Advance medical directive is a statement made by a patient ,which indicates patient′s acceptable or unacceptable treatments , when he or she is not competent to make a medical decision .There are two types of ad-vance directive , which are living will and durable power of attorney for healthcare .The paper will briefly introduce advance directive′s history and analyse its controversies throughout the world .In China , most people don′t own an advance directive .When these patients are faced with medical emergency , their desires can not be known by their relatives, and not to mention let their relatives respect their desires .Cultural barrier and the lack of regulation and propaganda on advance directive are the main reasons cause the current situation of advance directive in china . Based on the analyses above , the paper offers a suggestion that it is necessary to widely promote advance directive in China .During the process of promoting advance directive , should pay attention to guide and respect traditional culture .

Objective To select the suitable macroporous adsorption resins for enrichment and purifi-cation ferulic acid from Angelica sinensis so as to improve the product quality. Methods Macroporous ad-sorption resins were used to study the adsorption and desorption characteristics of ferulic acid. At the same time HPLC was used in detection. Results The best resin DA201 was chosen and the optimum parameters were obtained. The content of ferulic acid was increased from 0. 15% in the raw material to 25.1%. Con-clusion The material has a low cost and the operation is easy. The adsorption resins can be used again,which has a good applied foreground.

Thyroid peroxidase(TPO) gene was detected in 20 patients with congenital hypothyroidism. An insertion c. 2268insT of TPO gene was found in one of them, and c. 2268insT combined with c. 1477G＞C mutation in another. TPO gene mutation may be related to pathogenesis of congenital hypothyroidism in Chinese.

Objective To investigate the distribution and antimicrobial resistance of clinical bacterial strains isolated from the cervical secretions of parturient women .Methods A total of 239 bacterial strains were isolated from 1 519 cervical specimens of parturient women .These strains were identified and tested by Kirby‐Bauer method for their susceptibility to antimicrobial agents .Results Escherichia coli was the most frequently isolated bacteria ,accounting for 34 .3% .The bacterial strains were more or less resistant to commonly used antimicrobial agents .Conclusions Various bacterial species are identified in the cervical secretions of parturient women ,primarily Escherichia coli and Staphylococcus aureus .Bacterial culture and antimicrobial susceptibility testing are important for clinicians to take appropriate measures to reduce the incidence of mother‐to‐child infections .

Objective To verify the correlation between rs17118 polymorphism of xyluloknase homolog (XYLB) gene and risk of ischemic stroke in a Chinese Han population.Methods A case-control study design was used.The case group was the patients with first-ever ischemic stroke and the control group was the healthy subjects from hospital physical examination.Taqman probe fluorescence quantitative polymerase chain reaction technique was used to detect the genotype distribution of rs17118 C/A polymorphisms.Results A total of 475 patients with ischemic stroke and 483 controls were enrolled in the study.The proportion of hypertension (67.9％ vs.22.2％;x2 =292.982,P ＜ 0.001) and diabetes (24.2％ vs.7.3％;x2 =25.864,P ＜ 0.001),as well as the levels of triacylglycerol (1.649 ± 1.126 mmol/L vs.1.157 ±1.480 mmol/L;t=3.592,P＜0.001),and low-density lipoprotein cholesterol (3.499 ± 1.163 mmol/L vs.3.105 ± 0.627 mmol/L;t =-6.227,P ＜ 0.001) in the case group were significantly higher than those in the control group,but the total cholesterol level was significantly lower than that in the control group (5.144 ± 1.296 mmol/L vs.5.491 ± 1.335 mmol/L;t =4.650,P ＜ 0.001).The AA genotyp e (11.4％ vs.7.5 ％;x2 =6.136,P =0.016) and A allele (32.3 ％ vs.26.4％;x2 =8.093,P =0.005) frequencies in the case group were significantly higher than those in the control group.Multivariatelogistic regression analysis showed that after adjusting for traditional risk factors,the risk of ischemic stroke in AA genotype carriers was 1.97 times of the CC genotype carriers (odds ratio 1.971,95％ confidence interval 1.040-3.736,P=0.038).Conclusions The rsl7118C/A polymorphism of XYLB gene may be associated with the risk of ischemic stroke in the Chinese Han population.

Objective:To systematically evaluate the effectiveness and safety of intra-articular in-jection of mesenchymal stem cells (MSCs) and hyaluronic acid (HA) in the treatment of knee osteoarthritis.Methods:The relevant literatures published in both English and Chinese were systematically searched in PubMed, Embase, Wanfang database, China Knowledge Network (CNKI), SinoMed database and other data-bases from inception to May 2020. Two researchers independently extracted data and evaluated the included literature. Risk assessment of literature bias was carried out. RevMan 5.3 software was used for Meta analysis, and the combined sensitivity were calculated.Results:Finally, 13 references were included, including a total of 726 patients with knee osteoarthritis. Meta-analysis results showed that compared with the HA group, the Western Ontario and McMaster University Osteopathic Index Total Score (WOMAC) [ MD=-10.92, 95% CI (-16.87, -4.96), P<0.01], the visual analogue scale (VAS) score [ MD=-1.70, 95% CI(-2.44, -0.95), P<0.01], and the knee joint Lequesne index score of MSCs group all decreased significantly [ MD=-13.78, 95% CI (-15.03,-12.52), P<0.01]. Furthermore, there was no significant difference in the incidence of adverse events (AEs) between the two groups [ RR=1.11, 95% CI(0.90, 1.37), P=0.33]. However, American Knee Association Score (AKS score) [ MD=-10.15, 95% CI(-22.33, 2.03), P=0.10] and whole-organ magnetic resonance imaging score (WORMS) [ MD=-3.93, 95% CI(-11.60, 3.75), P=0.32] were not statistically significant ( P>0.05). Conclusion:Compared with intra-articular injection of HA, intra-articular injection of MSCs can significantly improve the symptoms and dysfunction, and has favorable clinical tolerability and safety, suggesting that MSCs is expected to bea new treatment for knee osteoarthritis.

Objective To evaluate whether the forced expiratory volume in sixth scend(FEV6) was the optimal surrogate for forced vital capacity (FVC) in the diagnosis for chronic obstructive pulmonary disease (COPD).Methods Retrospectively analyzed the spirometric data of 142 COPD patients (7 cases with mild COPD,60 cases with moderate COPD,48 cases with severe COPD,27 cases with extremely severe COPD) admitted to Hebei Chest Hospital from October 2011 to October 2012 who had FEV6 data.FEV6,FEV5,FEV4 and FEV3 were measured on volume-time curves and the diagnostic value was analyzed.Results FEV6,FEV5,FEV4 and FEV3 were highly correlated to FVC (r =0.994,0.939,0.935 and 0.923 respectively,P ＜0.001).Assuming =70％ as the diagnostic standard for obstruction,FEV1/FEV6 had a diagnostic rate of 92.96％ with a false negative rate of 7.04％.FEV1/FEV5,FEV1/FEV4 and FEV1/FEV3 had higher false negative rates (9.86％,13.38％ and 27.46％ respectively) than FEV6.The value of FEV1/FEV6-FEV1/FVC had no statistical significance between the mild-moderate and the severe-extremely severe COPD groups(t =1.376,P =0.171).Conclusion There is a strong correlation between FEV6 and FVC.FEV6 may be the best surrogate for FVC in the diagnosis of chronic obstructive pulmonary disease.Elevating diagnostic critical value can reduce the false negative rate.

OBJECTIVE To carry out "Occupation Exposition Risk Guard" curriculum practice in high rank nursing and discuss the value of built this curriculum in senior professional school.METHODS The skin damage and after-damage processing were investigated by questionaire before and after this curriculum.RESULTS People not accepted this curriculum had skin damage of 96.25%,after-damage processing rate of 36.25%,and reporting rate of 20.00%,vs 70.00%,100.00% and 87.5% in but people who accepted this curriculum.CONCLUSIONS In the process of training the education of occupation exposition protection knowledge has important value.

Objective To quantify the contents of baicalin, wogonoside, baicalein, wogonin, chrysim and oroxylinA in the Scutellaria baicalensis Georgi with different storage time by liquid chromatography-mass spectrometry( LC-MS) and determine the stability of Scutellaria baicalensis Georgi. Methods The LC system consisted of an Agilent Zorbax XDB-C18 column (2. 1 mm×150 mm,3. 5 μm) with acetonitrile and water (0. 1% formic acid) in linear gradient condition. The flow rate was 0. 2 mL·min-1 and the wavelength of detection was 276 nm. The mass spectrometer was operated under the positive ion mode with the ESI source. The precursor-to-product ion pair was 447/271 for baicalin,461/285 for wogonoside,271/123 for baicalein, 285/270 for wogonin, 255/153 for chrysim and 285/270 for oroxylinA, respectively. Results The contents of baicalin, wogonoside, baicalein, wogonin, chrysim and oroxylin A had a linear relationship with their peak areas within the ranges of 8. 86-177. 2, 2. 33-46. 5, 2. 6-52. 0, 0. 52-10. 4, 0. 04-0. 8 and 0. 04-0. 8 μg · mL-1 , respectively. The contents of baicalin, wogonoside, baicalein, wogonin, chrysim, and oroxylin A were overall decreased over the first 3 months of storage,but remained relatively stable between 0 and 18 months. Conclusion The results provides basis for the establishment of quality standard.

To evaluate the influence and long-term effects on systemic and local inflammation responses in rat with stable chronic obstructive pulmonary disease (COPD) treated with traditional Chinese medicine (TCM) for regulating and invigorating the lung and kidney, including invigorating the lung and spleen (Bufei Jianpi) therapy, supplementing the lung and kidney (Bufei Yishen) therapy, and nourishing qi and kidney (Yiqi Zishen) therapy.