The hospitalpice enterprise has developed vigorously in China ever since 1980s.However,influenced by the long history and traditional Chinese culture,there are some ethical dilemmas in the issues of choice of death and palliative treatment.Choice of death and palliative treatment for the dying patients have been restricted by the traditional Chinese philosophy of death,traditional principles of filial piety,and the absence of support from euthanasia legislation.It is suggested that during the introduction of hospitalpice into china,the traditional Chinese value be respected.Meanwhile,people's cognition of hospitalpice should also be shifted to decrease the constraint of traditional ideas.The whole social power should be united and professional regulation construction should also be strengthened.Besides,it is also important to improve training for related professionals,promote the process of hospitalpice legislation as well as go abide by the current laws in order to achieve a high-quality hospitalpice.

Objective To study clinical efficacy of leuprorelin acetate in treatment of uterine adenomyosis with infertility.Methods From January 1,2011 to March 31,2012,166 cycles in 166 infertile patients combined with uterine adenomyosis undergoing in vitro fertilization embryo transplant (IVF-ET) with long protocol ovum induction by leuprorelin acetate in centre of medical reproduction,ningbo women and children's hospital were studied retrospectively.In the mean time,200 cycles in 200 infertile patients with tubal factors were enrolled as control group.The volume of uterus and outcome of IVF-ET were compared and studied between two groups.Results (1) Volume of uterus:in adenomyosis group,after 2-6 cycles of injecting leuprorelin acetate (3.75 mg/28 days),the mean uterine volume was shrinked from (180 ±73) cm3 to (86 ± 67) cm3 (P ＜ 0.05).(2) Outcome of IVF-ET:the rate of embryo implantation was 39.1％ in adenomyosis group and 35.8％ in control group.The rate of clinical pregnancy was 54.2％ in adenomyosis group and 53.7％ in control group.The rate of abortion was 4.7％ in adenomyosis group and 4.2％ in control group.They all did not show statistical differences (P ＞0.05).(3) In adenomyosis group,the rate of fertilization,two pronuclear (2PN) and superior embryo were 67.2％ (319/475),60.8％(289/475) and 52.9％ (162/306) in patients with failed pregnancy and 74.2％ (423/570),67.7％(386/570) and 62.1％ (256/412) in patients with successful pregnancy after IVF-ET,which reached significant difference (P ＜ 0.05).Conclusion Leuprorelin acetate could improve volume of uterine adenomyosis and outcome of pregnancy in patients undergoing IVF-ET.

Objective To investigate the changing characteristics of myocardial movement in patients with dilated cardiomyopathy by three?di?mensional speckle tracking echocardiography(3D?STE). Methods The peak systolic global longitudinal train(GLS),global radial strain(GRS), global circumferential stain(GCS)and global area strain(GAS)of left ventricle were measured by 3D?STE technology in 69 patients with dilated cardiomyopathy. According to the left ventricular ejection fraction(LVEF),all patients were divided into group A(35%≤LVEF<50%)and group B (LVEF<35%). The differences of measurements were compared between two groups. The correlation between global myocardial strain in all direc?tions and left ventricular ejection fraction was analyzed. Results The GLS,GRS,GCS and GAS were significantly higher in group A than those in group B(P<0.01). The GLS,GRS,GCS and GAS were correlated with LVEF in group A(r=-0.871,0.610,-0.423,-0.797;P<0.05).The GCS,GRS and GAS were correlated with LVEF in group B(r=-0.517,0.368,-0.438;P<0.05). There was no significant correlation between GLS and LVEF in group B. Conclusion 3D?STE technology can be applied to evaluate the change of the myocardial movement. GLS is a promis?ing marker of the prognosis in patients with DCM.

Aim Toestablishanexcellentratasthmamodel from using OVA+pertussis sensitized, OVA sensitized and per-tussissensitizedrats.Methods Thethreemethodswereusedto sensitize rats;methacholine bronchial provocation tests were per-formed to determine airway hyperresponsiveness;bronchoalveolar lavage fluid ( BALF) was prepared after the animals were chal-lenged by nebulized antigen. The differential white cell count in BALF was performed, and lung tissue was detected by morpho-logicalanalysis.Results AllofOVA+pertussissensitization,OVA sensitization and pertussis sensitization could deteriorate lung function, increase inflammatory cells and cause pathological change, and OVA + pertussis sensitized rat model had better effect than OVA sensitized and pertussis sensitized rat models. Conclusion OVA+pertussissensitizationandOVAaerosolisa successful rat asthma model.

Objective To observe the morphology changes in articular cartilage of knee osteoarthritis ( KOA) model rats after intervention with Shudi Jisheng Zhuanggu Decoction (SJZD). Methods SD rats were randomized into 7 groups, namely blank control group, model group, Paracetamol group ( 0.270 g/kg) , Zhuangu Guanjie Pills group ( 1.08 g/kg) , and high-, middle- and low-dosage SJZD groups ( 27.450, 13.725, 6.863 g/kg, respectively). Rats were injected with papain solution into the right knee joint to build models of KOA before administration of drugs. Thickness of right knee joint was measured to evaluate the effect of SJZD on the swelling degree of knee joint. Histological changes of knee cartilage were evaluated by Mankin scoring method after the cartilage sections being stained with hematoxylin-eosin (HE). Results Swelling degree of knee joint and Mankin scores were significantly increased in the model group compared to the blank control group ( P<0.01). In comparison with the model group, the swelling degree of knee joint and Mankin scores of SJZD groups were significantly decreased (P<0.05 or P<0.01), and the pathological changes were relieved. Conclusion SJZD can ameliorate the pathological changes of knee articular cartilage in rats with KOA, so as to delay cartilage degeneration and protect the cartilage.

Gallbladder carcinoma is the most common malignancy in biliary tract.Early dissemination,rapid and silent progression and delayed diagnose could portend a dismal prognosis.The 5-year survival rate is less than 10％.Clarifying the etiological feature can improve the early diagnosis.Comprehending surgical indications of benign lesions can provide the methods for rational prophylactic resections.Standardized treatment of accident gallbladder carcinoma could improve the patients' prognosis.Efficient serologic markers could be used for early diagnosis and screening.

Objective To explore the efficacy of debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair.Methods From January 2007 to December 2013,208 cases with nesh infections following inguinal hernia repairs were treated with debridement in Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital,147 cases were treated with primary suture (suture group) and 61 cases were treated with dressing change (open group).Results The mean time of mesh infection was (8.37 ± 6.89) months.The results of bacterial culture in the two groups were similar.First grade healing rate of suture group was 80.95％ (119/147),compared to zero percent in open group.Length of stay [(20.86 ± 7.90) d vs.(31.82 ± 11.50) d,t =3.47,P =0.034] and hospital cost [(3 200 ± 5 800) yuan vs.(26 500 ± 6 600) yuan,t =4.51,P =0.02] in suture group were less than in open group.No patients developed recurrent hernia in suture group compared with one recurrence in open group.Conclusions Debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair could increase the rate of first grade healing,shorten average length of hospital stay and reduce total costs.

Objective:Explore a service model on hospice care in China. Method:Investigate on hospice care needs and demands in the city of Beijing, Shanghai and Baotou From June to September 2016. Result:More than 80 percent of the respondents willing to receive hospice care service, and people tend to have different hospice service model in different demographic groups, and the number of people choosing"general hospital" was the highest, nearly one- third. Conclusion:The society has a high demand for hospice care service, and to explore a service model which is government-led and the whole society involved and family as the core and community united and connected by hospice care institution and guided by the general hospital can promote the development of hospice care in China.

Malnutrition and obesity are common in children with cerebral palsy, leading to growth retardation, anemia, brain dysplasia or increased risk of cardiovascular diseases.Nutritional status and energy demand of children with cerebral palsy are usually determined by physical examinations, detections of anthropometric parameters, bone mineral density and body composition, and laboratory tests, thus developing nutritional intervention programs to improve their nutritional problems and quality of life.This study aims to summarize the research progress of nutritional intervention in children with cerebral palsy.

Objective: To study risk factors for non-alcoholic fatty liver disease (NAFLD) and vascular erectile dysfunction (ED) in patients with metabolic syndrome (MS). Methods: A total of 18 096 subjects were selected from people undergoing physical examination from 2008 to 2009 in northern cities of China by random cluster sampling method, and analyzed the risk factors for NAFLD and ED. Results: The 18 096 cases with age 18~76 (46.8±10.1) years old，containing 10 096 (55.79%) males and 8 000 (44.21%) females. Awareness rate of MS was 8.33% and prevalence rate of MS in healthy adults was 21.18%. Most common components of MS were hyperuricemia (27%, 4838/18096), obesity and overweight (21%), hypertension (20%,) and dyslipidemia (17%) in turn. Body mass index (BMI, kg/m2) and waist/hip ratio (WHR) of all MS subgroups from high to low were ED group [(28.9±1.1), (1.26±0.03)], overweight or obesity group [(27.5±2.3), (1.31±0.03)], prediabetes group [(26.8±2.6), (1.03±0.03)] and hypertension group [(26.1±1.3), (0.90±0.04)] in turn. A total of 3 721 MS patients （20.56%）complicated with NAFLD; By means of NAFLD complicated by MS as dependent variable, Logistic regression analysis indicated that increased ALT, waist circumference（WC）, age, DM family history, LDL-C and BMI (β=1.004~0.479, P=0.000~0.016 in turn) were risk factors for NAFLD, and physical exercise and occupational physical work were protective factors for NAFLD. There were 106 ED males and its prevalence rate was 1.04%; Logistic regression analysis indicated that age, WC, LDL-C, DM family history and BMI (β=0.681~0.238, P=0.000~0.018 in turn) were risk factors for ED, and educational degree, physical exercise and occupational physical work were protective factors for ED. Conclusion: Risk factors for NAFLD and ED in MS were closely correlated with MS. It’s a new path to prevent and treat NAFLD and ED through correcting risk factors of MS.