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.

Type 1 diabetes mellitus ( T1DM),arising through a complex interaction of immune,genetic and environmental factors,results from autoimmune destruction of insulin-producing β cells.In up to one third of patients the autoimmune attack is not limited to β cells,but expands into autoimmune polyendocrine syndromes(APS).APS are characterized by functional insufficiency of multiple endocrine organs due to an immunologically mediated destructive process.APS can commonly be divided into three types,including APS type Ⅰ,APS type Ⅱ and immune dysregulation,polyendocrinopathy,enteropathy,X-Linked syndrome (IPEX).Here,we discuss the susceptible factors,clinical manifestation,screening and treatment of APS,with the perspective of the clues they can offer to the pathogenesis and treatment of type 1 diabetes mellitus.

Anti-Bacterial Agents ; poisoning ; Education, Veterinary ; Ethers ; poisoning ; Veterinary Drugs ; poisoning

Objective To demonstrate the frequency changes in immune cells on secreting interleukin-10 (IL-10),interferon-? (IFN-?),tumor necrosis factor-? (TNF-?) and interleukin-4 (IL-4) under the stimulation of a mimic 7-amino acid peptide of HCV HVR1 (7P),and to explore the mechanism of such changes. Methods The peripheral blood mononuclear cells (PBMCs) were isolated from healthy people and co-cultured with 7P. Intracellular cytokine staining was performed using antibodies against IL-10,IFN-?,TNF-? and IL-4. The related cells were harvested on a FACSCalibur flow cytometer,and then analyzed with FACSCalibur software. Results Compared to the controls,the frequency of immune cells secreting IFN-? was significantly increased in both CD4+CD8-,CD4-CD8+ T cells and NK,NKT cells (P

Objective To evaluate the efficacy and safety of intravenous thrombolysiswith urokinase combined with emergency interventional therapy acute myocardial infarction(AMI).Methods 128 patients with AMI were randomized to thrombolysis plus PCI group and primary PCI group,the patency rate of infarct related artery(IRA) before intervention,the procedural success rate,the incidence of bleeding complications and acute ischemic events during hospitalization and the left ventricular ejection function(LVEF) measured by echocardiography before discharge were compared.Results The IRA patency rate in the thombolysis plus PCI group(65.7%) was significantly higher than that in the primary PCI group(24.3%)(P

AIM: To study the determination of dl-tetrahydropalmatine (THP) in Chi nese traditional patent medicines by TLC-Scanning from the viewpoint of the pro cess control of manufacture. METHODS: To select the 5 kinds of representative drugs and its prep arations contained, THP was extracted with solvent method. The mobile phase contains diethylamine. THP w as separated with high-efficiency silica gel plate or handcrafted silica gel p late. Iodine was used for chronogenic agent and fluorescence defectiion for dete rmination. TLC-Scanning results were compared with HPLC. RESULTS: The method is practicable, the result is correlative with the HPLC. CONCLUSION: TLC-Scanning is fit for the quality control of the Chi nese traditional patent medicine in the process of manufacture.

Objective To investigate the status of microchimerism in recipients and the relation between microchimerism and immunologic tolerance after vascularized allograft bone transplantation. Methods X-ray and histological examinations were performed on recipients after massive vascularized shaft of femur from female Japanese white rabbit donors was transplanted to male recipients. Microchimerism in different organs and tissues were checked postoperatively using a semi-quantitative polymerase chain reaction (PCR) with a Y-chromosome specific primer at different time. Results X-ray and histological examinations showed typical bone union in the experiment group but irregular new bone calluses surrounded the transplanted bones, with high density sequestrum in the control group.Semiquantitative PCR with a Y-chyomosome specific primer indicated that the incidence of microchimerism in organs and tissues in the experiment group was higher than that in the control group postoperatively and increased with time. Conclusions After vascularized allograft bone transplantation, organs and tissues show microchimerism that has a positive correlation with the histocompatibility of the transplanted bones.

Adult ; Aged ; Arsenic Poisoning ; drug therapy ; etiology ; Drugs, Chinese Herbal ; adverse effects ; Female ; Humans ; Male ; Middle Aged

Purpose　To study myocardial pathology and its pathogenesis in diabetes. Methods　Myocardial structure of alloxan induced diabetic rats was observed under light microscopy (LM)and transmission electron microscopy(TEM).Activity of superoxide dismutase(SOD),glutathione peroxidase (GSH-Px)，nitric oxide synthase(NOS)and content of malondialdehyde (MDA),nitric oxide(NO) were detected biochemically in myocardial homogenate. Results　Atrophy and degeneration of myocardium and interstitial fibrosis were found under LM and expansion of mitochondria and smooth endoplasmic reticulum, destruction of myofibril and interstitial proliferation of collogen fiber under TEM. Activity of SOD and GSH-Px decreased significantly, while content of NO and MDA and activity of NOS increased significantly in diabetic rats. Conclusion　Atrophy of myocardium, expansion of mitochondria,destruction of myofibril and interstitial fibrosis are the main morphological changes of diabetic cardiomyopathy, and lipid peroxidation and NO may be involved in it.

Objective Based on the mathematical models established in Department of Thoracic Surgery of Peking University People's Hospital for predicting malignant probability for solitary pulmonary nodules ( SPN),another continuous 145 patients with SPN were assessed to verify the accuracy of the model comparing with foreign models (Mayo model and VA model).Methods A retrospective cohort study in our institution included 145 patients with definite pathological diagnosis of SPN from Oct 2009 to Aug 2011,72 males and 73 females,average age (59.4 ± 12.2 ) years old.Clinical data included age,gender,course of disease,symptoms,history and quantity of smoking,time of smoking cessation,history of tumor,family history of tumor,tumor site,diameter,calcification,speculation,border,lobulation,traction of pleural,vascular convergence sign,and cavity.These raw data were incorporated into our model,Mayo model and VA model,the probability of malignant in every patient was calculated separately according to methods described before.The sensitivity and specificity of these 3 models were evaluated then.Afterwards,calibration of the 3 models was assessed by the Hosmer-Lemeshow (H-L) test.Discrimination was tested by calculating the area under curve ( AUC ) after the receiver operating characteristic (ROC) curve was drawn.Results 32.4％ (47 in 145 patients) of the nodules were malignant,and 67.6％ (98 in 145 patients) were benign in this group.Verified the accuracy of our model with sensitivity of 94.9％,specificity of 66.0％,positive predictive value of 85.3％ and negative predictive value of 86.1％.The H-L test showed good fitting in all models ( P ＞0.05 ).The AUC for our model was 0.874 ±0.035,and 0.784 ± 0.041 in Mayo model (P =0.004 compared to our model),0.754 ± 0.041 in VA model (P =0.002 compare to our model).And,there was not significant statistical difference between Mayo model and VA model (P ＞0.05 ).Our model has the best precision indexed by AUC,which were statistically significant differential compared with Mayo model and VA model.Conclusion The model established by our center has superior value than foreign counterparts in predicting the probability of malignant or benign in patients with SPN.