This article aimed to summarize the clinical experience of treating sjögren's syndrome of yin-deficiency and heat-toxin type based on the theory of exuberance of shaoyang ministerial fire accumulating to heat toxin. It is believed that sjögren's syndrome of yin-deficiency and heat-toxin type is attributed to dysfunction of shaoyang gallbladder， disruption in the circulation of sanjiao， stagnation of qi leading to fire， and prolonged accumulation of toxins causing damage. The core disease mechanism involves shaoyang dysfunction， hyperactivity of ministerial fire， and accumulation of heat toxins. In clinical practice， the therapeutic principles focus on regulating shaoyang， stabilizing and subduing ministerial fire， enriching yin and resolving toxins. For shaoyang dysfunction with internal stagnation of heat toxins， treatment should aim to unblock shaoyang， clear fire and expel toxins， using modified Sangchai Decoction （桑柴饮）； for shaoyang transformation into fire with symptoms of wood （the gallbladder） disease， the approach involves soothing and regulating gallbladder， clearing heat and resolving toxins， using modified Chaihu Shaoyao Decoction （柴胡芍药汤）； for disordered ministerial fire with excessive heat toxins， the strategy is to rescue the sovereign fire and stabilize the ministerial fire， employing modified Xinshen Liangjiao Decoction （心肾两交汤）； for unregulated ministerial fire with disordered distribution， treatment focuses on increasing body fluids and nourishing yin， stabilizing the ministerial fire， using modified Buyin Decoction （补阴汤）.

Objective:To explore the relationship between different gestational weeks of transvaginal ultrasound-guided fetal reduction and abortion in patients with multiple pregnancies after embryo transfer, and to seek the best gestational age for fetal reduction.Methods:The datas of 486 pregnant women with multiple pregnancies after embryo transfer in the Second Hospital of Hebei Medical University from January 2012 to December 2020 were retrospectively analyzed. The relationship between gestational weeks of fetal reduction and abortion rate was analyzed by curve fitting, threshold effect and multivariate logistic regression analysis.Results:After adjusting for age, infertility type, infertility years, number of births, abortion times, body mass index(BMI), various infertility and sterility factors, endometrial thickness on the day of transformation, monozygotic twins and reduction methods, when the gestational age was less than 8.43 weeks, the abortion rate increased significantly with the increase of reduction gestational age, and the abortion rate increased by 221% ( OR=3.21, 95% CI=1.47-6.99, P=0.003 3). When the gestational age of reduction ≥8.43 weeks, the abortion rate tended to be stable and did not increase ( OR=0.81, 95% CI=0.54-1.22, P=0.317 7); meanwhile, in stratified analysis, the OR value of the BMI ≥24 kg/m 2 was 12.38, and that of BMI <24kg/m 2 was 1.91, P=0.053 9. Conclusions:There is a non-linear relationship between gestational age and abortion rate of ultrasound-guided multiple pregnancy reduction in patients with embryo transfer. The abortion rate increases significantly with the increase of gestational age before 8.43 weeks of gestation. It is recommended to carry out the operation as early as possible before 8 weeks of pregnancy. The effect of BMI on the abortion rate of patients with fetal reduction needs further study.

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis. The high incidence rate, drug resistance rate and mortality rate of TB infection cause serious social and economic burden in developing countries. Due to high occupational exposure, medical institutions and healthcare workers take the potential risk of TB infection, which have negative impact on the public health and occupational health. As one of the countries with high burden of TB in the world, the occupational exposure of healthcare workers in China is serious, and the infection rate is far higher than that of developed countries. This article reviews the prevalence of latent tuberculosis infection among health care workers and the status quo of occupational protection in medical institutions in China.

Objective To investigate the distribution of gross α and gross β levels of centralized drinking-water of township in Beijing from 2018 to 2019, so as to carry out better monitoring and evaluating the radioactivity in water. Methods A total of 215 underground drinking water samples were collected from 12 districts of Beijing, then monitored and evaluated according to the Determination of gross alpha activity in water-thick source method EJ/T 1075—1998 and Determination of gross beta activity in water-evaporation method EJ/T 900—1994. Results The gross α level of centralized drinking water of township in Beijing was 0.050 (0.052) Bq/L, ranging from 0.001 to 0.210 Bq/L, and the gross β level was 0.048 (0.038) Bq/L, ranging from 0.002 to 0.261 Bq/L from 2018 to 2019. Gross α and gross β levels of all samples did not exceed the guidance value recommended by standards for drinking water quality. There was no significant difference in the distribution of gross α and gross β levels of samples of all districts from 2018 to 2019(P > 0.05), there were significant differences in the distribution of gross α and gross β levels of samples from different district in the same period (P < 0.05). And the levels of Miyun, Huairou and Shunyi in Chaobai River system were higher than other districts. Conclusion The distribution of radioactive background of centralized drinking-water of township in Beijing was mastered, which was in the normal range.

Objective:To explore the reasons why patients with severe mental disorders and their family members refuse to participate in the community management and treatment service network.Methods:Totally 12 patients with severe mental disorders hospitalized and 7 family members in a ClassⅢ Grade A psychiatric hospital in Chengdu between January and May 2018 received semi-structural interviews using descriptive qualitative research methods. The content analysis and Nvivo 10.0 were used to organize and analyze the interview materials.Results:The five themes that affected refusal of patients with severe mental disorders and their family members to participate in the community management and treatment network were: poor perception of the patients, which covered the sub-themes of insufficient awareness of severe mental disorders and incorrect understanding of the community management and treatment service network; negative emotions of the patients and their family members, including the sub-themes of severe feelings of stigma and lack of trust; the patients and their family members actual needs were not met; the introverted personality traits of the patients; the decision-making game between the patients and the main caregiver of the family.Conclusions:Strengthening publicity, fully protecting the privacy of the patients, eliminating doubts, building a professional psychiatric prevention team, providing a diverse community management and treatment service network, and grasping the relevant drivers for the patient's refusal to participate in the community management and treatment service network can help enhance the enthusiasm of patients with severe mental disorders and their family members to participate in the community management and treatment service network.

Objective To investigate the associations of variants in signal transducer and activator of transcription 4 (STAT4) in Chinese Han population with rheumatoid arthritis (RA). Methods The study was performed in 228 RA cases and 228 controls. Haplotypes from the HapMap database Chinese population were used to select tag-single-nucleotide polymorphisms (SNPs) (r2=0.9) in STAT4 gene. Twenty-three SNPs located in STAT4 gene were examined by multiplex polymerase chain reaction (PCR) and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The Hardy-Weinberg equilibrium (HWE) was tested by a chi-square and Fisherˊs analysis. Differences in genotypes of the STAT4 polymorphism variants were evaluated using a Chi-square test. All statistical analyses were done with Haploview 4.1 software. Results Significant difference was detected in three SNPs (rs11685878, rs129888 and rs16833437) in allele frequencies analysis (χ2=6.014 8, 4.024 8, 5.539 1, P<0.05). Association was detected for three SNPs (rs11685878, rs16833437 and rs12988825) in genotype analysis ( χ2=6.814 9, 6.098 7, 6.691 7, P<0.05). Conclusion STAT4 may associate with susceptibility in Chinese Han population.

Objective To examine the cytokeratin expression in cervical lymph nodes of patients with mandibular gingival squamous cell carcinoma and its clinical significance.Methods The data of 42 cases with mandibular gingival squamous cell carcinoma after operation from July 2009 to December 2012 were included.Forty-two patients (male=27,formale=15) were included,with a mean age of 54.1 years (range 27-77).The lesions were staged(stage Ⅰ:9,stage Ⅱ:16,stage Ⅲ:6,stage Ⅳ:11).The cervical lymph nodes were examined by immunohistochemistry and HE.The cytokeratin expression in the lymph nodes was analyzed.Results The rates of lymph nodes metastasis detected by routine HE staining,serial sections HE staining and IHC were 8.0％(47/585),9.6％(56/585) and 12.8％ (75/585),respectively.There was significant difference (x2=7.17,P＜0.01) in the diagnosis of lymph nodes metastasis between IHC and routine HE staining,There was no significant difference between IHC and serial HE staining (x2=3.10,P＞0.05).Metastasis occurred mainly in the Level Ⅰ,Ⅱ and Ⅲ.Nineteen lymph nodes in 12 patients were found micrometastasis with IHC.Serial sections and routine HE staining did not find micrometastasis.Conclusions CK markers is sensitive in detecting lymph node metastasis of mandibular gingival squamous cell carcinoma.

Objective To evaluated the sexual psychology changes and marriage quality for ovarian cancer patients after operation and supply selective psychological nursing intervention for patients and their family members.Methods Self-designed questionnaire was used to investigated ovarian cancer patients under 60 years old one month after operation to understand the sexual psychology changes and its related factors.Nursing intervention was adopted according to different conditions of patients.Results Factors that influenced the sexual psychology of patients included:age,education degree,chemotherapy process,clinical symptom,anxiety and depression status,marital status and degree of nursing intervention.Conclusions Sexual psychology Was influenced by many factors.We should adopt various kinds of nursing intervention to promote the physical and mental health of patients,facihtate the recovery of sexual function and improve their life quality.