Objective To investigate the clinical manifestations of aortic dissection (AD),the characteris-tics of early diagnosis and treatment,and the causes of misdiagnosis.Methods 40 cases of aortic dissection with clinical manifestations,auxiliary examination,clinical classification,emergency diagnosis and misdiagnosis were retro-spectively analyzed.Results Initial symptoms were severe chest pain and(or)low back pain in 25 patients;chest tightness,asthma,dyspnea in 4 cases(10.0%);Unexplained shock and collapse in 4 patients(10.0%);abdominal pain with abdominal discomfort in 4 cases(10.0%);1 case of limb numbness(2.5%);cough,fever and hemoptysis in 2 cases(5.0%).associated with blood pressure on both sides of the asymmetry,a difference of more than 10 mmHg in 10 cases(25.0%).Auxiliary examination:9 cases of abnormal ECG,3 cases(6.6%)of the patients with acute inferior myocardial infarction,emergency chest CT scan in 10 cases,10 cases of emergency nuclear magnetic reso-nance,CT angiography in 20 cases,9 cases of bedside ultrasound;Respectively:6 cases were misdiagnosed as acute coronary syndrome,1 case of cardiac insufficiency,2 cases of sever pneumonia,pancreatitis,cholecystitis,multiple organ dysfunction,1 case of renal failure,acute gastritis in 1 case;musdiagnosis time 1 day to 3 days.28 cases of covered stent in the treatment,the remaining 8 cases were transferred to surgical treatment and other conservative treatment,4 cases of death.Conclusion Aorta complicated and varied clinical manifestation,dangerous condition, improve the emergency physician of aortic dissection,open diagnostic thinking and timely diagnosis and differential diagnosis,according to the condition of reasonable selection of auxiliary examination,specific imaging examination is the key to reduce the misdiagnosis.

Objective:To investigate the curative effects of early continuous blood purification therapy on moderate to severe acute pancreatitis.Methods:The clinical data of 94 patients with moderate to severe acute pancreatitis who received treatment in the First People's Hospital of Shangqiu, China between January 2018 and October 2019 were retrospectively analyzed. These patients were divided into a control group and an observation group ( n =47/group) according to different treatment methods. The control group was treated with conventional treatment, while the observation group was treated with continuous blood purification therapy based on conventional treatment. The time to abdominal pain and distension relief, the changes of vital signs such as respiration and heart rate, renal function, the levels of liver enzymes, C-reactive protein and interleukin-6, median remission time of systemic inflammatory response syndrome, the Acute Physiology, Age, Chronic Health Evaluation II score, modified Marshall score, and modified CT severity index (MCTSI) were compared between the two groups. Results:The time to abdominal pain relief [(2.28 ± 0.44) d] and the median remission time of systemic inflammatory syndrome [(5.27 ± 0.95) d] were significantly shorter than those in the control group [(6.23 ± 1.01) d and (11.30 ± 1.12) d, t = 34.213 and 28.308, both P < 0.05]. The levels of alanine aminotransferase, blood urea nitrogen, serum creatinine, C-reactive protein and interleukin-6 in the observation group were (28.22 ± 34.38) U/L, (5.73 ± 1.83) mmol/L, (70.26 ± 4.34) μmol/L, (102.66 ± 3.29) mg/L, (110.45 ± 5.50) pg/L respectively, which were significantly lower than those in the control group [(47.26 ± 56.61) U/L, (10.55 ± 3.09) mmol/L, (114.21 ± 6.87) μmol/L, (210.51 ± 10.11) mg/L, (281.77 ± 14.99) pg/L, t = 3.520, 23.724, 81.266, 96.618, 114.005, all P < 0.05]. The Acute Physiology, Age, Chronic Health Evaluation II score, modified Marshall score, and modified CT severity index in the observation group were (11.43 ± 0.66) points, (3.06 ± 0.29) points, (8.16 ± 0.27) points, which were significantly lower than (18.49 ± 1.77) points, (4.92 ± 0.37) points, (9.57 ± 0.35) points respectively in the control group ( t = 39.590, 76.458, 67.484, all P < 0.05). Conclusion:Continuous blood purification therapy can effectively remove metabolites and poisons from the body, shorten the duration of systemic inflammatory response syndrome, promote the recovery of body function, and thereby improve the prognosis of moderate to severe acute pancreatitis.

Objective: To analyze the bioactive components of Acnoitum Kusnezoffii Reichb..Methods: To detect the water extraction of Aconitum kusnezoffii Reichb.by the method of ESI-MSn.Results: Three kinds of alkaloids were detected in the water extraction of Aconitum kusnezoffii Reichb.:monoester alkaloids,diester-diterpenoid aconitines and lipo-alkaloids.Conclusion: The effect components of processed and unprocessed Acnoitum Kusnezoffii Reichb.can be analyze rapidly by ESI-MSn,and only needs few sample.

AIM:To study the bioactive components effect of every kind of herbal in Naru Sanwei Pill (Fructus litseae, Fructus chebulae) on Radix Aconiti kusnezoffii. METHODS: Analysising the Naru Sanwei Pill, adding the extraction of Radix Aconiti kusnezoffii to Fructus chebulae and Fructus litseae and was analyzed by ESI-MS~n. RESULTS: The quantity of mesaconitin was low in the extraction of Aconitum kusnezoffii Reichb,and Fructus chebulae.Long Pepper did not have much effect on alkaloids of Aconiti kusnezoffii Reichb. CONCLUSION: Fructus chebulae reduced toxicity in the process of Radix aconiti kusnezoffii,through lowering the dissolving-out of aconitine.

Objective:To evaluate the prognostic value of combined detection of serum C-reactive protein(CRP), procalcitonin and lactic acid in elderly patients with community acquired pneumonia(CAP).Methods:Ninety-five elderly CAP patients in the emergency department of Shangqiu First People's Hospital were included as the case group, and 45 elderly healthy people in the emergency department of Shangqiu First People's Hospital were enrolled as the control group.Levels of blood lactic acid, procalcitonin and CRP were compared between the two groups.Meanwhile, blood levels of lactic acid, procalcitonin and CRP were compared between patients with different outcomes in the case group.The receiver operating characteristic(ROC)curve was used to evaluate the prognostic value of CRP, procalcitonin and blood lactic acid in elderly patients with CAP.Results:Compared with the control group, blood levels of lactic acid, procalcitonin and CRP were increased in the case group( t=20.77, 26.03 and 31.27, all P<0.01). During a 12-month follow-up, 13 cases(13.68%, 13/95)died and 82 cases(86.32%, 82/95)survived in the case group.Blood levels of lactic acid, procalcitonin and CRP were higher in the death group than in the survival group( t=25.56, 8.30 and 13.56, all P<0.01). ROC curve analysis showed that the sensitivity and specificity of serum lactic acid, procalcitonin and CRP in predicting the prognosis of elderly CAP patients were 76.92% and 73.17%, 84.62% and 78.05%, and 69.23% and 70.73%, respectively.The sensitivity and specificity of combined detection of the three indicators were 92.31% and 89.02%, respectively, higher than those of the individual indicators. Conclusions:Serum levels of lactic acid, procalcitonin and CRP are increased in elderly patients with CAP.Combined detection of the three indicators can improve the prognostic value and therefore has important clinical significance.

Objective:To investigate the expression of ras-related C3 botulinum toxin substrate 3 (RAC3) in glioma tissues and its effect on the migration and invasion of glioma cells.Methods:The expression of RAC3 in 57 glioma patients and their adjacent tissues from the First People’s Hospital of Shangqiu was detected by immunohistochemical assay. According to the experimental requirements, brain glioma cells U87MG were divided into experimental group and control group. The experimental group U87MG cells were transfected with RAC3-siRNA plasmid, and the control group U87MG cells were transfected with MOCK-siRNA plasmid. RAC3 mRNA in each group was detected by fluorescence quantitative PCR. The expressions of RAC3 and MMP2 in each group were detected by Western blot. Transwell was used to detect the migration and invasion ability of cells in each group.Results:The positive rate of RAC3 in glioma patients was 89.47% (51/57 cases) , and the expression rate in paracancer tissues was 14.04% (8/57 cases) . The expression rate of RAC3 in glioma tissues was significantly higher than that in paracancer tissues, with statistical significance ( P<0.01) . After siRNA transfection, mRNA expression of RAC3 in experimental group and control group was 1.23±0.20 and 0.43±0.12, and protein expression of RAC3 was 1.19±0.11 and 0.23±0.08, respectively. The expression of MMP2 protein was 1.19±0.11 and 0.23±0.08, respectively. The expression of MMP2 in experimental group was significantly decreased ( P<0.05) . Transwell assay showed that the number of invasive cells in experimental group and control group U87MG cells was (22±5) and (45±8) , and the number of migratory cells was (34±6) and (90±11) , respectively. In experimental group, U87MG cell migration and invasion ability decreased significantly (both P<0.05) . Conclusion:The high expression of RAC3 in glioma tissues may be related to the malignant degree of development, and affect the migration and invasion ability of glioma cells by regulating the expression of MMP2.

Objective To summarize the international current status of anesthesia nursing research. Methods The nursing papers were searched across the databank of PubMed and Web of science between 1946 and 2017 and 2012 and 2017,respectively to look into the external characteristics of international anesthesia nursing publications. Using the methods of common words analysis, cluster analysis and citation analysis, we analyzed high frequency subjects and highly cited articles from 2012-2017, analyzing the highlights in the anesthesia nursing. Results 5,041 articles from 1946-2017 were included. The number of articles in anesthesia nursing field was relatively small in first 30 years,increasing year by year since 1970s and speeding up since 1990s.The average number of articles from 2012-2017 was all above 150.The 5,041 articles distributed in 1,260 journals.The top 10 journals accounted for 24.36% of the total number (1228/5041).The articles were mainly published in the developed countries in Europe and America.The hot spots in anesthesia nursing research included anesthesia management and pain management,professional skills of anesthesia nurses and medical team collaboration,intervention on psychological status and complications among perioperative patients. Conclusions The research of anesthesia nursing aboard has attracted more and more attention and formed several research highlights.Domestic research in the field is still at the early stage and in the future,domestic scholars can draw on foreign research highlights to carry out relevant research.

Objective To explore and construct specialist nursing practice of safety management of sedation and analgesia in interventional surgery in China.Methods From February 2016 to November 2017, literature analysis, semi-structured interviews and cross-sectional survey were used to establish the practice scope of specialized nursing in the safety management of sedation and pain relief in interventional surgery. Delphi expert advice consultation method was used to consult and screen related items, and the weight was determined by analytic hierarchy process.Results The positive coefficient of the two rounds of expert consultation was 100％, the expert authority coefficient Cr was 0.85. The coordination coefficients of the second round from the recognition degree, correlation degree and operability were 0.204, 0.228 and 0.215 respectively (P<0.01). Finally, a total of 3 dimensions (46 items), including preoperative evaluation (8 items), intraoperative management (36 items), and postoperative evaluation and monitoring (2 items).Conclusions In order to promote the safety management of sedation and pain relief in interventional surgery, a set of specialized nursing practice areas suitable for nurses were constructed.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

[Objective] To analyze the infection status of hepatitis E virus (HEV) among blood donors in Zhengzhou, so as to provide data support for formulating local blood screening strategies. [Methods] Random samples from blood donors from January to December 2022 were tested for HEV RNA using PCR technology. Reactive samples were sequenced for gene analysis, and the donors were followed up. [Results] Among 21 311 samples, 3(0.14‰) were reactive for HEV RNA, all of whom were male. Genetic sequencing results revealed that one strong positive sample was genotype 4, while sequencing failed for the other two due to low viral load. A follow-up of 25 strong positive donors showed that ALT significantly increased on day 7 after donation, anti-HEV IgM and anti-HEV IgG turned positive. On day 21, ALT returned to normal, and on day 35, HEV RNA turned negative. Notably, anti-HEV IgM and anti-HEV IgG persisted until day 482. [Conclusion] There is HEV infection among blood donors in Zhengzhou, and it is necessary to expand the screening scope to comprehensively explore the prevalence and genotype distribution of HEV among blood donors.