Based on spleen deficiency-phlegm dampness as the core pathogenesis of obesity， and integrating recent advances in modern medicine regarding the key role of immune inflammation in obesity， this paper proposes a multidimensional pathogenic network of "obesity-spleen deficiency-phlegm dampness-immune imbalance". Various traditional Chinese medicine （TCM） herbs that strengthen the spleen， regulate qi， and resolve phlegm and dampness can treat obesity by improving spleen-stomach transport and transformation， promoting water-damp metabolism， and regulating immune homeostasis. This highlights immune inflammation as an important entry point to elucidate the TCM concepts of "spleen deficiency-phlegm dampness" and the therapeutic principle of "strengthening the spleen and eliminating dampness to treat obesity". By systematically analyzing the intrinsic connection between "spleen deficiency generating dampness， internal accumulation of phlegm dampness" and immune dysregulation in obesity， this paper aims to provide theoretical support for TCM treatment of obesity based on dampness.

Objective: To observe the clinical effect of Quyu-Huatan decoction combined with noninvasive positive pressure ventilation in treatment with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type. Methods: A total of 64 patients with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type were divided into observation group and control group according to the random number table method, with 32 cases in each group. The control group received routine clinical treatment combined with noninvasive positive pressure ventilation, while the observation group was treated with Quyu-Huatan decoction on the basis of the control group. After 4 weeks of treatment, the polysomnography (PSG) index (the apnea hypopnea index, AHI, the Oxygen saturation, SaO₂, the pulse pressure, PP, the longest apnea time), the degree of lethargy (Epworth sleepiness scale, ESS), the quality of sleep (Pittsburgh sleep quality index, PSQI) and the quality of life (Calgary mass index of life quality index, SAQLI) before and after the treatment of two groups were observed, and the clinical effect was compared. Results: The total effective rate of the observation group was 87.5% (28/32), which was significantly higher than that 68.8% (22/32) of the control group (Z=-3.187, P=0.000). After treatment, the AHI (8.59 ± 0.93 times/h vs. 18.62 ± 2.44 times/h, t=5.735), the PP (35.96 ± 4.02 mmHg vs. 43.33 ± 4.70 mmHg, t=5.083) and the longest apnea time (11.93 ± 1.86 s vs. 17.94 ± 2.43 s, t=4.863) of the observation group were significant lower than those of the control group (P<0.05), while the SaO2 content (93.07% ± 10.03% vs. 82.36% ± 9.37%, t=5.812) of the observation group were significant higher than those of the control group (P<0.05). After treatment, the ESS (5.33 ± 0.33 vs. 8.73 ± 0.96, t=4.682) and the PSQI (2.25 ± 0.31 vs. 5.68 ± 0.77, t=4.872) of the observation group were significant lower than those of the control group (P<0.05), and the SAQLI (6.12 ± 0.59 vs. 4.36 ± 0.53, t=4.631) of the observation group were significant higher than those of the control group (P<0.05). Conclusions The application of Quyu-Huatan decoction combined with noninvasive positive pressure ventilation in treatment with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type can improve sleep disordered breathing, relieve drowsiness, and improve sleep quality and quality of life.

Objective To analyse the influencing factors diagnosed by the virtual touch tissue quantification (VTQ) technology on the hardness of papillary thyroid carcinoma (PTC).Methods From May 2011 to March 2014,a total of 266 PTCs in 266 patients confirmed by pathology were enrolled in Shanghai Tenth People's Hospital.The shear wave velocity (SWV) values of PTCs were measured by VTQ.PTCs were divided into 2 groups including SWV ≥ 2.87 rn/s and SWV ＜ 2.87 rn/s.The x2 test was used to compare the basic clinical data,ultrasound features and immunohistochemical results between 2 groups.The influencing factors of SWV values of PTCs were analyzed by forward stepwise Logistic regression analysis.Results Of the 266 PTCs,183 were SWV ≥ 2.87 m/s and 83 were SWV ＜ 2.87 m/s.The x2 test showed that the ultrasound features of PTCs such as single or multiple,with or without central lymph node metastasis,location,size,shape,with or without posterior acoustic attenuation,with or without calcification,with or without capsule invasion,whether close to the trachea between the 2 groups were significant different (x2=4.233,4.740,9.910,4.988,4.416,4.737,7.154,8.559,all P ＜ 0.05 or 0.01).Logistic regression analysis demonstrated that nodules were single or multiple,location,with or without posterior acoustic attenuation,with or without calcification,whether close to the trachea were influencing factors of SWV value of PTCs.The regression equation was defined as Y=-2.507 + 0.670X1 (nodules were single or multiple) + 0.800X3 (location of nodules) + 0.851X6 (with or without posterior acoustic attenuation) + 0.628X7 (with or without calcification) + 1.106X9 (whether close to the trachea).Conclusions Multiple nodules,central lymph node metastasis,located isthmus,nodules size ＞ 10 mm,irregular shape,posterior acoustic attenuation,calcification,capsule invasion,close to the trachea were correlated with the diagnosis of PTC by VTQ technology.The more characteristics of nodules appeared,such as multiple nodules,located isthmus,posterior acoustic attenuation,calcification,close to the trachea,the harder PTCs were.

Objective To explore the development situation of hospital nursing assistants in certain regions of China in order to provide reference and evidence for improving the professional standardization management of nursing assistants .Methods Used questionnaire survey to investigate and analyze 538 nursing assistants'social demographic characteristics , education training , welfare, working conditions and degree of satisfaction.Results In the surveyed sample, 87.9% respondents were female nursing assistants; and 53.0%aged 40 to 49;78.3% came from rural area;73.6% only received middle school education or had lower education background.The nursing assistants who participated in pre-service training accounted for 96.5%, who participated in professional qualification training accounted for 31.4%, and only 15.1% had certification.The average monthly income of nursing assistants was 1902.5 RMB, but only 9.8%respondents had insurance and housing fund.41.4% nursing assistants had average daily working time longer than 8 hours.The highest proportion work done by nursing assistants was sorting and replacing the bed unit and personal items (92.3%), while the lowest percentage work was measuring axillary temperature for patients (26.3%).50.3% nursing assistants once had the idea of changing career, and 50.8% respondents'relatives and friends had a general thought or disagreed to their profession.In the sample, the satisfaction degree of the income and welfare was the lowest (43.1%).Conclusions Nursing assistants were almostly middle-aged women,who were normally without higher education and enough training .They did intensive work while received very low income;the service range provided by them was limited , too; and the stability of the team and occupation identity were poor.