Objective:To observe the application effect of skillful communication combined with pathway pain management on patients with hemorrhoids undergoing endoscopic sclerotherapy.Methods:Using the convenient sampling method, a total of 85 patients who received endoscopic sclerotherapy of internal hemorrhoids in the People's Hospital of Anyang City from September 2020 to August 2021 were selected as the research objects. They were divided into the intervention group (44 cases) and the control group (41 cases) . The control group was given routine nursing intervention, while the observation group was given skillful communication combined with pathway pain management on the basis of the control group. The pain level (VAS) before and 12, 24, 48, and 72 hours after the operation, as well as the negative emotions [anxiety (SAS) , depression (SDS) ], resilience (CD-RISC) and quality of life (WHOQOL-BREF) score of patients before and after the intervention were compared between the two groups.Results:Compared with before operation, the VAS scores of the intervention group at 12, 24, 48 and 72 h after operation were lower, and the VAS scores of the intervention group at each time point after operation were lower than those of the control group, and the differences were statistically significant ( P<0.05) . After the intervention, SAS and SDS scores of patients of the two groups were lower than those before the intervention, and SAS and SDS scores of the intervention group after the intervention were lower than those of the control group, and the differences were statistically significant ( P<0.05) . The scores of each dimension of CD-RISC after intervention in the two groups were higher than those before intervention, and the scores of each dimension of CD-RISC in the intervention group after intervention were higher than those in the control group, and the differences were statistically significant ( P<0.05) . The scores of each dimension of WHOQOL-BREF in the two groups after intervention were higher than those before intervention, and the scores of each dimension of WHOQOL-BREF in the intervention group after intervention were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Skillful communication combined with pathway pain management can reduce the pain level of patients undergoing endoscopic sclerotherapy of internal hemorrhoids, relieve the negative emotions of patients and improve their psychological resilience and quality of life, which is worthy of clinical promotion.

According to the information of the supervision and inspection of in vitro diagnostic reagents for clinical use, this article analyzed the compliance issues and discussed the methods to solve the problems, to urge medical institutions to reduce the regulatory risk of in vitro diagnostic reagents in use.
Government Regulation ; Indicators and Reagents ; adverse effects ; Risk

Tuoli Xiaodusan is the 65^th formula in the Catalogue of Ancient Famous Classical Formulas（First Batch）. In this study， the bibliometric method was used to summarize and verify the ancient books about Tuoli Xiaodusan in terms of its historical origin， composition and dosage of the formula， indications， decoction and administration method， and processing， etc. According to the research， there is no definite date of the formation of Tuoli Xiaodusan， the earliest can be traced back to Lizhai Waike Fahui in Ming dynasty， which has been widely circulated， with many versions of prescription composition， and the modern influential version is from Waike Zhengzong in Ming dynasty， which is made up of 12 Chinese herbs including Ginseng Radix et Rhizoma（3.73 g）， Chuanxiong Rhizoma（3.73 g）， Paeoniae Radix Alba（3.73 g）， Astragali Radix（3.73 g）， Angelicae Sinensis Radix（3.73 g）， Atractylodis Macrocephalae Rhizoma（3.73 g）， Poria（3.73 g）， Lonicerae Japonicae Flos（3.73 g）， Angelicae Dahuricae Radix（1.87 g）， Glycyrrhizae Radix et Rhizoma（1.87 g）， Gleditsiae Spina（1.87 g）， Platycodonis Radix（1.87 g）. The herb origins almost follow the 2020 edition of Chinese Pharmacopoeia， except that Angelica dahurica var. formosana is only recommended as the origin of Angelicae Dahuricae Radix， and Glycryyhiza uralensis is only recommended as the origin of Glycyrrhizae Radix et Rhizoma. All the herbs are recommended to be used in the raw products. As for the preparation method， it is recommended to decoct with water， add 400 mL of water， boil until 160 mL， and take 2-3 times a day. The formula has the functions of nourishing Qi and nourishing blood， detoxifying and draining pus， and was mainly used to treat ulcerative diseases with the syndrome of syndrome of healthy Qi deficiency and pathogenic factors excess in ancient times， and in modern times， it is used for a wide range of treatment， involving the skin and soft tissues， bones， digestion and many other systemic diseases， and is also mainly used for syndrome of healthy Qi deficiency and pathogenic factors excess. In this study， the ancient and modern applications of Tuoli Xiaodusan were summarized， and its key information was identified， providing a basis for its wider clinical application， in-depth research and formulation development.

Objective To analyze and identify the volatile constituents in different parts(flowers,stems and leaves)of Huai chrysanthemumin,and to lay a theoretical foundation for the comprehensive utilization for it.Methods The volatile oil in different parts of Huai chrysanthemumin were extracted by hydrodistillation,respectively.Their constituents were analyzed by gas chromatography-mass spectrometry(GC-MS).The compounds were identified by library search and literature screening.The relative percentage of each compound was obtained by the area normalization method.The differences in their chemical compositions were analyzed by Venn diagram,principal component analysis(PCA)and cluster heat map analysis.Results A total of 62 volatile chemical components were identified from different parts of Huai chrysanthemumin,including monoterpenes,sesquiterpenes,and their derivatives,as well as a small amount of aliphatic compounds.32,42 and 40 volatile components were detected from the flowers,stems and flowers,respectively.Furthermore 17 volatile components were shared by three parts,whereas 5,6 and 16 volatile components were unique to the flowers,stems and leaves,respectively.The results of stoichiometric analysis showed that both PCA and cluster heat map analysis could separate the flowers,stems and leaves,and their volatile components were different.Conclusion The types and contents of the volatile oil in the stems,leaves and flowers of Huai chrysanthemumin have certain variability,which provide a scientific basis for the further medicinal or industrial exploitation of different parts of Huai chrysanthemumin.

Objective:To develop a risk prediction model for identifying bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH) in very premature infants.Methods:This was a retrospective cohort study. The clinical data of 626 very premature infants whose gestational age <32 weeks and who suffered from BPD were collected from October 1 st, 2015 to December 31 st, 2021 of the Seventh Medical Center of the People′s Liberation Army General Hospital as a modeling set. The clinical data of 229 very premature infants with BPD of Hunan Children′s Hospital from January 1 st, 2020 to December 31 st, 2021 were collected as a validation set for external verification. The very premature infants with BPD were divided into PH group and non PH group based on the echocardiogram after 36 weeks′ corrected age in the modeling set and validation set, respectively. Univariate analysis was used to compare the basic clinical characteristics between groups, and collinearity exclusion was carried out between variables. The risk factors of BPD associated PH were further screened out by multivariate Logistic regression, and the risk assessment model was established based on these variables. The receiver operating characteristic (ROC) area under curve (AUC) and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the model′s discrimination and calibration power, respectively. And the calibration curve was used to evaluate the accuracy of the model and draw the nomogram. The bootstrap repeated sampling method was used for internal verification. Finally, decision curve analysis (DCA) to evaluate the clinical practicability of the model was used. Results:A total of 626 very premature infants with BPD were included for modeling set, including 85 very premature infants in the PH group and 541 very premature infants in the non PH group. A total of 229 very premature infants with BPD were included for validation set, including 24 very premature infants in the PH group and 205 very premature infants in the non PH group. Univariate analysis of the modeling set found that 22 variables, such as artificial conception, fetal distress, gestational age, birth weight, small for gestational age, 1 minute Apgar score ≤7, antenatal corticosteroids, placental abruption, oligohydramnios, multiple pulmonary surfactant, neonatal respiratory distress syndrome (NRDS)>stage Ⅱ, early pulmonary hypertension, moderate-severe BPD, and hemodynamically significant patent ductus arteriosus (hsPDA) all had statistically significant influence between the PH group and the non PH group (all P<0.05). Antenatal corticosteroids, fetal distress, NRDS >stage Ⅱ, hsPDA, pneumonia and days of invasive mechanical ventilation were identified as predictive variables and finally included to establish the Logistic regression model. The AUC of this model was 0.86 (95% CI 0.82-0.90), the cut-off value was 0.17, the sensitivity was 0.77, and the specificity was 0.84. Hosmer-Lemeshow goodness-of-fit test showed that P>0.05. The AUC for external validation was 0.88, and the Hosmer-Lemeshow goodness-of-fit test suggested P>0.05. Conclusions:A high sensitivity and specificity risk prediction model of PBD associated PH in very premature infants was established. This predictive model is useful for early clinical identification of infants at high risk of BPD associated PH.

OBJECTIVE To co mpare the difference of liposoluble constitue nts in different processed products of Huaizhong No.1 Rehmannia glutionsa （fresh R. glutionsa ，R. glutionsa and prepared R. glutionsa ），and to evaluate its in vitro antioxidant activity preliminarily. METHODS Liposoluble extracts were extracted from 3 processed products of R. glutionsa by Soxhlet extraction. Their constituents were analyzed by gas chromatography-mass spectrometry. The spectral library of NIST 98 system was used to automatically retrieve the mass spectrum information of components ，and the structures of compounds were identified in combination with relevant literature and by comparing with eight peak index and EPA/NIH library. Relative contents of the components were calculated by using peak area normalization method with Hewlett Packard software. The antioxidant activities of liposoluble constituents in 3 processed products of R. glutionsa were investigated by 1，1-diphenyl-2-picrylhydrazyl（DPPH）free radical scavenging. RESULTS A total of 79 liposoluble components were identified from different processed products of R. glutionsa，and 48，52 and 37 liposoluble compounds were identified from fresh R. glutionsa ，R. glutionsa and prepared R. glutionsa，respectively；their relative contents accounted for 92.69％，86.29％，92.89％ of the total components respectively. Among them ，there were 20 liposoluble compounds totally ，and their relative contents accounted for 88.73％，80.89％ and 85.87％ of liposoluble components in each processed product respectively ；they were mainly composed of fatty acids such as methyl linoleate，methyl palmitate and methyl oleate. In addition ，there were 18 unique liposoluble components in fresh R. glutionsa ， mostly terpenoids ；there were 17 and 6 unique liposoluble components in R. glutionsa and prepared R. glutionsa ，mostly alkanes. The results of antioxidant experiment showed that median scavenging concentrations of liposoluble components to DPPH limeng free radical were 0.756，0.660，0.758 mg/mL，respectively. CONCLUSIONS The common liposoluble components in different processed products of R. glutionsa are mostly acids；the unique liposoluble components in fresh R. glutionsa are mostly terpenoids ，and those of R. glutionsa and prepared R. glutionsa are mostly alkanes ；the liposoluble constituents possess in vitro antioxidant activities.