Elderly end-of-life patients often experience distress due to being caught in dilemmas of contemplation and decision-making. Narrative wills， grounded in life values and premised on respecting individual wishes and needs， present an individual’s unique life story through narrative forms， conveying their overall experience， interpretation of meaning， and understanding of life. They are preserved and passed on in a way that meets individual expectations， thereby promoting human exploration， reflection， and growth regarding the meaning of life through interpersonal interactions that transcend space and time. This paper explored the concept of narrative wills among elderly end-of-life patients， the ethical value and ethical principles of narrative wills， and the moral and ethical risks. It also provided specific ethical interpretations， assisting in the application and development of narrative wills in elderly end-of-life patients.

OBJECTIVE To evaluate the effectiveness， safety， economy， innovation， suitability and accessibility of recombinant Mycobacterium tuberculosis fusion protein （EC）， and to provide evidence for selecting skin detection methods for tuberculosis infection diagnosis and auxiliary diagnosis of tuberculosis. METHODS The effectiveness and safety of EC compared with purified protein derivative of tuberculin （TB-PPD） were analyzed by the method of systematic review. Cost minimization analysis， cost-effectiveness analysis and cost-utility analysis were used to evaluate the short-term economy of EC compared with TB-PPD， and cost-utility analysis was used to evaluate the long-term economy. The evaluation dimensions of innovation， suitability and accessibility were determined by systematic review and improved Delphi expert consultation， and the comprehensive score of EC and TB-PPD in each dimension were calculated by the weight of each indicator. RESULTS The scores of effectiveness， safety， economy， innovation and suitability of EC were all higher than those of TB-PPD. The affordability scores of the two drugs were consistent， while the availability score of EC was lower than those of TB-PPD. After considering dimensions and index weight， the scores of effectiveness， safety， economy， innovation， suitability， accessibility and the comprehensive score of EC were all higher than those of TB-PPD. CONCLUSIONS Compared with TB-PPD， EC performs better in all dimensions of effectiveness， safety， economy， innovation， suitability and accessibility. However， it is worth noting that EC should further improve its availability in the dimension of accessibility.

OBJECTIVE To explore the pharmaceutical service model in multidisciplinary diagnosis and treatment （MDT） of rare diseases in children. METHODS Clinical pharmacists of West China Second University Hospital （hereinafter referred to as “our hospital”） participated in the process of MDT of children’s rare diseases. Clinical pharmacists took part in the entire diagnosis and treatment process of children and established the MDT pharmaceutical service model of children’s rare diseases by formulating drug treatment plans based on evidence-based practice， improving the accessibility of drugs， pharmaceutical monitoring and drug treatment management. RESULTS From January 2021 to April 2022， clinical pharmacists of our hospital had participated in a total of 39 cases of rare diseases MDT in children， including 21 hospitalized children with rare diseases and 18 outpatient com children with rare diseases， involving a total of 23 rare diseases. Clinical pharmacists completed 45 pharmaceutical zhanglingli@scu.edu.cn rounds and 26 pharmaceutical consultations for rare diseases inpatients， 25 outpatients’ MDT and 5 pharmaceutical outpatient service for outpatients with rare diseases， 38 medication educations for inpatients and outpatients with rare diseases and 25 follow-up services for out-of-hospital patients. There were 24 cases （61.54%） of off-label drug use， involving 13 rare diseases and 16 therapeutic drugs， among which off-label drug use registration of 11 drugs had been completed or was in progress. The temporary purchase evaluations of 3 drugs had been completed； 268 cases of medical insurance drug and high-value drug prescription had been reviewed. CONCLUSIONS Our hospital have primarily established a loop pharmaceutical service model of MDT for children with rare diseases， which covers inpatients and outpatients. The model improves the availability and standardization of clinical application of therapeutic drugs， and diagnosis and treatment level for children with rare diseases in our hospital.

Objective:To explore the incidence of thirst in patients undergoing pancreaticoduodenectomy and analyze its influencing factors.Methods:From March to October 2022, 155 patients with pancreaticoduodenectomy admitted to the First Medical Center of the Chinese People's Liberation Army General Hospital were selected as the study subject by convenience sampling. The patients were surveyed using the self-made general information questionnaire, Thirst Numerical Rate Scale, oral mucosal misture score, Self-Rating Anxiety Scale, and Self-Rating Depression Scale to understand the incidence of thirst and analyze influencing factors.Results:A total of 153 valid questionnaires were collected, with a valid response rate of 98.71%. Among them, 124 patients (81.05%) experienced postoperative thirst. Univariate analysis showed that there were statistical differences in the incidence of thirst among patients with different ages, fasting time, smoking history, drinking history, hypertension history, diabetes history, anxiety and depression ( P<0.05). Logistic regression analysis showed that age, hypertension history, diabetes history, anxiety and depression were the main influencing factors for thirst in patients undergoing pancreaticoduodenectomy ( P<0.05) . Conclusions:Thirst is common in patients after pancreaticoduodenectomy. Age, hypertension history, diabetes history, anxiety and depression are the influencing factors of thirst in patients after pancreaticoduodenectomy. Medical and nursing staff should provide targeted interventions for thirst prevention and treatment based on relevant factors.

Objective: To evaluate the osteogenic effect of concentrated growth factor (CGF) combined with deproteinated bovine bone mineral (DBBM) in site preservation using clinical and histomorphometric observations. Methods : A total of 26 patients who needed extraction of affected teeth and received staged implantation after site preservation were selected. The patients were randomly divided into the DBBM group (Bio-Oss was implanted simultaneously after extraction) and CGF+DBBM group (CGF+Bio-Oss was implanted simultaneously after extraction), with 13 patients in each group, and both groups were covered with Bio-Gide collagen membrane. Cone beam computed tomography (CBCT) was performed preoperatively and 6 months later to measure the changes in alveolar bone height and width, and the bone specimens were drilled 6 months after site preservation during implant surgery for histological analyses. Results: CBCT showed that the height and width of alveolar bone were absorbed 6 months after site preservation in the CGF+DBBM and DBBM groups, and the reduction in alveolar ridge width in the CGF+DBBM group was statistically less than the DBBM group (P <0.05). The histomorphometry results showed that the percentage of new bone in the CGF+DBBM and DBBM groups were 35.30% ± 3.56% and 26.38% ± 5.04%, respectively, and the amount of new bone in the CGF+DBBM group was statistically higher than the DBBM group (P<0.05). Conclusion CGF combined with DBBM is superior to DBBM in maintaining the alveolar bone volume and shape in site preservation, which creates favorable conditions for implant restoration.

Objective: To study the use of a three dimensional (3D) visualization operative planning system in Ultrasound-guided percutaneous microwave ablation (US-PMWA) for large hepatic hemangiomas (LHHs). Methods: A total of 50 patients with LHHs from January 2011 to August 2018 were included in Department of Interventional Ultrasound, the First Medical Center, Chinese PLA General Hospital, including 12 males and 38 females (age from 28.0~60.0, mean age was 43.0). Fifty patients with LHHs were divided into the 3D and 2D groups (25 cases in each group). The therapeutic efficacy was assessed by contrast-enhanced imagings on follow-up. Hepatic and renal functions were studied. The complete ablation, tumor volume shrinkage and complication rates were analyzed. Results: The levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and creatinine after ablation in the 3D group were significantly lower than the 2D group [(126.7±56.4)U/L vs. (204.7±76.5)U/L; (141.0±60.8)U/L vs. (206.6±77.4)U/L; (57.3±17.6)U/L vs. (86.2±46.1)U/L; (66.6±16.6)mmol/L vs. (86.8±42.8)mmol/L, P<0.05, respectively]. Compared with the 2D group, the ablation energy, ablation time and proportion of hemoglobinuria in the 3D group were all significantly less, while the complete ablation rate was significantly higher [(93.7±3.3)% vs. (97.7±2.4)%](all P<0.05). Conclusion The 3D visualization operative planning system provided a scientific, quantifiable, and individualized therapy for LHHs using US-PMWA.

Objective To survey the contraceptive knowledge and service ability of postpartum visitors in Shanghai Minhang district.Methods A questionnaire survey on the contraceptive knowledge and contraceptive services was conducted in May 2018 among postpartum visitors from 13 community health service centers in Shanghai Minhang district.Results One hundred and forty-eight valid questionnaires were collected.All the participants were women,among whom 6.8％ (10/148) were obstetricians and gynecologists,8.1％ (12/148) were general practitioners and public health doctors,52.7％ (78/148) were nurses and 32.4％ (48/148) were village doctors.One hundred and ten participants were married women of childbearing age,among whom 18.2％(20/110) did not take contraceptive measures,43.6％(48/110) used condom,10.9％ (12/110) used in vitro ejaculation or safe period or combination of two methods,and only 27.3％(30/1 10) used IUD or tubal ligation.The overall correct rate of contraceptive knowledge was 65.9％ (1 755/2 664).The correct rates of knowledge about postpartum intrauterine device,the placement time of subcutaneous implantation of contraceptives,the correct use of condoms were particularly low.During the visits,postpartum lactating mothers,condom and safe period were recommended for contraception;and condom was recommended most (93.2％,138/148),however,only 24.3％(36/148) of them carried free contraceptive condom when visiting home.Conclusions The general levels of contraception-related knowledge and ability of community postpartum visitors are less satisfactory.It is necessary to strengthen the training and assessment of contraceptive knowledge for them.