With the rapid acceleration of aging in China, there is a huge need for elderly patients to have improved quality of life in the terminal stage.Palliative sedation is an integral part of palliative care and can alleviate painful refractory symptoms, and its use in patients in various terminal illnesses is being explored across the world.Attention is focused on its indications and implementation.In China, palliative sedation in clinical practice is in an early exploratory stage and relevant criteria and guidelines have yet to be established.A review of the current practice and research progress concerning palliative sedation for patients' end-of-life care in China and the rest of the world will offer insight and strategic considerations in the initial pursuit and accelerated acceptance in the future in China.

Pain is a prevalent symptom in both cancer and non-cancer end-stage diseases, often being the most feared by patients and significantly impacting their quality of life.Hospice care aims to address physical, psychological, spiritual, and other needs of patients and their families during this stage, with a focus on alleviating pain and discomfort.Effective pain management is a crucial component of hospice care, particularly given the increasing prevalence of cancer and chronic diseases in China and the growing elderly population.To provide analgesic management for hospice patients, a thorough assessment of pain is essential to identify its type and characteristics.Treatment approaches may include etiological interventions, pharmacotherapy, interventional therapy, physiotherapy, psychotherapy, and comfort care, all aimed at achieving comprehensive pain management.The use of opioid should be carefully guided by scientific principles to minimize adverse effects and optimize pain relief, ultimately enhancing patients' end-of-life quality of life.

Objective:To explore the distribution characteristics of pathogens in adult patients with community-acquired pneumonia (CAP) and to provide basis for the diagnosis, treatment, prevention of CAP.Methods:1 446 inpatients with CAP were prospectively enrolled in a third-class hospital in Beijing in recent 5 years (from January 2015 to December 2019). Respiratory tract samples were collected for smear, culture, nucleic acid, antigen and antibody detection to identify the pathogen of CAP. Mann-Whitney U test was used for continuous variables and χ 2 test or Fisher′s exact test was used for categorical data for statistical analysis. Results:Among the 1 446 patients, 822 (56.85%) patients were infected with a single pathogen, 231 (15.98%) patients were infected with multiple pathogens, and 393 (27.18%) patients were not clear about the pathogen. Influenza virus is the first pathogen of CAP (20.95%, 303/1 446), mainly H1N1 (8.51%, 123/1 446), followed by mycoplasma pneumoniae (7.19%, 104/1 446), Mycobacterium tuberculosis (5.33%, 77/1 446) and Streptococcus pneumoniae (5.05%, 73/1 446). The outbreak of H1N1 occurred from December 2018 to February 2019, and the epidemic of mycoplasma pneumoniae pneumonia was monitored from August to November 2019. Patients under 65 years old had high detection rates of Mycoplasma pneumoniae (14.41% vs. 2.41%, χ2=74.712, P<0.001), Streptococcus pneumoniae (8.16% vs. 2.99%, χ2=18.156, P<0.001), rhinovirus (6.08% vs. 3.56%, χ2=5.025, P<0.025), Chlamydia pneumoniae (5.90% vs. 1.15%, χ2=26.542, P<0.001) and adenovirus (3.13% vs. 0.92%, χ2=9.547, P=0.002). The severe disease rate of CAP was 14.66% (212/1 446), and the average mortality rate was 3.66% (53/1 446). The severe illness rate and mortality rate of bacterial-viral co-infection were 28.97% (31/107) and 19.63% (21/107), respectively. Conclusions:Influenza virus is the primary pathogen of adult CAP. Outbreaks of Mycoplasma pneumoniae and H1N1 were detected in 2018 and 2019, respectively. The remission rate and mortality rate of virus-bacteria co-infection were significantly higher than those of single pathogen infection. Accurate etiological basis not only plays a role in clinical diagnosis and treatment, but also provides important data support for prevention and early warning.

Objective:To explore the distribution characteristics of pathogens in adult patients with community-acquired pneumonia (CAP) and to provide basis for the diagnosis, treatment, prevention of CAP.Methods:1 446 inpatients with CAP were prospectively enrolled in a third-class hospital in Beijing in recent 5 years (from January 2015 to December 2019). Respiratory tract samples were collected for smear, culture, nucleic acid, antigen and antibody detection to identify the pathogen of CAP. Mann-Whitney U test was used for continuous variables and χ 2 test or Fisher′s exact test was used for categorical data for statistical analysis. Results:Among the 1 446 patients, 822 (56.85%) patients were infected with a single pathogen, 231 (15.98%) patients were infected with multiple pathogens, and 393 (27.18%) patients were not clear about the pathogen. Influenza virus is the first pathogen of CAP (20.95%, 303/1 446), mainly H1N1 (8.51%, 123/1 446), followed by mycoplasma pneumoniae (7.19%, 104/1 446), Mycobacterium tuberculosis (5.33%, 77/1 446) and Streptococcus pneumoniae (5.05%, 73/1 446). The outbreak of H1N1 occurred from December 2018 to February 2019, and the epidemic of mycoplasma pneumoniae pneumonia was monitored from August to November 2019. Patients under 65 years old had high detection rates of Mycoplasma pneumoniae (14.41% vs. 2.41%, χ2=74.712, P<0.001), Streptococcus pneumoniae (8.16% vs. 2.99%, χ2=18.156, P<0.001), rhinovirus (6.08% vs. 3.56%, χ2=5.025, P<0.025), Chlamydia pneumoniae (5.90% vs. 1.15%, χ2=26.542, P<0.001) and adenovirus (3.13% vs. 0.92%, χ2=9.547, P=0.002). The severe disease rate of CAP was 14.66% (212/1 446), and the average mortality rate was 3.66% (53/1 446). The severe illness rate and mortality rate of bacterial-viral co-infection were 28.97% (31/107) and 19.63% (21/107), respectively. Conclusions:Influenza virus is the primary pathogen of adult CAP. Outbreaks of Mycoplasma pneumoniae and H1N1 were detected in 2018 and 2019, respectively. The remission rate and mortality rate of virus-bacteria co-infection were significantly higher than those of single pathogen infection. Accurate etiological basis not only plays a role in clinical diagnosis and treatment, but also provides important data support for prevention and early warning.

Objective To investigate the epidemic tendency and drug resistance of common pathogenic bacteria in the patients with infectious diarrhea,and then provide scientific evidence for the treatment of bacterial diarrhea.Methods The feces specimens were collected from 12 156 patients with infectious diarrhea in our hospital during April 1,2012 and October 31,2017.Then,they were cultured,and the obtained bacteria were isolated and identified by the Vitek 2 Compact system and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS).The serotype and drug resistance of the obtained bacteria were analyzed by the agglutination test and K-B disk diffnsion method,respectively.Results A total of 1 218 strains (10.02％,1 218/12 156) of pathogenic bacteria were isolated from 12 156 feces specimens,including 926 (7.62％,926/12 156) strains of Vibrio,96 (0.79％,96/12 156) strains of Aeromonas,178 (1.46％,178/12 156) strains of Salmonella and 18 (0.15％,18/12 156) strains of Shigella.The detection rates of pathogenic bacteria per year were 9.2％,11.9％,13.4％,7.0％,11.3％ and 7.2％,respectively,from 2012 to 2017.The detection rate of Shigella was low,but it had a high resistance to ampicillin and compound sulfamethoxazole (SMZ-TMP).Other pathogenic bacteria were more sensitive to SMZ-TMP,ceftriaxone,aztreonam,gentamycin and quinolones except ampicillin.Conclusion The main pathogenic bacterium in the patients with infectious diarrhea is Vibrio,and Shigella has the highest resistance to most drugs.The overall infection tendency is sporadic.It is necessary to strengthen the monitoring of pathogenic bacteria and their drug resistance in the patients with infectious diarrhea.

Objective To further intensify the reform of public hospitals,promote talents team building and scientific research management innovation,enhancing the overall capacity of care delivery,as well as the development of science and technology in grass-roots hospitals.Methods A series of measures were adopted to arouse the enthusiasm of personnel to conduct research and finally increase the research outcomes.Concrete measures include talent training program and scientific research man-agement innovation,construction funding assurance,whole-process dynamic management,clarification of the quantitative evaluation index,research rewards,research funding management,as well as performance management.Results After implementation of such measures,the academic atmosphere changed a lot,medical technology improved,the quality of scientific research,project application and research outcomes increased dramatically which has statistical significance compare to previous situations.Conclusions The establishment of the incentive system plays a significant role.It helps in talent agglomeration during a relatively short period of time,exploring the potential capabilities of scientific research,enhancing the core competitiveness of hospital scientific research,which provide strong intellectual support and talent guarantee for hospitals development.

Objective To evaluate the effect of dexmedetomidine on pulmonary microvascular en-dothelial cell(PMVEC)injury induced by the serum of mice with renal ischemia-reperfusion(I∕R)injury. Methods Renal I∕R was induced by clamping bilateral renal pedicles for 60 min followed by 24 h of reper-fusion. Primary PMVECs of mice were divided into 3 groups(n=20 each)using a random number table:control group(group C), serum of mice underwent I∕R group(group I∕R)and dexmedetomidine group (group Dex). PMVECs were cultured with 10% serum of mice underwent sham operation in group C. PM-VECs were cultured with 10% serum of mice underwent I∕R injury in group I∕R. PMVECs were incubated for 3 h with dexmedetomidine at the final concentration of 0.1 μmol∕L before incubation with serum in group Dex. At 24 h of culture or incubation, the cell survival rate was detected by CCK8 assay, cell apoptosis by Hoechst 33258 staining, caspase-3 activity using colorimetric method, and the expression of Bcl-2 and Bax using Western blot. Results Compared with group C, the cell survival rate was significantly decreased, the apoptosis rate and activity of caspase-3 were increased, the expression of Bcl-2 was down-regulated, and the expression of Bax was up-regulated in I∕R and Dex groups(P<0.01). Compared with group I∕R, the cell survival rate was significantly increased, the apoptosis rate and activity of caspase-3 were de-creased, the expression of Bcl-2 was up-regulated, and the expression of Bax was down-regulated in group Dex(P<0.01). Conclusion Dexmedetomidine can reduce PMVEC injury induced by the serum of mice with renal I∕R injury, and the mechanism is related to regulating the expression of Bcl-2 and Bax and inhib-iting mitochondrial apoptosis pathway.

Background and objective The development of new treatments beyond first-line in metastatic non-small cell lung cancer (NSCLC) contributed to the increase in overall survival. Metronomic chemotherapy involves several mechanisms of anti-tumor with less toxicity. Oral vinorelbine has paved the way for innovative treatment strategies through metronomic regi-mens. Therefore, this study assessed the e?cacy and safety of metronomic oral vinorelbinen in advanced NSCLC after failure to multiple-lines treatments. Methods Our retrospective study enrolled 26 patients who received metronomic oral vinorelbinen. Survival factors were evaluated by univariate regression analysis. Results The median follow-up time was 4 months (range 2-12).The median number of treatment cycles was 2 (range 1-8). No patient achieved complete remission, 2 cases (8%) partial remis-sion, 11 cases (42%) stable disease, 13 cases (50%) progression disease. Overall response rate was 8% and disease control rate was 50%. The median progression-free survival (PFS) was 2 months. In univariate analysis, patients with performance status (PS)=1 had a statistically significantly longer PFS than patients with PS=2. Gender, age, smoking status and histology were not prognostic factors according to PFS. Treatment was well tolerated with rare serious toxicity. No grade 4 adverse events (AEs) or occurrences of intolerable toxicity were observed. There was no treatment-related death and none of the study patients required hospitalization for treatment-related adverse events. Conclusion Metronomic oral vinorelbinen is effective in advanced NSCLC after the failure of multiple lines treatments with an acceptable AE profile, especially in patients with high PS.

Background and objective Status of epidermal growth factor receptor (EGFR) gene is a predictor of response to EGFR tyrosine kinase inhibitor (TKI). However, lile is know about the relationship between EGFR status and response to chemotherapy. We evaluated the prediction value of EGFR mutation status on response to first-line chemotherapy in patients with advanced non-small-cell lung cancer (NSCLC). Methods e data of 181 patients with stage IIIb/IV NSCLC who diagnosed by histopathology from January 10, 2006 to December 20, 2013 in Beijing Chest Hospital, Capital Medical University were collected. e relationships between EGFR gene status, clinical characteristics and response and progression-free survival (PFS) were analyzed. Results All of the 181 patients’ EGFR statuses were determined. 75 (41.4%) patients har-bored EGFR-activating mutations and 106 (58.6%) patients were EGFR wild-type. All patients received first-line chemother-apy. e objective response rate (ORR) was 26.0% and disease control rate (DCR) was 70.2%. Patients with EGFR-activating mutations had a higher DCR than patients with EGFR wild-type (84.0% vs 60.4%, P=0.001) did. Subgroup analysis showed that the ORR and DCR in patients with EGFR exon 19 deletions were remarkably higher than those with EGFR wild-type (P= 0.049, 0.002, respectively). e DCR in patients with EGFR exon 21 L858R mutation was significantly higher than that in patients with EGFR wild-type (P=0.010). 168 patients were available for response evaluation in all of 181 patients and median PFS was 4.3 mo. e PFS of patients with adenocarcinoma was significantly higher than that patients with squamous cell carci-noma (4.7 mo vs 3.0 mo, P=0.036). e PFS in patients harbored EGFR-activating mutations was significantly higher than that in the patients with EGFR wild-type (6.3 mo vs 3.0 mo, P=0.002). e PFS of patients with a performance status (PS) of 0-1 was significantly higher than that in patients with a PS of 2 (4.4 months vs. 0.7 months, P= 0.016). Cox multivariate analysis indicates the EGFR-activating mutation is an independent factor aecting PFS (HR=0.654, 95%CI: 0.470-0.909, P=0.012). Conclusion EGFR-activating mutation is a predictor for PFS of first-line chemotherapy in advanced NSCLC patients.

Objective To explore the success rate and the risk of establishment of the acute myocardial infarction model between the beagle dogs and the mini-pigs by interventional technique ,further to provid theoretical basis for choose a more suitable animal model .Methods 6 dogs and 6 mini-pigs were anaesthetized ,then underwent the coronary arteriography via femoral artery .After is-chemic preconditioning the coronary balloon was inflated to occlude the middle left anterior descending coronary for 180 minutes . The electrocardiogram was examined throughout the operation and the pathological sections were examined until the animals were executed one week later .Results All beagle dogs survived ,while 1 case of mini-pigs dead(1/6) .There was 1 cases(1/6) of beagle dogs had acute myocardial infarction ,while 5(5/6)cases in mini-pigs .All mini-pigs had malignant arrhythmia(6/6) but never seen in beagle dogs .The time needed for building a model was similar between the two groups ,the difference had no statistical signifi-cance(P>0 .05) .Conclusion The risk of establish myocardial infarction model in mini-pigs is higher than beagle dogs ,but the suc-cess rate is still high ,it might be the better choice .