Eighty-five elderly patients treated for the upper gastrointestinal bleeding(UGB)in our hospital between January 2000 and December 2002 were divided into death or survival group.Their clinical characteristics,risk factors,treatment and complications were retrospectively analyzed.Eighteen patients died of UGB within 30 days.Univariate analysis indicated that documented diabetes,cardiovascular disease,cerebrovascular disease,gastric ulcer,hemoglobin,arrhythmia,stomach cancer,multiple organ dysfunction syndrome(MODS),and shock were significantly associated with inhospital mortality within 30 days(P＜0.05 or P＜0.01).Stomach cancer,MODS,and shock entered into the Logistic regression model.These findings demonstrate that stomach cancer,MODS,and shock might be independent risk factors for short-term prognosis in elderly UGB patients.

This paper presents a measurement which determines the CO2 concentrations in the patient's respiratory gases with G C during intravenous anesthesia.The method is simple, unexpensive, and its results are reliable. It is useful to detect the patients respiration, and to monitor oxygen supply after operation.

OBJECTIVE:To explore the development ofMedical support integrationservice mode under theHealthy China 2030development strategy. METHODS:The development experience ofMedical support integrationservice mode in developed countries like the United States,Australia,Japan,Germany and Sweden were summarized,and its enlightenment to China was ana-lyzed. RESULTS&CONCLUSIONS:In the United States,comprehensive services for the elderly was main project;Australia made full use of the third party platform to guarantee the reasonable operation of theMedical support integrationservice mode;Japa-nese health services for the elderly was taken by the combination of nursing insurance system with universal medical insurance sys-tem;Germany and Sweden encouragedHome careservice mode. Based on the advanced experience of foreign countries,com-bined with Chinese national conditions,ChineseMedical support integrationservice mode should adhere to the leading position of the government,introduce market competition mechanism,formulate strictMedical support integrationservices access stan-dards,and actively cultivate professional nursing staff,so as to achieve long-term development.

With the silver wave struck,China has becone the only country entered the elderly population country with lower income.How to solve the pension dilemma faced by the large elderly population was an unprecedented severe problem that China must face in 21st Century.Through the field research,it led and eucowraged private funds enter the pension service market basde on the construction of mdeical suppotr integration legalsand regnlations.How to provide the diversirfication of the main body and expand the path,how to establish medical support integration pension service information network platform,how to implement the nursing statls' training mechanism for medical suppor integration and how to scientificallg integrate the service resonrces for medical support integration were analyzed.The existing problems of medical support integration service mode in Shenyang was analyzed to provide development suggestions and strategies so as to provide strategic thought for implementing medical support integration in Shenyang.

Objective:As a new strategic industry,health industry was related to the national economy and the livelihood of residents.To probe into the current situation and problems of health industry in Liaoning so as to provide reference for the sustainable development of health industry in Liaoning.Methods:Using the method of literature analysis and interview to explore the comparative advantages and the bottleneck factors of the development of health industry in Liaoning.Results:Liaoning Province medicinal resources were rich and unique,with strong industrial base and protruding industrial cluster advantage,which had leading enterprises significant demonstration effect.Meanwhile,the healthy development of the industry was the imbalanced in regional development,lack of industry standards,lack of R & D innovation,health industry talent scarcity etc.Conclusion:Combined with the actual situation and problems of the development of health industry in Liaoning,it put forward countermeasures and suggestions to provide strategic thinking for improving the development of the health industry in Liaoning.

Objective To improve the diagnosis and therapy level of the uterine intravenous eiomyomatosis, we reported one case involving the right heart and reviewed the relative literatures.Methods and results The patient is 38 years old, she was admitted to hospital with fever, abdominal pain and chest tightness for one week in July 2010. She had a total hysterectomy owing to hysteromyoma in 2003. In July 2010, because she wanted a baby with the method of surrogate pregnancy, so she was injected medicine to stimulate follicle growth in the USA. The medicine was Li ShenBao injection, the total of 12d daily 3 branch (dose not stated). Afterward she couldn't stand fever, abdominal distension and chest tightness, she returned to China for treatment. After she was hospitalized, for diagnosis she got many image examination done, such as B-scan, CT, MRI and PET/CT. Result All image examination found that a massive solid and cystic tumor in the abdominal and pelvic cavity, left kidney hydrocele, ascites, and tumor embolus in the right atrium, inferior caval vein, left renal vein, also bilateral iliac vein. The thoracic-abdominal surgery was carried out, massive tumor was removed, also the tumor embolus in the right atrium and inferior caval vein. The pathological diagnosis was uterine intravenous leiomyomatosis. Conclusion Uterine intravenous leiomyomatosis is a rare disease, involving to heart case is seldomness. In recent years, the case increasing could be related with the usage count of sex hormone in Assisted Reproductive Technology. The imaging examination can give a confident diagnosis, and the final diagnosis depend on pathology. For treatment, surgery is the first choice, and must be thorough to prevent recurrence.

Objective: To observe the ultrasound characteristics of galactostasis at various physiological stages, so as to improve the diagnosis of galactostasis. Methods: The ultrasound data of 56 patients with galactostasis were retrospectively analyzed and the ultrasound characteristics were summarized. The ultrasonic manifestations of different physiological stages were compared. Results: During the lactation period,there were extensive mammary duct ectasias and floating weak signals were found in the mammary duct during pure galactostasis; large non-responsive fluid areas exhibited formations of honeycomb-like multilocular fibrous septa; and these cavities ruptured with abscess when secondary infection occurred. During the later lactation period,the dilated galactophores became hypoechoic or anechoic,which,together with the dot-like echoes of residual breast milk or macular strong echoes, formed mixed signals of retention cysts. After menopause, the galactophores atrophy occurred; the accumulation of galactostasis desiccated into patches or powder, which caused thick hyperechoic dots or multiple hyperechoic streaks in the galactophores or parenchyma. Conclusion: Ultrasonic images of galactostasis vary with the physiological and pathological changes of the mammary glands, and are related to the duration of galactostasis, absorption, concentration and desiccation of lactation.

OBJECTIVE:To provide experience and reference for the reform ofintegration of medicine and nursingunder the strategy ofHealth China 2030. METHODS:By literature analysis,the demand characteristics and supply situation ofinte-gration of medicine and nursingservice model in China were analyzed. The development bottleneck ofintegration of medicine and nursingservice model in China was discussed to put forward countermeasures and suggestions. RESULTS&CONCLUSIONS:Integration of medicine and nursingis a new model of the development of pension services in China. Throughout whole country, it is still in the stage of exploration and practice. There are some problems,such as serious inadequate beds,low participation of private pension institutions,pension service quality ofintegration of medicine and nursinghaving to be improved,weak market competition of pension institutions,social forces participation having to be improved,big demand gap of medical and nursing staff,inadequate high-quality medical and nursing talent. A clear positioning ofintegration of medicine and nursingservice model in China should be put forward andintegration of medicine and nursingmonitoring system should be improved. It is suggested to establish service complaint mechanism of pension institutions,encourage the active participation of diverse social forces,broaden the financing channels ofintegration of medicine and nursing,build service information sharing platform ofintegration of medi-cine and nursing,establish electronic health records for the elderly and set up maintenance personnel training mechanism so as to promote the rapid development of the reform ofintegration of medicine and nursing.

Objective To summarize studies about palliative care (PC) in mainland China and to provide a guidance for propagandizing the concept of palliative care and to carry out related investigations.Methods Key words of Shu Huan Yi Xue,Gu Xi Zhi Liao,An Ning Liao Hu,Ling Zhong Guan Huai,Shu Huan Yi Liao,together with conception,acceptance were used in CBM.And palliative care AND China AND(acceptance OR acknowledgement OR concept OR conception) were used in PubMed.Above searches were for articles,without any other limitations such as publishing date,author,journal,type or language.Eligible articles investigating acceptance of palliative care in mainland China were screened out with artificial work.Descriptive analysis was adopted as a statistic method.Results A total of 35 articles related with palliative care were picked out.Most of the investigation methods were questionnaire.The palliative care-accepting degrees were 25.3 ％ to 86.6％ in overall,25.3％ ～70.8％ in the elderly,30.8％ ～ 56.2％ in advanced stage of cancers,61.7％ ～ 68.4％ in families of patients,and 56.6％～95.8％ in health care workers.In the subgroup analysis,the acceptance showed no difference between genders.But age,followed by careers,degrees of medical education and religions and nationalities were all effective factors for the acceptance of palliative care,which was mostly agreed in all the articles.Conclusions People in mainland China are insufficient very much in the perception of palliative care idea.More publicity and education are needed to popularize the palliative care idea.More studies with better design and more rigorous protocol are needed to have a better understanding of the acceptance of palliative care.

Objective To compare effects between laparoscopy and laparotomy for the treament of ovarian endometriosis cysts and to investigate the value of laparoscopy in the treatment of ovarian endometriosis cysts. Methods We retrospectively analyzed 144 cases of ovarian endometriosis cysts,92 of which underwent laparoscopic operations(Laparoscopic Group) and 52 of which received open operations(Open Group).All the cases were followed for 4 months ~ 5 years.Results The operation time,postoperative hospital stay,and intraoperative blood loss were 69?41.8 min,3.5?1.0 d,and 55?12.0 ml in the Laparoscopic Group,respectively,and 137?54.3 min,8.7?3.5 d,and 178?105.9 ml in the Open Group,respectively,with significant differences between the two groups(t=-8.402,-11.048,and-13.350;P=0.000).There was no significant difference in the rate of abdominal pain relief between the Laparoscopic Group(66.0%,35/53) and the Open Group(52.8%,19/36)(?~2=1.580,(P=0.209)).The recurrent rate was 19.6%(18/92) in the Laparoscopic Group and 19.2%(10/52) in the Open Group,without significant difference between the two groups(?~2=0.002,P=0.961). Conclusions Laparoscopic surgery gives similar efficacy to open surgery in the treatment of ovarian endometriosis cysts.Laparoscopic surgery can be used as the first choice in treating ovarian endometriosis cysts because of its minimally invasive characteristics.