“Three Yin and Three Yang” syndrome differentiation is a method and system generated from “Treatise on Febrile Diseases”. And it is a principle of syndrome differentiation and a criterion of treatment. Modern physicians give many descriptions on levels of “Three Yin and Three Yang” syndrome differentiation. There are a lot of different opinions on it, including “Yin and Yang”, ”three steps of Cluster analysis”, “one divided into two” combining with “one divided into three”, and “three steps of recognizing symptom, understanding disease and differentiating syndrome” theories. The author believes “Three Yin and Three Yang”syndrome differentiation consists of three levels:differentiating syndrome principle, differentiating syndrome category and differentiating syndrome type. Strengthening research on levels of syndrome differentiation helps to improve accuracy of syndrome differentiation, guide drug description and enhance clinical efficacy.

Objective To evaluate the wound healing efficacy of negative pressure wound therapy (NPWT) combined with topical oxygen therapy ( TOT ) on the traumatic chronic wounds , and to explore new conception and method for traumatic chronic wounds . Methods Sixty-four patients with traumatic chronic wounds were randomized into two groups ( n=32 ) .Patients in the control group were treated by NPWT , and those in the intervention group were treated by NPWT and NPWT with TOT 3L/min.The treatment time lasted 12 days, and the dressing and tubes were changed every three days in the two groups .After 12 days, all the pa-tients were treated by standard moist therapy or surgery until healing or three months .Indicators of observation: The pressure ulcer scale for healing (PUSH) scores and granulation covered rate at 0, 3, 6, 9, and 12 days were measured, and healing rate and healing time during three months were calculated in the two groups . Results The PUSH scores were declined with intervention time during 12 days in the two groups , indicating the treatment was effective , but there was no significant difference between the two groups ( P>0 .05 ) .The granulation covered rate was increased with intervention time , and the granulation covered rate was higher in the intervention group than in the control group(P<0.001).The healing rate was higher in the intervention group than in the control group (87.50%vs 59.38%, P<0.05 ).The healing time of 14 days was shortened in the intervention group compared with the control group (P<0.001). Conclusion NPWT combined with TOT is an effective and feasible method for complicated traumatic chronic wounds , which can en-hance granulation growth , rise healing rate and shorten healing time .

Objective Pressure Ulcer Scale for Healing ( PUSH) was published in 1998 by National Pressure Ulcer Advisory Panel ( NPUAP) as a tool to evaluate the effects of pressure ulcer care.This study aimed to verify the reliability and validity of the Chi-nese version of PUSH in order to provide an efficient and reliable tool for evaluating the effects of pressure ulcer care. Methods Using the Brislin translation model, we translated the English version of PUSH into Chinese and finalized the Chinese version through modifica-tion by an advisory panel, pretests, and verification of its reliability and validity in the care of 126 cases of stage-Ⅱ-Ⅳpressure ulcers. We analyzed the reliability and validity of the scale based on its item scores, content validity, construct validity, Cronbach′s αcoeffi-cient, and test-retest reliability. Results The correlation coefficient value of the total and individual item scores was 0.616-0.963 (P<0.01).Each individual item score was significantly higher in the 27%high-score group (n=35) than in the 27%low-score group (n=36).The total content validity coefficient was 0.965, the correlation coefficient of construct validity between the total and individual item scores was 0.750-0.954 (P<0.01), and that between individual items was 0.666-0.826 (P<0.01), with statistically signifi-cant differences between the total and individual item scores at 7 and 21 days after treatment (P<0.01).The Cronbach′s αreliability coefficient value of the total score was 0.823 and those of individual item scores were 0.770, 0.791, and 0.868, respectively.The inter-rater reliability coefficients were all >0.85 and the test-retest reliabili-ty coefficients of individual items were 0.826, 0.885, and 0.958, re-spectively ( P<0.01) . Conclusion The Chinese version of PUSH, with its high validity and reliability, can be used to evaluate interven-tion effectiveness of Chinese patients with pressure ulcers.

Objective The incidence rate of pressure ulcer is high in critical patients and off-loading mattresses and reposi-tioning are known as effective interventions for the prevention of pressure ulcers .However, evidence is lacking for selection of the right type of mattresses and suitable interval of repositioning .This study was to compare the effects of two types of off-loading mattresses with two different repositioning intervals in preventing pressure ulcers in critical patients . Methods According to the design of this ran-domized controlled trial , we made a training plan concerning the participants , methods of intervention and comparison , criteria and methods of observation , and methods of recording , and trained 26 nurses from 7 hospitals .Using non-inferiority design and the method of stratified blocked randomization , we divided 1194 patients with the risk of pressure ulcer into a trial group ( n=596) and a control group ( n=598) , a viscoelastic sponge mattress with every-four-hours repositioning used for the former and an automatic aeration mat-tress with every-two-hours repositioning for the latter , both for 7 successive days .We examined the patients every day , recorded the in-cidence and stages of pressure ulcer , and compared the data obtained between the two groups of patients . Results The total inci-dence rate of pressure ulcer was 1.09%(13/1194), significantly lower in the trial than in the control group (0.34%[2/596] vs 1.84%[11/598], P=0.012). Conclusion A viscoelastic sponge mattress with every-four-hours repositioning is superior to an automatic aeration mattress with every-two-hours repositioning and therefore is preferred to the latter in preventing the incidence of pressure ulcer in critical patients in the ICU .

Objective To analyze the clinical characteristics of inpatients with skin tears and to explore corresponding nursing strategies. Methods A data collection form was developed to collect data of the 35 patients with skin tears by retrospective analysis, including their age, gender, underlying diseases, nutritional status, department, location and severity level, activity ability, consciousness level and nursing measures, with the results analyzed by descriptive statistics.Results Out of the 35 patients, male accounted for 57.1% (20/35), with average age of (68.5±0.8) years old, and 74.3% (26/35) equal to or above 65 years old. Characteristics of skin tears ( with locations included): lower extremities and trunk were the most, both accounted for 28. 6% (10/35), followed by upper limbs, accounting for 14.3% (5/35), hands and feet, both accounting for 11. 4% (4/35), and the least of head and face, accounting for 5.7% (2/35). Severity of skin tears: Grade-3 was the most, accounting for 42. 9% ( 15/35 ) , followed by Grade-2b, accounting for 25.6% (9/35), Grade-1b, accounting for 14.3% (5/35), and Grade-1a and Grade-2a, both accounting for 8. 6% ( 3/35 ) . Clinical characteristics: those with activity slightly limited accounted for 51. 4% (18/35), followed by those with activity very much limited, accounting for 28.6% (10/35), with no limitation, accounting for 14. 3% ( 5/35 ) , and completely limited, accounting for 5. 7% ( 2/35 ) . Consciousness level:Conscious patients accounted for 80% (28/35), and unconscious ones 20% (7/35). Preventive nursing measures were taken only by 20% (7/35).Conclusions The majority of inpatients with skin tears are with slight limitation of activity, conscious minds, and old age. Implementation rate of preventive measures is very low. It is advised to strengthen training of nurses, improve awareness of prevention, pay more attention to patients with high risk of skin tears and improve the implementation rate of preventive measures.

IgG4-relaed hepatobiliary diseases (IgG4-HBD) are the hepatobiliary manifestations of IgG4-related disease, a multisystem fibro-inflammatory disorder. Previous studies on the pathogenesis of genetics and immunology have provided significant assistance in understanding the disease, rational diagnosis and treatment, but there are still many unknowns and challenges. The current research progress summarizes several factors influencing fibrosis and inflammation in the pathogenesis of disease.

Objective To analyze the characteristics and the effect of nursing invention on repeated sebaceous cyst infection. Methods 38 cases of repeated sebaceous cyst infection were selected from February 2013 to February 2014, and surveyed the demographic data, living habits and diet structure, location, primary disease control, local wound treatment and other aspects. They were given the nursing intervention for 6 months of follow up and observed the effects. Results Within the patients, most of them were at the age from 18 to 30 years old or over 50 years old. 65. 79% patients were male. The hip infection accounted for 44. 73% patients. Staphylococcus aureus infection accounted for 71. 05% patients. 52. 63% patients had hyperglycemia, and 47. 36% patients had dyslipidemia. The nursing intervention included dietary guidance, exercise instruction and local wound care nursing intervention. 38 patients all had the wound healed. The healing time were (25. 71 ± 10. 66) days and had no relapse within 6 months of follow up. Conclusions The relapse of sebaceous cyst infection was associated with male gender, inappropriate living habits, blood glucose and dyslipidemia. Balanced diet, appropriate activities, control of blood glucose and blood lipid, individualized wound care is helpful for wound healing and recurrence control.

Objective To study the effects of team-ladder training model on the training of new nurses in the wound care center.Methods After making training goals and content, the team-ladder training model was used to train new nurses, and the completion was observed.Results By the team-ladder training model, the basic knowledge and practice ability of new nurses were improved significantly.Besides, after the repeated interacted training and practice, the ability of literature retrieval, conclude document, speech skills and expression were improved significantly as well.After two-year training, the mean score of reading report increased from 77 to 88.The case report trained the ability of analyzing the problem, problem-solving and basic research ability.All the nurses had published articles at core journals within the two-year training.The group of new nurses took the first place in the nursing article report session.Conclusions The team-ladder training model can enhance the overall strength of nursing management, improve the team’ s cohesion and promote the whole development of the department.

Objective To retrospectively analyze the reason of the difficulty of wound healing after breast cancer surgery, and to investigate the effects of systematic wound treatment. Methods The studycollected 33 cases of wounds healing difficulty after breast cancer surgery, and retrospectively analyzed the factors that hindered the recovery. The local and systematic treatment would be suggested and observed. Results In 33 cases, one patient was lost to follow-up; two cases were not healed ( bone necrosis after radiotherapy); the healing rate was 90% and no scars occurred. The treatment time was 10 - 56 days, (31. 65 ± 12. 54) days average. Conclusions The systematic intervention method of moist therapy combined with physical therapy is effective to prevent scars, and to improve the healing rate and patients′satisfaction.

Objective To explore the effect of preventing skin tears with prevention protocol based on guideline. Methods According to International Guideline of Prevention Skin Tears to discuss and make prevention protocol, including prediction risk people, prevention fall and fall from bed with auxiliary means, wearing long sleeves clothes, using emollient on skin twice a day, providing nutrients and water, prevention friction and shear force with movement skills, totally six comprehensive measures. Wound care team trained backbone nurses the measures and backbone nurses trained clinical nurses. Before and after intervention 5 month and 17 month, every patient with age more than 18 years and hospitalized more than 24 hours was checked skin from head to toes in order to observe and compare skin tears incidence and practicable rate of prevention measures by cross-sectional survey.Results Before intervention, skin tears incidence was 0.77%(12/1 558), and skin tears incidence after intervention 5 month and 17 month was 0.16%(3/1 777) and 0.22%(4/1 825) ( P<0.05) . Practicable rate of 6 measures in patients with risk and with skin tears after intervention 5 month and 17 month was increased than that before intervention which was unsatisfactory (P>0.05).Conclusions Preven-tion skin tears protocol can reduce skin tears incidence, but practicable rate need be improved. In future nurses training, guidance and management bedside should be strengthened in order to enhance practicable rate of prevention measures.