Objective To prepare paclitaxel-natural borneol complex,and to explore the prescription and preparation process of paclitaxel-natural borneol complex drug-loaded submicroemulsion,and its in vitro anti-tumor effect.Methods The Paclitaxel-natural borneol complex was prepared by grinding method and identified by Fourier Transform infrared spectroscopy(FT-IR)and differential scanning calorimetry(DSC).The compound drug-loaded submicroemulsion was prepared using a two-step high-pressure emulsification method.The single-factor investigation and the orthogonal experimental design were applied to optimize the formulation and preparation process.MTT assay,cell cloning assay,and cell scratch assay were used to evaluate the effect of this preparation on HCT-116 cells.Results The infrared spectral absorption peaks of taxol-natural borneol complex at 3 312.76 cm-1 and 3 513.92 cm-1 disappeared,and DSC analysis showed that a new absorption peak of taxol-natural borneol complex appeared at 154.56 ℃,indicating that taxol be coupled with natural borneol to form a new complex.The optimal prescription was 0.44％active pharmaceutical ingredient[paclitaxel-natural borneol(1∶3)],10％medium chain triglyceride,3％emulsifier[egg yolk lecithin-Poloxam 188(1∶2)],2％glycerol,0.3％oleate.The optimal process was emulsification at 80 ℃,60 MPa high pressure homogenization 10 times.The half inhibitory concentration(IC50)was 0.75 μg·mL-1 by MTT asssy in cell.In the cell cloning assay,the scratch healing area of blank control group,paclitaxel raw material and paclitaxel/natural borneol submicroemulsion were(36.44±3.35)％,(13.59±9.28)％,(8.30±4.09)％,respectively.The results were statistically significant(P＜0.05).In the plate cloning experiment,the cell cloning rates of blank control group,paclitaxel bulk drug group and submicroemulsion group were(37.92±0.729)％,(9.16±1.335)％and(3.36±1.065)％,respectively,the differents were statistically significant(P＜0.05).Conclusion This submicroemulsion has reasonable prescription,feasible process and good stability.Cell experiments showed that the submicronemulision effectively inhibits the proliferation and migration of HCT-116 cells,suggesting its potential as a promising antitumor agent.

Objective To explore the main categories and changing directions of hospitalization expenses of gynecological tumors,and provide strategies and suggestions for effectively controlling hospitalization expenses and improving the payment scheme of medical insurance fund.Methods The expense information of patients discharged from Huzhou Central Hospital from January 2020 to December 2022 was collected,and analyzed by the payment method of structural variation and disease diagnosis related groups(DRG)with grey correlation,and the correlation degree was observed.Results From 2020 to 2022,the average hospitalization cost of 2 138 gynecological tumor patients showed a downward trend.The hospitalization cost structure of patients showed that surgical and laboratory expenses accounted for a relatively high proportion,while nursing and treatment expenses accounted for a relatively low proportion.The changes in the hospitalization structure of patients showed that material costs were gradually decreasing,while operating costs,bed fees,pathology fees,and nursing fees were gradually increasing.Diagnosis and treatment fees,drug fees,radiation fees,testing fees,treatment fees,surgery fees,and other expenses were first decreasing and then increasing.In the hospitalization expenses of gynecological tumors from 2020 to 2022,the most closely related expenses were surgical expenses,drug expenses,and laboratory expenses,while the least related expenses were bed expenses,nursing expenses,and treatment expenses.The proportion of patient hospitalization expenses was basically consistent with the degree of correlation.The structural change rate of hospitalization expenses for gynecological tumors from 2020 to 2022 was 13.67％,with a structural change rate of 14.61％from 2020 to 2021 and 10.77％from 2021 to 2022.The direction of structural changes showed that from 2020 to 2022,there were positive changes in operating fees,bed fees,pathology fees,and nursing fees,with significant changes in surgical fees.The largest contribution rate of changes in the hospitalization cost structure of gynecological tumors from 2020 to 2022 was surgical expenses,accounting for 37.29％,followed by examination expenses,accounting for 13.08％.The contribution rates of various expenses to the structural changes of average hospitalization expenses varied during different time periods.From 2020 to 2021,the largest contribution rate of hospitalization expense structural changes was surgical expenses,accounting for 33.05％,followed by drug expenses,accounting for 12.05％.From 2021 to 2022,the largest contribution rate of hospitalization expense structural changes was surgical expenses,accounting for 48.00％,followed by drug expenses,accounting for 16.85％.Correlation analysis showed that the hospitalization expenses of patients were related to medical insurance type and length of stay(P＜0.05).Conclusion The average hospitalization cost of gynecological tumor patients has been effectively controlled,and their clinical hospitalization costs are gradually rationalized.However,material and surgical costs still have a significant impact on the hospitalization costs of patients,indicating that the labor value of clinical medical personnel has increased less.DRG payment can control clinical medical expenses to a certain extent,and further optimization is needed to improve supporting policies,enhance the technical value of medical personnel,and strengthen the management of medical consumables.

Objective:To investigate the correlation between lung ultrasound score at the end of spontaneous breathing trial (SBT) and cumulative fluid balance at 48 h and their predictive value of extubation outcome in patients with intro-abdominal infection (IAI) under mechanical ventilation.Methods:A retrospective study was conducted. Patients with IAI under mechanical ventilation for more than 48 h were collected from three hospitals from October 1, 2017 to September 30, 2018. Routine demographic variables and clinical characteristics were recorded. The patients were divided into the successful extubation group and failed extubation group according to whether they could maintain spontaneous breathing for 48 h after extubation. LUS at the end of SBT (before extubation) and cumulative fluid balance at 48 h were compared between the two groups. LUS and cumulative fluid balance at 48 h were analyzed by bivariate correlation analysis, and their correlations with shallow fast breathing index (RSBI) and precursor protein of BNP (Pro-BNP) were analyzed. The predictive value of LUS at the end of SBT (before extubation) and cumulative fluid balance for extubation failure were analyzed by receiver operating characteristic curve (ROC).Results:Totally 207 patients were enrolled. There were significant differences in LUS before extubation [12 (10, 14) vs. 16 (14, 17) points], cumulative fluid balance [-318 (-1 116, 200) mL vs. 1 140 (685, 1 614) mL], RSBI [60 (55, 66) (times/min)/L vs. 70 (65, 78) (times/min)/L], pro-BNP [250 (122, 1 292) pg/mL vs. 1156 (285, 4 346) pg/mL], IAP >15 mmHg [32.8% vs. 46.6%], and ICU stay [8 (6, 12) days vs. 11 (8, 14) days] ( P<0.05). Logistic regression analysis showed that the COPD history, RSBI, LUS at the end of SBT, and cumulative fluid balance at 48 h before extubation were independent risk factors for extubation failure. Correlation analysis showed that LUS was moderately correlated with cumulative fluid balance at 48 h ( r=0.41, P<0.001), weakly correlated with RSBI ( r=0.381, P<0.001), and weakly correlated with pro-BNP ( r=0.220, P<0.001). Cumulative fluid balance at 48 h was weakly correlated with RSBI ( r=0.31, P<0.001), but not with pro-BNP. LUS at the end of SBT and cumulative liquid balance at 48 h had predictive value for extubation failure [AUC=0.87 (95% CI: 0.82-0.91), AUC=0.89 (95% CI: 0.85-0.94), P<0.001]. Conclusions:There is a moderate correlation between LUS at the end of SBT (before extubation) and 48 h cumulative fluid balance in patients with IAI and mechanical ventilation. LUS at the end of SBT (before extubation) and cumulative fluid balance at 48 h have some predictive value for extubation failure.

Objective:To develop a list of basic and expanded medical laboratory tests in community health service centers in Shanghai.Methods:The status quo of human and equipment resource allocation, the test items and quality control currently performed, the perspectives of various stakeholders, the capacity building of community clinical laboratory in community health service centers in Shanghai were investigated by quantitative survey and qualitative interview; and the rating scores of each test item were assessed by expert consultation using Delphi method. The expert focus discussion was conducted, and each test item was rated and classified. Finally a list of the basic tests and expanded tests in clinical laboratories of community health service center was developed.Results:A total of 247 questionnaires were distributed and 192 (77.7%) were answered. A list of 94 laboratory test items was screened out based on the questionnaire survey of the laboratories of the community health centers. Thirty one experts in the relevant areas were invited to rate the test items, the average authority coefficient of experts was 0.90, with which the weighted average of the expert ratings was made. There were 45 (47.9%) items scored 7 or higher, 38 (40.4%) scored between 5 and 7, and 11 (11.7%) scored less than 5. Based on the results of the expert focus discussion, 48 items were recommended as the basic tests and 46 items as the extended tests.Conclusion:In this study a list of tests recommended to clinical laboratories in Shanghai community health service centers has been developed, which contains 48 basic tests and 46 extended tests.

Objective:To explore the relevance of a new comprehensive respiratory mechanics parameter, elastic power, to the 28-day prognosis of ARDS patients.Methods:Patients with ARDS hospitalized for at least 48 h with invasive mechanical ventilation in five intensive care units in three local hospitals in Lianyungang City from June 2018 to June 2022 were included in the study. Their baseline data and respiratory mechanics parameters were collected. Elastic power, mechanical power, driving pressure and lung compliance are calculated according to the corresponding formulae. The prognostic risk factors of ARDS patients were analysed using COX multi-factor regression, and the predictive value of EP/Cst on the 28-day prognosis of ARDS patients was evaluated based on ROC curve analysis and Kaplan-Meier survival curve.Results:There was no significantly difference in tidal volume and PEEP settings between the patients in the ARDS survivor and death groups ( P> 0.05). However, the differences in respiratory rate, plateau pressure, driving pressure, lung compliance, mechanical work, elastic work, EP/cst and MP/cst between the two groups were significantly different (all P< 0.01). Multifactorial COX regression analysis showed that EP/cst ( HR=1.211, 95% CI:1.091-1.323) and RR ( HR=1.209, 95% CI:1.046-1.339) were strongly associated with a more severe degree of illness and a worse prognosis in ARDS. And the cumulative survival rate at 28 d was significantly lower in the high Cst-EP group than in the low Cst-EP group (50.00% vs. 82.40%, P < 0.01). Conclusions:The new respiratory mechanics parameters EP and EP/Cst can assess the severity of ARDS with a good predictive effect on patient prognosis at 28 days.

Objective To evaluate the effect of virtual reality(VR)on alleviation of fatigue in patients undergoing chemotherapy for non-small cell cancer so as to enhance the quality of life of the patients.Methods This study was conducted with a quasi-randomised controlled trial.Sixty patients with non-small cell cancer treated under initial chemotherapy in a general hospital in Shanghai were enrolled in the study between January 2020 and January 2021.The patients in Ward-Ⅰ were assigned as the control group and those in Ward-Ⅱ as the trial group,with 30 patients per group.The patients in control group was treated with routine nursing strategy and those in the trial group with VR intervention in addition to routine nursing.An interactive immersion with six 3-D switching relaxation-oriented scenes was introduced in the VR intervention including travel,starry sky,four seasons,globe,parks and ocean world.Patients received a 20-minute VR intervention before chemotherapy at two times per week during the intermittent periods of chemotherapy.The revised piper fatigue scale in Chinese version(RPFS-CV)was used to assess the patients on admission and early,middle and late phases referring the third,fifth and seventh courses of the chemotherapy,respectively.Scores of the assessments were compared between the groups.Results All of the 60 patients had smoothly completed the 7 courses of chemotherapy.With repeated measures analysis of variance,the differences were found to be statistically significant in the scores of RPFS-CV,time,and interaction across different time points(all P<0.001).The scores of RPFS-CV taken at the fifth and seventh courses of chemotherapy in the trial group were significantly lower than that of the control group(P<0.001).There were no significant differences in the scores of RPFS-CV within the control group at the fifth and seventh courses of chemotherapy,but the differences were statistically significant in the other courses of chemotherapy(P<0.008 or P<0.001),showing a trend that the later the treatment course,the higher the score of RPFS-CV would be,and ultimately it went steady.In the trial group,there was no significant difference between the third course of chemotherapy and the fifth and seventh courses,as well as between the fifth and seventh courses(P>0.05);but the score taken before the chemotherapy was significantly lower as compared to those taken at the third,fifth and seventh courses(all P<0.001).Conclusion VR intervention with deep relaxation immersive interactive experience could inhibit fatigue by activating the hypothalamic-pituitary-adrenal axis and facilitating the secretion of cortisol via enhancing visual stimulation,thus alleviating cancer fatigue in patients undergoing chemotherapy for non-small cell cancer.

A 54-year-old male patient with severe acute respiratory distress syndrome caused by inhalation injury was admitted to the First People's Hospital of Lianyungang City on June 26 th, 2022. After admission, the patient received invasive mechanical ventilation (driving pressure-guided ventilator parameter setting) combined with prone position treatment immediately, but his condition continued to deteriorate. Five hours after admission, the patient received veno-venous extracorporeal membrane oxygenation (VV-ECMO) supporting treatment, treatment based on ultra-protective lung ventilation strategy combined with prone position ventilation for more than 12 hours per day. At the same time, pulse contour cardiac output monitoring technology was used to monitor cardiac index and extravascular lung water index to guide volume management, and fiberoptic bronchoalveolar lavage was performed for several times. After that, the patient was successfully weaned from VV-ECMO and ventilator, and then discharged from hospital successfully. During follow-up of one year after the injury, the patient showed no obvious respiratory symptoms, and his lung function was basically normal.

Objective:To investigate the infection rate in close contacts of COVID-19 patients before and after the last negative nucleic acid test, evaluate the effect of dynamic nucleic acid test in determining the infectivity of COVID-19 patients.Methods:Dynamic nucleic acid test results of COVID-19 cases were collected in a retrospective cohort study. COVID-19 cases with negative nucleic acid test results before their first positive nucleic acid tests were selected as study subjects. Close contacts of the index cases and the secondary close contacts were kept isolation for medical observation to assess their risk of infection.Results:This study included 89 confirmed cases from two local COVID-19 epidemics in Ningbo. A total of 5 609 close contacts were surveyed, the overall infection rate was 0.20%. No close contacts of the COVID-19 cases before the last negative nucleic acid test were infected, and the infection rate in the close contacts of the COVID-19 cases after the last negative nucleic acid test was 1.33%, all of these close contacts lived together with the index cases. No secondary close contacts were infected.Conclusion:COVID-19 patient becomes infectious after the last nucleic acid is negative, and has no infectivity before the last nucleic acid negative.

Objective:To explore the impact of standardized training on the career planning of undergraduate nursing students, and to provide a reference for the formulation of reasonable interventions.Methods:Semi-structured in-depth interviews were conducted among 15 undergraduate nursing students to obtain their real experience, and the data were analyzed using phenomenological methods.Results:Some undergraduates expressed their understanding and acceptance of the training policy and adopted a positive coping attitude; some undergraduates had negative emotions and chose to study or change careers; the main reasons for negative emotions were high economic pressure, family support, and lack of belonging. And lack of relevant information sources and guidance on training.Conclusion:The relevant departments should strengthen the publicity and interpretation of the standardized training system, cultivate professional identity, guide nursing students to choose the appropriate employment direction, and at the same time, they should improve the comprehensive treatment of regulated students and reduce the worries of nursing students when choosing a career, so that they can correctly view standardized training and make correct and reasonable career plans to reduce the brain drain of the nursing team.

Objective:To evaluate effectiveness of prevention and control strategies for COVID-19 in Ningbo by using an epidemic dynamic model.Methods:The incidence data and epidemic information of COVID-19 reported in Ningbo as of 9 March, 2020 were collected, and based on the implementation of prevention and control strategies, we developed a SEIR epidemic dynamics model. The basic and real-time reproduction numbers were calculated to evaluate effectiveness of prevention and control.Results:A total of 157 cases of COVID-19 were confirmed, without death, in Ningbo. The proportion of severe cases was 12.1 %. The mean incubation period was estimated to be (5.7±2.9) days. The mean interval from illness onset to diagnosis was (5.4±3.7) days. The mean duration from diagnosis to hospital discharge was (16.6±6.5) days. A total of 105 339 contacts had been under medical observation. The infection rates in contacts with home quarantine and centralized quarantine were 0.1 % and 0.3 %, respectively. In the confirmed cases, those who had been under medical observation before diagnoses accounted for 63.1 %. The basic reproduction number was estimated to be 4.8. With the strengthening of prevention and control measures, real-time reproduction number showed a gradual downward trend, dropping to below 1.0 on 4 February, and then continued to drop to 0.2 in mid-February. Conclusion:The effectiveness of the prevention and control measures for COVID-19 in Ningbo can be evaluated by using epidemic dynamic model to provide scientific evidence for the development of the prevention and control strategies.