Objective To analyze the utilization and influencing factors for community health service (CHS)of the elderly population under the community first contact care background.Methods 1028 elderly citizens were investigated at their homes with a stratified random sampling method.Results The two-week prevalence rate was 29.56％ and the two-week visiting rate was 61.00％ of the elderly population surveyed.52.30％ of the surveyed objects were willing to choose community health service centers for outpatient.90.08％ of the surveyed could get to one community health service center in 15 minutes.The influencing factors of choosing community health centers were age,income,chronic illness,satisfaction of service quality of CHS and the skill of community physicians.Conclusions The utilization level of CHS need improvement for the elderly population.To improve the service quality of CHS and professional skills of community physicians are critical factors attracting elderly population to choose community health centers.

Objective To improve students' nursing skills by studying on the management method of skill training after class. Method 2 random sampled classes were investigated. One class was experimental group, and received student-oriented management method. The other was control group, and received ordinary management method. Result The experimental group was different from control group in training attendance, number of questions, theory and skills examination performance. There was significant difference between them. Conclusion Student-oriented management approach improves students' training interesting, students' self-management ability, organizational capabilities, ability of expression and critical thinking.

Objective To improve the diagnostic level by analysing and the CT features of undifferentiated embryonal sarcoma of liver(UES) in 6 cases all proved by pathology. Methods We retrospectively reviewed the clinical,pathologic,and imaging features in 6 cases.6 cases underwent unenchanced CT scan,5 case enchanced CT Results CT scan revealed a large uniloculated cyst in 3 and multiloculated cyst within hyperdense septations of variable shapes and thickness in 3.The margins of the lesions were well defined. Some solid portions at the periphery or adjacent to the septa were found in all cases. Punctate calcification at the periphery of the lesion was found in 1 case. A thin rim was seen surrounding the cystic tumor in all cases corresponding to the pathologic psedcapsule. The solid portions and the psedcapsule of the tumor had increased attenuation values and the cystic areas showed low attenuation after injection of contrast material. US demonstrated a single echogenic mass within some anechoic spaces of variable size in 4 cases. Conclusion CT scan showed well defined uniloculated or multiloculated cyst within variable amount of solid portions and an enhancing rim and predominantly solid at US. Discrepancy of internal architecture between US and CT was one of the important characteristic of UES.

Objective To summarize the manifestation of pediatric eosinophilic gastroenteritis by ultrasound and discuss the diagnostic value of ultrasonography in pediatric eosinophilic gastroenteritis. Methods The ultrasonic appearances of 31 cases of pediatric eosinophilic gastroenteritis confirmed by clinics and pathology were reviewed and analyzed. Results Nineteen of 31 cases were observed in association with eosinophilic infiltration of other organs which were diagnosed as idiopathic hypereosinophilic syndrome.Eosinophilic cystitis was the most common among the complications(89.4%,17/19).Twelve of 31 cases were diagnosed as eosinophilic gastroenteritis without complications.The endoscopic appearances of eosinophilic gastroenteritis were nonspecific which include erythematous,hyperemia edema,and partiality erosion changes.Endoscopy demonstrates increased numbers of eosinophils in the propria of stomach and the duodenum.Ultrasound features of the gastroenteritis appeared diffuse or the parts of gastrointestinal tract.The most common sites of eosinophilic gastroenteritis were the stomach and duodenum.Involvement of muscle layer and serosal layer showed wall thickening of cyclic annular and uniformity.Ultrasound might show nodular or irregular thickening of the folds in the gastric antrum when the submucosa were thickening.The mucosal layer involvement was not easy to be found by ultrasound.The echo of serous layer and submucosa associated with the disease stage.The thickening of surrounding omentum and mesenteric tissue,echo enhancement and nonspecific hyperplastic mesenteric lymph nodes infiltrated with eosinophils might be present.Eosinophilic ascites could often be detected.Conclusions Ultrasound has obvious advantages in the diagnosis of pediatric eosinophilic gastroenteritis,and the ultrasonic changes of pediatric eosinophilic gastroenteritis are characterized.Ultrasonography can provide the possible diagnosis when combined with inflammatory of other organs,especially cystitis inflammatory changes.

Objective:To evaluate the synergistic antibacterial effects of lysozyme with ethylenediami-netetraacetic acid disodium salt (EDTA-2Na) on Enterococcus faecalis (E.faecalis) and Porphyromonas endodontalis ( P.endodontalis) .Methods:E.faecalis and P.endodontalis were cultured and adjusted to 108 CFU/mL.Then 0.3, 0.5, 1, 2, 5, 10, 50, 100, 150 and 300 g/L of lysozyme were prepared with deionized water;and the lysozyme solutions were mixed with 0.5, 1.0, 2.0 g/L of EDTA-2Na, re-spectively.The bacteria and lysosome with/without EDTA-2Na interacted for 15 min, then water-soluble tetrazolium (WST) working solution was added and the activity of the bacteria was calculated by mea-suring optical densities at 450 nm and 630 nm with microplate spectrophotometer .Results:Regarding the pure lysozyme from 0.5 g/L to 150 g/L, more E.faecalis and P.endodontalis were inhibited when the concentration of lysozyme was higher , especially for E.faecalis.There was synergistic effect of lysozyme with EDTA-2Na on antibacterial activity , which was related to the concentration of lysozyme .On E.fae-calis, the antibacterial activity of lysozyme with EDTA-2Na was 1.2-3.7 folds than the pure lysozyme when the concentration of lysozyme was 0.5-50 g/L (P<0.05), and on P.endodontalis, the antibac-terial activity of lysozyme with EDTA-2Na was 1.3 -3.5 folds than the pure lysozyme when the concentration of lysozyme was 0.5-10 g/L (P<0.05).When the concentration of lysozyme was higher than 100 g/L, EDTA-2Na did not show synergistic effect on the antibacterial activity (P>0.05). Conclusion: For E.faecalis and P.endodontalis, a low concentration of lysozyme with EDTA-2Na showed significant synergistic antibacterial activity , while a high concentration of lysozyme with EDTA-2 Na did not .

Objective:To develop the representative fingerprint for the quality control of placenta polypeptide injection.Methods:The chromatographic separation was performed using a Phenomenex Gemini C18 column (250 mm × 4.6 mm,5 μm) maintained at 30 ℃.0.1％ aqueous trifluoroacetic acid (Solvent A) and acetonitrile contained 0.1％ TFA (Solvent B) were used as mobile phase with a gradient elution.Detection wavelength was 280 nm with the sample injection volume of 50 μL; the flow rate was 1.0 mL/min.The fingerprints of different samples were investigated by similarity analysis.Results:Nine peaks were identified as the characteristic common peaks.The similarities of the fingerprints of the 10 batches of samples were above 0.992.Conclusion:This method showed high precision and good repeatability,and provided the basis for the improvement of the quality control of placenta polypeptide iniection.

Objective:To analyze the ultrasonographic images and clinical characteristics of congenital mesoblastic nephroma (CMN), and to investigate the differential performances with Wilm′s tumor (WT).Methods:Twenty-one cases of CMN patients confirmed by pathology from December 2008 to December 2019 in Beijing Children′s Hospital, Capital Medical University were collected as the CMN group, and in the same criterion, 51 cases of WT patients were taken as WT group. Ultrasonographic images and clinical characteristics were collected retrospectively, and then the tumor size, site, echo and age were compared and analyzed between the two groups. ROC curve was used to evaluate the differential performance.Results:The difference analysis showed that except for echo ( P=0.694), there were statistically significant differences in tumor size, site and age between the two groups (all P<0.05). In prenatal, the incidence of CMN was significantly higher than WT (61.9% vs 3.9%, P<0.001), and the specificity was 96.1%. The median age (interquartile range) of CMN after birth was significantly earlier than WT( Z=-4.044, P<0.001). The area under the ROC was 0.949, the best cutoff was 112.5 days, with a sensitivity of 87.5% and a specificity of 93.9%. Conclusions:It is difficult to distinguish CMN and WT by echo, but the diagnosis performance can be improved through combining tumor size with site, especially age.

Objective To analyze the efficacy and safety of catheter-directed thrombolysis (CDT) for acute lower extremity deep venous thrombosis (DVT) in patients aged 70 years and over.Methods Clinical data of 109 cases who had acute lower extremity DVT and had been treated with CDT from March 2011 to September 2014 were retrospectively analyzed.Results Inferior vena cava filters (IVCF) were implanted in 109 patients.A thrombolytic catheter was inserted from the contralateral femoral vein (21 cases),ipsilateral popliteal vein (44 cases),posterior tibial vein (28 cases) or small saphenous vein (16 cases).The duration of thrombolysis was (5.47±2.13) d.The dosage of urokinase was (3.80 ± 0.56) million units.Forty-two cases underwent balloon dilatation alone,and 67 cases combined balloon dilatation with stent implantation.Gingival bleeding occurred in 7 patients and gross hematuria occurred in 4 patients during thrombolysis,which disappeared after medication adjustment.No symptomatic pulmonary embolism (PE) or other serious complications were found in any patients.There were significant differences in the venous patency score and lower limb circumferences at 10 cm above and below the knee one week after treatment (t=3.874,P=0.031).Ninety-seven cases were followed up for a mean period of (20.76.5) months,and the vein patencyrate was (77.9± 10.5) ％ and (73.1±9.4) ％ at 6 and 18 months after treatment,respectively.Recurrence of deep vein thrombosis was found in 6 cases,of which 2 cases had recurrent stent thrombosis,and treatment with CDT again was successful.No severe deep venous thrombosis syndrome (PTS) was found during the follow-up.Conclusions CDT is a minimally invasive procedure and can rapidly resolve limb venous drainage disorders.CDT is safe,has few complications and usually generates satisfactory outcomes.For very-old elderly patients who have no anticoagulation and thrombolytic contraindications,CDT is a useful option for the treatment of acute lower limb DVT.

Teaching model plays an important role in clinical education. Problem based learning (PBL) model, with an outstanding feature of stimulating the learning enthusiasm of students, was applied by many American colleges. American College of Acupuncture&Oriental Medicine (ACAOM) combined PBL teaching model with traditional lecture based learning (LBL) model, which had achieved good results. In this article, PBL model and its characters were explored via qualitative case analysis, to provide reference for universities and colleges of traditional Chinese medicine on clinical education.

Objective To observe the effect of pravastatin on the expression of heat shock protein B7 (HSPB7) in acute myocardial infarction (AMI) rats. Methods A total of 80 AMI rats were randomly divided into AMI group and pravas-tatin (P) group. Forty SD rats were used as sham operation (SH) group. Rats were then subdivided into 1 h, 3 h, 6 h and 12 h subgroups (10 for each group). Rats were not ligated after thoracotomy in SH group. The 1eft anterior descending coronary ar-tery was ligated in rats of AMI group. The 1eft anterior descending coronary artery was ligated in P group and given intragas-tric administration of 0.5 mg/(kg · d) pravastatin. The other groups were given the same amount of normal saline via gavage. The left ventricle infarcted myocardial tissues were taken at each time intervals. The corresponding myocardial tissues were harvested in sham-operated rats. The HSPB7 mRNA and protein expressions were measured by RT-PCR and immunohisto-chemistry respectively.Results The expression levels of HSPB7 mRNA and protein were significantly higher in the AMI group and P group than those of SH group(P<0.01). The expression levels of HSPB7 mRNA and protein were significantly increased 1 h after AMI and reached the peak value at 3 h after AMI. The expression levels of HSPB7 mRNA and protein were still higher in 6-h group and 12-h group than those of SH group. The expression levels of HSPB7 were higher in differ-ent time points of P group than those of AMI group. Conclusion HSPB7 could express in the early stage of acute myocardi-al infarction in rats. Pravastatin could promote the upregulation of HSPB7 in myocardial infarcted border zone after AMI, which may play a protective role in early myocardial infarction.