Objective To analyze of internal strength in patients with chronic disease,make clear the concept development,property,prerequisites,outcome and evaluation index of internal force.Methods To retrieve the relevant research literature in the knowledge service platform of Pubmed,PsycINFO and Chinese CNKI,Wanfang data,using the Rodgers analysis method to analyze the evolution of the concept of internal force.Results The molding process of internal strength of patients with chronic diseases included 4 defining characteristics:self concept,support,development and transcendence.Conclusions Rodgers evolution concept analysis method can help medical workers make clear concept essence of internal strength,deepening their cognition and understanding,so as to provide the basis for the implementation of the related research and clinical interventions.

Objective To evaluate the veracity and consistency of the results obtained from three automated hematology an-alyzers. Methods The reproducibility tests were used to assess the precision,the verification tests were exerted to evaluate the accuracy and consistency of test parameters(WBC,RBC,Hb,Hct and Plt) of the three hematology analyzers. According to the 1/2 standard of American Clinical Laboratory Improvement Amendment (CLIA,88),the relative bias of the reference analyzer and other assessed analyzers were determined. Results The results obtained from the three analyzers showed ex-cellent precision and stability,the coefficients of variation (CV) were all less than 5%; compared with the results of LH750,the results of Gens 5diff and ACT-5diff showed excellent correlation,all coefficients of correlation(?) exceeded 0.975. The results of both RBC and Hct obtained from Gens 5diff and ACT-5diff exceeded allowable error; the results of WBC,Hb and Plt were in the allowable error range. Conclusion In the condition of the excellent precision and stability,system errors existed in the analyzer can be found by verification on time. Through being adjusted and calibrated,the hematology ana-lyzers can meet the requirements and these results are consistent.

Objective To investigate the thyroid ultrastructural pathological changes of diabetes mellitus (DM) rats as well as the intervention effects of insulin and aminoguanidine. Methods Totally 87 rats were treated with streptozotocin to establish DM animal models and divided into DM group(n=27),insulin intervention group(n=32) and aminoguanidine intervention group(n=28),25 rats were taken as normal controls. Twelve and 20 weeks after the animal model establishment, animals were sacrificed, thyroid tissue was taken and ultrastructure was observed. Results In the thyroid of DM rats, follicular epithelial cells present as applanate shape, microvilli were depleted, rough endoplasmic reticulum dilated to irregular vesicular. None pinocytotic vacuole and casual primary or secondary lysosome were seen. Follicular cavity was dilated, colloid in the cavity had higher electronic-density. Interstitial edema, capillary base lamian was thickened at different stage. Proteo-substance deposition with granulo-shape, cloud shape or homogeneity appeared. The number of thyroid parafollicular cells increased. But endocrine granule in parafollicular cells was few. When compared with DM group, the thyroid tissue injury of insulin intervention group and aminoguanidine intervention group were lessened to different degree. Conclusion The hypofunctional thyroid follicular cells, large quantity of proteo-substance deposition in the interstitium and increased parafollicular cells of DM rats may be related with hyperglycemia toxicity. Insulin and aminoguanidine treatment have some protection effects.

Objective To investigate the expressions of Livin and vascular endothelial growth factor (VEGF)in pancreatic carcinoma and their cilinical significances.Methods The expressions of Livin and VEGF proteins were tested by immunohistochemistry in 68 cases of pancreatic carcinomas and 44 cases of adja-cent paracancerous tissues.Results The positive rates of Livin in pancreatic carcinomas and adjacent paracan-cerous tissues were 73.5% and 4.5% respectively,and the difference was statistically significant (χ2 =48.137,P<0.001).The positive rates of VEGF in pancreatic carcinomas and adjacent paracancerous tissues were 69.1% and 13.6% respectively,and the difference was statistically significant (χ2 =29.147,P <0.001).The expressions of Livin and VEGF were related with tumor differentiation (χ2 =6.061,P=0.014;χ2 =6.592,P=0.010),TNMstage (χ2 =4.175,P=0.041;χ2 =9.992,P=0.002),lymph node metasta-sis (χ2 =11.731,P=0.001;χ2 =12.002,P=0.001)and neural invasion (χ2 =9.950,P=0.002;χ2 =7.433,P=0.006).Significantly positive correlation was found between the expressions of Livin and VEGF by using Spearman correlation analysis (r=0.320,P=0.008).Survival analysis showed that the expressions of Livin and VEGF were independent prognostic factors in pancreatic carcinoma.Conclusion Livin and VEGF involve in the development,migration and metastasis of pancreatic carcinoma.Livin may upregulate the expres-sion of VEGF,which may lead to the angiogenesis and migration in pancreatic carcinoma.

AIM:To observe the effect ofTongmai Liquid on endothelin(ET),interlenkin-18(IL-18),macrophage colony stimulating factor(M-CSF)in patients with coronary heart disease(CHD).METHODS:Eighty patients with coronary heart disease accompanied by heart and spleen qi deficiency and qi stagnanty+phlegm stasis and were randomly assigned into test group and control groups.Forty patients in test group were treated with Tongmai Liquid,30 mL,thrice per day,Forty patients in control group were treated with Shexiang Baoxin Pills,2 pills every time,thrice per day.The therapeutic course for both groups was 30 days.The blood-serum ET,IL-18 and M-CSF had been tested before and after the treatment.RESULTS:The levels of blood-serum ET,IL-18 and MCSF in the two groups decreased significantly after treatment(P＜0.05).There's significant difference in two groups'blood-serum of ET(P＜0.05),There're no significant diffference in two groups'blood-serum level IL-18 and of M-CSF(P＞0.05).CONCLUSION:Tongmai Liquid may decrease blood-serum level of ET,IL-18 and M-CSF in patients with coronary heart disease without side effect.

Objective:To investigate the expression of receptor for advanced glycation end products (RAGE)in the thyroid tissue of diabetes mellitus (DM)rats.Methods:The rat model of DM was established by high-lipid diet and vena caudalis injection of streptozocin.The rats of DM models were then randomly divided into three groups:DM group(n=17),insulin intervention group(n=16)and aminoguanidine intervention group(n=16).Nine normal rats were taken as controls.Twelve weeks after the establishment of DM model,rats were sacrificed and the thyroid tissue was taken to determine RAGE mRNA and the protein expression with the method of RT-PCR and Western Blot.Results:The levels of RAGE mRNA and protein expression were higher in the thyroid tissue of DM rats than those in controls (P＜0.05).The levels of RAGE mRNA and protein expression were lower in the thyroid tissue of insulin intervention group and aminoguanidine intervention group than thor of DM group (P＜0.05).Conclusion:The levels of RAGE mRNA and protein expression were up-regulated in the thyroid tissue of DM rats,which can be restrained by controlling blood glucose and blocking the formation of advanced glycation end products.

This study was aimed to explore clinical functions of consensus-based clinical practice guidelines (CB CPGs) in traditional Chinese medicine (TCM). Under the guidance of the State Administration of TCM, 42 TCM hospitals in China had conducted a questionnaire survey for 73 CB CPGs and 2993 questionnaires had been included and analyzed. According to the category of good, general and bad, the proportion of the good in improving safety performance was 69.43%, controlling cost was 58.57%, regulating medical behavior was 55.50%, improving clinical effectiveness was 46.74%. It was concluded that the CB CPGs had played a good role in improving safety performance and controlling cost in TCM clinical practice.

Background Idiopathic orbital inflammatory pseudotumor (IOIP) is a commom orbital disease,with serious eye symptoms and replase tendency,and its pathogenesis is still unclear.Nuclear factor-κB (NF-κB)-related proteins participate in many important pathophysiological process,however,whether NF-κB plays a role in the IOIP process is worthy of attention.Objective This study was to explore the roles of NF-κB pathway in IOIP pathogenesis.Methods Twenty-four IOIP specimens were collected during surgery in Beijing Tongren Hospital from September 2010 to May 2016.The histopathological characteristics of IOIP were examined by hematoxylin and eosin staining.The expression and location of NF-κB/p65,p-p65,p50 and inhibitor of κB (IκB-ot) were detected by immunohistochemistry and verified by immunocytochemistry and Western blot assay.Results The histopathological features of IOIP were numerous small lymphocyte infiltraion and fibrous tissue proliferation,and a lot of epithelioid cells were seen in lacrimal gland-involved specimens.NF-κB/p65 was positively expressed in the cytoplasm of all 24 specimens and the nucleus in 15 specimens with the expressing rate of 62.5％.p50 was expressed in the cytoplasm in 22 specimens with the expressing rate of 91.7％ and in the nucleus in 17 specimens with the expressing rate of 70.8％.The positive expression of p-p65 was found in 22 specimens with the expressing rate of 91.7％,and IκB-α was expressed in the cytoplasm of 11 specimens with the expressing rate of 45.8％.These results were confirmed by immunocytochemistry and Western blot assay.Conclusions NF-κB pathway is activiated during IOIP process,and NF-κB pathway may be involved in the pathogenesis of IOIP.

The insulinoma, which is the most common pancreatic neuroendocrine tumor, can be misdiagnosed and mistreated easily.Recently, the misdiagnosis rate has decreased significantly owing to the establishment of diagnosis and treatment system.However, the misconception about its diagnosis and treatment still exists because the diagnosis and treatment level varies greatly among different centers.This article aims to summarize the experience in the diagnosis and treatment of insulinoma in Peking Union Medical College Hospital, and introduce the qualitative and localization diagnosis, surgical and interventional treatment and perioperative management about insulinoma, so as to standardize the diagnosis and treatment procedure in China.

Laparoscopic pancreaticoduodenectomy (LPD) is one of the most complicated operations in laparoscopic field.After been widely reported nowadays, LPD has been cautiously regarded as feasible and safe for radically resection.At present, several large pancreatic surgery centers in China have successively carried out this kind of surgery, with over one thousand cases in all.However, partly due to its complexity and steep learning curve, this procedure only remains limited to a few selected large pancreatic centers.Large sample prospective random control test studies are still required.We suggest that in China, LPD should only be developed steadily and step by step by highly skilled open and laparoscopic surgeons who have minimally invasive concept, contrary to fears and could grasp technical expertise.