Objective To explore the medical characteristics of end of-life care in elderly inpatients for improving their quality life and distributing appropriately the end-of-life medical expenditure.Methods The historical cohort study was used to survey the characteristics of admission disease,diagnosis and treatment and hospitalization expenditure.The patients were divided into the elderly group (age 60 years and over,228 cases) and control group (age ＜60 years,156 cases).Results There was a statistically significant difference in the admission disease proportion between elderly group and control group (x2 =91.345,P ＜ 0.0001),but the malignant tumor proportion had no differences between the two groups (x2 =9.761,P=0.082); the operation proportion in elderly group (16 cases,7.0％) was lower than in control group (28 cases,17.9％) ; the hospital stay time was longer in elderly group (12.5 days) than in control group (5 days),and the salvage times of elderly group (3 times)was more than that of control group,but the usage of medical device had no differences between the two groups (x2 =0.029,P =0.864).The hospitalization expenditure,medicine expenditure,western medicine expenditure,traditional Chinese medicine expenditure,and medicine proportion were higher in elderly group (15356.0 yuan,6448.3 yuan,5070.0 yuan,895.5 yuan,40.2％,respectively) than in control group.Conclusions Most of the elderly patients with chronic diseases at the end of life have no indication of operation and rely on medicine to maintain life for a long time,and the end-of-life medical expenditure is higher.

Objective To observe the effect of Jiawei Siwu Decoction for idiopathic thrombocytopenic purpura (ITP) on the effi‐cacy and immune aspects of the model mice .Methods We used guinea pig anti mouse platelet serum immune IT P model ,then con‐duct the corresponding drug treatment .The mice were observed in peripheral blood ,bone marrow changes of nuclear cell count ,ser‐um IL‐6 content and changes in the spleen index .Results Compared with the model group of physiological saline of peripheral blood WBC ,prednisone group and Chinese medicine group PLT count ,bone marrow nucleated cell counts were significantly elevated (P<0 .01) ,the content of IL‐6 in serum were increased significantly (P<0 .01) ,no difference between the two treatment groups . Thymus and spleen index increased too (P<0 .05) .Conclusion Jiawei Siwu Decoction may be related to the regulation of cellular immunity ,increased serum IL‐6 content ,improve bone marrow hematopoietic microenvironment to achieve therapeutic effects in the ITP mice .

BACKGROUND: To apply mouse anti-human cTnI monoclonal antibody as the drug vector in the treatment and diagnosis of myocardial injury, it is important to degrade the immunity of murine antibody and overcome human anti-mouse reaction. Humanization has been applied as an attempt to resolve this problem.OBJECTIVE: To clone murine anti-cTnI Fab fragment and analyse the nucleotide and deduced amino acid sequences.DESIGN: Single sample study.SETTING: An institute of cardiovascular disease under a medical university-affiliated hospitalMATERIALS: The study was conducted in the Institute of Cardiovascular Diseases, First Affiliated Hospital of Nanjing Medical University from January 2003 to May 2004. The hybridoma cell line JS200202 which secrets the anti-cTnI monoclonal antibody was provided by Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University.METHODS: IgG heavy chain primers and κ light chain primers of amplified mouse were designed. Total RNA was extracted from hybridoma cells which secrete cTnI. Reverse transcription polymerase chain reaction(RT-PCR) was amplified. Cloning and subsequent sequence analysis of the Fab fragment was performed. The deduced amino acid sequence was compared and analysed with previously published sequences.MAIN OUTCOME MEASURES: Heavy chain Fd segment and κ light chain gene sequence and its subgroups.RESULTS: A band of approximate 700 and 800 base pairs were amplified using IgG heavy chain primers and κ light chain primers respectively. Sequence analysis indicated that the deduced amino acid sequences were in consistent with the characterization of the amino acid in the murine IgGl Fab fragment(GenBank accession NO AY484430, AY484431; Protein Bank accession NO AAR83243, AAR83244).CONCLUSION: A complete murine anti-cTnI Fab fragment was obtained in this study, which may provide basis for the production of the chimeric anti-cTnI antibody.

Objective:To evaluate the relationship between red blood cell distribution width (RDW) and metabolic syndrome (MS) in patients with impaired glucose tolerance (IGT).Methods:A total of 415 patients with abnormal glucose tolerance were screened by oral glucose tolerance test in Changsha Traditional Chinese Medicine Hospital (Changsha Eighth Hospital) from October 2015 to September 2019. General data were collected and blood routine and biochemical indexes were detected. There were 193 cases in the observation group and 222 cases in the control group. The RDW and other clinical indicators were compared between the two groups, the correlation between RDW and other indicators was analyzed, and the risk factors of metabolic syndrome were analyzed.Results:⑴ The RDW, systolic blood pressure (SBP), diastolic blood pressure (DBP), height (Ht), weight (Wt), waist circumferenc (Wc), triglyceride (TG), cholesterol (CHOL), low density lipoprotein (LDL), creatinine (Cr), uric acid (UA), alanine aminotransferase (ALT), high sensitive C-reactive protein (hs-CRP), body mass index (BMI) of the observation group were significantly higher than those of the control group, while the high density lipoprotein (HDL) was significantly lower than that of the control group, with statistically significant difference ( P<0.05); ⑵ correlation analysis showed that RDW was positively correlated with SBP, DBP, Ht, Wt, Wc, TG, CHOL, Cr, UA, ALT, hs-CRP, BMI, and negatively correlated with HDL ( P<0.05); ⑶ binary logistic regression analysis showed that RDW, Wt, Wc, CHOL, HDL, LDL and hs-CRP were independent risk factors for MS in patients with impaired glucose tolerance. Conclusions:The increase of RDW is a predictor of metabolic syndrome in people with abnormal glucose tolerance, which may provide some reference value for the prevention and treatment of metabolic syndrome.

Based on SWOT analysis and relevant information about the premarital healthcare services through on-site survey and literature research , this paper systematically analyzed the Strengths , Weaknesses , Opportunities and Threats of “one-stop” premarital healthcare services .It also puts forward some strategic suggestions on premarital healthcare services in China including enhancing communication and cooperation between the related national minis -tries and commissions , building a government-led multi-sectoral coordination mechanism , increasing the resource in-vestment , promoting the premarital health care service and pre-pregnancy physical examination integration , and strengthening publicity and mobilization of “one stop” service for premarital healthcare service policy recommenda-tions to provide a basis for decision-making in the promotion of the policy-related works .

OBJECTIVE: To investigate the characteristics of syndromes of phlegm and blood stasis in patients with coronary heart disease by multiple statistical methods of matching matrix, factor analysis and clustering analysis, and to provide some references for classification and normalization of diagnosis of syndromes of phlegm and blood stasis of coronary heart disease. METHODS: The correlations among 46 kinds of symptoms in syndrome of non-phlegm and non-blood stasis, syndrome of blood stasis, syndrome of phlegm and syndrome of phlegm-blood stasis blocking in 200 patients with coronary heart disease were analyzed by matching matrix, factor analysis and clustering analysis. RESULTS: The manifestations of tongue and pulse in syndromes of phlegm and blood stasis were significantly different from those in syndrome of non-phlegm and non-blood stasis. The pathogenesis of viscera in syndromes of phlegm and blood stasis lied in the heart and kidney, and the syndrome of deficiency of heart qi was the most common one while the syndrome of deficiency of kidney qi took the secondary place. The syndrome of phlegm was often accompanied by syndrome of deficiency of spleen qi. Only 15 ones of 46 clinical symptoms showed high frequency in concomitant appearance in syndrome of blood stasis, syndrome of phlegm and syndrome of phlegm-blood stasis blocking. Apart from having the common symptoms in syndrome of deficiency in origin, the syndrome of phlegm especially showed white and greasy fur and slippery pulse as well as distention and fullness of chest and abdominal distension; the syndrome of blood stasis showed purplish tongue and ecchymosis on tongue as well as fixed pain; and the syndrome of phlegm-blood stasis blocking showed the main symptoms of both syndrome of phlegm and syndrome of blood stasis. CONCLUSION: The statistical methods of matching matrix, factor analysis and clustering analysis are convenient, and can definitely indicate the clinical characteristics and syndrome differentiation of viscera of different syndromes of phlegm and blood stasis, which are beneficial to further research of diagnosis and differentiation of such syndromes of coronary heart disease.

OBJECTIVE: To explore the relationship between polymorphism of apolipoprotein E (ApoE) exon 4 gene and different syndromes in patients with coronary heart disease (CHD). METHODS: Two hundred patients with CHD were divided into four groups according to syndrome differentiation, including syndrome of phlegm (PS), syndrome of blood stasis (BSS), syndrome of phlegm-blood stasis blocking (PBBS) and syndrome of non-phlegm and non-blood stasis (NPNBS). One hundred healthy volunteers were included in control group. Blood lipids were measured by routine examination. Total DNA of peripheral blood was extracted. ApoE genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. All data were analyzed by SAS software. RESULTS: (1)The occurrence rate of epsilon4 allele of ApoE in patients with CHD was 19.5%, significantly higher than 9.5% in the control group (P<0.05), and the E 3/4 genotype was especially more frequent (P<0.01). (2) The levels of total cholesterol (TC), total triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) in patients with epsilon4 were higher than those in patients without epsilon4 (P<0.01). (3) The frequencies of epsilon4 allele and E3/4 genotype in patients with PS were significantly higher than those in patients with BSS (P<0.05). CONCLUSION: ApoE epsilon4 allele, especially E3/4 genotype, is the risk factor of CHD. There is a relatively close relationship between patients with ApoE epsilon4 allele and PS. It may be one of the main susceptible genes in CHD patients with PS.

Objective: To summarize the different cardiac shunt presentation in right heart contrast echocardiography and to clarify its clinical value for diagnosing the patients with congenital heart disease (CHD).
Methods: We retrospectively analyzed 102 patients who received right heart contrast echocardiography in our hospital from 2006 to 2014. The contrast media was the hand-vibrated mixture of 9 ml 50% glucose solution with 1 ml air.
Results: There were 49/102 patients with abnormal blood shunt detected including 8 patients of atrial septal defect (ASD) with right to left or dual shunt, 7 of ASD with left to right shunt, 9 of patent foramen ovale (PFO) with functional right to left shunt, 13 of patent ductus arteriosus (PDA) combining pulmonary arterial hypertension, 3 of pulmonary arteriovenous ifstula (PAVF), 9 patients with persistent left superior vena cava (PLSVC) and 8 of them drain to coronary vein sinus, 1 drain to left atrium.
Conclusion: Right heart contrast echocardiography may simply and effectively detect abnormal blood shunt in patients combining pulmonary arterial hypertension and improve the diagnostic accuracy of CHD.

Objective:To discuss the effects of premarital health care services on birth defects in order to pro-vide some references for promoting the premarital policy .Methods: The rate of premarital healthcare and the inci-dence of birth defects and other relevant data during the period from 2000 to 2014 were collected in Guangxi province using SPSS18 .0 statistical software to carry out descriptive analysis , rank correlation analysis and time series analysis of the relevant collected data .Results: With the increase in premarital healthcare rate , the incidence of birth de-fects, neural tube defects , cleft lip and fetal edema syndrome decreased .Having a premarital subsequent effect , the higher the premarital healthcare rate , the lower of the incidence of the congenital heart disease and neural tube de-fects in the next year .Conclusion:The premarital healthcare services play an important role in reduction of birth de-fects and people's health quality improvement .As a suggestion , more attention should be paid to premarital health-care services and strengthen them , intended to improve people's health and reduce birth defects incidence .

With the universal two-child policy implementation, the birth rate increased, posing challenges to pediatrician allocation. Based on the birth rate, we calculated pediatrician demands and gaps during the period from 2016 to 2020 by the method of health service demand. The results showed that except Beijing and Shanghai, the ped-iatrician supply and demand ratios are less than 0 . 80 and additional numbers of pediatricians ranging from 191 981 to 198 287 are needed to meet the service demands. We recommend increasing the number of pediatricians taking both national supply-demand ratios and gaps by rationally using reasonable enrolment quota and improving the treatment and other reasonable ways to increase pediatricians. In addition, we should enhance information disclosure and guid-ance, and improve the hierarchical hospital visit system to alleviate the pressure of big cities.