Background The Qingcaosha Reservoir is facing issues of algal blooms and eutrophication, and the resulting increase in the level of chlorination disinfection by-products in the water has been a major concern. Objective To evaluate the impact of "Algae Monitoring and Control Program in Qingcaosha Reservoir" (hereinafter referred to as the program) on the control of trihalomethanes (THMs) in conventional finished water. Methods From 2011 to 2019, water samples were collected from the Lujiazui Water Plant once per season, one sample each time, and the concentrations of four THMs (trichloromethane, dichlorobromomethane, monochlorodibromomethane, and tribromomethane) were measured in the samples. Using 2014 when the program was implemented as a cut-off point, the entire study period was divided into two phases: pre-implementation (2011–2013) and post-implementation(2014–2019). Segmented linear regression with interrupted time series analysis was applied to assess the concentrations and trends of THMs in the finished water before and after the program launch. Results The concentration of total THMs in finished water increased by 1.561 µg·L⁻¹ (P=0.010) for each season of time extension before launching the program. The change in the concentration of total THMs in finished water was not statistically significant after the program launch, but the THMs concentration showed a decreasing trend as the slope was −0.626 (P=0.001). From 2017 until the end of 2019, the average concentration of THMs in finished water of Lujiazui Water Plant dropped to 10 μg·L⁻¹ or less. Conclusions The algae and eutrophication control measures in Qingcaosha Reservoir have achieved good results, controlling THMs in finished water at a low level, and the trend of THMs has changed from a yearly increase pattern before the program to a yearly decrease pattern after the program.

OBJECTIVE: To investigate the effect of lateral prone position ventilation in patients with acute respiratory distress syndrome (ARDS). METHODS: A prospective control study was conducted. A total of 75 patients with moderate to severe ARDS admitted to the department of critical care medicine of Jingxian Hospital in Anhui province from January 2020 to December 2022 were selected as the research objects. According to the envelope method, the patients were divided into the lateral prone position ventilation group (38 cases) and the traditional prone position ventilation (PPV) group (37 cases), using lateral prone position ventilation and traditional PPV, respectively. The mechanical ventilation parameters were set according to the ARDS treatment guidelines and lung protective ventilation requirements in both groups, and the time of prone position for the first 3 times was not less than 16 hours per day. General data of patients were recorded, including heart rate (HR), mean arterial pressure (MAP), airway resistance and lung static compliance (Cst) before prone position (T0), 1 hour (T1), 4 hours (T2), 8 hours (T3), and before the end of prone position (T4), oxygenation index (PaO₂/FiO₂) before the first prone position (t0) and 12 hours (t1), 24 hours (t2), 48 hours (t3), and 72 hours (t4) after the intensive care unit (ICU) admission, as well as the incidence of pressure injury (PI) and vomiting, tracheal intubation time, and mechanical ventilation time. Repeated measures analysis of variance was used to compare the effects of different prone positions on patients before and after the prone position. RESULTS: There were no significant differences in age, gender, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II), underlying diseases, HR, MAP, pH value, PaO₂/FiO₂, blood lactic acid (Lac), arterial blood pressure of carbon dioxide (PaCO₂) and other general information between the two groups. The HR (intergroup effect: F = 0.845, P = 0.361; time effect: F = 1.373, P = 0.247; interaction: F = 0.245, P = 0.894), MAP (intergroup effect: F = 1.519, P = 0.222; time effect: F = 0.169, P = 0.954; interaction: F = 0.449, P = 0.773) and airway resistance (intergroup effect: F = 0.252, P = 0.617; time effect: F = 0.578, P = 0.679; interaction: F = 1.467, P = 0.212) of T0-T4 between two groups showed no significant difference. The Cst of T0-T4 between the two groups showed no significant difference in the intergroup effect (F = 0.311, P = 0.579) and the interaction (F = 0.364, P = 0.834), while the difference in the time effect was statistically significant (F = 120.546, P < 0.001). The PaO₂/FiO₂ of t0-t4 between the two groups showed no significant difference in the intergroup effect (F = 0.104, P = 0.748) and the interaction (F = 0.147, P = 0.964), while the difference in the time effect was statistically significant (F = 17.638, P < 0.001). The group factors and time factors were tested separately, and there were no significant differences in the HR, MAP, airway resistance, Cst, PaO₂/FiO₂ between the two groups at different time points (all P > 0.05). The Cst at T1-T4 and PaO₂/FiO₂ at t1-t4 in the two groups were significantly higher than those at T0/t0 (all P < 0.05). There were no significant differences in the tracheal intubation time [days: 6.75 (5.78, 8.33) vs. 7.00 (6.30, 8.45)] and mechanical ventilation time [days: 8.30 (6.70, 9.20) vs. 7.40 (6.80, 8.75)] between the lateral prone position ventilation group and the traditional PPV group (both P > 0.05). However, the incidences of PI [7.9% (3/38) vs. 27.0% (10/37)] and vomiting [10.5% (4/38) vs. 29.7% (11/37)] in the lateral prone position ventilation group were significantly lower than those in the traditional PPV group (both P < 0.05). CONCLUSIONS Both lateral prone position ventilation and traditional PPV can improve Cst and oxygenation in patients with moderate to severe ARDS. The two types of prone position have little influence on HR, MAP and airway resistance of patients, and there is no difference in the influence on tracheal intubation time and mechanical ventilation time of patients. However, the lateral prone position ventilation mode can reduce the incidence of PI and vomiting, and is worthy of clinical promotion and application.
Humans ; Respiration, Artificial ; Prone Position ; Prospective Studies ; Lung ; Respiratory Distress Syndrome/therapy* ; Respiration ; Vomiting

Objective:To explore the effect of scientific research group-based model on the improvement of nursing scientific research ability in a county-level hospital.Methods:A nursing research group was established, the composition of team members and work contents of the group were clarified, tiered focused scientific research training was implemented through progressive research content and flexible training methods, and individual and progressive research guidance was provided through research counseling application forms, while literature reading activities were conducted through article reports and literature debriefings. Retrospective analysis of the nursing research practice, the number of scientific research outputs, and research capacity were applied to evaluate the effect of the nursing research group-based model.Results:Within 2 years of the establishment of the nursing research group, 37 training programs were conducted, 33 scientific research materials were pushed to the WeChat public account, 23 scientific research projects were tutored, and 6 research projects were successfully declared. The scientific research ability score of nursing staff participating in literature reading debriefing increased from 44.24±19.12 to 53.57±13.86( P<0.001). Conclusions:The application of the nursing research group-based model can improve the nursing scientific research ability of the county-level hospital.

Objective:To understand the status of psychological capital and disaster preparedness of clinical nurses and analyze the relationship between them.Methods:From August to October 2020, 508 clinical nurses were selected from 8 Class Ⅲ hospitals in Zhejiang province by convenience sampling method. General information questionnaire, nurses' psychological capital questionnaire and disaster preparedness questionnaire were used. A total of 508 questionnaires were sent out and 503 valid questionnaires were collected with an effective rate of 99.01%.Results:The total score of disaster preparedness score of 503 clinical nurses was (179.53±41.11) points, mean items score was (3.99±0.91) points, psychological capital was (91.86±14.68) points, mean items score was (4.49±0.73) points. Correlation analysis showed that nurses' psychological capital was positively correlated with disaster preparedness ( r value was 0.610, P<0.05). Regression analysis showed that psychological capital, department, working years, whether participated in disaster training and disaster event rescue had significant impact on disaster preparedness of clinical nurses ( t values were 2.002-16.770, P<0.01 or 0.05). Conclusions:The knowledge, skills and post disaster management of clinical nurses are still deficient. Psychological capital affects the level of disaster preparedness of nurses to a certain extent. Nursing managers should formulate targeted intervention measures to enhance the level of psychological capital of nurses, so as to better improve the disaster preparedness of clinical nurses.

Objective:To investigate the expressions of human epidermal growth factor receptor 2 (HER2) in recurrent patients after radical gastrectomy and its correlation with clinicopathologic features and prognosis.Methods:The clinical data of 116 recurrent patients after radical gastrectomy between December 2011 and March 2019 in Fujian Cancer Hospital were retrospectively analyzed. The relationship between HER2 expression of the tissues after radical gastrectomy and clinicopathological features as well as prognosis was also analyzed.Results:HER2 positive rate was 19.8% (23/116) in gastric cancer specimens of 116 patients after radical gastrectomy. HER2 positive rate in highly and moderately differentiated patients with gastric cancer was higher than that in those with poorly differentiated gastric cancer [33.3% (11/33) vs. 14.5% (12/83), χ2 = 5.292, P < 0.05]. HER2 positive rate in patients with lung metastasis was higher than that in patients without lung metastasis [42.1% (8/19) vs. 15.5% (15/97), χ2 = 5.517, P < 0.05]. There were no statistical differences in HER2 positive rate among gastric cancer patients with different gender, age, tumor location, recurrent site, TNM stage, number of metastasis, neurovascular invasion, liver metastasis, local recurrence (all P > 0.05). HER2 expression was not associated with disease-free survival time ( P > 0.05). Conclusion:HER2 expression is associated with the differentiation degree of gastric cancer and the location of distant metastasis, but it can not be used as a predictor for recurrence of gastric cancer.

Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) targeted treatment has been a standard therapy for advanced non-small cell lung cancer (NSCLC), but it is not tolerated well by all patients. In China, some studies have reported that traditional Chinese medicinal herbs (TCMHs) may increase efficacy and reduce toxicity when combined with EGFR-TKI, but outside of China few studies of this kind have been attempted.

Objective To compare the effectiveness and safety of Foley catheter(FC)and vaginal prostaglandin E2 suppository(PGE2,Propess)for cervical ripening and labor induction in fullterm pregnant women with unfavorable cervix.Methods A prospective randomized controlled trial was conducted.Women with a term or post-term,live,singleton fetus in cephalic presentation,intact membranes,Bishop score＜6,not in labor,medically indicated for labor induction from June 2009 to December 2009 in Drum Tower Hospital of Nanjing University Medical School were randomly divided into two groups:FC group(n=64)and Propess group(n=62).In FC group,a 16-F Foley catheter was inserted into patient's cervical canal; once past the internal os,the balloon was inflated with 80 ml saline.Intravenous oxytocin was initiated after the balloon was spontaneously extruded from the cervix or after 24 hours.In Propess group,vaginal Propess was used.x2 or Fisher's exact test and t test were used to compare the outcomes,delivery mode and induction success rate between the two groups.Results There were no significant differences in gestational weeks,Bishop score,indication of induction,improvement of Bishop score,success rate of induction,rate of vaginal delivery,total duration of labor and volume of postpartum hemorrhage between the two groups(P ＞ 0.05,respectively).Propess group had a higher rate of vaginal birth within 24 hours[56.5％(35/62)vs 28.1％(18/64),t=10.37,P＜0.05],a higher risk for excessively frequent and hard uterine contraction[17.7％(11/62)vs 0.0％(0/64),P＜0.05]and lower incidence of oxytocin induction/augmentation during labor[21.0％(13/62)vs 87.5％(56/64),x2 =56.27,P＜0.05]than those of FC group.There were no differences in neonatal Apgar score,meconium staining and neonatal birth weight between the two groups.Puerperal infection occured in neither group.Conclusions Under strict control of indication and aseptic manipulation,Foley catheter was as effective and safe as Propess for cervical ripening with lower risk of excessive uterine activity.It is suggested that Foley catheter could be used for cervical ripening,especially in patients with economic difficulty.

Objective To search for the neutralizing epitopos on hepatitis E virus (HEV) capsid besides the known neutralizing epitope (aa459-606). Methods By analysis of several strains of monoclonal antibodies against HEV capsid and their recognized epitopes, the neutralizing activity of epitope (aa394-458) at N-terminus was compared with that of an immunodominant neutralizing epitope (an459-606). Re-suits The research showed a novel potential neutralizing epitope in aa423-437 of HEV ORF2 though detec-ting and comparing the characteristics of several antibodies and corresponding determinations. The epitope is a linear non-immunodominant epitope which is different from the other neutralizing epitope in aa459-606.And the amino acids sequence of this novel epitope is conservative. Conclusion ORF2 aa423-437 is a no-vel potential neutralizing leaner epitope of HEV. It is believed that the present work adds fundamental knowl-edge to our understanding of HEV capsid domain and contributes to the prevention and control of this dis-ease.

Objective To express the recombinant caspid of genotype 4 hepatitis E virus(HEV) ORF2. Methods HEV recombinant capsid protein D66 was expressed in E. coli, using the ORF2 fragment (aa368-606, obtained from swine bile) of genotype 4 HEV. Results The recombinant capsid proteins D66 self-assemble to be particle with a radius of 13 nm through dimeric form in neutral solution. Coated particles reacted well with sera obtained from patients during acute or recovered phase of HEV infection. Immunofluorescence and immnoblot assay suggested that D66 bound and penetrated HepG2 cell lines, and the process of attachment was blocked by sera collected from patients during acute or recovered phase of HEV infection.Conclusion Recombinant D66 particles simulate the structure at the surface of genotype 4 HEV well and specifically adhere and penetrate the host cells, which lays the foundation for the investigation of the molecular mechanism of genotype 4 HEV infection.

Objective To study the helical CT dual-phase feature of peripheral enhancement in small hepatocellular carcinoma (SHCC) and to evaluate its correlation with the histopathology. Methods The helical CT dual-phase feature of peripheral enhancement in SHCC was analyzed in 17 cases with 18 lesions, all the lesions were confirmed by operation and histopathology. Results In 17 lesions, peripheral enhancement ring of the lesions wasn′t intact, the thickness of peripheral enhancement ring wasn′t uniform, and small nodular enhancement was found inside the peripheral enhancement ring in hepatic arterial phase (HAP). In 1 lesion, the peripheral enhancement ring of the lesion was intact and the thickness of peripheral enhancement ring was uniform in HAP. The density of the peripheral enhancement ring and the small nodular enhancement decreased to hypodense or isodense than the normal liver parenchyma in portal venous phase. Pathologic pattern: 16 lesions were trabecular type and 2 lesions were scirrhous type. The differentiation of the tumor cell was grade I in 2 lesions, grade Ⅱ in 14 lesions, grade Ⅲ in 1 lesion, and grade Ⅳ in 1 lesion, respectively. In 12 lesions, the vessels were richer in the lesion border than that in the lesion center. In 6 lesions, the vessels were less rich in both center and border. In 3 lesions, the pseudo-capsule was showed in the border of the lesion. In 10 lesions, the flecks of necrosis were demonstrated in the border and/or center of the lesion. Conclusion The helical CT dual-phase feature of peripheral enhancement in SHCC is characteristic, and SHCC might be distinguished from other hepatic diseases with peripheral enhancement.