Objective To evaluate the effects of stepwise and fine-grained dietary management on the diet control of liver cirrhosis patients complicated with gastrointestinal hemorrhage. Methods Eighty liver cirrhosis patients complicated with gastrointestinal hemorrhage were assigned to experimental group (41 cases) and control group(39 cases) by random digits table method. The patients in experimental group were treated with stepwise and fine-grained dietary management and the patients in control group were given conventional dietary treatments. The compliance diet, mastery of nutrition knowledge, malnutrition risk at admission, intake food, discharge and 2 months after discharge between two groups were monitored. The incidence of rebleeding was tracked after 1 year of discharge. Results The incidence of malnutrition risk in Child-Pugh class C was higher than that in Child-Pugh class B( Z=-4.3, P<0.05 ) . The incidence of malnutrition risk in patients with high education level was lower than that in patients with lower education( r=-0.453, P<0.05 ). The experimental group significantly outperformed control group in mastery of nutrition knowledge at discharge:80(70, 84) points vs. 52(42, 64) points, in compliance diet and malnutrition risk after 2 months after discharge:86(76, 91)%vs. 53(46,57)%, 1(1, 2) points vs. 2(1,3) points, the rebleeding rate in experimental group was significantly less than that in control group within 1 year after discharge 14.6%(6/41) vs. 35.9%(14/39), and the differences were statistically significant between two groups ( χ2 = 4.226- 51.232, all P < 0.05 ). Conclusions Stepwise and fine-grained dietary management can improve the mastery of nutrition knowledge, compliance diet and nutritional status, and reduce the occurrence of rebleeding, worth popularizing further in clinical care of liver cirrhosis patients complicated with gastrointestinal hemorrhage.

Objective To set up weight coefficient of qualification and evaluation system so as to implement a normative and standardized system for assessment of clinical teachers of master of nursing specialist (MNS) postgraduates. Methods The indicator system was established by Delphi method. The indicators weight was obtained through analytic hierarchy process, and the logic consistency test was calculated. Results The first five weight of qualification indicators were as follows: registered nurse (0.1686), clinical working experiences (0.2352), clinical teaching experiences (0.2016), education background and professional title (0.1410), research subjects they preside over or participate in (0.0817). The results of indicators order in single level and whole system had a satisfied consistency (CR<0.10). Conclusions The study on weighting values of the system could help it more scientific,reliable and practical.

Objective To explore the nuclear emergency nursing rescue process, and ensure safety and effectiveness of implementation of nuclear emergency nursing rescue. Methods Based on the analysis of the existing national standards, and on the basis of literature review, the method of Delphi was used to collect 23 experts′suggestions, and to make a preliminary draft nuclear emergency nursing rescue process on site. Results The experts' enthusiasm was very high, and the degree of authority (Cr) coefficient was 0.91. A on-site rescue unit partition graph, and two rescue unit process that were preliminary sorting and decontamination, and an on-site rescue process had been drew up. Conclusions After two rounds of expert enquiry, the emergency nursing rescue process is reasonable. And the study could provide objective basis for the implementation of the nuclear emergency nursing rescue.

Objective To observe the effect of raloxifene, a selective estrogen receptor modulator, on osteoporosis in the osteoprotegerin (OPG) gene knock-out female and male mice. Methods Two groups of OPG gene deficient (OPG-/-) female and male mice, 20 mice in each group, were assigned to raloxifene-treated (3 mg The effect of raloxifene was evaluated by comparing the values of bone mineral density (BMD) , bone strength,histomorphometric measurement and osteoclast number between the raloxifene treated group and placebo group.Results As compared with placebo group osteoporotic manifestations were improved in OPG-/- female mice treated with raloxifene orally. BMD was increased both in lumbar vertebrae (P<0.05) and femurs (P<0.01).Bone strength was measured in femurs by three-point bending test and vertebrae by stress test. Results showed that ultimate load, ultimate stress and Young's modulus were increased both at lumbar and femur bone, suggesting decreased risk of fracture. Tartrate-resistant acid phosphatase, a marker enzyme of osteoclasts, was detected, and the number of osteoclasts declined significantly after the treatment of raloxifene. At the same time, results of histomorphometric measurements indicated that bone trabecular volume was increased and bone formation rate decreased from(8.05±4.02)mm3·mm-2·year-1 to (5.48±1.89)mm3·mm-2· year-1(P＜0.05).These findings were found in the group of OPG-/- female mice treated with reloxifene but not in male mice. Conclusions Raloxifene is effective in treating osteoporosis in female OPG-/- mice, indicating that its action is at least in part independent of OPG gene. But it is ineffective in male OPG-/- mice.

Objective Using the stage management to evaluate the normalized pain management and to alleviate pain of primipara during delivery and improve comfort .Methods Sixty pregnant women were selected and were divided into the control group and the observation group , each with 30 cases.The control group was given the usual care during the first stage of delivery , while the observation group was given a set of normalized pain management and alternative experiences of intervention , therapeutic massage , meditation with music and birth ball.The numerical rating scale (NRS) and visual analog score (VAS) were used to assess the degree of pain, emotions and comfort feelings .Then, the degree of pain and changes of emotions and comfort were compared between groups .Results Within the observation group , 12 primipara ( 40.00%) had mild pain, 17 primipara (56.67%) had moderate pain, 1 primipara (3.33%) had severe pain.Within the control group, 5 primipara (16.67%) had mild pain, 21 primipara (70.00%) had moderate pain, 4 primipara (13.33%) had severe pain.There was a significant difference between groups (U =2.235, P =0.025).Within the observation group, 22 primipara (73.33%) had mild discomfort, 8 primipara (26.67%) had moderate discomfort.Within the control group, 10 primipara (33.33%) had mild discomfort, 17 primipara (56.67%) had moderate discomfort , 3 primipara ( 10 .00%) had severe discomfort .There was a significant difference between groups (U=3.222, P=0.001).There was no significant difference in the emotions between groups (U=0.800,P=0.424).Conclusions The stage management can significantly reduce the pain of primipara during delivery and improve their comfort .

Objective To investigate the clinical diagnostic value of circulating tumor cells (CTCs)and circulating cell-free DNA (cfDNA) in peripheral blood samples in breast cancer. Methods From July 2017 to April 2018, 47 patients with BMC (7 in stage Ⅱ, 19 in stage Ⅲ and 21 in stage Ⅳ), 24 patients with benign breast diseases and 28 healthy people were selected. After collecting peripheral blood samples, serum and blood cells were separated. The size-based high-throughput microfluidic chip was used to capture CTCs. The real-time fluorescent quantitative PCR based on Alu sequence was used to detect the length of cfDNA(247 bp, 115 bp)in the serum, and the ratio of amplified products of long and short fragments was used as the index of DNA integrity. The Mann-Whitney U test or Kruskal-Wallis H test was used to compare the differences between the groups and analyze the relationship between CTCs and cfDNA and clinical parameters of breast cancer. The ROC curve was drawn and the area under the curve (AUC) was used to evaluate the feasibility of blood cell CTCs and plasma cfDNA detection as diagnostic criteria. Results The CTCs and cfDNA of 47 BMC patients were analyzed. The CTCs and cfDNA integrity index (Alu 247/115) of BMC patients were significantly higher than those of physical examination patients[(13.98± 12.36)cells / ml vs (1.14 ± 1.35) cells / ml; 0.7687 ± 0.3868 vs 0.5094 ± 0.2456], and the difference was statistically significant(the U value was 126.5,359.0;P<0.001), the area under ROC curve of CTCs was 0.885 (95％CI: 0.805-0.965), cut-off value was 7.68/ml, sensitivity was 80.4％, specificity was 96.4％. The area under ROC curve of Alu 247/115 was 0.727(95％CI: 0.608-0.847), cut-off value was 0.431, sensitivity was 71.7％, specificity was 71.4％. The AUC of CTCs and Alu 247/115 was 0.919 (95％CI 0.854-0.984), which was higher than the single test of each indicator. Conclusions CTCs and cfDNA may be the potential biological indicators for breast cancer diagnosis. The combined detection of CTCs and cfDNA maybe improve the diagnosis rate of breast cancer patients.

Objective To analyze the change in trends and existing problems of the water quality testing capabilities of the Centers for Disease Control and Prevention (CDC) in different cities and counties (districts) in Shaanxi Province from 2017 to 2019, and to provide references for laboratory capacity building. Methods A unified questionnaire was developed to investigate the water quality testing ability of all CDCs in different regions of Shaanxi Province, and the data were reported through the ^“National Drinking Water Quality Inspection Information System^”. Results From 2017 to 2019, in the testing of conventional indicators, the average number detected by the municipal CDCs was 37, 37, and 38, respectively, and all of them passed the measurement certification/laboratory accreditation. The average number detected by the county (district) CDCs was 30, 29, and 30, respectively, and only 65.14% of the county (district) CDCs passed the measurement certification/laboratory accreditation. In the testing of unconventional indicators, the average detectable number by city-level CDCs was 3, 5, and 4, respectively, while the average detectable number by county (district)-level CDCs was at most 1 item. There was no statistically significant difference in the average detection ability of CDCs at the city and county (district) levels in different regions in the same year (P>0.05); there was no significant difference in the average detection ability of CDCs at the city and county (district) levels in the same region in different years (P>0.05). Conclusion There is no difference in the CDC water quality testing level in different regions of Shaanxi Province, and the testing capacity needs to be further improved. It is recommended that the government should increase funding for disease control institutions, optimize the allocation of equipment and strengthen the construction of professional teams.

It is believed that qi and blood disharmony is the key pathogenesis of essential hypertension， for which mildly regulating qi and blood is recommended. According to the different pathological states and related causes of qi and blood disorders， essential hypertension can be divided into five syndrome types for differentiation and treatment. In terms of blood deficiency and liver constraint， it is recommended to nourish the blood and soften the liver， rectify qi to resolve constraint， using Xiao Yao Powder （逍遥散） or self-made Qihua Jieyu Decoction （七花解郁汤）. For qi stagnation and blood stasis， the method of regulating qi and harmonizing blood， dissolving stasis and unblocking collaterals should be used， with self-made Guitao Tongluo Decoction （桂桃通络汤）. For phlegm-dampness internal obstruction， it is recommended to move qi and promote urination， dissolve phlegm and eliminate dampness， using self-made Zhuanqi Sanzhuo Formula （转气散浊方）. For binding of phlegm and stasis， dissolving phlegm and dispelling stasis， dredging the bowels and directing the turbid downward is advised， and self-made Sanren Tiaozhi Formula （三仁调脂方） can be used. In terms of deficiency of both qi and blood， it is recommended to boost qi and nourish blood， supplement deficiency and consolidate the root， using Gui Pi Decoction （归脾汤） or self-made Shenqi Zaizao Decoction （参芪再造汤）.

Objective To assess the health risks of fluoride in drinking water in rural schools in drinking-water fluorosis areas in Shaanxi Province, and to provide a scientific basis for formulating measures to prevent fluoride and improve water quality. Methods The drinking water of rural schools in Guanzhong and northern Shaanxi Province was monitored from 2017 to 2020. The fluoride concentration was evaluated in accordance with the ^“Sanitary Standards for Drinking Water^” (GB5749-2006). The health risk assessment method recommended by USEPA was used to assess the health risk of rural students exposed to fluoride through drinking water in the two regions. Results A total of 2 826 water samples were monitored from 2017 to 2020. The overall compliance rate of fluoride in water quality was 92.29%, with an average concentration of 0.500 mg/L. The non-carcinogenic health risk of fluoride in drinking water in rural schools in drinking-water fluorosis areas was <1. There was no statistically significant difference in non-carcinogenic health risk of fluoride in water quality between different regions of the same age group (P > 0.05). In the same age group, the non-carcinogenic health risk of fluoride in groundwater was higher than that in surface water (P < 0.05). The order of non-carcinogenic health risk of fluoride in drinking water with different water treatment methods from high to low was disinfection only > sedimentation filtration > conventional treatment > untreated (P < 0.05). Conclusion The non-carcinogenic risk of oral intake of fluoride in drinking water from rural schools in drinking-water fluorosis areas in Shaanxi Province is still at an acceptable level. In the future, it is necessary to continue to promote comprehensive prevention and treatment measures focusing on water improvement and fluoride reduction.

OBJECTIVE: To explore the effect of occupational aluminum exposure on the blood of male workers. METHODS: A total of 249 male workers were selected as the research subjects by cluster sampling method in the electrolytic workshop of an aluminum plant. Blood samples were collected for determination of the blood aluminum concentration and blood routine. The subjects were divided into low-, medium-, and high-aluminuml groups based on the tertile of blood aluminum level(P_(33) is 13.9 μg/L, P_(67) is 37.7 μg/L). RESULTS: The red blood cell(RBC) count and hemoglobin level in patients of the high-aluminum group were lower than that of the low-aluminum group(P<0.05). There was no significant difference of the RBC count and hemoglobin level of patients in middle-aluminum group compared with that of the low-and high-aluminum groups(P>0.05). There was no statistical significant difference in white blood cell count and platelet count among the three groups(P>0.05). The results of the generalized linear regression model showed that the higher the blood aluminum level, the lower the RBC count and hemoglobin level of workers(P<0.05) after eliminating confounding factors such as age, length of service, education level, smoking, and drinking. CONCLUSION: Occupational aluminum exposure can cause a decrease of RBC count and hemoglobin level with a dose-effect relationship in workers.