Objective To explore the application of the integrated graded diagnosis,treatment and ambulance model based on circulation respiration abdomen motor speech (CRAMS) score in patients with multiple traumas. Methods From March 2023 to March 2024,160 patients with multiple traumas admitted to the department of emergency of Shanghai Sixth People's Hospital were selected as the research subjects. Based on a random number table,the patients were divided into an observation group and a control group,with 80 patients in each group. And the control group received routine emergency treatment,while the observation group was assessed by the intervention team using the CRAMS scoring scale to evaluate the condition,and then implemented an integrated graded diagnosis and treatment model based on the assessment results. The specific measures were as follows:establish an intervention team composed of 1 attending doctor from the emergency resuscitation room,1 head nurse specializing in trauma care,and 3 trauma specialty nurses. The attending doctor was responsible for diagnosing and treating the patient's condition;the head nurse specializes in assessing the patient using the CRAMS scoring scale;the trauma specialty nurses were tasked with implementing interventions for the patient. The CRAMS score,injuy seveity scoe (ISS),triage time,waiting time for treatment,treatment time,complication rate,and patient satisfaction rate were compared between the two groups before and after the intervention. Results There were no significant differences in CRAMS scores and ISS scores between the two groups before intervention. After intervention,the CRAMS score of the observation group was significantly higher than that of the control group (8.85±0.89 vs. 7.52±1.02,P<0.05),while the ISS score was significantly lower than that of the control group (15.98±2.98 vs. 20.77±3.02,P<0.05). The triage time,waiting time for treatment,and treatment time of the observation group were significantly shorter than those of the control group[triage time (minutes):3.25±0.62 vs. 5.89±1.02,waiting time for treatment (minutes):3.02±0.45 vs. 5.78±0.98,treatment time (minutes):45.85±5.23 vs. 65.22±6.41,all P<0.05]. Complication incidence of the observation group was significantly lower than that of the control group[3.75％ (3/80) vs. 12.50％ (10/80),P<0.05],while the satisfaction rate of the observation group was significantly higher than that of the control[93.75％ (75/80) vs. 77.50％ (62/80),P<005]. Conclusion The integrated graded diagnosis and rescue model based on CRAMS scores can improve the treatment efficiency of multiple trauma patients,improve their condition and prognosis,and enhance their satisfaction with treatment.

Objective To explore the application of the integrated graded diagnosis,treatment and ambulance model based on circulation respiration abdomen motor speech (CRAMS) score in patients with multiple traumas. Methods From March 2023 to March 2024,160 patients with multiple traumas admitted to the department of emergency of Shanghai Sixth People's Hospital were selected as the research subjects. Based on a random number table,the patients were divided into an observation group and a control group,with 80 patients in each group. And the control group received routine emergency treatment,while the observation group was assessed by the intervention team using the CRAMS scoring scale to evaluate the condition,and then implemented an integrated graded diagnosis and treatment model based on the assessment results. The specific measures were as follows:establish an intervention team composed of 1 attending doctor from the emergency resuscitation room,1 head nurse specializing in trauma care,and 3 trauma specialty nurses. The attending doctor was responsible for diagnosing and treating the patient's condition;the head nurse specializes in assessing the patient using the CRAMS scoring scale;the trauma specialty nurses were tasked with implementing interventions for the patient. The CRAMS score,injuy seveity scoe (ISS),triage time,waiting time for treatment,treatment time,complication rate,and patient satisfaction rate were compared between the two groups before and after the intervention. Results There were no significant differences in CRAMS scores and ISS scores between the two groups before intervention. After intervention,the CRAMS score of the observation group was significantly higher than that of the control group (8.85±0.89 vs. 7.52±1.02,P<0.05),while the ISS score was significantly lower than that of the control group (15.98±2.98 vs. 20.77±3.02,P<0.05). The triage time,waiting time for treatment,and treatment time of the observation group were significantly shorter than those of the control group[triage time (minutes):3.25±0.62 vs. 5.89±1.02,waiting time for treatment (minutes):3.02±0.45 vs. 5.78±0.98,treatment time (minutes):45.85±5.23 vs. 65.22±6.41,all P<0.05]. Complication incidence of the observation group was significantly lower than that of the control group[3.75％ (3/80) vs. 12.50％ (10/80),P<0.05],while the satisfaction rate of the observation group was significantly higher than that of the control[93.75％ (75/80) vs. 77.50％ (62/80),P<005]. Conclusion The integrated graded diagnosis and rescue model based on CRAMS scores can improve the treatment efficiency of multiple trauma patients,improve their condition and prognosis,and enhance their satisfaction with treatment.

The clinical data of 120 patients admitted to our hospital with renal stones treated by flexible ureteroscopy (FURS) and the imaging-related data measured by virtual reality technology were retrospectively analysed. The results of the univariate analysis showed that stone surface area (S), renal pelvis volume (P), length of calyces funnel (L), pelvic calyceal height (H) and essence of stone (E) were closely related to stone-free rate. The H. L.P.E.S. score was constructed to predict stone-free rate after FURS based on the above factors, and the area under the receiver aperating characteristic curve for the H. L.P.E.S. and S. O.L.V.E. scoring systems was 0.921 and 0.754 respectively.The H. L.P.E.S. scoring system has higher predictive value.

OBJECTIVE： To investigate the rationality of TLC identification method （3） of （R，S）-epigoitrin in Isatis indigotica stated in 2015 edition of Chinese Pharmacopeia （partⅠ） （later abbreviated as pharmacopeia）， and make some improvements. METHODS： Three batches I. indigotica were collected and prepared into decoction pieces according to the processing method of I. indigotica in pharmacopoeia. TLC identification of （R，S）-goitrin in I. indigotica decoction piece and medicinal material were conducted according to identification method （3） in pharmacopeia （80％ ethanol as solvent for sample treatment， ultrasound extraction）； the rationality of pharmacopoeia method was investigated. Then the method was improved by changing the extraction solvent and pretreatment method （method one： using water as solvent， ultrasound extraction； method two： soaking in water for 1 h， then adding into methanol， ultrasound extraction； method three： the sample was wetted and then dried， using 80％ methanol as solvent， ultrasound extraction） of samples， and the optimal method was verified. According to the optimal method， the TLC identification of （R，S）-goitrin was detected by using chromatographic plates from different manufacturers， under the conditions of low temperature and low humidity （7 ℃， relative humidity 48％） and high temperature and high humidity （35 ℃， relative humidity 75％） respectively，to investigate the durability of the method. RESULTS： According to the method of pharmacopeia， in the chromatograms of decoction pieces， the same color spots appeared at the corresponding chromatographic positions of reference substance， but no corresponding spots appeared in the medicinal material chromatograms. After the samples were treated by three improvement methods， in medicinal material chromatograms， the same color spots appeared in the corresponding chromatographic positions of reference substances. There were single chromatographic spot after medicinal materials were treated with method one， and there were more spots after medicinal materials were treated with method two and three， and method two consumed less time than method three. The results of validation tests and method durability tests  showed that after the treatment of I. indigotica and its decoction pieces according to method two， the same color spots appeared in the corresponding positions of the decoction pieces and the medicinal materials chromatograms as those of the control. CONCLUSIONS： The improved TLC identification method is effective， the chromatographic spots are clear， and the repeatability is good.

Objective To study the correlation of fingerprint chromatograms of Cinnamomi Ramulus formula granules, decoction pieces and water decoction by HPLC; To investigate the difference of main chemical constituents among different forms. Methods The Diamonsil C18 column (4.6 mm × 250 mm, 5 μm) was used with mobile phase of acetonitrile and 0.1% phosphoric acid at the flow rate of 1.0 mL/min, with detection wave of 280 nm and temperature of 30 ℃. The detection of 10 batches of Cinnamomi Ramulus formula granules, 10 batches of decoction pieces and 10 batches of water decoction were established respectively. Results Totally 12 peaks in the HPLC fingerprint chromatogram from 10 batches of formula granules could be tracked in the water decoction; 10 peaks in the HPLC fingerprint chromatogram could be tracked in the decoction pieces. Three components, such as protocatechuic acid, coumarin and cinnamic acid were verified. Conclusion The main chemical components of Cinnamomi Ramulus formula granules and water decoction are basically the same, and the common component contents have similar proportion.

MRCP can be applied to display three-dimensional morphology of the biliary tract clearly.Laparoscopic surgery via cystic duct for choledocholithiasis possesses obvious advantages, but it is not suitable for all cases because there are great variations in the cystic duct.So how to make proper choice of the therapeutic strategy becomes very important.In this prospective study, different surgeries were administrated in patients with common bile duct stone based on the 4 categories of cystic ducts in 96 cases judged by MRCP images.These findings demonstrated that according to the cystic duct morphological type,LCTBDE is suitable for thick-straight type, and LCBDE is fit for thin-crooked type.Be careful to choose laparoscopic surgery in the other two types considering their individual features.Thus, this classification will be propitious to maximize the advantage of laparoscopic operation as a minimally invasive treatment.

Objective To investigate the best pathway of laparoscopic surgery for choledocholithiasis. Methods According to MRCP,the cystic duct was divided into four types.The thick-straight type (n =89)and the thin-crooked type (n =65)patients randomly received the laparoscopic operations via the cystic duct or com-mon bile duct.The operation time,transit operation rate,complication rate and length of hospital stay after opera-tion were analysed.Results There were 46 cases of the thick-straight type via cystic duct,43 cases via common bile duct.The former had shorter operation time and hospital stay after operation (P <0.05),but there was no significant difference in transit operation rate and complication rate.There were 32 cases of the thin-crooked type via cystic duct and 33 cases via common bile duct and there were significant differences in the operation time, transit operation rate,complication rate and length of hospital stay after operation(P <0.05).Conclusion Ac-cording to different types,LCTBDE is suitable for the patients with thick-straight type,and LCHTD can be per-formed in thin-crooked type.Therefore,it can maximize the advantage of minimally invasive surgery.

Objective To establish the molecular weight distribution of anti-HBV placenta transfer factor injection (PSTF) by electrophoresis, HPLC and MS.Methods Using the methods of SDS-PAGE, HPSEC, MALDI-TOF-MS to test the molecular of PSTF.Results The Molecular was 8000 Da by SDS-PAGE.There were 5026.67,6783.44,7496.42,8736.55 Da components in PSTF by HPSEC.The main component molecular was 2972 Da and the maximum molecular component was 8194 Da.Conclusion HPSEC is simple and rapid to determine the maximum component molecular of PSTF.

OBJECTIVE:To investigate the application of fuzzy comprehensive evaluation in formulation screening. METH-ODS:Taking Compound paracetamol and chlorphenamine maleate granules as model drug,based on single factor experiment,L9(34) orthogonal test was used to screen the formulation with the amount of aspartame,hawthorn powder essence,milk powder essence and saccharose as factors,using dissolution rate of caffeine as index. The granules prepared by 9 kinds of formulation in orthogonal test were evaluated with fuzzy comprehensive evaluation in terms of taste,aroma,color and dissolubility. The optimized formula-tion was validated and compared with original formulation. RESULTS:The formulation 5 was the optimal choice in both orthogo-nal test and fuzzy comprehensive evaluation,and obtained same results. Compared with sensory comprehensive score (63.12) and dissolution rate of caffeine (91.3%) in original formulation,two indicators of optimized formulation in 3 tests were 84.00 and 99.07% in average (RSD<2.0%,n=3). CONCLUSIONS:Fuzzy comprehensive evaluation can be used for the formulation screening of sensory evaluation index. It is scientific and accurate.

Objective To explore the theoretical framework and method of community-based rehabilitation assessment for children with cerebral palsy based International Classification of Functioning, Disability and Health (ICF). Methods The system of assessment of community-based rehabilitation was developed based on the theoretical framework ICF, combined with multi-tools and self-compiled work scales.The system was used for 50 rural children with cerebral palsy after 1-year of community-based rehabilitation. Results and Conclusion The system of assessment is applicable for rural community-based rehabilitation of children with cerebral palsy, with satisfactory efficacy and compliance.