Orthodox Manual of External Diseases is a book giving an exhaustive description on various kinds of external and surgical disease,written by CHEN Shi-gong(1617),the author pay more attention to concept of wholism and syndrome differentiation.He provided the original view on the treatment of disease that combine internal with external therapy,needle with herbs.① All the external symptoms originates from internal causes and all diseases arisen from pathogenetic fire.Carbuncle definitely caused by visceral disorders,addiction to greasy diet,overstrain and exhaustion of sexual activities.② Based on occurrence and development of surgical disease,currency of ebb and flow between pathogenic factors and health qi,he provided three therapeutic methods for surgical disease including resolving,expelling from within,and reinforcing.③ He created and improved some surgical operation and provide the new therapeutic way that expelling the pathogenic factor by opening and drainage.④ He also believed that invigorating and regulating spleen and stomach,harmonizing qi and blood should be put in the first place when treating disease.

Hepatitis A is one of the global public health problems,and China has high prevalence. In order to decrease the incidence of hepatitis A,China has integrated Hepatitis A vaccine into Expanded Program on Immunization (EPI) in 2007. The paper will provide some ideas on the immunogenicity and impact factors of the different types of hepatitis A vaccines that are used in China.

The pancreatic polypeptide (PP) cells of rat pancreatic islets were demonstrated by immunocytochemical method. The distribution and morphology of PP cells were investigated in order to observe their changes during postnatal development. At the lst day and 7th day of rat after birth, the PP cells of islets were different from that in adult, the processes of PP cells were not evident, and the immunoreactivity was weaker. In addition, the PP cells were also presented in the duodenum epithtlium. After 18th day, the distribution and morphology of the PP cells did not show obvious difference from that in adult. The percentage of PP cells of islets was less in lst day, and approximated to adult level in 18th day, and over adult level in 28 th day. The above changes of percentage of the PP cells showed mainly in islets in the head of pancreas. The changes of volume density and numerical density per area corresponded with the changes of percentage of the PP cells. Immunoelectron microscopic study showed that the secretory granules (SGs) and gold la belled particles on the SGs of the PP cells in 7th day were less than that in 28th day and adult. Based upon the morphology of the SGs, the PP cells can be classified into two types. The type Ⅰ cells contained SGs with medium electron density or empty-like cores, and larger SGs were more. The type Ⅱ cells contained SGs with lower electron density cores, and small SGs were more. The gold labelled particles in SGs in the type Ⅰ were more than that in the type Ⅱ. The results suggest that the PP cells of rat islets continue to change after birth.

Objective To explore the construction and application effects of extended care form for children with epilepsy based on Omaha System.Methods Based on Omaha System,the form was established by referring medical records,literature review and three rounds of focus group discussion.From February to June,2016,48 children with epilepsy were selected as the observation group and received routine care as well as management using the form based on Omaha System;from August to December,2015,48 children with epilepsy were selected as the control group and received routine care and follow-up.The effects of intervention and scores of Family Management Measure were compared between two groups.Results Nursing issues in all domains for the observation group 3 months after intervention were lower than those during hospitalization except financial situation (P＜0.05);there was statistically significant difference in scores of knowledge-behavior-status of main nursing issues before and after intervention except cognition and mental health items (P＜0.05).Duration of hospitalization,expenditure,readmission rate,EEG results and scores of FAMM in the observation group were better than those in the control group (P＜0.05).Conclusion The construction and application of the form based on Omaha System can provide references for longterm management for children.

Purpose There is no agreement for contrast enhanced ultrasound (CEUS) in differential diagnosis of benign and malignant thyroid nodules. This paper aims to evaluate the diagnostic value of the conventional and contrast-enhanced ultrasonography in the diagnosis of thyroid nodule by meta analysis. Materials and Methods Literature search was performed in PubMed, CNKI and Wanfang databases to identify relevant English and Chinese literatures by using pathological results as the gold standard from January 1990 to September 2014. The quality of each selected study was evaluated by QUADAS. The pooled weighted sensitivity, specificity and the corresponding 95% CI were calculated. Summary receiver operating characteristic curves (SROC), area under curve (AUC) and the Q* index were also calculated. Results A total of 14 literatures (1970 nodules) were included, the pooled weighted sensitivity and specificity of conventional ultrasonography were 0.74 and 0.70; those of contrast-enhanced ultrasonography were 0.86 and 0.82. The AUC by using the two methods were 0.84 and 0.93, respectively, and the Q* index were 0.77 and 0.86, respectively. Conclusion In the diagnosis of thyroid nodule, the accuracy of contrast-enhanced ultrasonography is better than conventional ultrasound; however, both of them have high clinical value in the diagnosis of thyroid nodule, thus they are helpful in avoidance of unnecessary surgical treatment in patients with thyroid disease.

In non-dialytic composite treatment of chronic renal failure, wheat (or corn) starch should be used for low protein (20-40 g/day) diet in substituting grains, to increase high biological value protein intake (about 50-70% of total protein intake). This principle has been used in 30 Patients (33 times) for 1-2 monthes. Daily total calorie intake should be maintained within 2000-3000 kcal. According to the status of the patient, EAA-TR2 (13.8 g/day I.V.) and other supporting measurements may be used for most patients. In all the patients, except six (2 cases useless, observation of 4 cases discontinued), uremic manifestations were ameliorated, nutritional status was improved and azotemia markedly alleviated, life span may be prolonged. According to nitrogen balance studied, in 6 cases it is indicated that nitrogen balance can be maintained if protein intake is not less than 0.5 g/kg/day (with sufficient calorie intake) for chronic renal failure patients (Cr clearance 5-10 ml/min).

In this paper the authors submitted their experience in application of video assisted thoracic surgery (VATS) in 204 cases at the surgical clinic of the General Hospital of PLA (Oct.1992 Jun.2002). A retrospective analytic study was carried out to assess the value of VATS in terms of the diseases and the surgical anesthesia, operation modes, complications and result. A satisfying result in the group was obtained in each of the cases. There was no operative mortality or morbidity. The mean operation time was 110 minutes, the overall median duration of chest tube drainage was 2 days, and the mean hospitalization time was 9 days. The postoperative recovery was uneventful. As a minimally invasive surgical technique with very low morbidity, VATS is worth considering and has been established as a procedure of choice with exceptional results in various chest diseases. Our experience confirms the safety of VATS in both diagnostic and therapeutic procedures. Due to progress over the past several years, VATS is by now a standard surgical procedure in thoracic surgery, and has become an inseparable part of thoracic surgery. There are differences of opinion with regard to major pulmonary and esophageal resections for cancer, thus further clinical investigation deserves to be carried out.

Combined pulsed-field gradient, shaped pulses, and product operator calculations (algorithm), two-dimensional 1 H-31 P hetero-nuclear multiple quantum coherence ( HMQC) pulse sequence was established with the aid of C language. The result showed that coherent transfer path selection could be achieved by adjusting the ratio of two gradient strength ( g1 , g2 ) . The best ratio of g1 and g2 was -5:4 . The HMQC method based on the above sequence can be used for identifying the alkyl groups coupling with phosphorous nucleus. For the different alkyl groups, the sensitivity of this method decreased in the order methyl>isopropyl>ethyl>propyl. The limit of detection was about 10 mg/L. This method can be directly used for the screening and identification of phosphorus chemical warfare agents and related compounds.

As the important content of excellent quality nursing service, the performance appraisal of nursing staff was closely interrelated to their income distribution, professional title promotion and excellence choosing. Performance appraisal was the requisite part of nursing resource management. This study gave an overview about conception and development of nursing staff′s performance appraisal and summarize key performance indicator,balanced score card,SMART principle and 360 degrees performance appraisal, which was mainly used in domestic hospital. It suggested nursing manager should have complementary advantages of them and utilize foreign mature methods to explore and improve our countries performance appraisal of nursing staff and formulate the system which was in keeping with China′s national conditions.

Objective To discuss the efficacy and security of entecavir and interferon sequential combination therapy on chronic hepatitis B.Methods 108 patients with chronic hepatitis B were randomly divided into the sequential combination therapy group,the entecavir group and the interferon group.Each group had 36 cases.The efficacy and security of different therapy were observed.Results The HBV DNA negative rate of the sequential combination therapy group was 77.78％,and the ALT normalization rate was 91.67％,which were both higher than those of the entecavir group and the interferon group(x2 =14.40,22.12,20.07,18.47,all P ＜ 0.05).The total effective rate of the sequential combination therapy group was 91.67％,which was obviously higher than that of entecavir group and the interferon group(x2 =12.09,6.82,all P ＜ 0.05).The entecavir and interferon sequential combination therapy had a good security.Conclusion Entecavir combined with interferon sequential therapy in the treatment of chronic hepatitis B had a significant clinical efficacy and deserved promotion.