Objective To construct an evidence-based practice model for nurses in preventing deep vein thrombosis(DVT)and provide a scientific and targeted theoretical basis for nurses to carry out evidence-based nursing practice in DVT prevention.Methods Based on the previous evidence-based nursing practice project on DVT prevention after hip and knee arthroplasty,the research team used theoretical analysis and brainstorming to develop a draft of the work model.Expert meetings were organized to validate the content of the draft using the Delphi method,leading to the finalization of the evidence-based practice model for nurses in preventing DVT.Results The Knowledge-to-Action(KTA)framework was selected as the basic framework for constructing the evidence-based nursing practice model for preventing DVT.Theoretical Domain Framework,Theory of Planned Behavior,and Social Cognitive Theory were chosen to explore the influencing factors of nurses'behavior change in preventing DVT through evidence-based practice.The authority coefficient of the participating experts was 0.904,indicating high reliability.The final model consisted of 6 key components:knowledge generation,problem identification,localization and adaptation,knowledge application,sustained knowledge use,and conceptual framework for behavior change through evidence-based practice.Conclusion Based on theoretical analysis and clinical practice,this study developed an evidence-based practice model for nurses in preventing DVT using the expert meeting.The research methodology was scientific,and the content was reliable,providing a theoretical basis for nurses to engage in evidence-based nursing practice for DVT prevention.

Objective:To investigate the prevalence of mild cognitive impairment(MCI)in elderly inpatients in high altitude areas, analyze the influencing factors, and then construct a risk factor model.Methods:A cross-sectional random sampling method was used to conduct a questionnaire survey among elderly patients over 65 years old hospitalized at Qinghai Provincial People's Hospital from October 2018 to February 2019.The survey contents included demographic data, lifestyles, physical activities and cognitive function.The occurrence of MCI was analyzed with descriptive epidemiological measures, a predictive model of influencing factors was established using Logistic regression analysis, and influencing factors were ranked.Results:There were a total of 1412 elderly people aged 65 and above, with 760 males, accounting for 53.8%.The ages of respondents ranged between 65-82 years, with an average age of(72.8±5.8)years.Of the subjects, 600 had MCI, with a prevalence of 42.4%.Male( OR=1.318, P=0.02), junior high school education or above( OR=0.521, P<0.001), bedriddenness( OR=2.658, P=0.002), lifestyle( OR=0.702, P=0.011), abnormal defecation( OR=1.625, P=0.005)and frailty( OR=1.536, P=0.002)were included into the predictive model of influencing factors.The area under the ROC curve in this study was 0.676(95% CI: 0.648-0.704), with sensitivity=0.553, specificity=0.741, and Youden index=0.274.When ordered by importance, the independent risk factors were frailty, male, abnormal defecation, bedriddenness, lifestyle, and education level. Conclusions:Male, frailty, abnormal defecation and long-term bedriddenness are risk factors for cognitive impairment in elderly people, whereas living with a partner and education above junior high school are protective factors.

Objective:To investigate the neural mechanism of long-term exposure to high altitudes environment on the processing stage of perceptual closure.Methods:A cross-sectional study was conducted. Thirty college students who first entered the plateau area (at an altitude of 3 658 m) and had lived in high-altitude areas for two years were selected as high altitude group (HA group), and 29 college students matched in age, gender and education level who had never been to the plateau area were selected as sea level group (SL group). The differences of basic physiological parameters were compared between the two groups.The face pairwise comparison paradigm was applied in the subjects of the two groups and the differences between the two groups were compared by event-related potentials (ERPs) technology. SPSS 22.0 software was used for statistical analysis, and the mean ± standard deviation was used for statistical description. Independent sample t test was used for comparison of physiological data between the two groups, and repeated measurement variance analysis was used for ERP data. Results:The physiological results revealed that the HA group had a higher pulse rate((86.71±10.82)/min, (75.97±11.28)/min ; t=-3.19, P=0.002) and diastolic blood pressure than the SL group ((75.93±9.19)mmHg, ( 68.59±11.42) mmHg ; t=-3.20, P=0.002). The oxygen saturation level was significantly lower than that of SL group ((90.77±2.25)%, (98.31±1.56) %) ; t=14.00, P<0.001). In the face pairwise comparison paradigm test, the main effect of P1 latency of ERP was significant.Compared with SL group, HA group showed significantly shortened latency of P1 ((105.10±15.59) ms, (128.35±14.40)ms, P<0.001). The main effect of group of N170 amplitude was significant, HA group was larger than that of SL group((-7.57±3.83) μV, ( -5.11±3.26) μV, P=0.005). The interaction effect between group and hemisphere of NCL amplitude was significant ( F(1, 57)=9.72, P=0.003). Simple effect test showed that the amplitude on the right hemisphere of SL group was significantly larger than that on the left hemisphere((0.46±1.31) μV), (1.16±1.33) μV ). The latency of P1 was significantly correlated with heart rate( r=-0.46, P<0.01), oxygen saturation level( r=0.64, P<0.01) and diastolic blood pressure( r=-0.26, P=0.049). Conclusion:After long-term exposure to high altitude, the neural response related to early visual perception is faster. More psychological resources are recruited during the face structural encoding stage. Contra-lateral compensating effect appeares in the stage of perceptual closure.

Objective:To summarize the experience of diagnosing and treating de novo gastric cancer after liver transplantation(LT).Methods:The clinical data were analyzed for 3 LT patients with de novo gastric cancer during follow-ups.Results:The mean diagnostic age was 57(47~67)years, mean time interval between LT and diagnosis of de novo gastric cancer 82(40~122)months and mean follow-up time 23(4~42)months. After surgical resections, 2 survived and another died of recurrence.Conclusions:LT recipients are recommended for regular screening of de novo malignancies. Regular endoscopic screening of gastric tumors contributes to early detection, diagnosis and treatment. It may improve long-term survival outcomes in LT recipients.

Objective:To investigate the effect of epidermal growth factor receptor tyrosine kinase inhibitor on the radiosensitivity of human non-small cell lung cancer cells and its possible mechanism.Methods:Human non-small cell lung cancer cells H1299 were cultured in vitro. CCK-8 was used to detect the toxic effects of erlotinib on H1299 cells, IC 50 and IC 20 were calculated, and IC 20 was utilized as the drug concentration for subsequent experiments. The colony formation assay was performed to identifiy the effect of X-ray combined with erlotinib on H1299 cells, the radiosensitivity parameters were calculated, and the cell survival curves were delineated. Flow cytometry was conducted to detect the cell cycle distribution and apoptosis. Western blot analysis was used to detect the expression of EGFR/PI3K/AKT pathway and apoptosis-related proteins. Results:Erlotinib exerted inhibitory effect upon the proliferation of H1299 cells, IC 50 was calculated as 27.3 μmol/L, and 3.3 μmol/L for IC 20. X-ray combined with IC 20 concentration of erlotinib could reduce the cloning ability of H1299, increased the proportion of G 0/G 1 phase and G 2/M phase, decreased the proportion of S phase, aggravated cell apoptosis, down-regulated the expression of pEGFR and pAKT proteins, and up-regulated the expression of apoptosis-related proteins including Active Caspase 3 and Cleaved PARP. Conclusions:Erlotinib exerts a radiosensitizing effect on H1299. The possible mechanism is that erlotinib combined with radiation can suppress the EGFR/PI3K/AKT pathway, reduce the ability of repairing cell damage, change cell growth cycle and induce cell apoptosis.

Venous thromboembolism (VTE) is one of common complications in hospitalized patients. Hospitalized patient tend to have high risk factors to develop VTE. As an important part of VTE prevention and treatment, it is of great significance for nurses to accurately identify risk factors, to conduct risk assessment of VTE in a timely manner, and to take appropriate preventive measures.

Human epidermal growth factor receptor (HER)-2-positive breast cancer is a type of highly invasive breast cancer with a high recurrence rate. Although the single-targeted treatment for HER-2 prolongs survival, patients still develop recurrence and metas-tasis. The mechanisms of dual-targeted therapies are non-overlapping and have synergistic effects, which further improves the survival of patients. Based on trastuzumab, this article reviews the current status and progression indual-targeted therapeutic regimens con-taining anti-HER-2.

Objective To explore the effects of the action research method on improving the accuracy of Caprini venous thromboembolism risk scale used by nurses to evaluate the risk of venous thrombosis in traumatic orthopedic patients. Methods Traumatic orthopedic nurses were trained by raising questions, detailing the use of the scale, taking action, observing, and then designing, implementing, observing and reflecting once again based on the action research method between September 2017 and April 2018. The difficulty in using and evaluating the scale was analyzed to propose an impeccable approach to scale evaluation. The accuracy of the scale used by nurses were compared before and after intervention. Results A total 205 patients were evaluated in the study. Consistent results by duty nurses and the research group were found in 170 patients, accounting for 82.93%; and the consistency rate of evaluation by duty nurses and the research group in newly admitted patients reached 100.00%. Conclusions The action research method, when used by traumatic orthopedic nurses to evaluate the risk of venous thrombosis in patients can improve the timeliness and accuracy of evaluation, hence ensuring the safety of traumatic patients.

AIM: To investigate the effects of sodium hydrosulfide ( NaHS ) , a donor of hydrogen sulfide ( H2 S) , on the membrane permeability , intracellular Ca 2+concentration ( [ Ca2+] i ) and the release of IL-1βinduced by a-denosine triphosphate (ATP) in rat microglia, and to explore the effect of H2S on ATP-P2X purinergic signaling pathway and the molecular mechanism of its neuroprotective effect .METHODS: Rat microglia in logarithmic growth phase were used in the study.The [Ca2+]i was detected by Fura-2/AM staining.Fluorescent dye YO-PRO-1 was used to observe the membrane permeability.Interleukin-1β(IL-1β) was measured by rat IL-1βELISA kits.RESULTS:The YO-PRO-1 flu-orescence intensity was obviously elevated by ATP induction in a dose -dependent manner in the rat microglia , but this effect was counteracted by NaHS pretreatment (P<0.05).[Ca2+]i rapidly increased and then decreased slowly , forming a sta-ble platform for a long time when rat microglia were treated with ATP .Ca2+spike activity induced by ATP had no change , but the platform disappeared (P<0.05) after NaHS pretreatment.The ATP and LPS together facilitated the release of IL-1β, but the phenomenon was inhibited by NaHS (P<0.05).CONCLUSION:Hydrogen sulfide may decrease the mem-brane permeability , calcium inflow and IL-1βrelease in rat microglia activated by high dose of ATP .The cytoprotection of hydrogen sulfide may be mediated by purinergic signaling pathway .

Objective To discuss the safety and advantages of prone-straddle position applied in transvaginal hysteromyomectomy of the posterior wall of the uterus. Methods The clinical data of patients who were admitted into our hospital from March 2013 to Janaury 2015 and received transvaginal hysteromyomectomy were retrospectively analyzed. They were divided into group A ( prone-straddle position, 30 cases) and group B (traditional lithotomy position,24 cases). The exposure of operative field, convenience of operation, time of the placement, time of operation, patient satisfaction, as well as patients’ heart rate, blood pressure, and oxyhemoglobin saturation were observed and ana-lyzed. Results Compared with the lithotomy position, there were significant differences in the time of the placement and the time of opera-tion in the patients treated by prone-straddle position. The patients with prone-straddle position cooperated well, and there was no obvious discomfort. Their vital signs were stable during the operation. The operative field during prone-straddle position exposed better and it was more convenient which make the operation became easier for both the operators and nurses. Conclusion Prone-straddle position applied in transvaginal hysteromyomectomy of the posterior wall of the uterus is safe and practicable, and it is valuable for clinical application.