ObjectiveBased on ultra performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS^E） technique， we identified qualitatively the metabolites of aristolochic acid（AAs） in rat in order to analyze the metabolic differences between water extract of Aristolochiae fructus（AFE） and Aristolochic acid Ⅰ（AAⅠ）. MethodSD rats were selected and administered AFE（110 g·kg^-1·d^-1） or AAⅠ（5 mg·kg^-1·d^-1） by oral for 5 days， respectively. Serum， urine and feces were collected after administration. Through sample pretreatment， ACQUITY UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm） was used with the mobile phase of 0.01% formic acid methanol（A）-0.01% formic acid water（B， containing 5 mmol·L^-1 ammonium acetate） for gradient elution（0-1 min， 10%B； 1-7 min， 10%-75%B； 7-7.2 min， 75%-95%B； 7.2-10.2 min， 95%B； 10.2-10.3 min， 95%-10%B； 10.3-12 min， 10%B） at a flow rate of 0.3 mL·min^-1. Positive ion mode of electrospray ionization（ESI⁺） was performed in the scanning range of m/z 100-1 200. In combination with UNIFI 1.9.4.053 system， the Pathway-MS^E was used to qualitatively analyze and identify the AAs prototype and related metabolites in biological samples（serum， urine and feces）， and to compare the similarities and differences of metabolites in rats in the subacute toxicity test between AFE group and AAⅠ group. ResultCompared with AAⅠ group， 6， 10， 13 common metabolites and 14， 20， 30 unique metabolites were identified in biological samples（serum， urine and feces） of AFE group， respectively. Moreover， the main AAs components always followed the metabolic processes of demethylation， nitrate reduction and conjugation. Compared with common metabolites in AAⅠ group， prototype components of AAⅠ in serum and most metabolic derivatives of AAⅠ［AAⅠa， aristolochic lactam Ⅰ（ALⅠ）a， 7-OHALⅠ and its conjugated derivatives］ in biological samples were significantly increased in AFE group（P<0.05， P<0.01）， except that the metabolic amount of ALⅠ in feces of AFE group was remarkably lowed than that of AAⅠ group（P<0.01）. In addition， a variety of special ALⅠ efflux derivatives were also identified in the urine and feces of the AFE group. ConclusionAlthough major AAs components in AFE all show similar metabolic rules as AAⅠ components in vivo， the coexistence of multiple AAs components in Aristolochiae Fructus may affect the metabolism of AAⅠ， and achieve the attenuating effect by increasing the metabolic effection of AAⅠ and ALⅠ.

Objective? To explore the predictive effect of original Wells Scale and revised Geneva Scale for pulmonary embolism (PE) by receiver operating characteristic (ROC) curve among patients with abnormal D-dimer (≥500 μg/L) so as to reduce the misdiagnosis of PE. Methods? From January 2018 to March 2018, we selected 207 abnormal D-dimer patients with suspected PE (84 cases diagnosed as PE by CTPA and 123 cases excluded from PE) from 10 departments at a ClassⅢ Grade A hospital in Ningbo City as subjects by convenience sampling. Patients' data were collected with the general information scale, original Wells Scale and revised Geneva Scale, and the predictive value of two kinds of scale were analyzed and compared. Results? The Cronbach's α reliability coefficient, half reliability and content validity of the original Wells Scale were higher than those of the revised Geneva Scale (0.877 vs. 0.679, 0.792 vs. 0.673, 0.577 vs. 0.547). The area under ROC curve of the original Wells Scale was 0.902 [95%CI: (0.853, 0.939)]with Wells Score ＞1.5 for the cut-off value, 96.43% for the sensitivity, 70.73% for the specificity, 3.29 for the positive likelihood and 0.05 for the negative likelihood. The area under ROC curve of the revised Geneva Scale was 0.894 [95%CI: (0.844, 0.932)]with Wells Score ＞5 for the cut-off value, 85.71% for the sensitivity, 85.31% for the specificity, 5.86 for the positive likelihood and 0.17 for the negative likelihood. Conclusions? Two kinds of scale are all value for predicting PE of abnormal D-dimer patients. However, the sensitivity and specificity of the original Wells Scale are higher than those of the revised Geneva Scale with low missed diagnosis rate which more suitable for predicting PE of abnormal D-dimer patients.

Deep venous thrombosis (DVT) is an acute critical disease with high clinical incidence and easy to be misdiagnosed and missed. Not early assessment and effective prevention, it is very easy to lead to the occurrence of post thrombotic syndrome and pulmonary embolism, with high mortality and a serious threat to the life safety of the patients. The early and effective individual assessment of the DVT risk assessment tool is the basis for risk stratification and appropriate preventive measures. It is the key to reduce the incidence of DVT, misdiagnosis rate, missed diagnosis rate, incidence of complications and mortality. This paper is to review the research progress of individual DVT risk assessment tools at home and abroad, with a view to the same kind. The development of the research can be used for reference.

Objective To investigate the effect of romethamine injection combined with uterine filling in the treatment of postpartum hemorrhage of preplacental cesarean section .Methods From May 2014 to March 2017 , 100 cases of placenta previa cesarean section postpartum hemorrhage in Jiande Maternal and Child Health Care Hospital Obstetrics and Gynecology were selected as the research objects , and they were randomly divided into observation group and control group according to the digital table ,with 50 cases in each group .The observation group received romethamine injection combined with uterine filling treatment ,the control group received oxytocin combined with uterine cavity filling treatment .The clinical curative effect of the two groups was compared .Results The blood loss during delivery between the two groups had no statistically significant difference ( t =1.335, P >0.05 ). Postpartum 2h and 24h,the blood loss of the observation group were significantly lower than those of the control group [(657.58 ±63.21)mL vs.(875.23 ±65.42)mL,(712.52 ±64.32)mLvs.(958.12 ±74.66)mL],the differences between the two groups were statistically significant (t=8.265,11.356,all P<0.05).Before and after treatment,the heart rate , blood pressure and blood oxygen saturation between the two groups had no statistically significant differences ( t =3.255, 2.365, 3.255, 2.365, t =3.365, 2.658, 4.365, 1.654, all P >0.05 ). Conclusion Romethamine injection combined with uterine filling in the treatment of postpartum hemorrhage of preplacental cesarean section has significant effect ,it is worthy of application .

Nurses can assess the risk of pulmonary embolism (PE) in patients quickly and accurately with a PE risk assessment tool. PE risk assessment tools are widely used in clinical practice. This article reviews the development, diagnostic thresholds, applicable populations and assessment effects of PE risk assessment tools, summarizes and analyzes the existing problems of assessment tools and future research directions, in order to provide a basis for modifying PE risk assessment tools and expanding its scope of clinical application.

Spinal cord injury is a catastrophic injury causing lifelong severe disabilities, and poses a great burden to the individuals, families and society. In order to promote the standardization in treatment of traumatic spinal cord injury, the consensus on the evaluation, treatment and rehabilitation of traumatic spinal cord injury was suggested by experts, who came from authoritative multicenter in China. The expert consensus, which formed a standardization process from the first aid clinical treatment to rehabilitation of spinal cord injury, shall give a better practical guide for clinic and rehabilitation physicians.

Objective To investigate delivery mode of uterine scar pregnancy and analyze the safety of vagi-nal delivery.Methods 210 delivery women with scar uterus after cesarean section and 85 delivery women with non -scar uterus vaginal delivery of maternal selection were collected.According to the different ways of delivery,the preg-nant women in the scar group were divided into A group (72 cases)and B group (138 cases).Delivery outcome, maternal complications and average hospitalization time between the two groups were compared.Results 72 cases of maternal vaginal delivery in scar A group was successful and smooth vaginal delivery in 64 cases,and success rate was 88.89%(64 /72).8 patients maternal modified cesarean section production,accounted for 11.11%(8 /72),including 3 cases of persistent occiput posterior position,2 cases of social factors give up vaginal delivery,2 cases fetal distress, 1 case for incomplete rupture of uterus.138 cases delivery women in scar B group successfully obtained the cesarean section.100 cases of delivery women in non scar group,91 cases successfully got vaginal delivery,and the success rate was 91.00% (91 /100).Another 9 cases of delivery women were replaced with caesarean birth[9.00%(9 /100)],of which 3 cases of fetal distress,2 cases for fetal macrosomia,2 cases of persistent occiput transverse position,2 cases as social factors give up of vaginal delivery.Scar in group A maternal average hospitalization time was significantly shor-ter than scar in group B,and mean postpartum hemorrhage was significantly increased than scar in group B,and the differences were statistically significant (t =15.87,26.32,all P <0.05).There were no significant differences in the incidence of postpartum hemorrhage and neonatal asphyxia between the two groups (χ2 =0.24,1.05,all P >0.05). The maternal average hospitalization time,mean postpartum hemorrhage,postpartum hemorrhage and incidence rate of neonatal asphyxia between scar group A and non scar group had no significant differences (χ2 =0.88,1.30,1.03, 0.00,all P >0.05).Conclusion When choosing vaginal delivery in scar uterus again pregnancy,we should strictly grasp cesarean section pregnancy after vaginal delivery of the indications.Under strict monitoring,the safety of vaginal delivery was high.It was worth of clinical promotion.

Objective To investigate the epidemiological and clinical characteristics of measles in patients of different age groups in Northeast China in 2014.Methods The clinical data of patients with measles in ten hospitals of infectious diseases in Northeast China from January 2014 to June 2014 were collected.Patients were divided into <16 age group and ≥16 age group, and the epidemiology , clinical characteristics, treatment and prognosis of all patients were retrospectively reviewed .SPSS 17.0 was used for data analysis.Results There were 1 401 patients with measles, in which 402 were <16-year old, and 999 were ≥16-year old.Clinical manifestations were mainly maculopapule (100.0%), fever (84.58%), cough (85.80%), Koplik’ s spot (73.23%), pharyngeal hyperemia (71.23%), diarrhea (43.97%), expectoration (40.97%), tears (39.40%) and runny nose (30.55%).The incidences of Koplik’s spot, sputum, pharyngeal hyperemia and diarrhea in <16 age group were lower than those in ≥16 age group (χ2 =8.364, 29.768, 10.953 and 6.701, P<0.05 or <0.01); while the incidence of runny nose was higher than that in ≥16 age group (χ2 =6.703, P<0.05).Abnormalities were found in blood routine examination, C-reactive protein (CRP), liver and kidney function, serum electrolyte levels, myocardial enzymes, and so on.Increasing in WBC, PLT and creatine kinase isoenzyme (CKMB), and decreasing in WBC were observed in 38(9.45%), 122(30.35%), 279(69.40%) and 105(26.12%), patients in <16 age group, which were higher than those in ≥16 age group [45(4.5%), 14(1.40%), 347(34.73%) and 202(20.22%)], and the differences were of statistical significance (χ2 =12.593, 274.033, 139.385 and 5.830, P<0.05 or P<0.01).Increasing in alanine aminotransferase (ALT), CRP, total bilirubin level (TBil), creatine kinase (CK), and decreasing in albumin (Alb), K+, Na+, Cl-were observed in 70(17.41%), 7(1.74%), 38(9.45%), 7(1.74%), and 214(53.23%), 59(14.68%), 45(11.19%), 94(23.38%) patients in <16 age group, which were lower than those in ≥16 age group [668(66.87%), 89(8.91%), 277(27.73%), 714(71.47), and 268(26.83%), 339(33.93%), 642(64.26%), 450 (45.05%)], and the differences were of statistical significance (χ2 =281.230, 23.073, 50.687, 159.740, and 14.674,114.286, 44.268, 271.546, P<0.01).Laryngitis and pneumonia were the most common complications.The incidence of laryngitis in <16 age group was 12.69% (51/402), which was higher than that in ≥16 years group (93/999, 9.31%,χ2 =3.545, P<0.05);while the incidence of spot shadows demonstrated by X-ray in <16 years group ( 72.89%, 121/166 ) was higher than that in ≥16 years group (265/445, 59.55%,χ2 =9.249, P<0.01).Conclusions There are differences in clinical features of measles in patients between <16 age group and ≥16 age group.Basic immunization in children and revaccination in adults should be enhanced to control the epidemics of measles .

Objective To establish the proposals of clinic and rehabilitation pathway for spine and spinal cord injury. Methods The experiences in clinic and rehabilitation treatment fields, the flow path of admission and the costs of hospitalization for spine and spinal cord injury patients in Chinese Rehabilitation Research Center were retrospectively summarized and analyzed. Related data in International Classification of Functioning, Disability and Health (ICF) core sets were also referred. Results The present proposals were applied to patients suffered from thoracic, lumbar or sacral spine injury with spinal cord injury. The proposals consisted of two parts: the surgical interventions in acute stage (within 2 weeks after injury) and clinic and rehabilitation treatments of spinal cord injury in sub acute and later stages (2 weeks to 6 months after injury). The criteria of surgical interventions in acute stage materialized the core therapies such as reconstruction of spine stability and neural decompression, etc. The criteria of treating spinal cord injury in subacute and later stages demonstrated the characteristic of combined therapy in which rehabilitation was the central element. Conclusion The establishment and implement of the present pathways were based on the time course of disease development and the staging feature of neural recovery and treatment after spinal cord injury. The purpose of this work is to improve the quality of medical service and reduce medical consumption.

In 2009, Ministry of Health mapped out the Guiding Principle of Clinical Pathway. Rehabilitation is different with early treatment of common diseases. This paper mainly introduces the objective of rehabilitation clinical pathway, organization of management system,guiding principle of mapping-out and implementation and evaluation and improvement of medical quality.