Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To construct a risk nomogram model for cancer-related fatigue in non-small cell lung cancer patients undergoing chemotherapy, and to verify the application value of the model.Methods:From from January 2017 to December 2021, 520 non-small cell lung cancer patients undergoing chemotherapy admitted to Taizhou People's Hospital and the Second People's Hospital of Lianyungang were selected as the research objects using the convenient sampling method, 400 patients admitted from January 2017 to February 2020 were selected as the model group, and 120 patients admitted from April 2020 to December 2021 were selected as the verification group. Lasso analysis and Logistic regression analysis were used to explore the risk factors of cancer-related fatigue in non-small cell lung cancer patients undergoing chemotherapy. R 4.1.2 software was used to establish a risk nomogram model to predict the risk of cancer-related fatigue in non-small cell lung cancer patients undergoing chemotherapy, and to verify the application value of the model.Results:The incidence of cancer-related fatigue in the model group was 65.5% (262/400) . Logistic regression analysis showed that age≥60 years old, female, living alone, TNM stage (Ⅲ-Ⅳ stage) , poor sleep, depression, frequency of chemotherapy>2 times and percentage of forced expiratory volume in one second to the predicted value (FEV 1%) <70% were the risk factors of cancer-related fatigue in non-small cell lung cancer patients undergoing chemotherapy. The results of risk nomogram model showed that consistency index of the model group and the verification group were 0.846 (95% CI: 0.810-0.889) , 0.887 (95% CI: 0.857-0.917) respectively. The calibration curve showed that the actual and predict values of the model group and the validation group had a good fitting degree. The areas under receiver operating characteristic curve of the model group and the validation group were 0.845 and 0.866, respectively. The decision curve showed that the predictive graph of cancer-induced fatigue in non-small cell lung cancer patients undergoing chemotherapy had good clinical efficacy. Conclusions:Age≥60 years old, female, living alone, TNM stage (Ⅲ-Ⅳ) , poor sleep, depression, frequency of chemotherapy>2 times and FEV 1%<70% are the risk factors of cancer-related fatigue in non-small cell lung cancer patients undergoing chemotherapy, the risk nomogram model established based on the above risk factors is helpful to developing the screening and prevention measures of patients at high-risk of cancer-related fatigue.

Objective:To explore the effects of power feedback method on knowledge, attitude, practice and quality of life in patients with permanent colostomy for rectal cancer.Methods:Totally 110 patients receiving permanent colostomy for rectal cancer in the Second People's Hospital of Lianyungang from April 2018 to March 2019 were selected by convenient sampling. The 55 patients admitted between April and September 2018 were divided into control group, while the 55 patients admitted from October 2018 to March 2019 were divided into observation group. Patients in the control group learned the knowledge about colostomy care by presentation to group, while patients in the observation group received interventions based on the power feedback method. Colostomy Patient Colostomy Knowledge Attitude and Practice Scale (CPCKAPS) and City of Hope-Quality of life-Ostomy Questionnaire (COH-QOL-OQ) were used to compare the effects of intervention.Results:The CPCKAPS scores in the observation group were higher than those in the control group after intervention, and the difference was statistically significant ( P<0.05) . After intervention, the COH-QOL-OQ score of the physical health dimension in the observation group was lower than that in the control group, and the difference was statistically significant ( P<0.05) . There was no statistically significant difference in the scores of psychological, social and mental health dimensions between the two groups ( P>0.05) . Conclusions:The power feedback method can improve the level of knowledge, attitude and practice of patients with permanent colostomy for rectal cancer, and further large-scale and long-term research is needed to explore its effects on the quality of life of patients.

Objective To establish a scientific and reasonable evaluation index system of perioperative accelerated rehabilitation for lung cancer patients. Methods From March 2018 to January 2019, based on the Donabedian model, the evaluation index system of perioperative accelerated rehabilitation of lung cancer patients was established through literature review, semi-structured interview and Delphi methods. Results The authority coefficients of experts was 0.89, and the Kendall coordination coefficient was 0.411. After two rounds of inquiry, the evaluation index system of perioperative accelerated rehabilitation for lung cancer patients includes 3 primary indicators, 10 secondary indicators and 55 tertiary indicators. Conclusions Based on Donabedian model, the evaluation index system of perioperative accelerated rehabilitation of lung cancer patients is scientific and practical, which can provide scientific basis for the quality evaluation of perioperative accelerated rehabilitation of lung cancer patients..

Objective:To evaluate the clinical application of vancomycin in a cancer hospital in order to promote the rational use of vancomycin. Methods:The records of 66 patients treated with vancomycin in 2015 were reviewed and analyzed in the respects of in-dications of medication, pathogenic examination, usage and dosage, course of treatment, drug combination, drug monitoring and drug utilization index(DUI). Results:Among the 66 cases, most drug use was rational, which accounted for 69. 70% with DUI of 0. 82. There were still several types of irrational drug use including no medication indications, irrational usage and dosage, too long or too short course of treatment, irrational combination and prophylactic use time. Conclusion:The application of vancomycin is basically ra-tional, while irrational phenomenon still exists. The management and supervision should be further strengthened in order to promote clinical rational drug use and ensure medication safety of patients.

Objective:To analyze the correlation between cyclosporin A blood concentration and drug-induced liver and kidney in-jury in the patients with aplastic anemia, investigate the significance of cyclosporin A concentration in the monitoring of liver and kidney toxicity, and provide theoretical basis for clinical individualized drug use. Methods:A total of 149 patients with aplastic anemia trea-ted with cyclosporin A as the main therapeutic drug were selected, and after 3-day treatment, the blood concentration of cyclosporin A was detected by an HPLC-UV method 10 minutes before the administration and 2 hours after the administration. The liver and kidney function were measured at the same time. The correlation between the different concentration of cyclosporine A and the change of liver and kidney function was analyzed. Results:All the patients were monitored cyclosporine A blood concentration with 1236 samples, and 34 patients (22. 82%) were with drug-induced liver injury and 51 patients (34. 23%) showed drug-induced kidney toxicity. The average C0 of liver injury patients was (297. 92 ± 74. 14) μg·L-1 , and C2 was (944. 47 ± 148. 47) μg·L-1 , while the average C0 of kidney injury patients was (311. 41 ± 52. 80)μg·L-1, and C2 was (926. 25 ± 136. 02) μg·L-1. The function indices of liver (ALT, AST, TBIL) and kidney (SC, BUN, UA) were significantly higher than those in the normal group (P<0. 05), and the blood concentration of cyclosporin A was significantly correlated with the liver,and kidney function. Conclusion:There is a certain correla-tion between cyclosporine A -induced toxicity and its blood concentration and C2 may be a more valuable predictor for drug -induced liver injury.

Throughin-depth study and thinking ofthe current situation of medical education,this paper exploredtraining strategies of applied talents in medical colleges under the new situation.From the training ofapplication talents in medical colleges under new situation,we should focus on the current reality,learn experience.Combined with the characteristics of medical specialty,we should explore the model of strengthening the humanistic quality moral training of current medical application talents from the curriculum,teaching content selection,teachers' construction,environment shaping,teaching methods,assessment and evaluation,and thus to adapt to the medical mode conversion,alleviate the doctor-patient contradiction and promote medical students employments.

Objective:To compare the therapeutic and adverse effects of concurrent raltitrexed plus oxaliplatin and radiotherapy with those of PF synchronous radiotherapy in the treatment of advanced esophageal cancer. Methods:A total of 84 pathologically con-firmed patients with advanced esophageal carcinoma were randomly distributed to the concurrent raltitrexed plus oxaliplatin and ra-diotherapy group (experimental group, n=40) and to the PF synchronous radiotherapy group (control group, n=44). All patients were treated with 3DCRT at a total dose of 60 Gy/30f. The chemotherapy in the experimental group consists of raltitrexed at 2.5 mg/m2, d1, plus oxaliplatin at 130 mg/m2, d2. The chemotherapy of the control group consists of DDP at 25 mg/m2, Dd1-3, plus 5-FU 500 mg/m2, d1-5. Two cycles of concurrent chemotherapy were administered during radiotherapy on d1 and d29. The comparison results were used to estimate the therapeutic and adverse effects of the two groups. Results:The rerponse rate, complete response, and one-year overall survival rate of the experimental group were higher than those of the control group [(87.50%vs. 79.54%, P=0.3293), (32.50%vs. 18.18%, P=0.13), and (82.50%vs. 79.50%, P=0.701)], but the difference was not statistically significant. The incidence rates of nau-sea and vomiting, appetite degression, leucopenia, radiation-induced esophagitis, and cardiotoxicity were significantly lower (P<0.05) in the experimental group than in the control group. Other adverse effects of the two groups were similar (P>0.05). Conclusion:Simi-lar to PF chemotherapy and radiotherapy, the concurrent raltitrexed plus oxaliplatin and radiotherapy achieved a similar short-term therapeutic effect but lower adverse effects on patients with esophageal cancer.

Objective:To establish an HPLC method for the determination of paclitaxel and docetaxel in plasma to provide refer-ence for the individualized treatment regimen and the evaluation of curative effect and adverse reactions. Methods:Paclitaxel and do-cetaxel were used as the internal standard for each other. The samples were precipitated by acetonitrile and separated on a DikMA Dia-monsil C18 column with a mixture of acetonitrile-water (55: 45) as the mobile phase. The flow rate was 1. 2 ml·min-1 . The column temperature was set at 25℃. Paclitaxel and docetaxel were detected by UV-detection (λ= 227 nm). Results: A linearity was ob-tained within the range of 0. 078-10. 0 mg·L-1 for paclitaxel and docetaxel. The limit of quantitation was 0. 039 mg·L-1 . The aver-age recovery of paclitaxel and docetaxel was 99. 85% and 100. 35%, respectively. The inter- and intra-day RSD were both less than 5% and the RSD for freeze-thaw stability was below 10%. The plasma concentration of paclitaxel in clinical samples was within the range of 0. 18-6. 16 mg·L-1 and obvious individual difference was shown. Conclusion:Therapeutic drug monitoring is very important due to the obvious differences in plasma concentration of paclitaxel and docetaxel. The established method is sensitive, accurate, con-venient and rapid in r the therapeutic drug monitoring, and is useful for the adverse drug reactions monitoring and pharmacokinetic study.

Objective:To analyze the prophylactic use of antibiotics during the perioperative period of typeⅠincision operation in a cancer hospital in order to promote the safe, effective and rational use of antibiotics. Methods:The rationality of 480 cases of typeⅠincision operation from January to December in 2013 and from January to December in 2014 was evaluated respectively, and the analy-sis and comparison were performed on the prophylactic use of antibiotics. Results: Through the pharmaceutical intervention including the special evaluation carried out by clinical pharmacists, the use of antibiotics gradually reached the rational level. Conclusion: The participation of clinical pharmacists in the use management of antibiotics in typeⅠincision operation can improve the rationality of the drugs used in clinic.