ICU nursing is a vitalpartof the development of specialized nursing in China, and the standardized training of the corecompetence of ICU nurses is the primary goal of the development of ICU nursing. This paper took the First Affiliated Hospital of Sun Yat-sen University in China and the Royal Free Hospital in London, the United Kingdom as example, and compared the hierarchical management and core competencies training status of ICU nurses in China and England to find out the similarities and differences, and then to put forward valuable suggestions for hierarchical management and the core competence training of ICU nurses in China.

Objective To compare the curative efficacy of conventional transcatheter arterial chemoembolization(C-TACE)and drug-eluting bead transcatheter arterial chemoembolization(D-TACE)combined with local thermal ablation in the treatment of massive hepatocellular carcinoma(HCC).Methods A total of 72 patients with massive HCC,who were admitted to the Nanyang Municipal First People's Hospital of China from April 2018 to June 2021,were enrolled in this study.By using random number table method,the patients were divided into study group(n=36)and control group(n=36).The patients of the control group were treated with local thermal ablation combined with C-TACE,while the patients of study group were treated with local thermal ablation combined with D-TACE.The clinical efficacy,tumor markers,liver function,serological indicators,blood perfusion indexes,and adverse reactions were compared between the two groups.All patients were followed up for two years.The progression-free survival(PFS)were compared between the two groups.Results The disease control rate(DCR)and objective response rate(ORR)in the study group were higher than those in the control group(P＜0.05).At 3 months after operation,the levels of alpha-fetoprotein(AFP)and prothrombin induced by Vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)were decreased in both groups(P＜0.05),which in the study group were obviously lower than those in the control group(P＜0.05);the alanine aminotransferase(ALT)level was increased in both groups,which in study group was lower than that in the control group(P＜0.05);the albumin(ALB)level was decreased in both groups(P＜0.05),which in the study group was higher than that in the control group(P＜0.05);the epidermal growth factor receptor(EGFR),vascular endothelial growth factor(VEGF)and thymokinase 1(TK1)levels were decreased in both groups(P＜0.05),which in the study group were lower than those in the control group;the blood volume(BV)and blood flow(BF)were decreased in both groups(P＜0.05),which in the study group was lower than those in the control group;the mean transit time(MTT)of contrast agent was increased in both groups(P＜0.05),which in the study group was higher than that in the control group.During the follow-up of two years,one patient in each group was lost in touch,the follow-up success rate was 97.22％.The median PFS in the study group and the control group was 15.41 months(95％CI:7.02-23.19)and 12.34 months(95％CI:6.16-22.30)respectively.The PFS curve of the study group was better than that of the control group(P＜0.05).Conclusion Local thermal ablation combined with D-TACE can improve liver function and blood perfusion in patients with massive HCC,with a remarkable clinical efficacy.This therapy can reduce tumor markers levels,regulate serum EGFR,VEGF and TK1 expressions,and prolong the median PFS,besides,it is clinically safe and reliable.

Objective Based on the Integrated Theory of Health Behavior Change(ITHBC),the influencing factors of home medication safety were explored in patients with chronic heart failure(CHF).Methods This qualitative de-scription,involving a semi-structured in-depth interview of 22 CHF patients based on purposive sampling,was con-ducted from December 2022 to May 2023,at 3 hospitals in Changsha,Hunan.NVivo 11.0 software was used to or-ganize and code data,and content analysis was performed to analyze data.Results Totally 9 generic categories be-longing to 4 categories were extracted.These were knowledge(knowledge of disease and knowledge of medication safety),attitude and belief(attitude towards diseases and medication belief),self-regulation(participation in medica-tion safety self-management and growing through experience),and social facilitation(hospital consultation services,family support and objective situation interference).Conclusion Knowledge,belief,self-regulation and social facili-tation were interrelated to influence medication safety behavior of patients with CHF at home.Medical workers,family members and society should work together to provide medication safety information,create a supportive envi-ronment,focus on improving patients'awareness and ability of self-regulation,strengthen their belief in taking medi-cation,and ultimately ensure the home medication safety for CHF patients.

There are certain limitations in the current clinical evaluation methods and evaluation modes of new Chinese herbal medicines for syndromes， and there is a lack of a clinical evaluation system that meets the characteristics of traditional Chinese medicine （TCM）. Based on the characteristics of TCM "syndrome differentiation and treatment" and "correspondence of formulas and syndromes"， the target design model， hypothesis and its scope of application are proposed on the basis of the combination of diseases and syndromes. On the basis of fully considering the dual factors of diseases and syndromes， we distinguished the "centre of the target"， "middle ring" and "outer ring" through the differences of different signs and symptoms in people with same syndrome， in order to determine the degree of conformity of the syndrome. Then， the population with same syndrome could be analysed according to the "centre of the target"， "middle ring" and "outer ring"， so as to achieve the precise positioning of new Chinese herbal medicines for syndromes， and try to provide research ideas and methods for syndrome differentiation and treatment of TCM and precise intervention.

Objective To investigate the correlation between MEX3A and differentiation characteristics of gastric cancer and intestinal metaplasia,and its combination with caudal-related homeobox transcription factor 2(CDX2)and mucin 2(MUC2)and mucin 5AC(MUC5AC)to determine the role of carcinogenic intestinal metaplasia.Methods From January 2010 to December 2014,a total of 410 cases of gastric cancer and paracarcinoma paraffin-embedded tissue samples were selected from the Central Hospital Affiliated to Shenyang Medical College and the Second Hospital Affiliated to Shenyang Medical College.According to pathological diagnosis,they were divided into control group(mild superficial gastritis,79 cases),intestinal metaplasia group(149 cases)and gastric cancer group(182 cases).The expressions of MEX3A,CDX2,MUC2 and MUC5AC were detected by immunohistochemistry.Results MEX3A was highly expressed in gastric cancer group and intestinal metaplasia group,especially diffuse gastric cancer,poorly differentiated gastric cancer and type Ⅲ intestinal metaplasia(P<0.05).CDX2 and MUC2 were highly expressed in gastric cancer group and intestinal metaplasia group,especially intestinal type gastric cancer,highly and moderately differentiated gastric cancer,type Ⅰ and type Ⅱ intestinal metaplasia(P<0.05).The expression of MUC5AC was high in control group and low in gastric cancer group and intestinal metaplasia group,especially in intestinal type gastric cancer,type Ⅰ and type Ⅲ intestinal metaplasia(P<0.05).Gastric cancer and intestinal metaplasia differentiation were negatively correlated with MEX3A and MUC5AC expression,but positively correlated with CDX2 and MUC2 expression(P<0.05).MEX3A was negatively correlated with the expression of CDX2 and MUC2,and positively correlated with the expression of MUC5AC in gastric cancer(P<0.05).MEX3A was negatively correlated with the expression of CDX2 and MUC2 in intestinal metaplasia(P<0.05),while CDX2 was positively correlated with the expression of MUC2(P<0.05).Conclusion MEX3A is negatively correlated with gastric cancer and intestinal metaplasia differentiation.Gastric cancer is characterized by high MEX3A expression and low CDX2 and MUC2 expression.