Objective To make a rapid determination of ferulic acid and identification of its structure in rhizome of Phragmites communis (RPC). Methods The chemical constituents were extracted by solvent and the relative content and structure of ferulic acid in RPC were determined and identified using GC-TOFMS technique. Results By GC-TOFMS, the ferulic acid was successfully isolated from the extracts of RPC in a relative content of 5%. According to the exact masses and corresponding elemental compositions of molecular ion and eight characteristic ions, a possible fragmentation pathway of the ferulic acid molecule was proposed, by which the molecular structure was confirmed. Conclusion GC-TOFMS technique is a rapid, accurate, sensitive, and reliable method for determination of the relative content of ferulic acid in RPC and identificatiion of its structure.

Objective To investigate clinical characteristics and risk factors in early and advanced menopausal women with coronary heart disease (CHD).Methods A total of 259 menopausal women with CHD confirmed by coronary angiography in our hospital were selected as research objects,among whom 102 cases were in menopause≤ 10 years group,and 157 cases in menopause ＞ 10 years group.The clinical characteristics and risk factors of two groups were compared.Results The menopause ≤ 10 years group had higher incidence rate of hypertension and estrogen levels(P ＜ 0.05),but there was no significant difference in HLD-C,and TC levels,and carotid intima-media thickness (IMT) reached the degree of atherosclerosis.Menopause ＞ 10 years group showed a significantly higher incidence of diabetes,but LDL-C level and estrogen levels was significantly lower (P ＜ 0.05).The coronary artery disease in the menopause≤ 10 years group mainly occurred in single lesion,while the menopause ＞ 10 years group in double or multi-vessel lesion (P ＜0.05).Multivariate analysis showed that hypertension,diabetes,triglycerides,low-density lipoprotein cholesterol were risk factors for coronary heart disease,while estradiol was a protective factor.Conclusion Hypertension,diabetes,triglycerides,and low-density lipoprotein cholesterol and decreased estrogen are risk factors for women with coronary heart disease.Conditions of vascular endothelium and atherosclerosis of early postmenopausal women are better than the advanced postmenopausal women,and estrogen alternative is favorable for the patients.

Objective To investigate clinical characteristics and risk factors in early and advanced menopausal women with coronary heart disease (CHD).Methods A total of 259 menopausal women with CHD confirmed by coronary angiography in our hospital were selected as research objects,among whom 102 cases were in menopause≤ 10 years group,and 157 cases in menopause ＞ 10 years group.The clinical characteristics and risk factors of two groups were compared.Results The menopause ≤ 10 years group had higher incidence rate of hypertension and estrogen levels(P ＜ 0.05),but there was no significant difference in HLD-C,and TC levels,and carotid intima-media thickness (IMT) reached the degree of atherosclerosis.Menopause ＞ 10 years group showed a significantly higher incidence of diabetes,but LDL-C level and estrogen levels was significantly lower (P ＜ 0.05).The coronary artery disease in the menopause≤ 10 years group mainly occurred in single lesion,while the menopause ＞ 10 years group in double or multi-vessel lesion (P ＜0.05).Multivariate analysis showed that hypertension,diabetes,triglycerides,low-density lipoprotein cholesterol were risk factors for coronary heart disease,while estradiol was a protective factor.Conclusion Hypertension,diabetes,triglycerides,and low-density lipoprotein cholesterol and decreased estrogen are risk factors for women with coronary heart disease.Conditions of vascular endothelium and atherosclerosis of early postmenopausal women are better than the advanced postmenopausal women,and estrogen alternative is favorable for the patients.

Objective: To analyze the epidemiological and etiological characteristics of hand-foot-mouth disease (HFMD) in Tongren City during 2018 to 2022, so as to provide the reference for HFMD effective prevention and control. Methods: Monitoring data on HFMD in Tongren City from 2018 to 2022 was collected from National Infectious Disease Reporting Information Management System. Descriptive epidemiological method was conducted on the data analysis. Results: A total of 14 376 cases of HFMD were reported in Tongren City during 2018 to 2022, the average annual incidence rate of HFMD was 89.43/100 000. Totally 47 severe cases were reported, accounting for 0.33% of the total cases. The incidence rates of HFMD were generally declining trend during 2018 to 2022 (124.68/100 000, 95.37/100 000, 78.50/100 000, 61.63/100 000, 87.80/100 000) ( χ 2 trend =393.05, P <0.01), mainly occurred during April to July (48.13%), among children under 5 years old (95.72%). During 2018 to 2022, a total of 967 laboratory diagnosed cases reported in different years, regions, age groups showed significant differences in pathogen composition ratio ( χ 2=169.62, 456.65 , 167.96, P <0.05). From 2018 to 2022, the dominant pathogen of HFMD was constantly changing. Other enteroviruses were the dominant epidemic strains in 2018 and 2022 (33.04%, 37.62%), CoxA 6 was the dominant epidemic strain in 2019 to 2020 ( 68.75 %, 50.78%), and CoxA16 was the dominant epidemic strain in 2021(43.30%).In 2018, one case was infected with CoxA16 and EV71.The difference of pathogen composition ratio varied in different years ( χ 2=169.62, P <0.01). Conclusions The prevalence of HFMD in Tongren City has showed a declining trend during 2018 to 2022, and the dominant strain of HFMD has changed in recent years. The pathogen monitoring of HFMD should be strengthened to timely grasp the distribution and changes of pathogens, so as to provide a basis for the precise prevention and control of HFMD.

Objective:To explore the analysis of staging alteration and prognosis of 8th edition of the American Joint Committee on Cancer (AJCC) staging update for breast cancer with different molecular subtypes.Methods:The clinical data of 965 breast cancer patients treated in Xijing Hospital from January 2011 to December 2017 were retrospectively collected, and 103 patients met the inclusion criteria. The staging results between all the patients and patients with 4 different molecular subtypes were compared according to the 7th and 8th edition of the AJCC. Fisher's exact test was used for staging differences, Kaplan-Meier was used for survival analysis, log-rank test was used to compare survival rates of different groups, the prognostic judgement efficacy and staging alteration for all patients and cases with different molecular subtypes in the 8th edition was also compared.Results:Compared with the 7th edition, a total of 52 cases (50.5%) had staging declined and 8 cases (7.8%) had staging risen in the 8th edition, and there was a statistically significant difference in composition change ( P < 0.05). There was no rise in staging for Luminal subtype patients, but the decline in 34 cases, with the decline rate of 87.2% (34/39); no rise in staging for patients of HER2 + subtype, but the decline in4 cases, with the decline rate of 19.0% (4/21). No rise in staging for triple positive subtype patients, but the decline in 14 cases, with the decline rate of 82.4% (14/17). Oppositely, for the patients with previous subtypes, no decline in staging of patients with triple negative subtypes, but the rise in 8 cases with the rise rate of 30.8% (8/26). The difference in all the above staging changes was statistically significant ( P = 0.001). According to the 7th edition of the AJCC, the disease-free survival (DFS) time of all the cases and Luminal subtype patients had no statistical differences among different staging groups ( P > 0.05), but according to the 8th edition of the AJCC, the differences were statistically significant ( P < 0.05). DFS time was shorten with the increase of staging, indicating that the 8th edition of staging could more accurately assess the prognosis of patients. Conclusions:Compared with the 7th edition of the AJCC, for the staging changes determined by the 8th edition of the AJCC, the proportion of staging declined in all the cases is significantly higher than that of staging risen, and patients with different molecular subtypes has different staging changes, among which the patients with the triple negative subtypes have staging risen and the rest have staging declined. The DFS analysis for all the patients and patients with Luminal subtypes indicates that the 8th edition of the AJCC staging is a more accurate predictor of prognosis compared with the 7th edition of the AJCC.

With the development of critical care ultrasound technology, clinics begins to pay attention to the role of critical care ultrasound in nursing of critically ill patients. The increasingly extensive application of ultrasound in the field of critical care provides a visual tool for clinical nursing work, which can qualitatively and quantitatively evaluate nursing indicators, help to solve the existing nursing problems and nursing difficulties and promote the improvement of critical care quality and the development of nursing academics. To this end, experts formulates this consensus based on years of experience and application of intensive care ultrasound practice.

Objective:To formulate the Nursing standards of clinical practice of critical care ultrasonography (referred to as the Standards), so as to provide recommendations for the application of ultrasound in intensive care nursing practice. Methods:Based on the experience of intensive care ultrasound nursing practice and literature research, combined with the consensus recommendations of intensive care ultrasound, the critical care ultrasound study group formed the first draft of the Standards. After expert interview, consensus discussion, two rounds of Delphi expert letter consultation and other methods, the content of the Standards was revised and improved, and the final draft of the Standards was formed. Results:The Standards included four parts, such as basic application of intensive care ultrasound, nursing evaluation standard of intensive care ultrasound guidance, nursing operation process guided by ultrasound and intensive care ultrasound training. Conclusions:The establishment of Standards is scientific and practical, which can provide guidance for nursing practice of clinical operation technology of critical care ultrasonography.

Jupi Zhurutang originated from Synopsis of the Golden Chamber （《金匮要略》）， which consists of Pericarpium Citri Reticulatae， Caulis Bambusae in Taenia， Ginseng Radix et Rhizoma， Zingiberis Rhizoma Recens， Jujubae Fructus， and Glycyrrhizae Radix et Rhizoma and is used to treat retching. It has been put on the list of Catalogue of Ancient Classical Prescription （First Batch） released by National Administration of Traditional Chinese Medicine. With the bibliometric method， we searched the medical classics containing Jupi Zhurutang and systematically examined the information on the origin of the prescription， the indications， compatibility rule， medicinals in the prescription， dosage and usage， processing method， and decocting method. It was found that there are many versions of Jupi Zhurutang， and there are common grounds of main symptoms， pathogenesis， composition and dosage between the same prescription with different names and different prescriptions with the same name. The prescription which is closest to the original version in Synopsis of the Golden Chamber is mainly used for the treatment of stomach deficiency and qi counterflow without obvious cold or heat. According to the weights and measures， ratio of Pericarpium Citri Reticulatae， Caulis Bambusae in Taenia， Radix Ginseng， Rhizoma Zingiberis Recens， and Radix Ginseng in Synopsis of the Golden Chamber is approximately 6∶2∶8∶5∶1. The Jupi Zhurutang derived from other ancient classics such as Yanshi Jisheng Fang（《严氏济生方》） is a different prescription for hiccups caused by the stomach heat， and the ratio of Pericarpium Citri Reticulatae to Caulis Bambusae in Taenia in this prescription is about 1∶1. It is also found that cold herbs such as Red Poria， Eriobotryae Folium and Ophiopogon Japonicus are added to the formula in later generations. Therefore， the Jupi Zhurutang used in modern times is mostly modified and different from that in Synopsis of the Golden Chamber. This study summarizes the historical evolution of Jupi Zhurutang and identifies the key information， with a view to providing a reference for the rational modification of this prescription in clinical settings and further research.

【Objective】 To investigate the potential mechanism of miR-17 in vascular smooth muscle cells in coronary artery disease (CAD). 【Methods】 mRNA expression of miR-17 and insulin growth factor 1 (IGF-1) in serum and VSMCs of CAD patients were detected by RT-qPCR. Potential targets of miR-17 were detected by bioinformatics and luciferase reporter assay; CCK-8 and cloning formation assay was performed to measure the proliferation of VSMCs. 【Results】 RT-qPCR results showed that compared with those in control group, the miR-17 mRNA expression in VSMCs and serum of CAD patients were significantly upregulated (P<0.01). The results of CCK-8 and clone formation assay showed that compared with those in control group, the number of VSMCs proliferation and cloning formation in the miR-17 overexpression group were significantly increased (P<0.01); those in the miR-17 low expression group were significantly reduced (P<0.01). Bioinformatics analysis showed that the 3’-UTR of IGF-1 had an miR-17 binding site. The luciferase reporter assay showed that the luciferase activity of VSMCs co-transfected with wild-type IGF-1 plasmid and miR-17 mimic was increased (P<0.001). However, the luciferase activity of VSMCs transfected with mutant IGF-1 plasmid and miR-17 mimics remained unchanged. Compared with that in control group, the expression of IGF-1 in VSMCs was upregulated after miR-17 overexpression (P<0.01). And the number of VSMCs proliferation and clone formation in the IGF-1 overexpression group was significantly increased (P<0.05). 【Conclusion】 miR-17 promotes the proliferation of VSMCs by targeting IGF-1. This indicates that miR-17 can be used as a predictive biomarker of CAD, and IGF-1 may be a potential therapeutic target.

POEMS syndrome is a rare condition associated with plasma cell disorders， and it often involves multiple systems and has diverse clinical manifestations. This article reports two cases of POEMS syndrome with hepatosplenomegaly as the initial manifestation. During the course of the disease， the patients presented with lower limb weakness， hepatosplenomegaly， lymph node enlargement， ascites， hypothyroidism， positive M protein， and skin hyperpigmentation， and ¹⁸F-FDG PET-CT imaging revealed bone lesions mainly characterized by osteolytic changes and plasma cell tumors. There was an increase in the serum level of vascular endothelial growth factor. The patients were finally diagnosed with POEMS syndrome， and the symptoms were relieved after immunomodulatory treatment.