Objective To develop a self-assessment scale for medication literacy in patients with coronary heart disease comorbidity diabetes and to test its reliability and validity.Methods According to medication literacy theory model,the initial scale was formed through literature review,the qualitative interview and expert inquiry.Cognitive interview was used to optimize the expression of item text.421 patients with coronary heart disease comorbidity diabetes in a tertiary hospital in Zhejiang province from November 2022 to April 2023 were selected to investigate the reliability and validity of the scale by convenience sampling.Results The self-assessment scale of drug literacy for coronary heart disease comorbidity diabetes mellitus included 23 items in 5 dimensions including acquisition,understanding,communication,evaluation and calculation.The total Cronbach's α coefficient of the scale was 0.911;the retest reliability was 0.948;the average content validity index was 0.997;the correlation coefficients between each dimension and total score of the scale and the calibration scale ranged from 0.485 to 0.926.The exploratory factor analysis was employed to extract 5 common factors,and the cumulative variance contribution rate was 73.753％.Confirmatory factor analysis showed that the scale factor structure was stable.Conclusion The scale has good reliability and validity,and it can be used as an effective tool to evaluate the self-rated medication literacy level of patients with coronary heart disease comorbidity diabetes.

Objective:Utilizing multi-criterion optimization (MCO) technology to improve plan design quality based on knowledge-based planning (KBP) model.Methods:Fifty-five patients with nasopharyngeal carcinoma (NPC) who had completed radiotherapy were selected, and fixed-field intensity-modulated radiotherapy (IMRT) technology was used in each case. Among them, 40 cases were randomly selected as training set 1. Then, IMRT plans in training set 1 were preprocessed by MCO technology to construct a new training set 2. With the initial training set 1 and the processed training set 2 as training samples, the traditional KBP model and the MCO-KBP model refined by MCO technology were trained, respectively. Among the remaining 15 cases, 5 cases were randomly selected as the validation set, and the remaining 10 cases were used as the test set. After verification, the test set was used to statistically analyze the plan quality of the initial manual plan and the automatic plan generated by the traditional KBP model and the MCO-KBP model.Results:The target dose (D 95%) of plans generated by the traditional KBP model and the MCO-KBP model met the clinical requirements. Conformity index (CI) and homogeneity index (HI) were almost the same ( P>0.05), and the doses of organ at risk (OAR) of the automatic plans generated by the MCO-KBP model were lower than those of the traditional KBP model. For example, compared with the traditional KBP model, the average D max of the brainstem in the automatic plans generated by the MCO-KBP model was lower by 2.13 Gy, the average D mean of the left parotid gland was lower by 1.39 Gy, the average D mean of the right parotid gland was lower by 1.59 Gy, and the average D max of the left optic nerve was lower by 1.42 Gy, the average D max of the right optic nerve was lower by 1.16 Gy, and the average D max of the pituitary gland was lower by 1.88 Gy. All of the above-mentioned dosimetry indexes were statistically significant. Conclusion:Compared with the traditional KBP model, the IMRT plans designed by the refined MCO-KBP model have obvious advantages in the protection of OAR, which proves the feasibility of utilizing MCO technology to improve the plan design quality of the KBP model.

Objective:To investigate nursing students' attitudes toward death and hospice care before they start clinical practice, analyze the correlation between the two attitudes and compare their differences in junior and regular nursing college students.Methods:A cross-sectional study was adopted to investigate the attitudes toward death and hospice care in 232 senior nursing students at school. Instruments included the Chinese version of the Death Attitude Profile-Revised (DAP-R) and the Chinese version of the Frommelt Attitude Toward Care of the Dying Scale-Form B (FATCOD-B). Pearson correlation analysis and independent t-test were used to analyze the data.Results:The mean scores of the 5 dimensions of death attitude were neutral acceptance (4.10±0.43), fear of death (2.76±0.66), death avoidance (2.73±0.74), approach acceptance (2.61±0.58), and escape acceptance (2.48±0.75), respectively. The total score of hospice care attitude was (107.63±8.45), which was negatively correlated with fear of death ( r=-0.247, P<0.01), death avoidance ( r=-0.278, P<0.01), and escape acceptance ( r=-0.145, P<0.05) scores and positively correlated with neutral acceptance score ( r=0.405, P<0.01). The death avoidance score of regular nursing college students was significantly lower than that of junior nursing college students ( t=-2.043, P<0.05), and the hospice care attitude score of regular nursing college students was significantly higher that of junior nursing college students ( t=2.639, P<0.01). Conclusion:There is a big room to improve nursing students' attitudes toward death and hospice care. Strengthening end-of-life care education is imperative.

Objective: To investigate the current status and influencing factors of geriatric nursing competence of clinical nurses from grade A tertiary hospitals in Guangdong Province, and provide basic materials and evidence-based reference for the set of suitable allocation of geriatric nursing competence training plan. Methods: By convenience sampling, a total of 2 067 clinical nurses from 40 grade A tertiary hospitals in 16 prefecture-level cities in Guangdong Province were investigated with general information questionnaire and self-made geriatric nursing competence scale for clinical nurses. Results: The item average score was 2.30±0.71. Among three domains, professional literacy scored the highest, followed by professional practice and professional development. Among ten sub-domains, the top three scored were law and ethic, critical thinking and safe management while the bottom three were coaching and mentoring, professional learning, research and innovation. Multiple linear regression showed that the influencing factors of geriatric nursing competence were nursing age (B=0.011, 95%CI 0.006-0.015, P<0.01), professional title (B=0.031, 95%CI 0.002-0.066, P<0.05), interest in aged care (B=0.214, 95%CI0.179-0.250, P<0.01) and experience regarding geriatric specialized or professional nurses qualification training(B=0.250, 95%CI 0.152-0.349, P<0.01). Conclusions The geriatric nursing competence of clinical nurses from grade A tertiary hospital in Guangdong Province is in the middle level. Interventions to improve the professional development competence of clinical nurses is thus much needed. Hospital managers should establish the talent team according to geriatric nursing competence of clinical nurses, and take related training.

This study aimed to investigate the effects of fusion proteins GnRH-GRP(G3G6)and HSP65-STEAP1(HST1)on dendritic cells(DC)and the sensitization of DCs to B16F10 melanoma. The fusion proteins G3G6 and HST1 were obtained using the previous engineering strains in our laboratory. Group by unsensitized DC(US-DC), the G3G6 fusion protein sensitized DC, the HST1 fusion protein sensitized DC(HST1-DC)and the combined sensitized DC(GH-DC), the mouse bone marrow-derived DCs were sensitized with fusion protein to obtain the fusion protein sensitized DC vaccines. B16F10 melanoma cells were transplanted into C57BL/6J male mice to construct a melanoma model(1×106 cells per mouse), and DC vaccine was injected for treatment. The antitumor efficacy of DC vaccine was explored by in vitro and in vivo experiments. Flow cytometry analysis showed that the fusion protein can effectively stimulate DC into differentiation and maturation; in the animal experiment, the inhibition rate of melanoma treated with G3G6-DC was 35. 75%, that of HST1-DC group and combination group were 34. 03% and 55. 74%. It was initially proved that both G3G6-DC and HST1-DC can effectively inhibit the growth of transplanted tumors of melanoma B16F10 cells in mice, and the combination therapy is superior to the single therapy.

Objective To analyze the clinical characteristics and screen pathogens and prognosis of anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis in children and so as to improve the diagnosis and treatment of anti-NMDAR encephalitis in children.Methods A retrospective and follow-up analysis of 38 cases of pediatric anti-NMDAR encephalitis was performed,who were admitted to the West China Second University Hospital,Sichuan University from May 2012 to June 2016,and their clinical features,associated pathogen screening,treatment and progno-sis were reviewed.Results Those 38 cases included 14 males and 24 females.The age ranged from 1 year and 10 months to 17 years and 6 months.The most common symptoms were psychiatric symptoms(33 cases),and dyskinesias and movement disorders(33 cases),speech disturbances(31 cases).Twenty-four cases(63.2%)received positive pathogenic screening and only one case had right ovarian mature cystic teratoma.Among them,11 cases had positive mycoplasma pneumonia immunoglobulin M(IgM)antibodies,10 cases had positive virus screening,and 1 case had toxoplasma gondii IgM antibodies positive,and 2 cases had mix infection.Symptoms of one case were relieved after anti-toxoplasma treatment without immunosuppression treatment,and another case had partial symptom relief after mycoplas-ma pneumonia treatment.Thirty-seven cases received immunosuppressant therapy(4 cases were treated with glucocor-ticoid,12 cases were treated with glucocorticoid combined with immune globulin,2 cases were treated with glucocorti-coid combined with plasma exchange,still 19 cases were treated with glucocorticoid combined with immune globulin and plasma exchange).After follow-up for median 12 months,3 cases relapsed,29 cases were fully recovered,5 cases had mild language impairment,2 cases had mild memory impairment,and 2 cases had involuntary movement.Conclusions The most common symptoms of the patients were psychiatric symptoms,dyskinesias and movement disorders,and speech disturbances.Children with anti-NMDAR encephalitis had a low incidence of tumors,while various pathogen infections including mycoplasma pneumonia,virus and toxoplasma gondii,which may trigger abnormal immune response of anti-NMDAR encephalitis.Pathogen screening needs to be done for pediatric anti-NMDAR encephalitis and anti-patho-genic treatment may be helpful for disease remission.

Objective To detect the plasma concentration of fluorouracil in patients with advanced colorectal cancer who uesd fluorouracil , and to explore the relationship between chemotherapy efficacy , tumor response, toxicity and survival of patients with advanced colorectal cancer after chemotherapy with fluorouracil.Methods 174 patients with advanced colorectal cancer were collected from the General Hospital of Ningxia Medical University from January 2014 to December 2016.Patients with advanced colorectal cancer were treated with FOLFOX scheme , venous blood was taken from patients 18-24 hours after intravenous infusion of fluorouracil .The concentration of 5-FU in blood was measured by nami-enhanced immune assay.The targeted AUC range of 5-FU was 20-30 mg· h/L.The patients were divied into three groups-targeted range group , lower than the targeted range group and higher than the targeted range group . The therapeutic efficacy, toxicity and survival of patients were recorded , in order to observe the difference of different target range groups.To analyze the correlation between the different target groups and the clinical characteristics,a logistic method was used.Chi-square test was used to compare the efficacy and toxicity of the three groups.The survival curves were plotted by kaplan-meier method. Results To detected the concentration of fluorouracil at the same time after infusion of fluorouracil .The AUC was 2.267-31.06 mg· h/L,it was very different, the median AUC was 15.368 mg· h/L, and the highest AUC was 31.06 mg· h/L,it was 13.7 times that of the lowest blood concentration (2.267 mg· h/L) .The relationship between the concentration of fluorouracil and the clinical indicators was found as follows :(1)Clinical characteristics : the blood concentration of 5-Fu after infusion was different , which was related to the preoperative CEA status (r＝0.318,P＜0.05), EGFR(r＝0.558,P＜0.05), Lymph node metastasis status(r＝0.325,P＜0.05), and the number of metastatic organs ( r＝0.404, P＜0.05 ) .( 2 ) Effect of chemotherapy : There were significant differences in the effect of chemotherapy between different target groups (χ2＝6.78,P＜0.05). The effect of chemotherapy in the targeted range group was lower than that in the target range group , and the difference has statistically significant(χ2＝2.030,P＜0.05).(3)toxicity: there have statistical difference among the three groups,the toxicity of higher targeted range group was higher than the other two groups (χ2＝2.01,P＜0.05).(4)Survival: The survival time of patients with targeted range group was lower than that of targeted range group, and the difference has statistically significant (χ2＝7.263,P＜0.05).Conclusion The method of testing the concentration of fluorouracil in patients with advanced colorectal cancer is valuable to predict the efficacy , toxicity and prognosis of patients with colorectal cancer.

Objective To investigate the application of combined detection of serum calcitonin(PCT),interleukin-6 (IL-6)and C reactive protein(CRP)in early diagnosis of sepsis in intensive care unit(ICU).Methods ICU ward diagnosed 89 cases of patients with early sepsis(sepsis group),fever and did not peak use of antibiotics,send blood to blood culture and detection of PCT,IL-6,CRP level,and at the same time to select 132 cases of healthy subjects(healthy control group),blood samples were collected to detect PCT,IL-6,CRP;PCT,IL-6 for the detection of electrochemical luminescence method.The detection of CRP by immunoturbidimetric method.Results ICU patients with sepsis in PCT,IL-6,CRP detection value is significantly higher than the control group,and the difference was statistically significant(P＜0.01);combined detection sensitivity and specificity was significantly higher than that of single detection,PCT+ IL-6,PCT+ CRP,PCT+ IL-6-+-CRP sensitivity of three kinds of combined detection were 91.3 ％,90.5％ and 91.9％,the specificity was 89.5％,88.3％ and 89.4％,and accuracy were 85.5％,85.3％ and 85.6％.Conclusion Combined detection of PCT+ IL-6 + CRP or PCT+ IL-6 or PCT+CRP,is helpful to the clinical recognition of early sepsis.

Objective To explore the demands of schizophrenics and their primary caregivers for knowledge of mental health during rehabilitation period,so as to provide some references for improving their mental health knowledge.Methods Using the convenience sampling method,49 schizophrenics and 59 primary caregivers completed the general information questionnaire and needs for knowledge of mental health questionnaire.Results The total score of demands for knowledge of mental health of schizophrenics was (55.83±19.29),while the total score of caregivers was (64.88±19.83)(t=-2.376,P=0.019). Conclusions Demands for mental health knowledge of schizophrenics and their primary caregivers are different. Implementation of health education programs should be targeted and individualized.

Objective To explore the effects of stress and self-efficacy on the quality of life in patients with gallstones and the effect relationship of self-efficacy in the quality of life and stress, and provide guidance for the health intervention of patients with gallstones. Methods Totally 362 patients with gallstones after operative that already returned to the community for 12 months were investigated, and their stress condition, self-efficacy and quality status of life were measured by the life events scale ( LES ) , self-efficacy scale and gastrointestinal quality of life index (GIQLI). The effect relationship of self-efficacy in the quality of life and stress was analyzed.Results The self-efficacy played partial mediating effect between stress and quality of life. When the intermediary variables-self-efficacy sense was participated in, the regression coefficient between stress and quality of life was significantly reduced (β was reduced from -0. 695 to -0. 548 ) . Self efficacy played regulating effect between stress and quality of life, which means that self efficacy sense × stress partial regression coefficient in the regression which regard the quality of life as the dependent variable can reach to a significant level (β=-0.086, P<0.05) , and introduced interaction terms after new interpretation (△R2 ) also can reach to a significant level (△R2 = 0. 017, P<0. 05 ) . Conclusions Self efficacy played the mediating effect and regulating effect in the relationship between stress and quality of life. Nursing staff can reduce the negative effects of stress events in patients′quality of life through the interventions in patients′self-efficacy.