in medical costs of malignant tumor. In order to decrease the risk of malignant tumor and medical costs, we should pay more attention to the prevention of type 2 diabetes mellitus and the screening of malignant tumor due to type 2 diabetes mellitus.
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Objective To investigate the clinical efficacy of ear acupoint thumbtack needle embedding in treating senile primary insomnia.Method Seventy patients were allocated, using a random number table, to observation and control groups, 35 cases each. The observation group received ear acupoint thumbtack needle embedding with alternate selections of left and right ear acupoints and the control group took estazolam tablets, 1 mg once before bedtime. Both groups were treated once every other day, for 30 days. The Pittsburgh Sleep Quality Index (PSQI) score and the Insomnia Severity Index (ISI) score were recorded before and after treatment. The clinical therapeutic effects were evaluated.Result The total efficacy rate was 91.4% in the observation group and 82.9% in the control group. It was higher in the observation group than in the control group; there was a statistically significant difference (P<0.05). In the observation group, the sleep quality, sleep efficiency and daytime dysfunction scores and the total score were lower after treatment than before (P<0.05). In the control group, the sleep duration and sleep efficiency scores and the total score were lower after treatment than before (P<0.05). After treatment, the sleep disturbance and daytime dysfunction scores and the total score were lower in the observation group than in the control group (P<0.05) and the sleep duration score was lower in the control group than in the observation group (P<0.05). In both groups, the ISI score was lower after treatment than before (P<0.05). It decreased more significantly in the observation group than in the control group; therewas a statistically significant difference (P<0.05).Conclusion Ear acupoint thumbtack needle embedding has a definite therapeutic effect on senile primary insomnia. It can reduce sleep disturbances, improve daytime function and decrease insomnia severity in the patients.
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Objective To observe the clinical efficacy of screwing via the paraspinal muscle approach plus single-segment laminectomy decompression via the dorsomedian approach for thoracolumbar fractures complicated with spinal cord injury.Methods From February 2013 to September 2015,21 patients with thoracolumbar fracture plus spinal cord injury were treated at our department.They were 15 men and 6 women,aged from 20 to 54 years (average,33.2 years).The injury was located at T1 1 in 2 cases,at T12 in 6,at T12 and L1 in one,at L1 in 7 and at L2 in 5;the injury was rated as grade A in one case,grade B in 3 cases,grade C in 8 and grade D in 9 according to the American Spinal Injury Association (ASIA) grading system.A1 the patients were treated by screwing via the paraspinal muscle approach followed by single-segment laminectomy decompression via the dorsomedian approach.Results The operation time averaged 116.1 + 24.5 minutes and the amount of bleeding 580.7 + 80.8 mL.At 3 days after surgery and the final follow-up,their visual analogue scale (VAS) score,anterior vertebral height and cobb angle were significantly improved in comparison with the preoperative values (P ＜ 0.05).At the final follow-up,their Japanese Orthopaedic Association (JOA) the score were also significantly better than the preoperative one (P ＜ 0.05),giving 12 excellent cases,6 good ones and 3 fair ones.Their ASIA grading at the final follow-up showed one case of grade B,2 cases of grade C,6 cases of grade D and 12 cases of grade E.Conclusion Treatment of thoracolumbar fractures complicated with spinal cord injury by crewing via the paraspinal muscle approach plus single-segment laminectomy decompression via the dorsomedian approach is a good way due to limited invasion,less bleeding,simple operation,excellent reduction,reliable fixation and rapid recovery.
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Objective Since it is a common problem for medical practice that paper instructions for medicine information are difficult to update and inconvenient to search ,this article is to provide convenient service of pharmacy information for clini-cal practice by developing medicine information search software in our hospital .Methods According to the practical needs of clinical study and pharmacy research ,we took appropriate measures to collect data ,categorize contents ,scan pictures ,polish images and extract information for the medicine instructions .Based on the above work ,we applied Oracle 10G to establish medicine information database for our hospital and utilized Java to design medicine information search software .Results Our search software includes 1 201 kinds of medicines ,taking up 98 .85% of the medicines in our catalogue .The users can use four different search methods (including common name search ,commodity name search ,fuzzy search and key word search) to gain the written material and photographic information of medicine instructions .Conclusion With the help of the software of Oracle and Java ,the newly designed software for medicine information search can provide convenient pharmacy information service for clinical practice .
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Objective To investigate the awareness rate of health knowledge,health behavior formation rate and psychological state before and after retirement intervention,analyse comprehensive psychological intervention and general psychological intervention to health behavior formation and improve the negative emotion in retired population.Methods By using cohort study method,206 retired people were randomly divided into comprehensive psychological intervention group (experimental group) and only given general psychological intervention group (control group),and each group included 103 cases.Comprehensive psychological intervention group were given health behavior and cognitive intervention,psychological intervention,psychological intervention in general family and social family care intervention,and the control group was given healthy behavior and cognitive intervention,psychological intervention.The staff were treated within 1 weeks of first assessment,2 weeks after the second assessment,4 weeks after the final.Health behavior was surveyed by Ministry of finance,the Ministry of health on public health subsidies special funds notice in city community health education pilot project in the questionnaire.Health status and quality of life were assessed with the family APGAR index (APGAR).Mental state evaluation and assessment of the treatment effect by using Hamilton Depression Scale (HAMD),MBI index method was assessed with activities of daily living.The effect of the two groups were compared before and after the intervention of health knowledge rate and formation rate of different intervention methods and psychological state of health behavior.Results The results showed that there were no significant differences between experimental group and control group in age,sex,level of education and other social,and there was no significant difference in HAMD,MBI and APGAR scores at baseline.Through the implementation of the comprehensive of psychological intervention,subjects have varying degrees of improving the awareness rate of health knowledge,and the intervention group was significantly higher than the control group (P ＜ 0.05).The two group of healthy behavior of subjects in the chopping board monitoring,physical fitness,blood pressure to separate raw and cooked on such projects had different degrees of improvement,at the same time,although no intervention,in the monitoring of blood pressure.The control group increased compared with the baseline significantly (P＜ 0.05).Intervention group had significant difference in APGAR score increased (P＜ 0.05).HAMD score and MBI score decreased and the differences were statistically significant (P＜ 0.01),while the control group had no significant difference before and after intervention.Conclusion Comprehensive psychological intervention can significantly improve the rate of formation from the awareness rate of health knowledge and health behavior of retirees,and improve the state of negative emotions from retiree.
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Objective To investigate the predictive values of P-selectin (P-sel),thrombus precursor protein (TpP) and D-dimer (D-D) in the early diagnosis of portal vein thrombosis (PVT) in patients submitted to splenectomy (or to devascularization).Methods The clinical data of 48 patients with portal hypertension (the PVT group,n=26; and the non-PVT group,n=22) who received operation in our hospital from 2009 to 2011 were retrospectively analyzed.Detecting the P-sel,TpP and D-D levels in the two groups of patients were done on preoperative day 1 and postoperative day 1,3,5,7,14.The SPSS software was used for statistic analysis.Results There were no significant differences on the preoperative day 1 levels of P-sel,TpP and D-D in the two groups (P＞0.05).The postoperative day1 levels of the three indicators in the PVT group were significantly higher than the non-PVT group (P＜0.05).Receiver operating characteristic (ROC) curves showed the area under curve (AUC) of P-sel was largest (0.893),followed by D-D,and TpP.The combined detection of the 3 indicators was highest,with the AUC up to 0.977.Conclusions Combined detection of P-sel,D-D and TpP levels were useful in the early diagnosis of PVT after splenectomy in patients with portal hypertension.
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<b>Objective: </b>We analyzed articles in the Japanese Journal of Drug Informatics with the goal of identifying recent research trends in drug informatics.<br><b>Method: </b>The appearance frequencies of keywords in the Japanese Journal of Drug Informatics (2001: vol. 3 (1) to 2009: vol. 11 (4)) and Japanese Journal of Pharmaceutical Health Care and Sciences (2009: vol. 35 (1) to (6)), and words in abstracts in Japanese Journal of Drug Informatics (2009: vol. 11 (1) to 2010: vol. 12 (4)) were analyzed. <br><b>Results: </b>To investigate keywords in the Japanese Journal of Drug Informatics, appearance frequencies of information, drug, drugs and pharmacist in 2001: vol. 3 (1) to 2003: vol. 5 (4), those of information, drug, drugs, medical, medication and questionnaire in 2004: vol. 6 (1) to 2006: vol. 8 (4), and those of information, drug, questionnaire, survey, pharmacist, adverse and generic in 2007: vol. 9 (1) to 2009: vol. 11 (4) were higher than those of other keywords. In the Japanese Journal of Pharmaceutical Health Care and Sciences, appearance frequencies of drug, pharmacy, care, patient, pharmaceutical, cancer, education, training, analysis and drugs were higher than those of other keywords. Information, drug(s), patients, pharmacists, hospital, use, questionnaire, medical, adverse, survey, agents, generic and pharmaceutical were high frequency words used in abstracts published in the Japanese Journal of Drug Informatics. These words in abstracts indicate a Zipf’s law-like rank distribution. Co-occurrence network graphs using abstracts showed that the first cluster consisted of medical, drug, adverse, drugs, pharmaceutical, hospital, doctors, contents and drug around information and pharmacists as hubs, and the second cluster consisted of 3 words (agents, woman and pregnant). Furthermore, co-occurrence network graphs indicated that care, medical, pharmaceutical, information, adverse, pharmacists, hospital, doctors, questionnaire, woman, pregnant, package and side were matters of important arguments and/or phenomena.<br><b>Conclusion: </b>These data suggest that the scope of themes in articles published in the Japanese Journal of Drug Informatics is establishing definitive categories. The recent themes and contents of the Japanese Journal of Drug Informatics were closely and mutually related.
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@#Objective To investigate the key words related with the growth of psychological rehabilitation literature of psychological rehabilitation in China. Methods The journal articles associated with psychological rehabilitation in CNKI were analyzed with key word frequency.The relationship between the cumulative frequency of key words and the growth of literature were analyzed with Linear Regression Analysis. Result Based on the cumulative frequency of 340 key words frequencies more than 4 in each year, Linear Regression Analysis extracted 10 words that correlated with the literature growth, which were Psychological Nursing, Psychological Problem, Psychological Response,Psychotics, Emotional Disorder, Type A Behavior, Social Psychology, SCL-90, Prosthesis, and Psychiatry. Conclusion The major objects of the researches of psychological rehabilitation in China were psychological problem, psychological response, psychotics, emotional disorder, type A behavior; the major tools were social psychology, SCL-90; the researchers mainly come from the nurse, and the professionals of prosthesis and psychiatry.