Objective To evaluate the effect of midwives′antenatal clinic service on management of gestational weight and birth outcomes .Methods Totally 420 primiparas who had made registration and regular antenatal examination in a hospital ,were randomly divided into two groups .The women in the control group(n=208) received routine antenatal clinicservice .In addition ,the women in the experimental group(n=212) participated in an individual midwives′antenatal clinic .The primiparas′gestational weight gain and birth outcomes were measured and compared between the two groups .Results The rate of natural birth in the experimen‐tal group was higher than that of the control group .The rate of fetal macrosomia ,episiotomy and labor analgesia were lower than that of the control group(P<0 .01) .The rate of naturalbirth ,fetal macrosomia ,episiotomy ,labor analgesia were significantly lower than that of the control group(P<0 .01) .The neonatal weight[(3 250 .58 ± 270 .03)g vs .(3 405 .42 ± 403 .28)g] and volume of bleeding[(199 .13 ± 64 .37)mL vs .(249 .53 ± 93 .56)mL] 2 hours postpartum in the experimental group were significantly lower than that of the control group(t=28 .610 ,P<0 .01 ;t=20 .581 ,P<0 .01) .There were no significant differences in the rate of gesta‐tional diabetes mellitus ,pregnancy‐induced hypertension and fetal distress in uterusbetween the two groups (P>0 .05) .Conclusion The midwives′antenatal clinic service has good effects on management ofgestational weight gain ,improves birth outcomes and pro‐vides primiparas positive experience of childbirth .

Objective To clarify the effects of exercise- and food intake restriction-induced weight reduction on expression of ghrelin in plasma and stomach of obese rats,and to explore the role of ghrelin during weight loss. Methods 100 weaned Sprague-Dawley(SD) rats were randomly divided into control group(fed with standard chow,n= 20) and model group (two-bottle-feeding method,fed with standard chow and high-fat diet simultaneously, n=80). After 20 weeks feeding, Lee' s index of control was used as the reference of diet-induced obesity identification, and then diet-induced obese rats were randomly divided into four groups:obese control group,swimming group,food intake restriction group and swimming+food intake restriction group, eight rats in each group. Rats in swimming group underwent long-term(40 min,6 days/week for 5 weeks)swimming exercise. Calorie in food intake restriction group was restricted 1/3 of normal kcal for 3 weeks,and subsequently restricted 1/3 for 2 weeks. Swimming+food restriction group had the same intervention as swimming and food restriction group. 8 normal diet rats were also chosen as controls. After five weeks of treatments,peripheral fat mass of testis and kidney,ghrelin proteins in plasma and stomach,and ghrelin mRNA in stomach were measured. Results Gastric ghrelin protein and mRNA were significantly lower in obese control group than those in normal control group (P<0.05). However, plasma ghrelin did not decrease markedly in obese control rats(P>0.05). Compared with obese control group,weight and fat mass in all weight loss groups declined notablely(P<0.05);in swimming and swimming+food restriction groups,the expression of ghrelin protein or mRNA in plasma or stomach increased remarkably( P<0.05); in food restriction group, the level of ghrelin mRNA raised significantly (P<0.05), while ghrelin protein in plasma and stomach had not change. Conclusion The level of ghrelin increased in exercise induced weight loss,while showed no significant change in food intake restriction group, suggested that ghrelin might be involved in the process of weight loss induced by exercise.

Objective:To study the expression of miRNA-7 in B lymphocytes of primary Sj?gren's syndrome (pSS) and its relationship with phosphatase andtensin homolog deleted (PETN) and disease activity.Methods:Twenty newly diagnosed outpatient and inpatient pSS patients were used as case group collected from January 2017 to December 2019 of Qinghai Provincial People's Hospital. Twentyhealthy persons were used as the control group. Disease-related indicators of the case group were collected. Quantitative polymerase chain reaction (RT-qPCR)was used to detect miRNA-7 and PETN mRNA expression in B lymphocytes of the two groups and the consistency between miRNA-7 expression in the plasma and B lymphocytes of the case group was analyzed. Western Blotting method was used to detect the PETN protein in B lymphocytes of the two groups. Correlation analysis was used to analyze the relationship between miRNA-7 expression in B lymphocytes and disease activity in the case group. Linear regression analysis was performed between miRNA-7 and PETN mRNA.Results:The expression of miRNA-7 (0.53±0.17) in the B cells increased and the expression of PTEN mRNA (0.88± 0.24) and protein (0.51±0.12) in the case group were reduced compared with that of miRNA-7(0.39±0.11), PTEN mRNA(2.32±0.30) and protein(1.03±0.21) of the control group. The above differences were statistically significant ( t=2.990, P<0.05; t=16.98, P<0.05; t=8.41, P<0.05). Linear regression showedthat PTEN miRNAwas negatively correlated with miRNA-7 ( b=-0.78, P<0.01), the expression of miRNA-7 in the case group was positively related with EULAR Sj?gren′s syndrome Disease Activity Index (ESSDAI), IgG, IgA, anti-SSB and was negatively correlated with C4 and WBC. Conclusion:There is a certain relationship between miRNA-7 and disease activity. MiRNA-7 may participate in the pathogenesis of pSS byregulating PETN in B cells of pSS. MiRNA-7 has certain clinical value for disease activity evaluation.

Objective To compare the effects of health education on fat intake behavior and its psychology in students with different BMI,provide evidence for improving individual healthy education.Methods A experimental epidemiology was used,Twenty-nine secondary school classes were randomly selected by multi-stage cluster sampling from two cities in Zhejiang province.Overweight or obesity group included all students who were judged overweight or obesity,normal group included students who were judged normal and basic matched by age,grade,sex and stage of baseline.Intervention based on transtheoretical mode was conducted on two groups and intervention results were measured by the adolescent fat intake behavior of psychological measurement scales (Chinese version).Chi-square tests,T-tests,non-parameters tests and binary logistic regression were performed for data analyses.Results Stage of students with overweight or obesity and with normal BMI all moved forward after intervention,while the proportion of stage advance for students with overweight or obesity was further than students with normal BMI.Change strategy(2.60±0.79),pros(3.58±0.90) and self-efficacy(3.01±0.72) of students with overweight or obesity better than students with normal BMI in baseline((2.34±0.86),(3.08±0.91),(2.79±0.81)) while difference was not significant after intervention.Logistic regression analysis discovered that the promotion of change strategy moved stage forward for students with normal BMI(OR=2.168,95％ CI:1.560-3.014)and promotion of self-efficiency moved stage forward for students with overweight or obesity (OR=1.801,95％ CI:1.026-3.159).Conclusion The intensity and duration of psychological intervention is essential to be reinforced for students with normal BMI,while for students with overweight and obesity,psychological intervention should be promoted in combination with social support.

Objectives To explore the relationships between the current physical exercise behaviors and psychological factors of middle school students,so as to provide scientific evidence for improving health education and carrying out targeted health intervention measures.Methods The Multi-stage stratified sampling and cluster sampling method was adopted to choose 3600 students from 12 junior and senior middle schools in Hangzhou,Wuhan and Xi'an.The date was collected using the adolescent physical exercise behavior-psychological measurement scale(Chinese version).The structural equation model was built to explore the relationships between psychological factors(including the change of strategy,decision balance positive effect,decision balance negative effect and self-efficiency)and physical exercise.Results The change of strategy has biggest effect on physical exercise behaviors,with the standardized direct effect value of 0.344.The standardized direct effect value of decision balance negative effect,decision balance positive effect and self-efficiency were 0.071,0.093 and 0.169 respectively.The negative correlation among the four dimensions was significant statistically.Conclusion Psychological factors have direct effects on the change of the behaviors,and the change of the strategy has the largest impact on physical exercise behaviors of middle school students.The four psychological factors are closely correlated with one another,which is important in formulating middle school sports programs to promote the physical quality of middle school students.

As an effective treatment for cancer, chemotherapy not only removes tumor cells, but also produces obvious killing effects on proliferating cells, especially hematopoietic cells, resulting in bone marrow suppression after chemotherapy, and affecting the effects of chemotherapy drug treatment and treatment cycle. Therefore, starting from the aspects of hematopoietic microenvironment damage and hematopoietic stem cell aging, to explore the mechanism of myelosuppression after chemotherapy, which provides new ideas and theoretical support for the intervention and management of bone marrow suppression after cancer chemotherapy.

Hypoxia is one of the significant characteristics of the microenvironment of malignant tumors in the blood system. Hypoxic microenvironment can promote the metastasis and infiltration of tumor cells, which is one of the key factors leading to treatment tolerance, and also an important factor for resistance against tumor immune response. In acute myeloid leukemia (AML), the cellular oxygen sensing pathway is an important signaling transduction pathway that participates in the cell's response to hypoxic environments and can regulate biological processes such as metabolism, growth, and survival. Starting from how hypoxia affects the oxygen sensing pathway of leukemia cells, and targeting the cell adaptation mechanism induced by hypoxia, exploring new directions for targeted treatment of hematological malignancies in hypoxic environments can provide new ideas and theoretical support for the treatment of AML.

Hangzhou Sijiqing Community Health Service Center has started the precise contract service mode with the characteristics of competitive contract,regional medical alliance and team service form 2016,which improved hypertensive and diabetic patients management in community.After adopting the precision contract service mode,the contracting rate of hypertensive and diabetic patients increased from 56.1％ (2 680/4 777)to 81.6％ (5 602/6 863),the rate of referral to regional medical alliance increased from 26.1％ (2 678/10 259)to 44.4％ (5 589/12 589),consultation rate of contracted doctor increased from 47.1％ (54 603/115 986) to 56.3％ (93 219/165 725),contract renewing rate increased from 41.3％ (5 794/10 822) to 67.2％ (7 282/10 838),and the rate of home nursing care in increased from 9.5％ (47/495) to 61.5％ (392/637).The precise family doctor contract service is an effective mode for primary care,which improves the management rate of hypertensive and diabetic patients,provides continuous medical service,facilitates referral and home nursing service,and promotes the continuity of contract service.

Objective To construct an active targeting drug delivery system‐polymer vesicles(PVs), and examined the cellular uptake. Methods Maleimide‐ polyethylene glycol‐poly(lactic‐co‐glycolic acid)(MAL‐PEG‐PLGA)was used as carrier materials to prepare PVs by self‐assembling. And then PVs was modified by Tf and Tet‐1(Tf/Tet‐1‐PVs). To evaluate its ac‐tive targeting, coumarin‐6 was used as a fluorescent probe to analyze cellular uptake of PVs for both BCEC and Neuro‐2a cells. Results PVs was about 80 nm with rounded shape and had obvious film structure. Tf/Tet‐1‐PVs exhibited a significant role in promoting cellular uptake for both BCEC and Neuro‐2a cells compared with control and single ligand‐modified group. Conclusion PVs modified with dual ligands could promote the cell uptake for both brain capillary cells and nerve cells.

Objective To explore the key techniques used for surveillance and disposal of infectious diseases,food poisoning and hospital infection to improve the ability of surveillance and disposal on public health emergency.Methods Framework on surveillance and disposal of infectious diseases,food poisoning and hospital infection was set up,based on literature review and expert group discussion.Delphi method and technique for order preference by similarity to ideal solution comprehensive evaluation method were used for ordering preference by similarity,to screen key techniques set for surveillance and disposal of the above said events.Results Framework to be used for selecting key techniques was designed,based on the classification of emergency events,processing cycle of emergency events and level of techniques.Twenty six public health experts were selected for a 2-round consultation,with their authority as 0.796.Ten key techniques with important significance for surveillance and disposal of infectious diseases,food poisoning and hospital infection were selected from each event.Among these key techniques,the early-warning system was recognized as the key technique,important for the surveillance and disposal of all three emergency events.Items as technology used for unknown pathogenic microorganism detection,personal protection,gene sequencing and tracing technology,microorganism molecular typing technology,nucleic acid detection technology etc.were the key techniques and need to develop for the surveillance and disposal of infectious diseases and iatrogenic infection.Data regarding key technologies on security and privacy,early warning and forecasting,field rapid detection were sorted out that all in need to improve the surveillance programs on disposal of infectious diseases and food poisoning.Data exchange appeared another key technique on infectious diseases,with toxin detection and other 5 techniques the key techniques for food poisoning.Data collection,standardization and other 3 techniques appeared as the key techniques on iatrogenic infection.Conclusions Key techniques were selected in this study to meet the requirements of surveillance,disposal of infectious disease,food poisoning and iatrogenic infection.Authority of the experts got improved in the two-round consultation,ensuring the reliability of the results of screening and providing a scientific basis for the further research and priority development of the key techniques.