Objective:To examine the impact of palliative care pilot programs on medical expenditures.Methods:Data from 28 major Chinese cities from 2011 to 2020 were analyzed by the Synthetic Control Method(SCM),with Changchun City,a first-round pilot city,serving as the treatment group.Results:Palliative care reduced average per capita medical expenditures in Changchun by 138.31 Yuan,a decrease of approximately 12.86%compared to the synthetic control.Conclusion:It is recommended to expand the palliative care pilot nationwide and incorporate its costs into the basic medical insurance system.Further investment is needed to develop sustainable palliative care models and train professional end-of-life care teams.

Objective:To examine the impact of palliative care pilot programs on medical expenditures.Methods:Data from 28 major Chinese cities from 2011 to 2020 were analyzed by the Synthetic Control Method(SCM),with Changchun City,a first-round pilot city,serving as the treatment group.Results:Palliative care reduced average per capita medical expenditures in Changchun by 138.31 Yuan,a decrease of approximately 12.86%compared to the synthetic control.Conclusion:It is recommended to expand the palliative care pilot nationwide and incorporate its costs into the basic medical insurance system.Further investment is needed to develop sustainable palliative care models and train professional end-of-life care teams.

Objective:To explore the clinical characteristics of mirtazapine-related thrombocytopenia.Methods:The diagnosis and treatment of a patient with mirtazapine-related thrombocytopenia who was admitted to the Aerospace Center Hospital was reported, and the main clinical data (gender, age, indications of mirtazapine use, dosage of mirtazapine, combined medication, platelet count before and after medication, time from application of mirtazapine to thrombocytopenia occurrence, clinical treatment and prognosis, etc.) of the case and similar cases collected by searching relevant databases (up to August 31, 2023) were analyzed by descriptive statistic method.Results:A total of 9 patients were enrolled in the analysis, including 4 males and 5 females; the age ranged from 28 to 74 years, with a median age of 52 years. The indication of medication was depression in 8 patients, and 1 had no record. The daily dose of mirtazapine was 15 mg in 4 patients, 30 mg in 3 patients, and no record in 2 patients. Two patients were treated with mirtazapine alone, 6 patients were treated with mirtazapine combined with other drugs, and it was not recorded in 1 patient. The time from the application of mirtazapine to occurrence of thrombocytopenia in the 9 patients ranged from 2 to 28 days, with a median time of 8 days. The severity of thrombocytopenia was grade 1, 3, and 4 in 3, 3, and 2 patients, respectively; 1 patient had no relevant record. Of the 5 patients with severe thrombocytopenia, 3 developed bleeding, and 1 had skin ecchymosis. The results of drug-dependent antiplatelet antibody test in 2 patients were positive. Nine patients stopped mirtazapine treatment after diagnosis of thrombocytopenia, 6 patients did not receive special intervention, and 3 patients were given symptomatic treatments. After drug withdrawal for 2-43 days with the median time of 9 days, platelet counts returned to the reference range in 7 patients, platelet count increased in 1 patient, and platelet count was unknown but skin symptom was improved in 1 patient.Conclusions:Mirtazapine-related thrombocytopenia usually occurs within 10 days of treatments, which can be improved after drug withdrawal. It is suggested to monitor the blood routine before and after the application of mirtazapine.

Objective:To explore the clinical characteristics of mirtazapine-related thrombocytopenia.Methods:The diagnosis and treatment of a patient with mirtazapine-related thrombocytopenia who was admitted to the Aerospace Center Hospital was reported, and the main clinical data (gender, age, indications of mirtazapine use, dosage of mirtazapine, combined medication, platelet count before and after medication, time from application of mirtazapine to thrombocytopenia occurrence, clinical treatment and prognosis, etc.) of the case and similar cases collected by searching relevant databases (up to August 31, 2023) were analyzed by descriptive statistic method.Results:A total of 9 patients were enrolled in the analysis, including 4 males and 5 females; the age ranged from 28 to 74 years, with a median age of 52 years. The indication of medication was depression in 8 patients, and 1 had no record. The daily dose of mirtazapine was 15 mg in 4 patients, 30 mg in 3 patients, and no record in 2 patients. Two patients were treated with mirtazapine alone, 6 patients were treated with mirtazapine combined with other drugs, and it was not recorded in 1 patient. The time from the application of mirtazapine to occurrence of thrombocytopenia in the 9 patients ranged from 2 to 28 days, with a median time of 8 days. The severity of thrombocytopenia was grade 1, 3, and 4 in 3, 3, and 2 patients, respectively; 1 patient had no relevant record. Of the 5 patients with severe thrombocytopenia, 3 developed bleeding, and 1 had skin ecchymosis. The results of drug-dependent antiplatelet antibody test in 2 patients were positive. Nine patients stopped mirtazapine treatment after diagnosis of thrombocytopenia, 6 patients did not receive special intervention, and 3 patients were given symptomatic treatments. After drug withdrawal for 2-43 days with the median time of 9 days, platelet counts returned to the reference range in 7 patients, platelet count increased in 1 patient, and platelet count was unknown but skin symptom was improved in 1 patient.Conclusions:Mirtazapine-related thrombocytopenia usually occurs within 10 days of treatments, which can be improved after drug withdrawal. It is suggested to monitor the blood routine before and after the application of mirtazapine.

Objective:To explore the clinical outcomes of top-quality blastocysts transfer developed from cleavage embryos with different grading and determine whether the cleavage stage embryo morphology grading should be taken into consideration when transferring the embryo at the blastocyst stage.Methods:A number of 3 059 cycles were included with single top-quality blastocyst transfer dating from January 2017 to May 2021 in Henan Provincial People′s Hospital. According to the number of cleavage sphere and degree of fragmentation, all cleavage stage embryos were divided into three groups: top D3 embryo (8 cells, ≤5% fragments)-TB group, suboptimal D3 embryo (8 cells, 5%0.05); and the early abortion rate were 10.74%, 12.54% and 12.62%, respectively ( P>0.05). After adjusting for confounders, logistic regression showed that no significant associations were found between cleavage stage embryo morphology grading and clinical pregnancy rate (suboptimal D3 embryo-TB group: OR=1.02, 95% CI: 0.76-1.38, P=0.879; normal D3 embryo-TB group: OR=0.84, 95% CI: 0.61-1.14, P=0.262) and early abortion rate (suboptimal D3 embryo-TB group: OR=1.18, 95% CI: 0.77-1.82, P=0.445; normal D3 embryo-TB group: OR=1.26, 95% CI: 0.81-1.98, P=0.309). The results of threshold effect analysis showed that when a single top-quality blastocysts was transferred, the effect of age on the clinical pregnancy rate showed a curve relationship, when the age was≥33 years old, the clinical pregnancy rate decreased significantly with age increased ( OR=0.89, 95% CI: 0.83-0.95, P=0.007); and there was no significant change in early abortion rate ( OR=1.01, 95% CI: 0.97-1.06, P=0.628). Conclusions:Cleavage stage embryo grading is not found to correlate with clinical outcomes in single top-quality blastcyst tranfer. Therefore, when considering blastocyst transfer, its morphology at blastocyst stage is more relevant. The effect of age on pregnancy outcomes of single blastocyst transfer should be considered.

Objective:To investigate the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) between donor and recipient. Methods:Pregnancy outcomes of 31 donors of infertility patients of ovarian hyperresponsiveness and 30 recipients receiving by IVF-ET from January 2011 to December 2016 in the Reproductive Center of Henan Provincial People's Hospital were retrospectively analyzed.Results:The implantation rate of frozen-thawed embryo transfer (FET) cycle (52.05% vs. 58.70%), the clinical pregnancy rate (69.23% vs.73.91%), the live birth rate per transplant cycle (61.54% vs.65.22%), the cumulative pregnancy rate per oocyte pick-up cycle (87.10% vs. 100.00%), the twin rate (40.74% vs. 48.39%), and the live birth rate (77.42% vs. 96.77%) were slightly higher in donor group than in recipient group, while there were no significant differences ( P>0.05). There were no significant differences in implantation rate (58.70% vs. 40.74%), clinical pregnancy rate (76.00% vs. 57.14%), early abortion rate (5.26% vs. 12.50%) and live birth rate per transplant cycle (72.00% vs. 42.86%) between group of <38 years old and group of ≥38 years old ( P>0.05). There were significant differences in cumulative pregnancy rate (100.00% vs. 66.67%) and live birth rate per oocyte pick-up cycle (94.74% vs. 50.00%) ( P=0.037, P=0.007). Conclusion:Oocyte donation IVF-ET is an effective method to assist infertility patients such as premature ovarian failure, perimenopausal period, chromosomal abnormalities, and repeated failure of IVF-ET. The success rate of pregnancy in the recipients of oocyte is similar to that in the donors. All different age groups of recipients can obtain good pregnancy outcomes, and the young recipients have a higher live birth rate.

Objective:To investigate the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) between donor and recipient. Methods:Pregnancy outcomes of 31 donors of infertility patients of ovarian hyperresponsiveness and 30 recipients receiving by IVF-ET from January 2011 to December 2016 in the Reproductive Center of Henan Provincial People's Hospital were retrospectively analyzed.Results:The implantation rate of frozen-thawed embryo transfer (FET) cycle (52.05% vs. 58.70%), the clinical pregnancy rate (69.23% vs.73.91%), the live birth rate per transplant cycle (61.54% vs.65.22%), the cumulative pregnancy rate per oocyte pick-up cycle (87.10% vs. 100.00%), the twin rate (40.74% vs. 48.39%), and the live birth rate (77.42% vs. 96.77%) were slightly higher in donor group than in recipient group, while there were no significant differences ( P>0.05). There were no significant differences in implantation rate (58.70% vs. 40.74%), clinical pregnancy rate (76.00% vs. 57.14%), early abortion rate (5.26% vs. 12.50%) and live birth rate per transplant cycle (72.00% vs. 42.86%) between group of <38 years old and group of ≥38 years old ( P>0.05). There were significant differences in cumulative pregnancy rate (100.00% vs. 66.67%) and live birth rate per oocyte pick-up cycle (94.74% vs. 50.00%) ( P=0.037, P=0.007). Conclusion:Oocyte donation IVF-ET is an effective method to assist infertility patients such as premature ovarian failure, perimenopausal period, chromosomal abnormalities, and repeated failure of IVF-ET. The success rate of pregnancy in the recipients of oocyte is similar to that in the donors. All different age groups of recipients can obtain good pregnancy outcomes, and the young recipients have a higher live birth rate.

Objective To explore the value of anti-Müllerian hormone (AMH) and age in predicting outcomes of patients undergoing in vitro fertilization and embryo transfer treatment. Methods In this retrospective study, 6 328 Chinese patients who underwent the first in vitro fertilization or intracytoplasmic sperm injection and embryo transfer treatment in Henan Provincial People′s Hospital between July 2016 and July 2018 were analyzed. All the patients were categorized into two groups according to pregnancy or not. Baseline data and outcomes of two groups were compared. The regression analysis was conducted to identify the independent factors of clinical pregnancy rates. Furthermore, correlation analysis was performed between AMH and other factors. Results (1) The total clinical pregnancy rate was 56.86% (3 547/6 238). Age, AMH, basal FSH, antral follicle number (AFC), starting dose of gonadotropin (Gn), total doses of Gn, duration of Gn, number of oocytes, transferable cleavage embryos and transferred embryos were significantly different (all P<0.01). (2) Correlation analysis showed that AMH had significant passive correlation with age, basal FSH, starting dose of Gn and total doses of Gn (all P<0.01), while showed significant positive correlation with AFC, body mass index, duration of Gn, number of oocytes and transferable cleavage embryos (all P<0.01). Of all the factors, AMH had the strongest correlation with AFC (P<0.01). (3) Multivariate logistic regression analysis suggested that age was the independent influencing factor of clinical pregnancy rate ( OR=0.938, 95%CI : 0.824-0.952, P<0.01), while AMH not ( OR=1.004, 95%CI : 0.984-1.024, P=0.687). In the subgroups according to age, the advanced group (age>35 years old) had lower clinical pregnancy rate and higher cancellation rate for no available embryos. Conclusions AMH has no predictive value of clinical pregnancy outcomes for patients with in vitro fertilization and embryo transfer treatment, while age has certain predictive value of pregnancy outcomes. AMH level may have indictive value for the evaluation of ovarian reserve.

Objective To investigate and analyze the chronic diseases and geriatric syndromes in elderly inpatients.Methods A total of 227 elderly patients undergoing the comprehensive geriatric assessment admitted into geriatric ward of our hospital from June to December in 2018 were retrospectively analyzed in this case-control study.The patients were divided into two groups aged 80-90 years(n=137)and 65-79 years(n=90).The prevalence of chronic diseases and distribution of geriatric syndromes were compared between the two groups.Results Among 227 patients,the top five chronic diseases were primary hypertension (155 cases,68.3 ％),cerebrovascular diseases (108 cases,47.8％),coronary heart disease(103 cases,45.4 ％),osteoarthrosis (9 cases,39.2 ％) and type 2 diabetes mellitus (79 cases,34.8％).The prevalence of chronic diseases and geriatric syndromes showed an increased tendency along with ageing in elderly patients.The incidence rate of malnutrition,nutritional risk,cognitive disorders,poor vision,hearing loss,fecal and urinary incontinence and constipation were higher in the group aged 80-90 years than in the group aged 65-79 years (P＜0.05).The decreases of activities of daily life and instrumental activities of daily life,and fragile were more severe in the group aged 80-90 years than in the group aged 65-79 years(P＞0.05).No significant difference was found between the two groups in the incidences of multidrug use,mood disorder,sleep disorder,chronic pain and falls.The prevalence of chronic diseases was positively correlated with the prevalence of geriatric syndromes(r =0.339,P ＜0.01).Conclusions Along with ageing in elderly inpatients,the number of chronic diseases is increased,geriatric syndromes are more obvious,and the function significantly declines in elderly inpatients.Elderly patients should receive the comprehensive geriatric assessment,in order to timely identify and intervene these geriatric problems.

Objective To investigate the pregnancy outcome of frozen-thawed embryos transfer in different endometrial progesterone preparation time.Methods From January to December 2012,pregnant outcome of 1 103 frozen-thawed embryo transfer cycles using artificial periodic endometrial preparation were studied retrospectively in Reproductive Medical Center of Henan Provincial People's Hospital.It was divided into 4 groups:group 3-3 (n =543,3 days after endometrial progesterone preparation and transfer D3 embryo),group 4-3(n =330,4 days after endometrial progesterone preparation and transfer D3 embryo),group 5-5 (n =150,5 days after endometrial progesterone preparation and transfer D5 blastula),group 6-5 (n =80,6 days after endometrial progesterone preparation and transfer D5 blastula).The rate of implantation,pregnancy,ectopic pregnancy,multiple pregnancy,and first trimester abortion were compared among those groups.Results (1) With the different endometrial progesterone preparation methods and transfer D3 embryos,implantation rate [group 3-3:39.9％ (429/1 074) ; group 4-3:44.1％ (286/648)],pregnancy rate [group 3-3:56.0％ (304/543) ; group 4-3:59.4％ (196/330)],ectopic pregnancy rate [group 3-3:3.3％ (10/304) ; group 4-3:2.6％ (5/196)],multiple pregnancy rate [group 3-3:38.5％ (117/304) ; group 4-3:43.4％ (85/196)]and early abortion rate[group 3-3:13.5％ (41/304); group 4-3:13.3％ (26/196)] had no significant differences between group 3-3 and group 4-3 (all P ＞ 0.05).(2) With the different endometrial progesterone preparation methods and transfer D5 blastocysts,implantation rate [group 5-5:64.7％ (191/295) ; group 6-5:69.4％ (100/144)],pregnancy rate [group 5-5:80.7％ (121/150) ; group 6-5:78.8％ (63/80)],ectopic pregnancy rate [group 5-5:2.5％ (3/121) ; group 6-5:0],multiple pregnancy rate[group 5-5:55.4％ (67/121) ; group 6-5:46.3％ (37/80)] and early abortion rate[group 5-5:5.8％ (7/121); group 6-5:7.9％ (5/63)].However,there were no significantly differences between group 5-5 and group 6-5 (all P ＞ 0.05).Conclusions The two different progesterone transformed endometrial methods can obtain satisfactory clinical outcome with D3 embryo or D5 blastocysts transfor.It is convenient to clinical and laboratory work arrangements.