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.

Objective:To observe and analyze the detection rate of optical disc and retinal neovascularization in stage Ⅳ diabetic retinopathy by multidirectional OCT angiography (OCTA).Methods:A retrospective study. From September to October 2018, 50 eyes of 46 patients with diabetic retinopathy of stage Ⅳ diagnosed in Tangshan Ophthalmological Hospital were included in the study. Among them, there were 18 males (19 eyes) and 28 females (31 eyes). The age ranged from 31 to 78 years, with an average age of 56.64±10.64 years. All patients underwent medical optometry, mydriasis fundus examination and FFA examination. All patients met the diagnostic criteria of stage Ⅳ diabetic retinopathy. All patients underwent multidirectional OCTA examination on the same day after mydriasis fundus examination and FFA examination. Angiography 6 mm × 6 mm scanning mode was selected for OCTA examination. The retinal areas of macular area, optic disc, superior nasal disc, superior optic disc, superior macular area, superior temporal macular area, temporal macular area, inferior nasal disc, inferior optic disc, inferior macular area and inferior temporal macular area were scanned respectively. All images were taken by the same physician and read by two physicians independently. Cases with inconsistent opinions between the two physicians were not included in this study. The optical disc and retinal neovascularization in patients with stage Ⅳ diabetic retinopathy were observed on FFA and multidirectional OCTA images.Results:In 50 eyes, the positive number of screening optic disc neovascularization using FFA was 8 eyes, OCTA was 15 eyes (100%). In the 42 eyes without optic disc neovascularization detected by FFA, OCTA detected 7 eyes, all located on the optic disc surface. Four of the eyes were located in the optic cup, linear and branching, with an area of less than 1/4 optic disc. In 50 eyes, the positive number of screening retinal neovascularization using FFA was 50 eyes, the positive number of OCTA was 43 eyes. In 43 eyes with detected by OCTA, retinal neovascularization buds were detected in 3 eyes, but not in FFA. The retinal neovascularization not detected by OCTA was located in the mid-peripheral part of the retina, which is beyond the inspection range of multi-directional OCTA.Conclusion:The positive rate of optic disc neovascularization and retinal neovascularization in stage Ⅳ DR by multidirectional OCTA is 100.0% and 86.0%, respectively.

BACKGROUND/OBJECTIVES: A variety of immunomodulators can improve the efficacy of low-dose chemotherapeutics. Active hexose correlated compound (AHCC), a mushroom mycelia extract, has been shown to be a strong immunomodulator. Whether AHCC could enhance the antitumor effect of low-dose 5-fluorouracil (5-FU) via regulation of host immunity is unknown. MATERIALS/METHODS: In the current study Hepatoma 22 (H22) tumor-bearing mice were treated with PBS, 5-FU (10 mg.kg-1.d-1, i.p), or AHCC (360 mg.kg-1.d-1, i.g) plus 5-FU, respectively, for 5 d. CD3+, CD4+, CD8+, and NK in peripheral blood were detected by flow cytometry. ALT, AST, BUN, and Cr levels were measured by biochemical assay. IL-2 and TNFalpha in serum were measured using the RIA kit and apoptosis of tumor was detected by TUNEL staining. Bax, Bcl-2, and TS protein levels were measured by immunohistochemical staining and mRNA level was evaluated by RT-PCR. RESULTS: Diet consumption and body weight showed that AHCC had no apparent toxicity. AHCC could reverse liver injury and myelosuppression induced by 5-FU (P < 0.05). Compared to mice treated with 5-FU, mice treated with AHCC plus 5-FU had higher thymus index, percentages of CD3+, CD4+, and NK cells (P < 0.01), and ratio of CD4+/CD8+ (P < 0.01) in peripheral blood. Radioimmunoassay showed that mice treated with AHCC plus 5-FU had the highest serum levels of IL-2 and TNFalpha compared with the vehicle group and 5-FU group. More importantly, the combination of AHCC and 5-FU produced a more potent antitumor effect (P < 0.05) and caused more severe apoptosis in tumor tissue (P < 0.05) compared with the 5-FU group. In addition, the combination of AHCC and 5-FU further up-regulated the expression of Bcl-2 associated X protein (Bax) (P < 0.01), while it down-regulated the expression of B cell lymphoma 2 (Bcl-2) (P < 0.01). CONCLUSIONS: These results support the claim that AHCC might be beneficial for cancer patients receiving chemotherapy.
Agaricales ; Animals ; Apoptosis ; Body Weight ; Carcinoma, Hepatocellular* ; Diet ; Drug Therapy ; Flow Cytometry ; Fluorouracil* ; Humans ; Immunologic Factors ; In Situ Nick-End Labeling ; Interleukin-2 ; Killer Cells, Natural ; Liver ; Lymphoma, B-Cell ; Mice* ; Radioimmunoassay ; RNA, Messenger ; Thymus Gland ; Tumor Necrosis Factor-alpha

Objective:To observe the multimodal imaging characteristics of tamoxifen retinopathy.Methods:A retrospective case study. From January 2019 to December 2021, 4 patients (8 eyes) with tamoxifen retinopathy diagnosed in Tangshan Eye Hospital were included in the study. All patients were female, with sick binoculus. The age was 59.5±4.6 years. After breast cancer resection, tamoxifen 20 mg/d was taken orally consecutively, including 1, 1, and 2 cases who took tamoxifen orally for 5, 7, and ≥10 years. All eyes were examined by fundus color photography, optical coherence tomography (OCT), OCT angiography (OCTA), fundus fluorescein angiography (FFA), and fundus autofluorescence (AF). The multi-mode image features of the fundus of the affected eyes were observed.Results:The yellow white dot crystal like material deposition in the macular area was observed in all eyes. In fundus AF examination, macular area showed patchy strong AF. FFA examination showed telangiectasia and fluorescein leakage in macular area at late stage. OCT showed that punctate strong reflexes could be seen between the neuroepithelial layers in the macular region with the formation of a space between the neuroepithelial layers, the interruption of the elliptical zone (EZ), and the formation of a hole in the outer lamella including 4, 5 and 3 eyes; The thickness of ganglion cells in macular region decreased in 7 eyes. OCTA showed that the blood flow density of the superficial retinal capillary plexus around the arch ring was decreased, and the retinal venules were dilated in 2 eyes; Deep capillary plexus (DCP) showed telangiectasia.Conclusion:Deposition of yellowish white dot like crystals can be seen in the macular region of tamoxifen retinopathy; dotted strong reflex between neuroepithelial layers, cavity formation, thinning of ganglion cell layer, EZ middle fissure and outer lamellar fissure; DCP capillaries and venules around the arch were dilated; telangiectasia in macular region; flaky strong AF in macular region.