Unplanned readmission is one of the adverse outcomes of patients after left ventricular assist device implantation,which seriously affects the prognosis of patients.This article reviews the incidence,causes,influencing factors and intervention measures of unplanned readmission of patients after left ventricular assist device implantation,in order to improve the attention of nursing staff,early identify high-risk groups of unplanned readmission of patients after left ventricular assist device implantation and provide references for formulating personalized intervention measures.

Objective: To understand the management of tuberculosis outbreaks in middle schools in Bijie City, and to put forward suggestions to improve the quality of tuberculosis epidemic situation in schools. Methods: A unified questionnaire was used to investigate the management of tuberculosis outbreaks in middle schools reported by tuberculosis information management system from August 27, 2018 to January 6, 2019 in Bijie City. Results: The screening rate of close contacts was 69.72%(99/142), which significantly varied by counties(P<0.01). The time from the date of diagnosis of patients to screening of close contacts by local CDC was 3(1-10.5) days. Rate of standardized management process for close contacts aged 15 years or older (0) was lower than that for close contacts aged younger than 15 years old (23.08%)(P<0.01). 3 462 close contacts were screened for TB symptom,and chest X-ray among those suspected individuals(process 1), and 2 439 close contacts were screened with TB symptom,PPD test,and chest X-ray among those suspected individuals or those with strong positive in PPD test(process 2). The detection rate of pulmonary tuberculosis in close contacts of Grade I was lower in Process 1 (28.89/100 000) than in Process 2 (328.00/100 000)(χ2=6.56, P=0.01). The latent infection rate of the first-class close contacts (6.39%) was higher than that of the second-class close contacts(1.93%)(χ2=54.86, P<0.01). Conclusion Management of tuberculosis outbreaks in middle schools in Bijie City in 2018 is effective and timely, but the standardization needs to be improved.

Objective? To compare the effects of constant pressure urination and timed urination during indwelling catheterization in elderly patients with coma in the emergency intensive care unit (EICU). Methods? Totally 100 elderly patients with coma admitted in EICU, the First Affiliated Hospital of Huzhou University from January 2015 to June 2017 were selected by convenient sampling. The 49 patients admitted from January 2015 to March 2016 were included into the control group, while the 51 patients admitted between April 2016 and June 2017 were included into the treatment group. Patients in the control group were allowed urination every 3-4 hours, while patients in the treatment group were monitored for continuous bladder pressure using a

Objective: Toexplore work process-oriented theory nursing ward round, research work process-oriented theory nursing ward round on critical thinking capacity of nursing undergraduates. Methods: Totally 80 Elective nursing ward round courses of nursing undergraduates were divided into the experimental A group and the experimental b group with 40 cases in each group. The experimental A group select the beginning of 9 weeks on Until, the experimental B group select the after of 9 weeks on Until. The nursing undergraduates were assessed by CTDI-CV on first, ninth, eighteenth weeks to evaluate the effect of the two groups. Results: Main effect of group factor and time factor of CTDI-CV had statistical significance (P<0.05) . There were significant interaction in the scores of CTDI-CV. Simple effect analysis demonstrated the scores of CTDI-CV in the experimental A group were higher than those of the experimental b group after the intervention (P<0.05) . Two groups of on first, ninth, eighteenth weeks measured values compared the effect of amount of F_B<F_A, the experimental group A intervention effect was better than in the experimental group B intervention. Conclusions For nursing undergraduates guided based on the working process of the curriculum of nursing ward round the critical thinking ability had good practice guidance, and on the start time to choose university grade three semester two on 9 weeks before commencement of nursing undergraduates promotes higher critical thinking ability.

This paper introduces the development and status quo of disaster prevention training at home and abroad,analyzes the necessity and importance disaster prevention simulation,and summarizes the ways to foster critical thinking and disaster prevention capabilities in disaster prevention training as well as the simulation model of disaster prevention training in lab. It provides scientific guidance for future disaster education and rescue activities so as to ensure the affected people can evacuate safely when disasters occur,thus reducing causalities and the wound and deformity rate.

Objective To analyze the mutation status of K‐ras gene in colorectal cancer patients ,further more ,to provide guid‐ance for personalized therapy for colorectal cancer .Methods Nested and COLD‐PCR were used to detect the K‐ras mutations in 560 patients with colorectal cancer .Results In 560 colorectal cancer patients ,the total positive rate of K‐ras gene mutations was 27 .08% ,the mutation rate was 0 in 128 plasma samples and it was 27 .08% in 432 tissue samples .The mutate sites were G12S , G12C ,G12D ,G12A ,G12V ,G13R ,G13C ,G13D ,Q61K ,Q61L ,there were significant differences existed in different samples (P <0 .000 1) ;the mutation rate of 362 male patients was 20 .44% and the types of mutation include G12S ,G12C ,G12D ,G12V ,G13R , G13C ,G13D ,Q61K and Q61L .The mutation frequency was 21 .72% in 198 female patients ,the mutation points were G12S ,G12C , G12D ,G12A ,G12V ,G13R and G13D .There were no significant difference between different sex (P= 0 .722 7) ;the mutation fre‐quency was 20% in 80 youth patients including G12S ,G12C ,G12D ,G12V ,G13D and the mutation rate was 33 .07% in 127 middle age patients ,the points of mutation were G12S ,G12D ,G12A ,G12V ,G13R ,G13C ,G13D ,Q61K ,Q61L ,the mutation frequency was 16 .71% in 353 old age patients ,the types of mutation include G12C ,G12D ,G12V ,G13R ,G13D ,the difference was significant a‐mong different age patients (P= 0 .000 5) .Conclusion The total rate of mutations is 27 .08% in 560 colorectal cancer patients ,and the main points of mutation is G12D ,G12V ,G13D .There are significant differences in different type of samples as well as in differ‐ent ages ,but no statistical significance in different sex patients .

Objective To build learning evaluation system and indicators connotation of problem-based in small-group teaching model.Methods Delphi technique was used to build learning evaluation system of problem-based for course of nursing education through a two-round expert consultation among 30 experts in Zhejiang province.Results The experts' authority coefficient was 0.89,determination coefficient was 0.90,and familiar confficient was 0.88.The finally learning evaluation system of problem-based for course of nursing education consisted of 3 first-level indicators,14t second-level indicators and 41 third-level indicators.The coordination coefficients of first-level indicators and second-level indicators were 0.37 and 0.31,respectively,there was significant difference,P＜0.01.Conclusion This project has a rigorous and reliable construction process with strong theoretical and practical significance,and could be used as a guidance and reference for problem-based in small-group teaching for course of nursing education.

OBJECTIVETo investigate the clinical and genetics characteristics of patients with monosomal karyotype acute myeloid leukemia (MK-AML).

METHODSThe karyotypes of 3743 patients with newly-diagnosed de novo AML were analyzed, which had identified 153 cases with MK-AML, for whom the clinical and genetics characteristics were analyzed.

RESULTSThere were 2056 patients (54.9%) among all patients. A total of 153 patients fulfilling the criteria for MK-AML were identified, which comprised 93 males and 60 females, with a median age of 54. The median white blood cell count on presentation was 4.4×10 (9)/L. One hundred and forty-five cases (94.8%) have fulfilled the criteria for complex karyotype (≥ 3 chromosomal abnormalities). Although the monosomy could be found with all autosomes, chromosome 7 has been most frequently involved (38.56%, 59/153).

CONCLUSIONMK-AML is a distinct cytogenetic subtype of AML. Monosomy 7 is frequently detected among MK-AML patients. The monosomal karyotype is common among elder patients with AML.

Adult ; Aged ; Chromosomes, Human, Pair 7 ; genetics ; Female ; Humans ; Karyotype ; Leukemia, Myeloid, Acute ; genetics ; Male ; Middle Aged ; Monosomy ; Young Adult

OBJECTIVETo explore the clinical and laboratory features of chronic myeloid leukemia (CML) with atypical e14a3 and e19a2 BCR-ABL fusion gene subtypes.

METHODSWe retrospectively analyzed a cohort of CML patients with Ph chromosome positive confirmed by cytogenetic and FISH but classical e13a3(b2a2), e14a2(b3a2)and e1a2 fusion transcripts negative identified by conventional real-time quantification RT-PCR (RQ-PCR). Further RQ-PCR was done with the forward primer and reverse primer designed to detect rare atypical BCR-ABL fusion genes including e14a3 and e19a2 transcripts. Direct sequencing analysis was performed on the PCR products and mutations in the BCR-ABL kinase domain were detected. The clinical data of patients were retrospectively analyzed.

RESULTSSix CML patients were found to carry t(9;22) abnormality and BCR-ABL rearrangement confirmed by FISH but classical BCR-ABL fusion genes negative detected by RQ-PCR. Further RQ-PCR and sequencing analysis confirmed the fusion of BCR exon 14 and ABL exon 3 in five CML patients (case 1-5) and the fusion of BCR exon 19 and ABL exon 2 in one CML patient (case 6). E255K and I293T IM-resistant mutations were detected in case 1 and 2, respectively. Among five cases with e14a3 transcripts, four were CML-CP, one CML-AP. Four patients were male and one was female. The median age was 48 years. The patient (case 6) with e19a2 transcripts was 40-year-old female with a diagnosis of CML-CP and PLT count was more than 1 000×10⁹/L. Imatinib (IM) therapy was administer in case 1, 2, 3, 4 and hematopoietic stem cell transplantation (HSCT) was undergone in case 5 after hydroxyurea (Hu) or interferon failure. Case 1 who had E255K IM resistant mutation, responded poorly to IM but obtained a complete cytogenetic remission (CCyR) after a substitution of dasatinib for IM. Case 2 and 3 achieved CCyR 6 months later after IM treatment and had been maintained well with IM despite I293T mutation in case 2. Case 4 attained CCyR 3 months later after IM treatment but relapsed and died soon. Case 5 was still in CCyR after HSCT. Case 6 with e19a2 transcripts got complete hematologic response after Hu treatment and CCyR was achieved soon after IM therapy.

CONCLUSIONIncidence of CML with atypical transcripts is extremely low. They could benefit from tyrosine kinase inhibitors or HSCT. Rare and atypical BCR- ABL fusion gene subtypes could be missed by conventional RQ-PCR.

Adult ; Female ; Fusion Proteins, bcr-abl ; genetics ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; classification ; diagnosis ; genetics ; Male ; Middle Aged ; Retrospective Studies

Objective To assess the effectiveness of continuous aspiration of subglottic secretions (CASS)in preventing ventilator-associated pneumonia.Methods The relevant randomized controlled trials were searched in the Cochrane Library,Pubmed,CNKI,VIP and Wanfang databases.The experimental group received CASS and the control group did not(NASS group).Two reviewers selected studies according to the inclusion and exclusion criteria,the quality of studies was critically appraised and data were extracted by two reviewers independently.Meta-analysis was conducted by using RevMan 5.2.Results Sixteen randomized controlled trials met the inclusion criteria and enrolled 2 576 patients.According to the meta analysis,compared with NASS,CASS reduced the incidence of ventilator-associated pneumonia,shortened the length of stay in the intensive care unit and the duration of mechanical ventilation.There was no effect on hospital mortality.Conclusions Continuous aspiration of subglottic secretions appears effective in preventing ventilator-associated pneumonia,decreasing the duration of intensive care unit length of stay and mechanical ventilation among critically ill patients with mechanical ventilation.