Objective:To retrieve,evaluate and integrate the best evidence of pain management in emergency adult patients with trauma,and to provide references for clinical nursing practice.Methods:The best evidence of pain management in emergency adult patients with trauma were systematically searched in domestic and international databases.The retrieval period is from the establishment of databases to December,2022.There were 2 researchers evaluating the quality of the literature and extracting the data.Results:Total of 16 articles were selected,including 5 top clinical decisions,6 guidelines,3 expert consensuses,2 systematic review. 36 pieces of best evidence were formed from 6 aspects,including pain management principles, pain assessment methods, pain medication principles, pharmacological interventions, non pharmacological interventions and dynamic monitoring of pain management.Conclusions:Medical staff can formulate corresponding nursing measures in clinical applications based on the actual situation of trauma patients, and use scientific methods to solve the pain problem of emergency adult trauma patients and improve their quality of life.

Objective To establish an improved type Ⅱ cardio-renal syndrome rat model and evaluate it.Methods Twenty male SD rats were randomly divided into sham and model groups with 7 rats in the sham group and 13 rats in the model group.The model group received the method of squeezing the heart under a small animal anesthesia machine to permanently ligate the left anterior descending branch of the coronary artery to cause myocardial infarction.One week later,unilateral nephrectomy(right nephrectomy)was performed.The rats underwent cardiac echocardiography,pathological staining,and blood and urine tests at 6 weeks to verify model establishment.Results Compared with the sham group,the cardiac function assessed by echocardiography and the endogenous creatinine clearance rate in the model group rats were significantly decreased(P<0.01),and the levels of brain natriuretic peptide,blood creatinine,urea nitrogen,and 24 h urine protein in the model group were significantly increased(P<0.01).HE staining revealed a disordered myocardial arrangement,glomerular atrophy,and inflammatory cell infiltration in model group rats.Picric acid-Sirius red staining showed a significant increase in myocardial collagen fibers,an irregular arrangement of renal tubules,and a large amount of collagen deposition in model group rats.The positive staining area ratio was also significantly increased(P<0.01).Conclusions This improved modeling method provided a typeⅡcardio-renal syndrome rat model with s simple operation,minimal surgical trauma,and low mortality rate.This model simulates the early onset of cardiac and renal function damage and pathological changes in type Ⅱ CRS,laying the foundation for systematic and in-depth research on the pathogenesis and pathological mechanism of type Ⅱ cardio-renal syndrome.

Pancreatic adenocarcinoma (PAAD) is one of the most lethal malignancies. Although gemcitabine (GEM) is a standard treatment for PAAD, resistance limits its application and therapy. Secoemestrin C (Sec C) is a natural compound from the endophytic fungus Emericella, and its anticancer activity has not been investigated since it was isolated. Our research is the first to indicate that Sec C is a broad-spectrum anticancer agent and could exhibit potently similar anticancer activity both in GEM-resistant and GEM-sensitive PAAD cells. Interestingly, Sec C exerted a rapid growth-inhibiting effect (80% death at 6 h), which might be beneficial for patients who need rapid tumor shrinkage before surgery. Liquid chromatography/mass spectrometry and N-acetyl-l-cysteine (NAC) reverse assays show that Sec C sulfates cysteines to disrupt disulfide-bonds formation in endoplasmic reticulum (ER) proteins to cause protein misfolding, leading to ER stress and disorder of lipid biosynthesis. Microarray data and subsequent assays show that ER stress-mediated ER-associated degradation (ERAD) ubiquitinates and downregulates YAP to enhance ER stress via destruction complex (YAP-Axin-GSK-βTrCP), which also elucidates a unique degrading style for YAP. Potent anticancer activity in GEM-resistant cells and low toxicity make Sec C a promising anti-PAAD candidate.

Organoids are complex tiny organ-like model systems formed by three-dimensional culture in vitro, based on the self-renew and self-organization of stem cells. This article reviewed the recent progress in organoids construction from tissues involved in the regulation of glucose homeostasis and chronic diabetic microvascular complications, and their applications in diabetes mellitus. Organoid technology is expected to further promote the progress of diabetes research in disease modeling, personalized medicine, and regenerative medicine.

Objective:To investigate the effect of different ways of reconstruction of left subclavian artery (LSA) in the treatment of complex aortic arch lesions.Methods:The clinical data of 34 patients with complex thoracic aortic disease undergoing intracavitary LSA reconstruction in our center from January 2019 to February 2020 were retrospectively analyzed. The distance of proximal healthy landing zone of all patients, including 29 aortic dissections involving LSA, 3 penetrating aortic ulcer and 2 thoracic aortic aneurysms, was less than 15 mm. Among them, 16 cases were treated with chimney technique, 16 cases were implanted with single branched stent-graft, 2 cases were received with left common carotid artery and LSA in situ fenestration.Results:The operation success rate of all 34 patients was 100%. One case was changed from in situ fenestration to chimney stenting. Followed up for 1-12 months, there were no death, cerebral ischemia, paraplegia and other postoperative complications. CTA review showed that the main and branch stents were in good shape, the patency rate of LSA branch stents was 100% and no endoleak occurred at 1 and 3 months after operation. The muscle strength and arterial blood pressure of bilateral upper limbs of all patients were basically the same.Conclusion:There is no consensus for the treatment of complex aortic arch lesions, so we need to customize the personalized plan and select the appropriate LSA reconstruction method in order to reduce the incidence of complications.

TA method for the content determination of methionine sulfoxide and methionine sulfone in compound amino acid injection (18AA-II) was established in order to investigate their level in 155 batches of this product, and to explore the reason for the generation of these two impurities.The determination was performed on an Agilent Poroshell 120 EC-C18 column with mobile phases of sodium acetate/tetrahydrofuran solution (A) and sodium acetate solution -acetonitrile-methanol (B, 200∶400∶400) (gradient elution) at the flow rate of 0.5 mL/min.The excitation wavelength and the emission wavelength of the fluorescence detector were 233 nm and 441 nm, respectively.The column temperature was 40 °C, and the injection volume was 8 μL.The contents of methionine sulfoxide and methionine sulfone from 155 batches of compound amino acid injection (18AA-II) was determined using this method, and the residual oxygen content was detected by headspace gas analyzer.The results showed that the linear range of methionine sulfoxide and methionine sulfone were 0.128 1-10.250 0 μg/mL (r = 0.999 9) and 0.261 0-10.440 0 μg/mL (r = 0.999 8), respectively.The limits of quantitation were 0.13 μg/mL and 0.26 μg/mL, respectively; the limits of detection were 0.04 μg/mL and 0.09 μg/mL, respectively.RSDs of precision, stability and repetitive test were all lower than 1.3%.The recoveries ranged 98.00%-100.79% (RSD = 1.15%, n = 9) and 98.19%-102.31% (RSD = 1.33%, n = 9).The content level of oxidized related substances from different manufacturers showed significant difference, showing relevance with the residual oxygen content to some extent, yet no significant correlation with the added amount of antioxygen (sodium pyrosulfite).The method is validated to be useful for the content control of methionine sulfoxide and methionine sulfone in compound amino acid injection (18AA-II).It is quite necessary to include the determination of oxidized related substance into the quality specification.Manufacturers should strengthen the control of remaining oxygen in their products.

【Objective】 To explore the clinical applications of low ionic strength salt solution polyethylene glycol (LISS-PEG) and low ionic strength salt solution bovine serum albumin (LISS-BSA) in the indirect antiglobulin test (IAT). 【Methods】 The common standard red blood cell(RBC) IgG irregular antibodies (anti-D, anti-M, anti-N, anti-S, anti-s, anti-Jk^a, anti-Jk^b, anti-Fy^a, anti-Fy^b, anti-Di^a, anti-K) were reacted with RBCs with corresponding antigens in IAT with LISS-PEG and LISS-BSA modification for 5-minute and 10-minute incubations, and then compared the results with conventional IAT. One hundred of blood samples from patients presenting irregular antibodies of erythrocyte IgG were selected to observe the effect of these two self-made modification. The agglutination intensity was recorded by AABB scoring method. 【Results】 No difference was noticed in IAT intensity reaction between LISS-PEG 5-minute and 15-minute incubation (P>0.05), nor between 5-minute/15-minute LISS-BSA incubation and conventional IAT (P>0.05). However, LISS-PEG modification demonstrated a significant superiority over the conventional technique just after incubation with 5 minutes(P<0.05). 【Conclusion】 Using the self-made LISS-PEG as the enhancement medium allows not only reduced incubation time (5 minutes) but also increased intensity of the reaction, which shortens the cross-matching time for emergency blood transfusion and is worthy of popularization.

OBJECTIVE： To establish a method for the content determination of 14 elements in Deproteinized calf blood extractives injection. METHODS： Inductively coupled plasma-mass spectrometry （ICP-MS） was adopted. The radiofrequency power was 1 350 W； flow rate of carrier gas （argon） and collision gas （helium） was 1.1 L/min and 4.5 L/min respectively； integration time was 1.5 s； plasma gas flow rate was 18 L/min； depth of sampling was 65 mm； speed of sampling peristaltic pump was 24.0 r/min； data sampling mode was peak-jump acquisition mode； data collection was repeated for 3 times. RESULTS： The linear ranges of Cd， Pb， As， Co， V， Ni， Tl， Ag， Mo， Cu， Cr， Ba and Al were 0.05-50 μg/L （r＝0.999 7）， 0.05-50 μg/L （r＝0.999 7）， 0.05-50 μg/L （r＝0.999 8）、0.05-50 μg/L （r＝0.999 5）， 0.05-50 μg/L （r＝0.999 5）， 0.05-50 μg/L （r＝0.999 8）， 0.05-50 μg/L （r＝0.999 6）， 0.05-50 μg/L （r＝0.999 5）， 0.05-50 μg/L （r＝0.999 5）， 0.05-50 μg/L （r＝0.999 8）， 0.05-50 μg/L （r＝0.999 6）， 0.05-50 μg/L （r＝0.999 6）， 0.05-50 μg/L （r＝0.999 7） and 0.5-70 μg/L （r＝0.999 8）， respectively. The limits of quantitation were 0.003 1， 0.008 9， 0.016 0， 0.025 0， 0.002 1， 0.006 9， 0.038 1， 0.002 1， 0.005 5， 0.002 0， 0.023 1， 0.005 0， 0.002 0， 0.324 9 μg/L， separately. The limits of determination were 0.000 9， 0.002 7， 0.004 8， 0.007 5， 0.000 6， 0.002 1， 0.011 4， 0.000 6， 0.016 5， 0.000 6， 0.006 9， 0.001 5， 0.000 6， 0.097 5 μg/L， separately. RSDs of precision， stability and repeatability tests were all less than 8％. The recoveries were 87.4％-94.3％（RSD＝2.6％， n＝9）， 110.3％-118.2％（RSD＝1.8％，n＝9）， 89.8％-99.7％（RSD＝3.1％，n＝9）， 77.7％-84.4％（RSD＝2.5％，n＝9）， 105.6％-113.4％（RSD＝2.3％，n＝9）， 106.7％-116.5％（RSD＝2.7％，n＝9）， 89.1％-104.5％（RSD＝4.5％，n＝9）， 105.6％-118.6％（RSD＝3.6％，n＝9）， 77.8％-88.0％（RSD＝4.0％，n＝9）， 106.7％-116.1％（RSD＝2.8％，n＝9）， 88.5％-97.1％（RSD＝3.1％，n＝9）， 80.5％-88.6％（RSD＝2.9％，n＝9）， 85.2％-99.4％（RSD＝4.2％，n＝9）， 97.6％-109.3％（RSD＝3.2％，n＝9）， respectively. CONCLUSIONS： The method is simple， accurate. The precision， stability and repeatability of this method are also good. It is suitable for simultaneous determination of 14 elements in Deproteinized calf blood extractives injection.

Objective To study the influencing factors of primary hypertension by investigating its prevalence in elderly patients of Deang nationality.Methods Nine hundred and thirty-nine elderly patients of Deang nationality were divided into hypertension group (n =353),prehypertension group (n=377) and control group (n=209).Their physical examination data were recorded and their blood pressure was measured.Results The detection rate of hypertension was significantly lower in elderly patients of Deang nationality than in those of the other nationalities in our country with their age ≥60 years (37.6％ vs 49.0％,P＜0.05).The detection rate of hypertension,isolated systolic hypertension and prehypertension increased with the increasing age (P＜0.05).Multivariate logistic regression analysis showed a cross interaction between economic level and alcohol drinking (P＜0.05) and a positive correlation of BMI,age,gender,divorce or widow,smonking,high salt diet with hypertension (P＜0.05).Conclusion The detection rate of hypertension is lower in elderly patients of Deang nationality than in those of the other nationalities in our country.Economic level,alcohol drinking,BMI,age,gender,divorce or widow,smoking,high salt and fat diet are the major risk factors for hypertension.However,regular eating of vegetables can reduce the risk of hypertension.

As the most common organ-specific autoimmune disease,autoimmune thyroiditis (AIT) is characterized by intrathyroidal lymphocyte infiltration and specificthyroid autoantibodies.Modern medicine is short of effective etiological treatment at present,and has no specific medicine foreuthyroidism of AIT patients,who have been followed-up passively.Chinese medicine treatmenthas the characteristics of multiple-targets,multiple-links and multiple-pathways,which plays a special superiorityrole in the prevention and treatment of AIT.The purpose of this article was to sort out and set forthmore Chinese medicine pharmacology on AIT recently,which provided evidence for further clinical apply.