Objective:To investigate the application value of aortic dissection detection risk score (ADD-RS) combined with D-dimer (DD) in the early diagnosis of acute aortic dissection (AAD).Methods:The clinical data of 70 patients with suspected aortic dissection detection admitted to The Second Hospital of Jiaxing from August 2019 to April 2020 were collected. All patients were scored using the ADD-RS, and grouped according to the scoring results. The sensitivity and specificity of ADD-RS plus DD in the early diagnosis of AAD were calculated. The areas under the receiver operating characteristic (ROC) curves that were plotted for drADD-RS plus DD versus DD alone to screen AAD were compared to evaluate efficacy. Results:CT angiography results showed that among 70 patients with suspected AAD, 29 patients had AAD and 41 patients had no AAD. A total of 21 patients were scored 0, 41 patients were scored > 1, and 8 patients were scored > 0. ADD-RS > 0 had an overall sensitivity of 79.31% and a specificity of 36.59% for AAD diagnosis. DD test results had an overall sensitivity of 86.20% and a specificity of 36.50% for AAD diagnosis. The area under the ROC curve of ADD-RS = 0 plus DD-negative result and the area under the ROC curve of DD-negative result alone in ruling out AAD were 0.885 with 95% CI (0.786-0.949) and 0.787 with 95% CI (0.673-0.876), respectively. The difference between the two groups was statistically significant ( P = 0.024). Conclusion:Compared with DD-negative result alone, the ADD-RS = 0 plus DD-negative result strategy offers greater specificity to rule out AAD. The combined strategy has a greater efficacy in ruling out AAD. However, a multi-center study involving a large sample is required for in-depth evaluation.

Melorheostosis is a rare disorder of osteopathia. The clinical characteristics of melorheostosis in children is totally different from that in adults. The radiographic features of melorheostosis include the hyperostosis in endosteal on the one side of the cavum medullare and formed streakiness. The soft tissue contracture of the limb and joint deformities are the symptoms of melorheostosis. Here, the authors reported a melorheostosis case of 6 years old girl who suffered from severe valgus deformity of the right knee with permanent patellar dislocation. A surgical stabilization was applied with lateral soft tissue release, medial soft tissue stabilization and transferred the vastus medialis laterally (kinetic stability). After 19 years follow up postoperatively, the limb developed well in satisfied alignment with good function of knee joints, even participated in some sports activities. Other authors reported a similar case of melorheostosis with surgical treatment and achieved good outcomes in limb realignment and reduction. The further suggested that the surgical treatment should be produced before epiphyseal closure.

Objective:To explore the effect of situational behavior record reflection training on the listening ability of newly recruited clinical nurses.Methods:From March to September 2020, cluster sampling was used to select 116 newly recruited clinical nurses from the First Affiliated Hospital of Zhengzhou University as the research object. According to the entry order, nurses were divided into the observation group ( n=58) and the control group ( n=58). The nurses in the control group were trained in accordance with our hospital's regular standardized training system, while the observation group used situational behavior record reflection training method. Before the intervention and 6 months after the intervention, the Hodgetts Listening Performance Scale and the Patient Satisfaction with Nursing Care Questionnaire were used to compare the listening ability and patient satisfaction of the two groups of newly recruited clinical nurses. A total of 116 questionnaires were distributed and 113 valid questionnaires were returned with the valid response rate of 97.41%. Results:Before the intervention, there was no statistically significant differences in the scores of the Hodgetts Listening Performance Scale and the Patient Satisfaction with Nursing Care Questionnaire between the two groups of nurses ( P>0.05). After the intervention, the scores of the Hodgetts Listening Performance Scale and the Patient Satisfaction with Nursing Care Questionnaire of the two groups of nurses were higher than those before the intervention, and those of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:Situational behavior record reflection training can improve the listening ability and patient satisfaction of newly recruited clinical nurses, which is conducive to alleviating the nurse-patient relationship and improving the quality of nursing care.

Objective:To analyze the characteristics of plasmids in KPC-2-producing Serratia marcescens ( S. marcescens) isolates. Methods:Four carbapenem-resistant S. marcescens strains were isolated from four patients admitted to the hepatobiliary ward of Affiliated Cancer Hospital of Zhengzhou University in 2016. BD Phenix-100 was used to identify the strains and detect the minimum inhibitory concentrations (MICs). Homology analysis was performed using pulsed-field gel electrophoresis (PFGE). The modified Hodge test was used to detect the phenotypes of carbapenemase. PCR and gene sequencing were used to detect the types of carbapenem resistance genes. The transferability of plasmids was detected by conjugation test. The characteristics of plasmids were analyzed by genomic alignment method after whole genome sequencing. DNAMAN V9 software was used to compare the amino acid sequences of the replication initiation proteins. A phylogenetic tree was constructed with neighbor-joining method using MEGA7.0. Results:All of the four S. marcescens strains were resistant to carbapenem antibiotics. They were highly homologous according to PFGE. Hodge test results were all positive and the carbapenemase genotype was blaKPC-2. Conjugation test results were positive. The plasmid was a circular DNA of 42 742 bp in length. It had the similar skeleton of incX6 plasmid and the similar amino acid sequence of replication initiation protein. Moreover, it and incX6 plasmid were at the same node in the phylogenetic tree. The blaKPC-2 was located in the core of drug resistance, which was composed of insertion elements including Tn3 family transposons, recombinant enzyme genes, △ISKpn6 and ISKpn27. Conclusions:The plasmid was incX6-like. The blaKPC-2 gene was located in the transposon of △Tn6296. More attention should be paid to the bacteria carrying KPC-2 in incX plasmids.

Objective: To investigate the expression and significance of NF-κB in oral squamous cell carcinoma and paracancerous tissues. Methods: Cancerous and paracancerous tissues about 5 mm outside the tumor boundary were cut from 47 patients with OSCC. NF-κB expression in these tissues were detected by the immunohistochemical SP method and compared with that in 32 normal oral mucosa tissues. Results : The average optical density (OD value) of immunohistochemical-positive cells in cancer tissues and paracancerous tissues was higher than that in normal tissues, and the difference was statistically significant (P < 0.001). There was no significant difference in the OD values between cancer tissues and paracancerous tissues (P=0.356). The rate of NF-κB positive expression in cancer tissue and paracancerous tissue was significantly higher than that in normal mucosa tissue, and the difference was statistically significant (P < 0.001). There was no significant difference in the rate of NF-κB positive expression between cancer tissues and paracancerous tissues (P=0.117), but the rate of moderate-to-strong positive expression in cancer tissues was significantly higher than that in paracancerous tissues (P < 0.001). Conclusion NF-κB may be involved in the development of OSCC.

Objective To evaluate the relationship between concurrent myocardial bridge at anterior descending branch and the formation of coronary atherosclerosis plaques by using transluminal attenuation gradient (TAG). Methods A total of 198 patients underwent coronary CTA in Renji Hospital of Shanghai Jiaotong University School of Medcine from June 2017 to March 2018 and the results showed the anterior descending myocardial bridge. The data were retrospectively analyzed. All patients completed the coronary CTA with 320?row detector CT. According to the manifestations of myocardial bridge on CTA,the patients were divided into deep and superficial myocardial bridge groups. According to whether the patients were complicated with coronary atherosclerotic plaques, they were divided into isolated myocardial bridge group and myocardial bridge with coronary atherosclerotic plaque group. The thickness and length of myocardial bridge, the volume of coronary atherosclerotic plaques at the site of myocardial bridge, the pre?bridge and post?bridge TAG values, and the K ratio were recorded. Independent sample t test (normal distribution) or Mann?Whitney U test (skewed distribution) was used to compare the difference of measurement data among different groups. χ2 test was used to compare the difference of enumeration data among different groups. Pearson correlation test was used to analyze the correlation among pre?bridge and post?bridge TAG values,K ratio,thickness and length of myocardial bridge and plaque volume. The influence of above indexes on plaque occurrence was analyzed by binary logistic regression analysis. The relationship between main influence indexes and plaque formation was analyzed by receiver operating characteristic curve (ROC). Results Ninety nine patients had isolated myocardial bridge,99 with myocardial bridge and coronary atherosclerotic plaques,27 with superficial myocardial bridge and 171 with deep myocardial bridge. All atherosclerotic plaques occurred in pre?bridge and the mean volume of plaques was (91.6±83.0)mm3. The differences in sex, age, height, body weight and body mass index werenot statistically significant between isolated myocardial bridge group and myocardial bridge with coronary atherosclerotic plaque group (all P>0.05). The difference in pre?bridge TAG value was statistically significant between the isolated myocardial bridge group and myocardial bridge with coronary atherosclerotic plaque group (all P<0.05), but not statistically significant in post?bridge TAG value and K ratio (all P>0.05). The difference in pre?bridge and post?bridge TAG values and K value was not statistically significant between the superficial group and the deep group (all P>0.05). There was a weak negative correlation (r=-0.205,-0.316,-0.339,respectively,P<0.05) between the plaque volume and pre?bridge&post?bridge TAG values and K ratio. The pre?bridge TAG value significantly affected the plaque formation (P=0.014) and the odds ratio was 0.884 (95% CI 0.801 to 0.976). While other factors had no significant effects on plaque formation (all P>0.05). The area under curveof plaque formation promoted by pre?bridge TAG value was 0.582. When the diagnostic critical value was －37.26 HU/mm, the sensitivity and specificity of pre?bridge TAG value in plaque formation were 31.31% and 81.82%, respectively. Conclusion The TAG value of anterior descending bridge is an independent risk factor for plaque occurrence. The abnormal TAG value of anterior descending myocardial bridge can be detected early by CTA.

Objective To study plasmid-mediated transfer,plasmid replicon typing,and genetic environment of blaNDM-1 gene in Enterobacteraerogenes(E.aerogenes).Methods E.aerogenes HN-NDM0711 was used as the subject of this research,the transferable properties of plasmid were analyzed by conjugation testing,conjugant was performed stability testing,plasmid type was determined by PCR-based replicon typing (PBRT),downstream and upstream of blaNDM-1 were sequenced using chromosome walking method,genetic context was analyzed by BLASTN and BALSTP,as well as annotated using Vector NTI 11.5.1 software,sequence pipeline graph was made,the sequence was submitted to Genbank through software Banklt.Results The conjugation testing of E.aerogenes pHN-NDM0711 was positive,after positive conjugant was conducted 4-day passage,minimal inhibitory concentrations (MICs) of imipenem and meropenem to all the cloned strains didn't change,blaNDM-1 were all positive.The replicon type was IncA/C;blaNDM-1 gene was localized between ISAba14 and IS91,at upstream of the blaNDM-1,class 1 integron and Tn3 transposon were identified,class 1 integron contained a new mosaic structure of a drug-resistant resistance gene cassette.Conclusion E.aerogenes pHN-NDM071 1,bearing blaNDM-1 gene in IncA/C plasmid,derived from gene recombination under different antimicrobial selection pressure.Antimicrobial use in clinical,industrial and agricultural area should be strictly controlled,so as to reduce the emergence of such bacteria.

Objective To explore the efficacy and safety of irinotecan as neoadjuvant chemotherapy (INAC) plus radical surgery (RS) for cervical cancer.Methods According to International Federation of Gynecology and Obstetrics (FIGO),81 cases were divided into Ⅱ B,ⅡA,and Ⅰ B2 groups.According to the tests of UGT1A1 gene polymorphisms,we adjusted the injection dose of irinotecan.The parameters were analyzed,including the efficacy,operation time and bleeding volume,postoperative pathology,survival time,and adverse reactions.The articles on irinotecan or paclitaxel combined with cisplatin for neoadjuvant chemotherapy between 2005 and 2015 were collected,and compared.Results The effective rate of chemotherapy was 81.5％ (Ⅰ B2 group:85.7％;Ⅱ A group:83.3％;and ⅡB group:72.2％),operation time was (5.3 ± 1.1) h,and blood loss was (781 ± 361.7) ml.After chemotherapy,37 cases were delayed diarrhea,70 cases were nausea,48 cases were vomiting,and 40 cases were bone marrow suppression.The infiltration rate,operation time,and blood loss on Ⅱ B group was significantly higher than that on Ⅱ A and Ⅰ B2 groups(P ＜ 0.05),and there was no significant difference in the chemotherapy efficiency,invasion depth,lymphatic metastasis,survival time and adverse reactions(P ＞0.05).Compared to three articles,the total effective rate in this study was higher than that in previous studies,also in Ⅱ A and Ⅱ B group.Conclusions Irinotecan chemotherapy regimens combined with cisplatin is effective and well tolerated.It is worthy of popularization and application.Detection of UGT1A1 gene polymorphism has guiding significance for chemotherapy regimen on irinotecan combined with cisplatin.

Objective:To explore the therapeutic effect of acupuncture plus Zi Shen Tiao Gan (Kidney-reinforcing and Liver-regulating) Decoction for perimenopausal women with insomnia.
Methods:A total of 126 eligible cases were randomly divided into two groups, 63 cases in each group. Patients in the observation group were given acupuncture plus Zi Shen Tiao Gan (Kidney-reinforcing and Liver-regulating) Decoction. Those in the control group were treated with the same acupuncture treatment as the observation group. The therapeutic effects were assessed after continuous treatment for four weeks.
Results:The total effective rate was 96.8%in the observation group and 74.6%in the control group. The comparison of the total clinical effects between the two groups was statistically significant (P<0.01). After treatment, the intra-group comparisons of SPIEGEL score were statistically significant in both groups (P<0.05, P<0.01);the inter-group comparison of SPIEGEL score difference between before and after treatment was statistically significant (P<0.05).
Conclusion: Acupuncture plus Zi Shen Tiao Gan (Kidney-reinforcing and Liver-regulating) Decoction for perimenopausal insomnia is affirmative in the therapeutic effect, and the therapeutic effect is better than simple acupuncture treatment.

Encephalomyocarditis virus (EMCV) ,named JZ1202 ,was isolated from domesticated boar in Henan ,China . We performed the full-length genome sequencing and molecular characteristic analysis of the isolated strain .Results showed that the full-genome sequence of EMCV JZ1202 generated a sequence of 7 735 bp in length ,and had 81 .2%-99 .9% nucleotide identity with other reference strains from different animals ,but 99 .4% with Chinese reference from pig .The phylogenetic tree was constructed based on the full-length genome;ORF and VP1 gene sequences identified EMCV was divided into G1 ,G2 and G3 groups ;the strain JZ1202 belongs to G1 with other Chinese reference strains .Results identified that the EMCV infection could cause severe clinical symptoms in domesticated boar .Big regional differences exist in EMCV and the transmission is limit-ed in a range of area .However ,cross infection and prevalence of EMCV disease between domesticated boar and mice might ex-ist .Mutation of some amino acid may occurred in EMCV infected domesticated boar .