Objective To establish an indicator system for evaluation of entrustable professional activity(EPA)of PICC specialist nurses hence to provide a reference in evaluation of the post competency.Methods Through literature review and expert correspondence,two rounds of expert consultations were conducted with 18 PICC specialist nurses to determine the indicators for EPA evaluation.Results The effective recovery rate of the consultation questionnaires was 100.00%from the 2 rounds of expert consultations with the 18 PICC specialist nurses.In the second round of consultation,the expert authority coefficient was 0.94.The Kendall harmony coefficients for first-level secord-level and tertiary indicator were 0.388,0.257 and 0.159,respectively(all P<0.001).Four primary evaluative indicators were extracted,covering health assessment,professional skills operation,clinical nursing and teaching and research.In addition,4 first-level indicators(health assessment,professional skill operation,clinical nursing and teaching and scientific research),a total of 11 second-level indicators(mortal history collection,puncture site and catheter selection,occupational protection,specialist nursing operation technology,PICC venous safety assessment and management,first aid nursing skills,health guidance,educational consultation,communication and collaboration,teaching guidance,nursing scientific research application and professional development)and 47 tertiary indicators were included.All indicators scored between 4.56～5.00 for importance in the second round of consultation,between 4.50～4.94 for observability,and between 4.61～5.00 for reflecting the corresponding core competencies.Conclusion The EPA indicator system for evaluation of PICC specialist nurses is scientifically reliable and comprehensive.It can serve as an objective quantitative tool in evaluation of the post competency of PICC specialist nurses.

Objective To establish an indicator system for evaluation of entrustable professional activity(EPA)of PICC specialist nurses hence to provide a reference in evaluation of the post competency.Methods Through literature review and expert correspondence,two rounds of expert consultations were conducted with 18 PICC specialist nurses to determine the indicators for EPA evaluation.Results The effective recovery rate of the consultation questionnaires was 100.00%from the 2 rounds of expert consultations with the 18 PICC specialist nurses.In the second round of consultation,the expert authority coefficient was 0.94.The Kendall harmony coefficients for first-level secord-level and tertiary indicator were 0.388,0.257 and 0.159,respectively(all P<0.001).Four primary evaluative indicators were extracted,covering health assessment,professional skills operation,clinical nursing and teaching and research.In addition,4 first-level indicators(health assessment,professional skill operation,clinical nursing and teaching and scientific research),a total of 11 second-level indicators(mortal history collection,puncture site and catheter selection,occupational protection,specialist nursing operation technology,PICC venous safety assessment and management,first aid nursing skills,health guidance,educational consultation,communication and collaboration,teaching guidance,nursing scientific research application and professional development)and 47 tertiary indicators were included.All indicators scored between 4.56～5.00 for importance in the second round of consultation,between 4.50～4.94 for observability,and between 4.61～5.00 for reflecting the corresponding core competencies.Conclusion The EPA indicator system for evaluation of PICC specialist nurses is scientifically reliable and comprehensive.It can serve as an objective quantitative tool in evaluation of the post competency of PICC specialist nurses.

Objective:To learn about the changes of the condition of coal-burning-borne endemic arsenism, the use of improved stoves and the formation of health-related behaviors in Shaanxi Province, and evaluate the effect of prevention and control measures.Methods:From 2015 to 2020, according to the "Implementation Plan for Monitoring Coal-burning-borne Endemic Arsenism in Shaanxi Province", regular field surveys were carried out in 4 natural villages, 2 counties in Ankang City and Hanzhong City, Shaanxi Province, to learn about the basic prevention and control situation in the monitoring village. Using the simple random sampling method, 10 families in each village were selected to investigate the use of stoves and the formation of health-related behaviors, and 5 of these families were selected to collect coal samples for arsenic content determination in accordance with the "Determination of Arsenic in Coal" (GB/T 3058-2008). According to the "Diagnosis of Endemic Arsenicosis" (WS/T 211-2015), the condition of the people exposed to high arsenic coal in the monitoring village was investigated. Urine samples of 30 adult patients (half males and half females) with arsenic poisoning were collected, the content of arsenic in urine was determined by the "Urine-Determination of Arsenic-Silver Diethyldithiocarbamate-Triethanolamine-Spectrophotometric Method" (WS/T 28-1996).Results:A total of 240 households were monitored in the past 6 years, and the quality conformance and correct utilization rates of improved stoves in the households monitored in the disease areas remained at 100.00% in 2018 - 2020. The utilization rate of clean energy increased from 75.00% (30/40) in 2015 to 100.00% (40/40) in 2018 - 2020 (χ 2trend = 25.5, P < 0.001). The 73.75% (177/240) of households using a variety of clean energy. From 2018 to 2020, the correct drying, storage and pre-processing washing rates of corn and pepper continued to reach 100.00% (40/40). The arsenic content of coal ( n = 120) in the disease areas was (118.09 ± 57.91) mg/kg, ranging from 16.70 to 280.94 mg/kg. The detection rate of arsenic poisoning decreased from 6.34% (231/3 646) in 2015 to 2.90% (109/3 754) in 2020 (χ 2trend = 121.8, P < 0.001), and no skin cancer or Bowen's disease was detected. The geometric mean of arsenic content in urine ( n = 720) was 0.038 1 mg/L, ranging from 0.000 5 to 0.312 9 mg/L. Conclusions:The condition of coal-burning-borne endemic arsenism areas in Shaanxi Province has reached the national elimination standard. The quality and correct utilization rate of improved stoves and the rate of using clean energy have increased. The healthy-related behaviors the people in the endemic areas have been basically formed. The prevention and control work has achieved good results.

Objective:By exploring the source of children's total fluoride intake and the relationship between children's total fluoride intake and dental fluorosis prevalence, to calculate the benchmark dose (BMD) of children's total fluoride intake and its 95% confidence lower limit (BMDL), and to provide the basis for revision of "Total Fluoride Intake for Inhabitants" (WS/T 87-2016).Methods:The villages that had water improvement for 5 years and more in 6 provinces of Jiangsu, Shandong, Hebei, Anhui, Henan and Shaanxi were selected as survey sites in April 2014. The water fluoride content of these villages was 0.3 - 3.0 mg/L, tap water samples from the centralized water supply were collected, and fluoride content was detected by ion selective electrode method. Children aged 8 to 12 years were selected, children's dental fluorosis was checked by Dean's method. Children's dietary and drinking water volume were surveyed by duplicate portion study (measurement for 3 d), and dietary fluoride content was detected according to the "Method for Determination of Fluorine in Foods". The mean and standard deviation of drinking water fluoride intake, dietary fluoride intake, and total fluoride intake were measured. According to the dose-response relationship between children's total fluoride intake and the detection rate of dental fluorosis, BMD and BMDL were calculated, and the reference dose (RfD) was calculated based on BMDL.Results:The mean of water fluoride of all 29 villages was 1.26 mg/L (from 0.41 to 2.85 mg/L). Totally 3 043 children aged 8 to 12 years were checked, and the detection rate of dental fluorosis was 30.2% (919/3 034). The lowest detection rate of dental fluorosis was 2.0% (2/100) and the highest was 71.4% (30/42) in the 29 villages. The children's dietary and drinking water volume of 769 person-time aged 8 to 12 years were surveyed, the children's daily drinking water fluoride intake, dietary fluoride intake, and total fluoride intake were (0.83 ± 0.66), (1.13 ± 0.61) and (1.96 ± 0.89) mg/d, respectively. The BMD of children's daily total fluoride intake was 2.43 mg, the BMDL was 2.21 mg, and the RfD was 2.21 mg.Conclusion:The BMD of 8 to 12 years old children's daily total fluoride intake is the same as the allowable limit (2.4 mg) of the national standard "Total Fluoride Intake for Inhabitants" (WS/T 87-2016).

Objective:To understand the molecular characteristics and correlation among isolated strains of Brucella melitensis (BM) so as to improve the strategies on prevention and control of the disease in Jiangxi province. Methods:A total of 25 strains of BM isolated from human in 17 counties of Jiangxi province were analyzed by multiple locus variable-number tandem repeat analysis (MLVA) method.Results:A total of 25 strains of BM were classified into 24 independent genotypes with similarities between 67.00% and 100.00% and Simpson index between 0.000 and 0.773. There were 3 genotypes in MLVA8, including 60.00% (15/25) as 42 genotype, 32.00% (8/25) as 43 genotype, and 8.00% (2/25) as 63 genotype, respectively. There were 7 genotypes in MLVA11 identified, with 116 genotype and 125 genotype the main genotypes, accounting for 56.00% (14/25) of all the identified strains.Conclusions:Genes from all the 25 strains of BM that isolated from human being were with high genetic diversities, and various, genotypes. However, no obvious epidemiological correlation was noticed among these strains, indicating the complexity of the source of infection on Brucella in Jiangxi province.

Brucella ; isolation & purification ; Brucellosis ; epidemiology ; China ; epidemiology ; Humans

The protective effect of niacinamide on interleukin-1beta (IL-1beta)-induced annulus fibrosus (AF) type II collagen degeneration in vitro and the mechanism were investigated. Chiba's intervertebral disc (IVD) culture models in rabbits were established and 48 IVDs from 12 adult Japanese white rabbits were randomly divided into 4 groups: normal control group, niacinamide-treated group, type II collagen degneration group (IL-1beta) and treatment group (niacinamide+IL-1beta). After culture for one week, AFs were collected for inducible nitric oxide synthase (iNOS), cysteine containing aspartate specific protease-3 (Caspase-3) and type II collagen immunohistochemical examination, and type II collagen reverse transcription polymerase chain reaction (RT-PCR). The results showed that rate of iNOS positive staining AF cells in the 4 groups was 17.6%, 10.9%, 73.9% and 19.3% respectively. The positive rate in treatment group was significantly lower than in the type II collagen degeneration group (P<0.01). Rate of Caspase-3 positive staining AF cells in the 4 groups was 3.4%, 4.2%, 17.6% and 10.3% respectively. The positive rate in treatment group was lower than in the type II collagen degeneration group (P<0.01). Type II collagen staining demonstrated that lamellar structure and continuity of collagen in treatment group was better reversed than in the degeneration group. RT-PCR revealed that the expression of type II collagen in treatment group was significantly stronger than that in type II collagen degeneration group (P<0.01). It was concluded that niacinamide could effectively inhibit IL-1beta stimulated increase of iNOS and Caspase-3 in AF, and alleviate IL-1beta-caused destruction and synthesis inhibition of type II collagen. Niacinamide is of potential for clinical treatment of IVD degeneration.

The protective effect of niacinamide on interleukin-1β (IL-1β)-induced annulus fibrosus (AF) type Ⅱ collagen degeneration in vitro and the mechanism were investigated. Chiba's intervertebrai disc (IVD) culture models in rabbits were established and 48 IVDs from 12 adult Japanese white rabbits were randomly divided into 4 groups: normal control group, niacinamide-treated group, type Ⅱ collagen degneration group (IL-1β) and treatment group (niacinamide+IL-1β). After culture for one week, AFs were collected for inducible nitric oxide synthase (iNOS), cysteine containing aspartate specific protease-3 (Caspase-3) and type Ⅱ collagen immunohistochemical examination, and type Ⅱ collagen reverse transcription polymerase chain reaction (RT-PCR). The results showed that rate of iNOS positive staining AF cells in the 4 groups was 17.6%, 10.9%, 73.9% and 19.3% respectively. The positive rate in treatment group was significantly lower than in the type Ⅱ collagen degeneration group (P＜0.01). Rate of Caspase-3 positive staining AF cells in the 4 groups was 3.4%, 4.2%, 17.6% and 10.3% respectively. The positive rate in treatment group was lower than in the type Ⅱ collagen degeneration group (P＜0.01). Type Ⅱ collagen staining demonstrated that lamellar structure and continuity of collagen in treatment group was better reversed than in the degeneration group. RT-PCR revealed that the expression of type Ⅱ collagen in treatment group was significantly stronger than that in type Ⅱ collagen degeneration group (P＜0.01). It was concluded that niacinamide could effectively inhibit IL-1β stimulated increase of iNOS and Caspase-3 in AF, and alleviate IL-1β-caused destruction and synthesis inhibition of type Ⅱ collagen. Niacinamide is of potential for clinical treatment of IVD degeneration.

BACKGROUND: Recent studies have demonstrated that energy metabolism-related genes play important roles in intervertebral disc (IVD) cell adaptation to negative environmental factors, such as hypoxia and insufficiency of nutrient. But the effects of these genes in pressure-induced intervertebral disc degeneration remain uncertain.OBJECTTVE: To investigate continuous pressure-induced expression of energy metabolism genes: hypoxia-inducible factor 1α(HIF-lo), glucose transporter-1 (GLUT-1) and vascular endothelial growth factor (VEGF) in rabbit annulus fibrosus (AF).DESIGN: A randomized controlled experiment.SETTING: The Central Laboratory and the Laboratory of Department of Orthopaedics, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: The experiment was carried out in the Central Laboratory and the Laboratory of Department of Orthopaedics, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from May to October 2005. Twenty-five Japanese white rabbits(about 4 months old, weighting 2.5-3.0 kg, provided by the Experimental Animal Center of Tongji Medical College, Huazhong University of Science and Technology) were selected to establish the animal model.METHODS: A controllable pressure-induced rabbit intervertebral disc degeneration model was adopted to impose various pressured on rabbit IVDs in vivo. The survived animals whose IVDs were compressed successfully were divided randomly into 4 groups. The IVDs were treated with no pressure as control (control group), with 15 kg axial load for 24 hours (24hours group), 72 hours (72 hours group), and 24 hours with 48 hours free for self-reparation (reparation group). Reverse transcriptase-polymerase chain reaction was used to detect the expression of HIF-1α and GLUT-1. Western Blot and immunohistochemical test were carried out for the content and distribution of VEGF.MAIN OUTCOME MEASURES: Expression of HIF-1α and GLUT-1, content and distribution of VEGF.RESULTS: Twenty of 25 rabbits entered result analysis. Two rabbits were missed because of vertebral fracture, while death of 3 rabbits within 1-3 days postoperatively caused another loss. ①HIF-1α. A very low expression was detected in the control group, while the expression in the 24 hours group was raised over 20 times than that in the control group (t=25.022, P＜0.01). The expression in the 72 hours group and reparation group decreased as compared with the 24hours group. ②GLUT-1 expressed weakly in the control group. The expression in the 24 hours group rose a lot as compared with the control group (t=18.314, P＜0.01) and the expression in the 72 hours group rose slightly than that in the 24 hours group (t =2.819, P＜0.05). The expression in the reparation group is close to that in the 24 hours group. ③Littie VEGF content was detected in the control group, while the content rose significantly in the other 3 groups. Immunohistochemical staining showed more VEGF positive stained cells in outer AF than in inner AF.CONCLUSION: Continuous pressure can strongly up-regulate the expression of energy metabolism gene: HIF-1α,GLUT-1 and VEGF in vivo. These genes play important roles in AF adaptation and reparation in over load-caused damage.

The regulatory effects of niacinamide (Nia) on intervertebral disc (IVD) aggrecan in vitro was investigated. Chiba's 10 ng/mL interleukin-1 (IL-1)-induced rabbit IVD degeneration model in vitro was established. 0.5, 0.25 and 0.05 mg/mL Nia was added to normal and degenerated IVDs for intervention. On the first and second week after intervention, safranin O-fast green staining intensity and glycosaminoglycan (GS) content were measured. The expression of aggrecan core protein was detected by RT-PCR. The results showed: (1) After treatment with 0.5 mg/mL Nia for one week, the GS content in nucleus pulposus (NP) was increased by 44.8 % as compared with control group (P＜0.01); The GS content in IL-1 induction groups was increased with the increase of Nia concentrations: After treatment with 0.5 mg/mL for one week, the GS content in NP was increased by 68.3 % as compared with control group (P＜0.01). After two weeks, GS content in NP and fibrous rings was still higher than in control group at the same period (P＜0.01)and untreated group (P＜0.01). (2) Safranin O-fast green staining revealed that with the increase of Nia concentrations, staining density in NP and fibrous rings was increased and histological structure damage to IVDs by IL-1β was alleviated. (3) RT-PCR showed that the expression of core protein gene in IL-1β-induced degenerated IVDS was increased with the increase of Nia concentrations.It was concluded that under conditions in vitro, Nia could up-regulate the expression of aggrecan in IVDs and protect IVDs from IL-1β-induced degeneration at least partially, which offers a potential choice for IVD degeneration clinical therapy.