This paper aims to discuss the construction and promotion strategy of medical care capacity framework based on the core literacy of palliative care， combining domestic and foreign research and clinical status. The research results show that it is particularly important to construct a framework of medical care competence based on palliative care. The core competencies required for palliative care include the ability to comprehensively evaluate and formulate personalized programs， effective communication skills， interdisciplinary teamwork skills， and the ability to continuously learn and improve themselves. The quality of care can be further improved if the above abilities are incorporated into the framework of medical care ability based on palliative care. However， there are a series of problems in the process of constructing the framework of palliative medical care capacity， such as difficult implementation of policy support， poor professionalism of talent team， single and irregular service model， low social acceptance， and difficult interdisciplinary cooperation and resource integration. After a detailed analysis of the problems， this paper puts forward the countermeasures to construct the framework of caring ability literacy based on palliative care. Effective countermeasures such as increasing policy support， cultivating comprehensive talents， developing diversified palliative care models， improving social recognition， and strengthening interdisciplinary cooperation and resource integration can effectively improve the core literacy and professional ability of medical care personnel， and then promote the development and improvement of palliative care services. In-depth discussion of the above contents can provide scientific reference for building a care model and literacy framework with palliative care as the core.

【Objective】 To investigate the matrix effect on the determination of potency in Recombinant Human Coagulation Factor Ⅷ for Injection (rFⅧ). 【Methods】 Two different detection matrices were used to establish two methods for detecting the potency in Recombinant Human Coagulation Factor Ⅷ for Injection. And the matrix effect on the determination of potency was determined, including specificity, linearity, repeatability, accuracy and intermediate precision. 【Results】 As to the specificity, the recoveries of the two substrates at high vs low concentration level were 112% and 110% vs 104% and 109%, respectively. As to the linearity, in the range of (0.125-1.000) IU/mL, the correlation coefficient between concentration and coagulation time of standard/ sample was higher than 0.99. As to the accuracy/repeatability, the recoveries of two matrices was 104% and 102%, and RSD was 2.4% and 1.9%. As to the intermediate precision, personnel factor of two matrices was 0.72 and 0.23, date factor was 0.79 and 0.85, and RSD(for 12 times) was 4.2% and 3.0%. Comparison of two matrices was as follows: Deviation in test results of 6 batches of rFⅧ was all lower than 5%. There was no significant difference between two matrices. 【Conclusion】 The two matrices for potency detection show good performance including specificity, linearity, repeatability, accuracy, and intermediate precision. They are suitable for the determination of potency in rFⅧ products.

Objective To evaluate left ventricular ( LV ) myocardial mechanical transmural longitudinal displacement ( LD ) and radial displacement ( RD ) with contrast agent and different power irradiation in open‐chest Beagle canines by ultrasound velocity vector images ( VVI) workstation . Methods T he anesthetized open‐chest Beagle canines were assigned into two groups randomly :Group A ( n ＝6) for baseline ,diagnostic ultrasound power irradiation ( 300 mW) 5 min ,combined with contrast agent irradiation 5 min and contrast agent 20 min conditions ; Group B ( n ＝ 6 ) for baseline and intensity ultrasound irradiation ( 1 W ,2 W and 3 W ,5 min respectively) conditions . T he standard short‐axis and long‐axis gray‐scale view s during three complete cardiac cycles in open‐chest Beagle canine models were acquired . T he peak LD subendomyocardium ( LD‐subendo) ,LD subepimyocardium ( LD‐subepi) ,RD subendomyocardium ( RD‐subendo) and RD subepimyocardium ( RD‐subepi ) of LV were analyzed using a dedicated Syngo VVI method . Results In group A ,the LV LD‐subendo ,LD‐subepi ,RD‐subendo and RD‐subepi in the most of segments showed increasing trend in diagnostic power irradiation ,contrast agent irradiation 5 min and contrast agent 20 min compared with baseline condition ,however the differences were not significant ( P ＞0 .05 ,respectively) . T he peak LD‐subendo and LD‐subepi ,RD‐subendo and RD‐subepi of LV in group A with the same condition were significant different ( all P ＜0 .05) . In group B ,LV LD‐subendo in ultrasonic power 3 W was lower than baseline condition ( P ＜ 0 .05 ) ,LV RD‐subendo was higher compared with baseline condition ( P ＜0 .05) . T he peak LD‐subendo and LD‐subepi ,RD‐subendo and RD‐subepi of LV in group B with the same condition were significant different ( all P ＜ 0 .05) . Conclusions On ultrasonic power 3 W ,LV LD‐subendo is decreased resulting to negative inotropic effect and RD‐subendo is increased to maintain the normal heart work .LV LD and RD on diagnostic ultrasound power irradiation 5 min , combined with contrast agent irradiation 5 min ,contrast agent 20 min conditions ,ultrasonic power 1 W and 2 W are not prominent changes .

Objective: To explore the diagnostic value of serum glutamyltransferase (GGT) and osteopontin (OPN) for asymptomatic secondary common bile duct stones. Methods: A total of 150 gallbladder stones patients were divided into asymptomatic secondary common bile duct stones patients (common bile duct stones group) 34 cases and gallbladder stone group 116 cases. The difference of serum liver function indexes and OPN concentration between 2 groups were compared. Meanwhile, the diagnostic value of serum GGT combined with OPN was assessed by receiver operating characteristic curve. Results: There were no statistical difference in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and direct bilirubin (DBil) between 2 groups (P>0.05). The GGT, alkaline phosphatase (ALP) and OPN in common bile duct stones were significantly higher than those in gallbladder stone group: (141.57 ± 47.11) U/L vs. (77.26 ± 21.76) U/L, (150.10 ± 17.55) U/L vs. (137.65 ± 24.36) U/L and (16.21 ± 3.26) mg/L vs. (11.50 ± 3.99) mg/L, there were statistical differences (P<0.05). Logistic multivariate analysis showed that GGT, ALP and OPN were the independent risk factors of asymptomatic secondary common bile duct stones (P<0.05). The areas under curve of GGT and OPN in diagnosis of asymptomatic secondary common bile duct stones were significantly higher than ALP (P<0.05). Conclusions Serum GGT and OPN can be served as early predictors for the gallbladder stone combine with asymptomatic secondary common bile duct stones.

OBJECTIVE:To investigate protective effects of different doses of atorvastatin pretreatment on non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients underwent percutaneous coronary intervention (PCI). METHODS:A total of 81 NSTE-ACS patients in a hospital during Jan. 2014-Apr. 2016 were divided into high-dose group(40 cases)and low dose group(41 cases)according to random number table. High-dose group was given Atorvastatin calcium tablet 80 mg 12-24 h before PCI,and then 40 mg 2 h before PCI. Low-dose group was given Atorvastatin calcium tablet 10 mg 12-24 h before PCI. Fractional flow reserve(FFR),coronary flow reserve(CFR)and index of microcirculation resistance(IMR)after surgery were all observed in 2 groups. The levels of creatine kinase(CK),creatine kinase myocardial band(CK-MB)and high sensitive C-re-active protein (hs-CRP) were compared between 2 groups before and after surgery. RESULTS:There was no statistical signifi-cance in FFR and CFR after surgery between 2 groups (P>0.05);IMR of high-dose group was significantly lower than low-dose group,with statistical significance(P<0.05). There was no statistical significance in CK,CK-MB or CRP between 2 groups before surgery(P>0.05). After surgery,the levels of CK-MB and CRP in low-dose group were significantly higher than high-dose group,with statistical significance(P<0.05). There was no statistical significance in CK level between 2 groups after surgery (P>0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:During PCI,pre-treatment with high-dose of atorvastatin(80→40 mg)could effectively improve microcirculatory disturbance and inhibit inflammatory reaction of NSTE-ACS patients.

Objective To investigate the correlation between body mass index (BMI) and features of tongue manifestation.Methods A total of 1 655 physical examination individuals were selected,and height and body weight were measured to calculate BMI.Traditional Chinese Medicine tongue inspection was performed,and map of tongue manifestation was photographed by a digital camera.Results Among the 1 655 physical examination individuals,prevalences of normal weight,overweight/obesity and low weight were 50.94％,43.74％ and 5.32％,respectively.The prevalences of individuals had dark red tongue (37.98％ vs.24.56％;x2=40.883,P＜0.001),purplish tongue (5.94％ vs.3.44％;x2=8.133,P=0.017),dark purplish tongue (2.35％ vs.0.59％;x2=10.398,P=0.006),yellow fur (63.95％ vs.58.84％;x2=9.570,P=0.008),thick greasy fur (24.86％ vs.17.20％;x2=18.698,P＜0.001) in the overweight/obesity group were significantly higher than those in the normal weight group,and the prevalence of individuals had exfoliative fur/little fur/less fur in the overweight/obesity group was significantly higher than that in the normal weight group (1.93％ vs.3.91％;x2=6.454,P=0.040).The prevalences of individuals had red or deep red tongue (48.86％ vs.24.72％;x2=24.608,P＜0.001),red dot tongue (7.95％ vs.1.93％;x2=12.254,P=0.002),thin whitish fur (22.73％ vs.9.53％;x2=14.030,P=0.001) in the low weight group were significantly higher than those in the normal weight group.Binary logistic regression analysis showed positive correlation between dark red tongue (OR 1.830,95％ CI 1.515-2.211;P＜0.001),purplish tongue (OR 1.874,95％ CI 1.211-2.901;P=0.005),dark purplish tongue (OR 4.259,95％ CI 1.610-11.266;P=0.003),yellow fur (OR 1.294,95％ CI 1.093-1.531;P=0.003),gray-black fur (OR 6.147,95％ CI 1.816-20.811;P=0.004),thick greasy fur (OR 1.597,95％ CI 1.289-1.978;P＜0.001) and BMI,and negative correlation between pink tongue (OR 0.766,95％ CI 0.637-0.920;P=0.004),red or deep red tongue (OR 0.659,95％ CI 0.549-0.789;P＜0.001),red dot tongue (OR 0.548,95％ CI 0.326-0.921;P=0.023),thin whitish fur (OR 0.695,95％ CI 0.536-0.900;P=0.006),whitish fur (OR 0.821,95％ CI 0.683-0.986;P=0.035) and BMI.Conclusions There is some correlation between BMI and features of tongue manifestation.Abnormal tongue color is mainly dark red tongue in the overweight/obesity individuals,and red or deep red tongue in low weight individuals.Abnormal tongue fur is mainly thick yellow fur.The tongue shape is normal in different body weight groups.

Objective To measure the chromatic differences of the tongue tip and tongue side and provide quantitative evidence for tongue color diagnosis. Methods Totally 683 healthy people were recruited, and their tongue photos were taken. Then ICC specific documents were used for the correction of all tongue photos, and chromatic values (L*, a*, b*, C*and h°) of tongue tip and tongue side were obtained for further statistical analysis. CIEDE2000 was used for calculating the color differences. Results The average color difference of tongue tip and tongue side in normal pink tongue was 5.4. When pink tongue has abnormal red tongue tip, the average color difference of tongue tip and tongue side was 10.85. Compared with normal tongue tip, the average color difference of tongue tip and tongue side in abnormal color tongue with abnormal red tongue tip increased from 5.4-7.0 to 11.23. Conclusion Red tongue tip is a sensitive sign indicating abnormal heat in the body. Tongue tip quantitative diagnosis is valuable in the determination of heat sign in TCM preventive treatment of disease, and reveal the diagnosis meaning and scientific connotation of red tongue tip.

This study was aimed to discuss the diagnosis significance of the diseased tongue demonstration in Shanghuo (heatiness) people. Based on 303Shanghuo cases, the relevance of diseased tongue demonstration and inquiry data were analyzed. The results showed that 53.14%Shanghuo cases had at least more than 2Shanghuo inducing causes. The most common inducing cause combinations were pathogenic factors neither endogenous nor exogenous (unbalanced diet, overworked) and internal factors (over stressed, emotional). When there were several Shanghuo causes occurred at the same time, the probability of appearing diseased tongue demonstration increased significantly. There were 29.95%Shanghuo cases occurredShanghuo experience frequently. And in these cases, the probability of appearing diseased tongue demonstration increased significantly. It was concluded that when Shanghuo people had diseased tongue demonstration appeared, it was not merely just“is going to get ill”, but was already suffering from heat syndrome. In traditional Chinese medicine (TCM) physical examination, to effectively differentiate“is going to get ill” and“being ill” was initially important. And the diseased tongue demonstration was a crucial diagnostic basis.

OBJECTIVETo investigate the effect and its indication of orbital fat flap for treating sunken upper eyelid in middle-aged and elder patients.

METHODSThe upper middle orbital fat was transferred to the sunken area as a flat flap to correct Sunken upper eyelid at grade I, II, III. The depression depth was graded as I (<0.5 cm), as II (0.5-1.0 cm), as III ( >1.0 cm). From April 2011 to April 2012, 66 cases were treated and 49 cases were followed up for 12-15 months.

RESULTSAll patients with sunken upper eyelid were successfully treated using this procedure and no complications were encountered. Fat absorption was not observed. The effective rate was 90.9% (20/22) for grade I , 31.0% (18/58) for grade II and 0 for grade III (0/18), showing significant difference between any of two groups (P<0.05).

CONCLUSIONSThe orbital fat flap is effective for grade I Sunken upper eyelid with long- term effect.

Adipose Tissue ; transplantation ; Aged ; Blepharoplasty ; methods ; Eyelids ; surgery ; Female ; Humans ; Male ; Middle Aged ; Orbit ; Surgical Flaps ; transplantation

This study was aimed to investigate the congenital constitution terms consist of Bing and connotation in medical books before Qing dynasty. By searching the character Bing as a keyword in the Encyclopedia of Tradi-tional Chinese Medicine (TCM), 6480 articles were retrieved. Through reading each of the articles, 9 congenital con-stitution terms were concluded. The results showed that Sui dynasty recorded the earliest congenital constitution term. And till the end of Ming dynasty, altogether 9 terms, which were Bing Qi, Bing Zhi, Bing Shou, Bing Fu, Suo Bing, Fu Bing, Qi Bing, Bing Ti and Su Bing, appeared in sequence. The terms appeared with high frequency were Bing Shou ( 33 . 27%) and Bing Fu ( 32 . 99%) . There were 5 congenital constitution relat-ed factors altogether , which were physique , parental heredity , life span , qi and blood as well as region , ap-peared in sequence . And the term appeared with high frequency was physique ( 32.11%) . It was concluded that before Qing dynasty, all congenital constitution terms occurred with the character of Bing (endowment). The usage of different terms to state congenital constitution was intended to describe different associated factors . It reflected the understanding of congenital constitution process. The first known congenital constitution factor was not parental heredity but physique . Qi and blood was the second most appeared factor . This indicated that con-genital constitution does not only involve the structure of the body ( physique ) , but also the function of the body (qi and blood). The investigation about congenital constitution of ancient TCM brings a positive practical signifi-cance for the modern health cognition and health maintenance .