Objective:To explore the relationship between the expression of angiopoietin 1 (ANGPT1) and Smadhomolog 9 (Smad9) genes in cancer tissues and tumor metastasis, invasion behavior and prognosis in patients with lung adenocarcinoma.Methods:Sixty patients with lung adenocarcinoma in Chengwu Hospital Affiliated to Shandong First Medical University from October 2018 to December 2019 were selected as the research objects. The expressions of ANGPT1 and Smad9 mRNA in cancer tissues and adjacent tissues were compared, as well as the expressions of ANGPT1 and Smad9 mRNA in cancer tissues of patients with different tumor metastasis and invasion behaviors. The relationship between ANGPT1 and Smad9 mRNA expression and tumor metastasis and invasion behavior of lung adenocarcinoma were analyzed, and the 1-year survival rate of patients with lung adenocarcinoma was calculated. The 1-year survival rate of patients with different ANGPT1 and SMAD9 mRNA expression levels were compared.Results:The relative expression of ANGPT1 mRNA and Smad9 mRNA in cancer tissues were lower than those in adjacent tissues: 2.45 ± 0.26 vs. 11.18 ± 0.93, 4.23 ± 0.31 vs. 7.58 ± 0.65, the differences were statistically significant ( P<0.05). There were significant differences in the relative gene expression of ANGPT1 and Smad9 mRNA in different clinical stages, tumor diameter, degree of differentiation, lymph node metastasis and pleural invasion ( P<0.05). Spearman correlation analysis showed that the expression of ANGPT1 and Smad9 mRNA were negatively correlated with clinical stage, tumor diameter, lymph node metastasis and pleural invasion ( r = - 0.517, - 0.539, - 0.606, - 0.679, P<0.05), and positively correlated with the degree of differentiation ( r = 0.628, P<0.05). The 1-year survival rate of 58 patients was 72.41%. Kaplan-Meier curve analysis showed that the 1-year survival rate of patients with low expression of ANGPT1 and Smad9 mRNA in cancer tissues were were lower than those in patients with high expression ( P<0.05). Conclusions:Down-regulation of ANGPT1 and Smad9 genes in cancer tissues will accelerate the metastasis and invasion behavior of lung adenocarcinoma. Up-regulating the expression of both genes can be a potential way to improve survival.

Objective: To investigate the expression of eukaryotic translation initiation factor 2B1(eIF2B1) in HCC and its correlation with clinical prognosis. Methods: Through the follow⁃up of the clinical data of 743 hepatocellular carcinoma patients in the specimen bank ,91 HBV⁃related liver cancer patients with complete follow⁃up information were screened out , and their postoperative tumor tissues were selected. Meanwhile , the adjacent tumor tissues with a distance of more than 2 cm from the tumor margin were collected to make tissue chips. Western blot and immunohistochemical experiments were performed. Image J was used to analyze the proportion of positive cells stained by tissue chip and the gray value of Western blot results. Clinical data and follow⁃up data of included patients were statistically analyzed by R4. 0. 5 software. Results: Immunohistochemical results suggested that eIF2B1 was more strongly expressed in HCC than in para⁃cancerous tissues. Western blot results showed that eIF2B1 was more strongly expressed in HepG2. 2. 15 cells than in HepG2 cells. The expression of eIF2B1 in HCC tissues was correlated with tumor number (P < 0. 05) . Cox multivariate regression analysis showed that the expression of eIF2B1 was an independent risk factor for the overall clinical prognosis of HBV⁃DNA positive patients (HR = 4. 28 ,P = 0. 018) . Conclusion The expression of eIF2B1 is significantly enhanced in HBV⁃associated HCC tissues and is significantly associated with overall survival in HBV DNA positive patients.

Objective: To test the reliability and validity of the Chinese version of the Handoff Clinical Examination Exercise (Handoff CEX). Methods: The Chinese version of the Handoff CEX was composed of two parts, one to assess the nurse providing the handoff and another to assess the nurse receiving the handoff. A total of 80 handoffs was evaluated to test the reliability and validity of the Chinese version of the Handoff CEX. Results: A total of 320 evaluations of handoff was obtained. The Cronbach α coefficient was 0.85 for the handoff provider, and that was 0.80 for the handoff recipient. Weighted kappa scores for provider evaluations ranged from 0.31-0.52, and that for recipient evaluations ranged from 0.35-0.55. The correlation coefficients between each factor ranged from 0.23 to 0.62, and that between each factor and the total scale ranged from 0.33 to 0.64 (P<0.05). Experienced nurses (>5 years) received significantly higher mean scores than inexperienced nurses(≤5 years) in all domains except organizational efficiency and professionalism(P<0.05). Conclusion The Chinese version of the Handoff CEX is a reliable and valid tool to assess the nursing handoff, which is useful for educators, supervisors and clinical nurses to provide training, ongoing assessment and feedback to improve the quality of handoff.

Objective:To explore the effects of contingency theory-based health education in patients with diabetes mellitus.Methods:Totally 112 diabetic patients admitted into Affiliated Hospital of Shaoxing University from January 2017 to December 2018 were selected by convenient sampling and randomized divided into the control group and the intervention group, with 56 patients in each group. Patients in the control group received routine care, while patients in the observation group received contingency theory-based health education. The health knowledge level, self-care ability, self-efficacy and quality of life of the two groups before and after intervention were compared.Results:The health knowledge level of the intervention group after intervention was higher than that of the control group [ (17.15±2.28) vs. (13.20±2.94) ], and the difference was statistically significant ( P<0.01) . The scores of self-care ability, self-efficacy and quality of life of the intervention group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The contingency theory-based health education can improve the disease knowledge, self-care ability, self-efficacy and quality of life of diabetic patients, which is worth promoting in clinical practice.

Objective: To identify the impeding and promoting factors of role definition in nursing handoff, in order to increase the quality of nursing handoff. Methods: Two nursing managers, 22 head nurses and four nurses were recruited by purpose sampling. Data were collected by using focus group study, and analyzed using content analysis. Results: According to the framework of role transition theory, the factors could be classified as individual factors (37 items, 23.72%), organizational factors (105 items, 67.31%), effectiveness of role definition (11 items, 7.05%), and problems of role definition (3 items, 1.92%). Conclusions Role definition in nursing handoff helping the coming nurse check the performance of the last shift and transfer the nursing responsibility, contributes to the improvement of nursing quality, but there are still many factors affecting the role definition in nursing handoff.

Objective To observe the effects of Huoxue Chubi Decoction on contents of PDGF-A and TGF-βin skin lesion of scleroderma mimicking mice models;To discuss its possible mechanism. Methods Thirty mice were randomly assigned into blank group, model group, TCM high-, medium-, low-dose group, with six mice in each group. Other than blank group, the rest of the 4 groups were given bleomycin-hydrocholoride 0.1 mL intradermal injection daily for 3 weeks to establish scleroderma mice models. From week 4 to 7, blank group and model group received gavage with equal amount of distilled water daily;TCM high-, medium-, low dosage group received gavage with Huoxue Chubi Decoction with different concentrations of 44.8, 22.4, 11.2 g/kg daily. The pathological changes in the skin tissue samples taken from each group were observed under microscope;the thickness of skin from each group was measured and the expression of PDGF-A, TGF-β, type-Ⅰ collagen (COL-Ⅰ) and type-Ⅲ collagen (COL-Ⅲ) were tested through immunohistochemical staining. Results Compare with blank group, the dermis tissue of model group was thicker, with the presence of thicker and greater number of collagen fibers, as well as infiltration of inflammatory cells. Compare with model group, thickness of skin and dermis collagen growth of TCM high-, medium-, low-dose group were milder varied by the concentration of the decoction. The result of immunohistochemical staining showed that the expressions of PDGF-A, TGF-β, COL-Ⅰ and COL-Ⅲ of modelgroup significantly increased than blank group (P<0.01); the expression of the mentioned indicators were statistically significant lower in the TCM high-, medium-, low-dose group than model group; The expressions of PDGF-A and TGF-β showed a positive correlation with the amount of COL-Ⅰ and COL-Ⅲpresented in each group. Conclusion Huoxue Chubi Decoction can suppress collagen expression and fibroblast formation in skin lesion of scleroderma mice models by down regulating the expressions of TGF-β and PDGF-A, thus demonstrate its potential in scleroderma treatment.

Objective:To evaluate the rationality of medical order in oncology department of our hospital and analyze the intervention effect of clinical pharmacist.Methods:Totally 180 medical orders in oncology department of our hospital from January to June in 2013 were selected as the pre-intervention group,and those with the same number from January to June in 2014 were selected as the post-intervention group.The rationality of medical orders including drug selection,administration routes,usage and dosage was investigated and compared between the groups. Results:The unreasonable rate was 41.11% before the intervention and 8.33% after the intervention with statistically significant difference(P<0.05).The irrational drug use included inappropriate indications,usage and dosage,improper drug replacement and combination,and inappropriate adjuvant drug use.Conclusion:Irrational drug use in oncology department can be significantly reduced and the level of rational drug use can be improved through the intervention of clinical pharmacist.

Objective To develop a hospice care attitude scale for medical workers and to test its reliability and validity. Methods The inital scale was formed by literature review, semi-structured interview and expert consultation. From September to December 2015, a total of 238 medical workers, from different departments from hospitals of different levels in Quanzhou, were selected hierarchically and randomly, and were investigated about their attitude towards hospice care, by which, reliability and validity of the scale were tested, and the final scale was formed. Results In the final scale of hospice care attitude for medi-cal workers, 7 dimensions with 26 items were included. By exploratory factor analysis, 7 common factors were extracted, with cumulative contribution of variance 62.238% . Content validity of the scale was 0.889, with Cronbach's alpha 0.891, split-half reliability 0.863 and test-retest Pearson correlation coefficient 0.867. Conclusions The hospice care attitude scale for medical workers has been proved to be reliable and valid, which can be used to assess hospice care attitude of the medical workers.

Jean Watson's caring science/caritas nursing model is the first of its kind which integrates "caring" and "science". He proposes to make caring decisions in a scientific way based on ten caring and nursing elements, and develops the caring science with reliable quantitative and qualitative research evidence. He also founds the Institute of caring science research, the International Union of Fraternity and the International Fraternity Comparison Database, which play a positive role in popularizing his evidence. It is an obvious example of Dr. Watson's emphasis on evidence to develop the International Energy Field Project for Nurses and promote the application and practice of his evidence-based caring science model with the research evidence from other disciplines.

Objective To analyze the variation tendency of correlative test indexes in the patients with type 2 diabetic mellitus (T2DM) and diabetic nephropathy (DN) .Methods The urinary microalbumin (M‐Alb) ,blood glucose and renal function were de‐termined in 167 cases of T2DM .Then the cases were divided into the simple DM group ,early DN group and clinical DN group ac‐cording to the excretion rates of urinary M‐Alb .The determined results were compared among 3 group and analyzed .Results The age in the simple DM group was smaller than that in the early DN group and clinical DN group (P<0 .05) .The positive rates of u‐rinary M‐Alb and urinary protein were highest in the clinical DN group ,the differences among 3 groups had statistical significance (P<0 .05) .The difference of blood glucose indexes had no statistical difference between the simple DM group and early DN group , the clinical DN group was apparently higher than that in the simple DM group and early DN group (P<0 .05) .The levels of urea (Urea) and creatinine(Cr) in the simple DM group were significantly lower than those in the early DN group and clinical DN group ,the differences among 3 groups had statistical significance (P<0 .01) .Conclusion The severe the DN ,the higher the urina‐ry M‐Alb ,blood glucose and renal function indicators ,the higher the positive rates of urinary protein and urinary glucose ,the more significant the tendency of renal function damage .