Objective The aim of the study was to investigate the application effect of de-escalation thinking in first aid nursing of craniocerebral injury complicated with cervical spine injury.Methods 23 cases of craniocerebral injury and cervical spine injury patients received first aid rescue in emergency department of our hospital during the period from September 2012 to August 2014 were set as the observation group,and the de-escalation thinking way was used during rescue process.19 cases of craniocerebral injury and cervical spine injury patients during the period from September 2010 to August 2012 were set as the control group,traditional way of clinical experience thinking way was used.The early warning time,emergency treatment time and missed diagnosis cases were compared between the two groups.Results The early warning time of diagnosed as traumatic brain injury complicated with cervical spine injury (t=18.035) and emergency treatment time (t=7.650) in the observation group were shorter than those of the control group,the difference was significant.The missed diagnosis rate of the observation group [4.35％(1/23)] was significantly lower than that of the control group (9/19),the difference was significant (x2=8.38).Conclusions Application of de-escalation thinking mode in rescue by emergency nurses can shorten the early warning and emergency treatment time,decrease the missed diagnosis rate and improve the timeliness of the rescue for craniocerebral injury complicated with cervical spine injury.

Objective:To analyze the survival and influencing factors of HIV infections and AIDS cases (HIV/AIDS) aged 15 years and over who had received antiretroviral treatment (ART) for more than 10 years in Henan Province.Methods:In this retrospective cohort study, data of HIV infections and AIDS cases in Henan province were collected from the AIDS Prevention and Control System between January 1, 2002 and December 31, 2020. This study included 20 256 participants alive after 10-year ART with complete baseline and follow-up information, such as demographic characteristics, CD4 +T lymphocyte count and viral load. Cox proportional risk regression model was used to analyze influencing factors of HIV/AIDS survival. Results:A total of 20 256 participants were followed up for 82 738.2 person-years, with an average follow-up of 4.1 person-years, of which most cases were blood transmission (85.5%) and married (71.2%). The male to female ratio was 1∶1.06 and the age at 10 years of ART was (51.2±8.7) years old. About 88.5% of HIV/AIDS patients received ART in village/township treatment institutions. Overall, there were 2 030 deaths during this period, among which 1 897 were due to AIDS-related diseases (93.5%) and the case fatality rate was 9.4% (1 897/20 256). Cox proportional risk regression model showed that participants aged 40-54, 55-69, and ≥70 years had a higher risk of death compared to those aged 25-39, with adjusted HRs (95% CI) of 1.57 (1.19-2.08), 3.78 (2.86-4.99), and 6.17 (4.33-8.79), respectively. Participants with the initial CD4 +T lymphocyte count about 200-349/μl and<200/μl had a higher risk of death compared to those with initial CD4 +T lymphocyte count ≥350/μl, with adjusted HRs (95% CI) of 1.81 (1.61-2.04) and 3.64 (3.20-4.15), respectively. Participants with the initial viral load outcome ≥1 000 copies/ml had a higher risk of death compared to those with the initial viral load outcome<1 000 copies/ml, with adjusted HRs (95% CI) of 1.73 (1.52-1.97). Participants receiving the second-line ART had a lower risk of death compared to those receiving the first-line ART, with adjusted HRs (95% CI) of 0.12 (0.11-0.14). Conclusion:From 2002 to 2020, the survival rate of HIV/AIDS treated with ART for more than 10 years is high in Henan Province. Age, CD4 +T lymphocyte count and viral load are influencing factors of HIV/AIDS survival.

Objective:To analyze the survival and influencing factors of HIV infections and AIDS cases (HIV/AIDS) aged 15 years and over who had received antiretroviral treatment (ART) for more than 10 years in Henan Province.Methods:In this retrospective cohort study, data of HIV infections and AIDS cases in Henan province were collected from the AIDS Prevention and Control System between January 1, 2002 and December 31, 2020. This study included 20 256 participants alive after 10-year ART with complete baseline and follow-up information, such as demographic characteristics, CD4 +T lymphocyte count and viral load. Cox proportional risk regression model was used to analyze influencing factors of HIV/AIDS survival. Results:A total of 20 256 participants were followed up for 82 738.2 person-years, with an average follow-up of 4.1 person-years, of which most cases were blood transmission (85.5%) and married (71.2%). The male to female ratio was 1∶1.06 and the age at 10 years of ART was (51.2±8.7) years old. About 88.5% of HIV/AIDS patients received ART in village/township treatment institutions. Overall, there were 2 030 deaths during this period, among which 1 897 were due to AIDS-related diseases (93.5%) and the case fatality rate was 9.4% (1 897/20 256). Cox proportional risk regression model showed that participants aged 40-54, 55-69, and ≥70 years had a higher risk of death compared to those aged 25-39, with adjusted HRs (95% CI) of 1.57 (1.19-2.08), 3.78 (2.86-4.99), and 6.17 (4.33-8.79), respectively. Participants with the initial CD4 +T lymphocyte count about 200-349/μl and<200/μl had a higher risk of death compared to those with initial CD4 +T lymphocyte count ≥350/μl, with adjusted HRs (95% CI) of 1.81 (1.61-2.04) and 3.64 (3.20-4.15), respectively. Participants with the initial viral load outcome ≥1 000 copies/ml had a higher risk of death compared to those with the initial viral load outcome<1 000 copies/ml, with adjusted HRs (95% CI) of 1.73 (1.52-1.97). Participants receiving the second-line ART had a lower risk of death compared to those receiving the first-line ART, with adjusted HRs (95% CI) of 0.12 (0.11-0.14). Conclusion:From 2002 to 2020, the survival rate of HIV/AIDS treated with ART for more than 10 years is high in Henan Province. Age, CD4 +T lymphocyte count and viral load are influencing factors of HIV/AIDS survival.

By reviewing ancient materia medica and combining with modern literature， the textual research of Magnoliae Flos has been conducted to verify the name， origin， producing area， harvesting and processing methods， in order to provide basis for the selection and use of this herb in the development of famous classical formulas. After the textual research， it could be seen that the correct name of Magnoliae Flos was Xinyi in the past dynasties， meaning spicy flower buds. The main original plants used in past dynasties are Magnolia denudata and M. biondii. The history of the research on its scientific name in recent times is complicated， many foreign scholars have given several different scientific names， but most of them are inconsistent with the actual situation of Magnoliae Flos used in ancient China， because foreign scholars failed to collect the original plants of Magnoliae Flos for accurate identification. Before the Ming dynasty， Magnoliae Flos was mainly produced in Shaanxi， and then the recorded production areas gradually increased. After the founding of the People's Republic of China， the products produced in Henan named M. biondii were highly respected， and Henan was regarded as authentic producing area， and because of the collection and distribution through Yuzhou， it was customarily called Huichunhua. In ancient times， the harvesting period of Magnoliae Flos mostly concentrated in the first and second months of the lunar calendar， and the flower buds of M. biondii were also recommended to be used as medicine， but nowadays the flower buds are mostly collected in winter and spring， and those with dry buds， large size， yellow-green color， tight inner petals， fragrant smell， and no impurities are preferred. In the past dynasties， raw products were the mainstream， and there were also frying， soaking and so on. Based on the results， it is suggested that the flower buds of M. biondii should be used in the development of famous classical formulas. If the original formula does not specify the processing requirements， the raw products can be used as medicine.

ObjectiveBased on the quality evaluation experience of "it is better to have a fragrant and strong aroma" summarized by materia medica of past dynasties， the chemical components of Sojae Semen Nigrum（SSN） and Sojae Semen Praeparatum（SSP） were systematically compared and analyzed， and the main fermentation products in different fermentation time were quantitatively analyzed， so as to clarify the transformation law of internal components in the processing process and provide scientific basis for the modern quality control of SSP. MethodUltra performance liquid chromatography-quadrupole tandem time-of-flight mass spectrometry（UPLC-Q-TOF-MS） was used for the structural identification of the chemical constituents of SSN and SSP， and with the aid of Progenesis QI v2.3 software， the negative ion mode was employed for principal component analysis（PCA） pattern recognition， and the data were analyzed with the aid of orthogonal partial least squares-discriminant analysis（OPLS-DA） for two-dimensional data to obtain S-plot， and components with |P|>0.1 were selected as the differential constituents. The contents of isoflavonoids in SSP during fermentation was determined by UPLC， and the samples were taken every 8 h in the pre-fermentation period and every 2 d in the post-fermentation period， and the dynamic changes of isoflavonoid contents in different fermentation stages were analyzed. The contents of amino acids and nucleosides in SSP and SSN from different fermentation stages were quantitatively analyzed by phenyl isothiocyanate（PITC） pre-column derivatization and high performance liquid chromatography（HPLC） gradient elution， and the contribution of flavor substances to the "delicious" taste of SSP was discussed by taste intensity value（TAV）. ResultA total of 19 kinds of differential components were screened out， mainly soybean saponins and isoflavones， and their contents decreased significantly or even disappeared after fermentation. In the pre-fermentation process of SSP， glycoside bond hydrolysis mainly occurred， and isoflavone glycosides in SSN were degraded and converted into the corresponding aglycones， the content of flavor substances such as amino acids increased gradually. In the post-fermentation process， protein degradation mainly occurred， after 8 d of post-fermentation， the content of isoflavones was basically stable， while the total content of amino acids increased by 8-40 times on average. Different amino acids form the special flavor of SSP， such as the TAV of glutamate is always ahead of other flavor substances， and sweet substances such as alanine and valine have made relatively great contributions to SSP. ConclusionBased on the law of constituent transformation， combined with the traditional evaluation index of "fragrant and strong"， it is difficult to control the fermentation degree of SSP by the existing standards in the 2020 edition of Chinese Pharmacopoeia. It is suggested that description of the characteristics of SSP be refined and changed to "fragrant， delicious and slightly sweet"， and at the same time， the post-fermentation index compounds such as glutamic acid， alanine and valine should be added as the quality control indicators of SSP， so as to standardize the production process and improve the quality of SSP.