By combing the development of tongue image,this paper analyzes the image features,advantages and disadvantages of different stages,and makes it clear that tongue image is an important carrier of clinical information of tongue diagnosis.It has been regarded as an important way to understand tongue image since the first monograph on tongue diagnosis.The article also analyzes the formation and development of modern digital and standardized tongue image,and explains the role and value of tongue image in the development of TCM tongue diagnosis terminology,providing reference for the formulation of international standards of TCM diagnosis terminology and the consensus reached by international experts.

Objective: To investigate the expression discordances of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor2 (HER-2) and Ki-67 in primary and metastatic breast cancer specimens and explore the clinical significances. Methods: Biopsies of metastatic lesions were performed in 203 patients with breast cancer recurrence and metastasis indicated by physical examination and/or imaging examination. We confirmed pathological properties and assessed the expressions of ER, PR, HER-2 and Ki-67 in primary and metastatic lesions, their relationships with prognosis were also analyzed. Results: Biopsy failed in 3 patients, the pathology and immunohistochemitry results of metastatic lesions were not obtained. One person was diagnosed as tuberculosis and another was primary lung cancer. Among the 198 cases of primary and metastatic lesions, the discordance rates of ER, PR, HER-2 and Ki-67 were 27.3%, 34.3%, 11.8% and 15.1%, respectively.The expressions of ER, HER-2 and Ki-67 were not significantly different between the primary and metastatic lesions, however, the expressions of PR were more likely to turn negative in the metastases (P<0.001). The disease-free survival (DFS) of patients with ER, PR positive, HER-2 negative and low expression of Ki-67 in metastatic lesion was much longer (P<0.05). Conclusions The expressions of ER, PR, HER-2 and Ki-67 in metastatic lesions are associated with the prognosis of breast cancer patients.Their expression discordances between primary and metastatic lesions can guide the treatment and evaluate the risks of recurrence and prognosis.

Objective To investigate the expression discordances of estrogen receptor ( ER), progesterone receptor (PR), human epidermal growth factor receptor2 ( HER?2) and Ki?67 in primary and metastatic breast cancer specimens and explore the clinical significances. Methods Biopsies of metastatic lesions were performed in 203 patients with breast cancer recurrence and metastasis indicated by physical examination and／or imaging examination. We confirmed pathological properties and assessed the expressions of ER, PR, HER?2 and Ki?67 in primary and metastatic lesions, their relationships with prognosis were also analyzed. Results Biopsy failed in 3 patients, the pathology and immunohistochemitry results of metastatic lesions were not obtained. One person was diagnosed as tuberculosis and another was primary lung cancer. Among the 198 cases of primary and metastatic lesions, the discordance rates of ER, PR, HER?2 and Ki?67 were 27.3%, 34.3%, 11.8% and 15.1%, respectively.The expressions of ER, HER?2 and Ki?67 were not significantly different between the primary and metastatic lesions, however, the expressions of PR were more likely to turn negative in the metastases (P＜0.001). The disease?free survival (DFS) of patients with ER, PR positive, HER?2 negative and low expression of Ki?67 in metastatic lesion was much longer ( P＜0.05). Conclusions The expressions of ER, PR, HER?2 and Ki?67 in metastatic lesions are associated with the prognosis of breast cancer patients.Their expression discordances between primary and metastatic lesions can guide the treatment and evaluate the risks of recurrence and prognosis.

Objective To investigate the expression discordances of estrogen receptor ( ER), progesterone receptor (PR), human epidermal growth factor receptor2 ( HER?2) and Ki?67 in primary and metastatic breast cancer specimens and explore the clinical significances. Methods Biopsies of metastatic lesions were performed in 203 patients with breast cancer recurrence and metastasis indicated by physical examination and／or imaging examination. We confirmed pathological properties and assessed the expressions of ER, PR, HER?2 and Ki?67 in primary and metastatic lesions, their relationships with prognosis were also analyzed. Results Biopsy failed in 3 patients, the pathology and immunohistochemitry results of metastatic lesions were not obtained. One person was diagnosed as tuberculosis and another was primary lung cancer. Among the 198 cases of primary and metastatic lesions, the discordance rates of ER, PR, HER?2 and Ki?67 were 27.3%, 34.3%, 11.8% and 15.1%, respectively.The expressions of ER, HER?2 and Ki?67 were not significantly different between the primary and metastatic lesions, however, the expressions of PR were more likely to turn negative in the metastases (P＜0.001). The disease?free survival (DFS) of patients with ER, PR positive, HER?2 negative and low expression of Ki?67 in metastatic lesion was much longer ( P＜0.05). Conclusions The expressions of ER, PR, HER?2 and Ki?67 in metastatic lesions are associated with the prognosis of breast cancer patients.Their expression discordances between primary and metastatic lesions can guide the treatment and evaluate the risks of recurrence and prognosis.

OBJECTIVE: To investigate the current status of quality of working life( QWL) among medical staffs in Minhang District,Shanghai City,and to explore the relationship between QWL and occupational stress. METHODS: A stratified sampling method was used to select 522 medical staffs in Minhang District,Shanghai City. The QWL and occupational stress were assessed using the Quality of Working Life Scale and the Effort-Reward Imbalance Questionnaire,respectively.RESULTS: The total score of QWL of medical staffs was( 97. 7 ± 13. 8),and the detection rate of high occupational stress was34. 7%( 181/522). The total QWL score of medical workers in the high occupational stress group was lower than that in the low occupational stress group( P < 0. 01). The results of multivariable logistic regression analysis showed that occupational stress and average weekly working time were risk factors of reduction in QWL( P < 0. 01). CONCLUSION: Occupational stress is the influencing factor of QWL. The increased occupational stress may reduce the QWL of medical personnel.

Objective: To investigate the relationship between workplace bullying and posttraumatic stress disorder (PTSD) in nursing staff, and to analyze the role of psychological capital between workplace bullying and PTSD. Methods: From December 2014 to June 2015, convenience sampling was used to collect 496 nurses from 5 grade A tertiary hospitals in a province of China. Their workplace bullying, psychological capital, and PTSD status were assessed using the Negative Acts Questionnaire, Psychological Capital Questionnaire, and Posttraumatic Stress Disorder Self-Rating Scale, respectively. The correlation between variables was analyzed using a structural equation model. Results: Among these nurses, the scores of negative acts, psychological capital, and PTSD were 37.15±12.83, 78.81±16.54, and 34.56±12.52, respectively. The score on each dimension of negative acts was positively correlated with that on each dimension of PTSD (P<0.01) ; the score on each dimension of psychological capital was negatively correlated with that on each dimension of PTSD and negative acts (P<0.01). Negative acts had a positive predictive effect on PTSD (β=0.539, P<0.01) , which was reduced after inclusion of psychological capital (β=0.513, P<0.01). The path coefficient was 0.62 for the effect of negative acts on PTSD, -0.18 for the effect of negative acts on psychological capital, and -0.11 for the effect of psychological capital on PTSD (P<0.05) . Conclusion Workplace bullying is a predictive factor for PTSD, and psychological capital plays a mediating role between workplace bullying and PTSD. The manager should reduce workplace bullying to improve the psychological capital in nursing staff and to prevent and reduce PTSD.

Objective To explore facial characteristics of patients with different organ diseases; To provide some references for objective study on TCM inspection information. Methods Smart TCM-I type Life Information Analysis Systems was used to detect facial characteristics of 510 patients with five zang-organs diseases. 36 specific quantitative parameters including red ?, green (G), blue (B) and hue (H), saturation (S), value (V) of the face, forehead, eyes, cheeks, nose and chin were collected, and the Kruskal M-Wallis H and Nemenyi test were used for statistical analysis. Results Among the 510 patients with five zang-organs diseases, 96 patients belonged to lung system diseases, 105 heart system diseases, 101 liver system diseases, 107 spleen and stomach system diseases and 101 kidney system diseases. There was statistical significance in R, G, B, H, S, and V in forehead, eyes, cheeks and nose. Conclusion Facial characteristics can provide objective references for the facial division of five zang-organs diseases.

Objective To explore the relationship between posttraumatic stress disorder and nurses′ psychological capital. Methods By convenient sampling, totally 550 nurses in 5 first-class upper level general hospitals in Zhejiang province were investigated by the posttraumatic stress disorder (PTSD)Cheeklist-Civilan Version (PCL-C) and Nurses Psychological Capital Questionnaire Revision (NPCQR), and the results were analyzed. Results 18.35%investigated nurses showed a certain degree of PTSD symptoms and 13.71% showed obvious PTSD symptoms. The positive rate was 32.06%.The overall score of nurses′psychological capital was 78.81 ± 16.54, which was in the middle level, and the dimension scores from high to low were self-efficacy (23.80±5.35), hope (23.36±5.24), resilience (19.66 ±4.29), and optimism (11.99 ± 3.21). The nurses′psychological capital had a negative effect on posttraumatic stress disorder (P<0.01). Conclusions Psychological capital of nurses is a negative predictor of PTSD symptoms, which suggested that managers should pay more attention to the development of nurses′psychological capital to reduce and prevent the occurrence of posttraumatic stress disorder,then to improve nursing service quality.

The number of people with type 2 diabetes mellitus (DM) is increasing every year,and the proportion of patients with digestive cancer is also increasing.At present,more and more studies have found that digestive system cancer is associated with type 2 diabetes.This paper reviewed the recent ten years of domestic and foreign researchers using meta-analysis in the study of type 2 diabetes and digestive system cancer outcomes.It suggested that type 2 DM has certain negative effects on the occurrence and prognosis of digestive system cancer.Its influence and mechanism still needs further study through a variety of methods.

This study mainly explored the pulse parameters in children with RRTI with different TCM syndromes,aiming at providing therapeutic indexes and objective basis for its diagnosis and treatment.Three hundred and forty-eight cases of RRTI were divided into five groups,including the group of qi deficiency in the lung (or Fei Qi Xu,FQX),the group of invasion of the lung by wind-heat (or Feng Re Fan Fei,FRFF),the group of invasion of lung by wind-cold (or Feng Han Fan Fei,FHFF),the group of obstruction of phlegm-damp in the lung (or Tan Shi Zu Fei,TSZF) and the group of obstruction of phlegm-heat in the lung (or Tan Re Yong Fei,TRYF).65 children of good health were involved in the control group.Z-BOX pulsemeter apparatus was applied to the paraticipants for analyzing their pulse parameters.As a result,it was found that values of h1,h3,h4,h5,t and h4/h1 of RRTI children decreased,compared with the children of good health (P ＜ 0.01);while h1,h3,h4 and h5 of children in FQX group declined (P ＜ 0.01);and the values of h4,h5,t,w,h3/h1,h4/h1 and h5/h1 of children in FRFF group went down (P ＜ 0.01);while the values of h1,h3,h4,h5,t,w,h3/h1 and h4/h1 of TRYF group fell (P ＜ 0.01);and those of h5,t and h5/h1 of children in FHFF group decreased (P ＜ 0.01).Compared with FQX group,h1 value of FRFF group increased (P ＜ 0.01),while the values of w,h3/h1,hs/h1 and w/t of FRFF group declined (P ＜ 0.01);and the h1 value of TSZF group boosted (P ＜ 0.01),while the value of w and h3/h1 of TRYF group decreased (P ＜ 0.01);and the h5/h1 value of FHFF group fell (P ＜ 0.01).In comparison with FRFF group,the values of t,w and h5/h1 of TSZF group went up (P ＜ 0.01),while the values of h1 and h3 of TRYF group declined (P ＜ 0.01).In comparison with TSZF group,the values of h3,h4,t and w of TRYF group went down (P ＜ 0.01),and the t value of FHFF group decreased (P ＜ 0.01).In conclusion,the pulse parameters of RRTI children can be recognized as objective indicators for TCM syndrome differentiations.