Objective:To explore the structural relationship between WMSDs in the upper limbs and various risk factors in the occupational population in China, based on a large sample epidemiological survey and structural equation analysis, and to establish a structural equation model, so as to lay a foundation for the prevention and control of such diseases.Methods:The Chinese version of the Musculoskeletal Disorders Electronic Questionnaire was used to conduct a nationwide survey on the prevalence of WMSDs in the upper extremity. Six factors related to WMSDs in the upper extremity were extracted by the classification standard of adverse ergonomic factors and their source and confirmatory factor analysis, including work organization, work type, upper extremity work posture, individual factors, upper extremity fatigue and upper extremity WMSDs. The structural equation analysis was carried out and the structural equation model was established.Results:The incidence of WMSDs and fatigue in the upper limbs was 24.44% and 43.76%, respectively. The adjusted structural equation model fitting indicators were generally up to the standard (GFI=1.000, AGFI=1.000, RMSEA=0.043, NFI=0.808, TLI=0.784) . The four exogenous latent variables of work organization, work type, upper limb work posture and individual factors were correlated. There was a strong positive correlation between job type and upper limb work posture ( r=0.865) , a moderate positive correlation between work organization and job type and upper limb work posture ( r=0.570, 0.490) , and a weak negative correlation between individual factors and the other three exogenous latent variables. Upper limb work posture and individual factors had direct effects on upper limb WMSDs, and the effect coefficients were 0.10 and 0.06, respectively. Upper limb fatigue played a mediating role between work organization, work type, upper limb work posture and upper limb WMSDs. The effect coefficient was 0.46, and the composition ratios of indirect effects were 100.0%, 100.0%, and 38.3%, respectively. The direct path effect of upper limb work posture, individual factors and upper limb WMSDs was weaker than the mediating path through upper limb fatigue. Conclusion:When carrying out the prevention and control of upper limbWMSDs, it is necessary to comprehensively consider the pathogenesis path of upper limb muscle fatigue and upper limb WMSDs caused by work organization, work type, and upper limb work posture, so as to provide theoretical reference for improving the prevention and control level of such diseases.

Objective:To explore the structural relationship between WMSDs in the upper limbs and various risk factors in the occupational population in China, based on a large sample epidemiological survey and structural equation analysis, and to establish a structural equation model, so as to lay a foundation for the prevention and control of such diseases.Methods:The Chinese version of the Musculoskeletal Disorders Electronic Questionnaire was used to conduct a nationwide survey on the prevalence of WMSDs in the upper extremity. Six factors related to WMSDs in the upper extremity were extracted by the classification standard of adverse ergonomic factors and their source and confirmatory factor analysis, including work organization, work type, upper extremity work posture, individual factors, upper extremity fatigue and upper extremity WMSDs. The structural equation analysis was carried out and the structural equation model was established.Results:The incidence of WMSDs and fatigue in the upper limbs was 24.44% and 43.76%, respectively. The adjusted structural equation model fitting indicators were generally up to the standard (GFI=1.000, AGFI=1.000, RMSEA=0.043, NFI=0.808, TLI=0.784) . The four exogenous latent variables of work organization, work type, upper limb work posture and individual factors were correlated. There was a strong positive correlation between job type and upper limb work posture ( r=0.865) , a moderate positive correlation between work organization and job type and upper limb work posture ( r=0.570, 0.490) , and a weak negative correlation between individual factors and the other three exogenous latent variables. Upper limb work posture and individual factors had direct effects on upper limb WMSDs, and the effect coefficients were 0.10 and 0.06, respectively. Upper limb fatigue played a mediating role between work organization, work type, upper limb work posture and upper limb WMSDs. The effect coefficient was 0.46, and the composition ratios of indirect effects were 100.0%, 100.0%, and 38.3%, respectively. The direct path effect of upper limb work posture, individual factors and upper limb WMSDs was weaker than the mediating path through upper limb fatigue. Conclusion:When carrying out the prevention and control of upper limbWMSDs, it is necessary to comprehensively consider the pathogenesis path of upper limb muscle fatigue and upper limb WMSDs caused by work organization, work type, and upper limb work posture, so as to provide theoretical reference for improving the prevention and control level of such diseases.

Objective:To explore the optimal postpartum nursing intervention method of elderly second-birth parturient based on the best evidence and evaluate its effect so as to improve the quality of clinical nursing.Methods:Based on the best evidence obtained from the previous study, the optimal nursing examination index of the elderly second parturient was established, and the evidence of best practice was obtained by using the evidence-based nursing method, and the 2017 revised version (the third edition of) Johns Hopkins evidence-based nursing practice model) was used to guide nurses to apply the evidence to clinical practice. During the period from March to May 2019, the baseline review was completed, including 82 pregnant women and 43 nurses. The evidence was incorporated into clinical practice in June 2019. From July to October 2019, the same indicators and inclusion and exclusion criteria were used to evaluate the effectiveness of evidence application in 43 nurses (including midwives) and 85 elderly second-child parturients in obstetric wards (including baby-friendly areas). The anxiety, depression, maternal satisfaction and nurses' correct implementation rate of the best evidence were compared before and after the application of evidence.Results:After the use of evidence-based intervention, the implementation rate of nurses was above 80%. The anxiety score of parturient decreased from 55.29±10.11 to 41.74±10.35, the difference was statistically significant ( t value was 8.55, P<0.001), and the depression score decreased from 57.77 ±8.32 to 47.86 ±9.33, the difference was statistically significant ( t value was 7.23, P<0.001). Maternal satisfaction increased from 92.68% (76/82) to 98.82% (84/85), the difference was statistically significant ( χ2 value was 3.92, P< 0.05). Conclusion:The result of practice shows that through evidence-based nursing intervention, we can further standardize the postpartum optimal nursing paradigm of elderly second-child parturients in China. Reduce postpartum anxiety and depression and improve maternal satisfaction. And quality review still needs to be continuously promoted and implemented in clinical practice in order to continuously improve the quality of nursing and ensure sustainability.

Objective:To select and extract the evidence of delivery mode decision making among repregnancy women with post cesarean section, and summarize the best evidence.Methods:Evidence-based nursing was used to retrieve the evidences on delivery mode decision making among repregnancy women with post cesarean section in the Chinese Guidelines Network, Guidelines International Network (GIN) , National Institute for Health and Clinical Excellence (NICE) , American GuidelineClearinghouse (NGC) , Joanna Briggs Institute Evidence-based Health Care Center of Australia, UpToDate, Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI) , WanFang data, Chinese Biological Medicine (CBM) and Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Excerpta Medica Database (Embase) . The evidences included the guidelines, systematic reviews, evidence summaries, recommended practices, best clinical practice information booklets and primary studies.The retrieval time was from the establishment of the database to 1st May 2019.Results:A total of 13 evidences were included, six guideline, one expert consensus and six systematic reviews, which involved 15 best evidences in four aspects, trial of labor after cesarean section (TOLAC) /vaginal birth after cesarean (VBAC) population, VBAC/uterine rupture influencing factors, delivery mode management and the delivery decision making tools.Conclusions:Evidences of clinical practice should be recommended according to the resource of medical institutions, promotion and barrier factors when medical staff apply evidences, reasonable judgments of clinician, clinical data provided by delivery women, will of delivery women and their family members. Users should continuously update evidences since the best evidences update over time to solve the problems of delivery mode decision making among repregnancy women with post cesarean section by scientific method so as to improve the nursing quality.

Objective: To understand prevalence, control of hypertension and intake of sodium and potassium among residents aged 50-69 years old in Zhejiang Province. Methods: A multi-stage random cluster sampling method was used to select 3 032 residents aged 50-69 years old in Zhejiang Province. The demographic characteristics, prevalence and control of hypertension were collected through a questionnaire survey, and physical measurement was also performed. The stratified random sampling method was used to detect the level of sodium and potassium in the 24 h urine of 676 subjects. The total amount of 24 h urinary sodium ≥102.55 mmol and the ratio of 24 h urinary sodium and potassium content ≥2 were defined as excessive. Results: The prevalence of hypertension (95%CI) was 56.89% (54.39%-59.40%), and the awareness, treatment and control rate of hypertension were 58.25% (55.01%-61.49%), 45.37% (42.10%-48.65%) and 19.75% (17.01%-22.50%), respectively. 78.99% (n=534) of residents had excessive 24 h urinary sodium, and 95.41% (n=360) of residents had excessive ratio of 24 h urinary sodium and potassium. Conclusion The prevalence of hypertension in residents aged 50-69 years old in Zhejiang Province was at a high level, and the control of hypertension was not satisfactory in 2017. Most of residents have excessive level of sodium intake and the level of sodium and potassium intake was not balanced.

Objective To understand prevalence, control of hypertension and intake of sodium and potassium among residents aged 50-69 years old in Zhejiang Province. Methods A multi?stage random cluster sampling method was used to select 3 032 residents aged 50-69 years old in Zhejiang Province. The demographic characteristics, prevalence and control of hypertension were collected through a questionnaire survey, and physical measurement was also performed. The stratified random sampling method was used to detect the level of sodium and potassium in the 24 h urine of 676 subjects. The total amount of 24 h urinary sodium ≥102.55 mmol and the ratio of 24 h urinary sodium and potassium content ≥2 were defined as excessive. Results The prevalence of hypertension (95%CI) was 56.89% (54.39%-59.40%), and the awareness, treatment and control rate of hypertension were 58.25% (55.01%-61.49%), 45.37% (42.10%-48.65%) and 19.75% (17.01%-22.50%), respectively. 78.99% (n=534) of residents had excessive 24 h urinary sodium, and 95.41% (n=360) of residents had excessive ratio of 24 h urinary sodium and potassium. Conclusion The prevalence of hypertension in residents aged 50-69 years old in Zhejiang Province was at a high level, and the control of hypertension was not satisfactory in 2017. Most of residents have excessive level of sodium intake and the level of sodium and potassium intake was not balanced.

Objective To understand prevalence, control of hypertension and intake of sodium and potassium among residents aged 50-69 years old in Zhejiang Province. Methods A multi?stage random cluster sampling method was used to select 3 032 residents aged 50-69 years old in Zhejiang Province. The demographic characteristics, prevalence and control of hypertension were collected through a questionnaire survey, and physical measurement was also performed. The stratified random sampling method was used to detect the level of sodium and potassium in the 24 h urine of 676 subjects. The total amount of 24 h urinary sodium ≥102.55 mmol and the ratio of 24 h urinary sodium and potassium content ≥2 were defined as excessive. Results The prevalence of hypertension (95%CI) was 56.89% (54.39%-59.40%), and the awareness, treatment and control rate of hypertension were 58.25% (55.01%-61.49%), 45.37% (42.10%-48.65%) and 19.75% (17.01%-22.50%), respectively. 78.99% (n=534) of residents had excessive 24 h urinary sodium, and 95.41% (n=360) of residents had excessive ratio of 24 h urinary sodium and potassium. Conclusion The prevalence of hypertension in residents aged 50-69 years old in Zhejiang Province was at a high level, and the control of hypertension was not satisfactory in 2017. Most of residents have excessive level of sodium intake and the level of sodium and potassium intake was not balanced.

Objective Through testicular sperm aspiration (TESA),testicular biopsy,and detection of serum reproductive hormone levels and testicular volume in azoospermia patients,to explore the correlation between spermatogenic function of testis and serum FSH,LH,INHB levels,and testicular volume.Methods 76 cases of azoospermia patients were collected as the research objects.Chemiluminescence method was employed to detect the levels of serum reproductive hormone,and testis model was used to detect testicular volume.Routine disinfection was given to make TESA.According to TESA results,patients were divided into sperm group (group A),and azoospermia group (group B).According to testicular biopsy results,patients were divided into normal spermatogenic function group (group C),sperm maturation block group(group D),permatogenic dysfunction group (group E),and sertoli-cell-only syndrome group (group F).At the same time,40 cases of healthy male were selected as the control group (group G),and they received sperm routine examination,serum reproductive hormone and testicular volume detection.Results The level of serum FSH,LH,INHB and testicular volume in group A and C had no significant difference compared with that in group G(P＞0.05).The level of serum FSH and LH was significantly higher in group C than that in group G.The level of serum INHB and testicular volume was significantly lower than that in group G (P＜0.05).The level of serum FSH in group E was higher than in group G.The level of serum INHB in group D and E was lower than that in group G,and the difference was statistically significant (P＜0.05).Spearman correlation analysis showed that the spermatogenic function of testis was negatively correlated with serum FSH and LH levels,and positively correlated with serum INHB level and testicular volume (P＜0.05).Conclusion The detection of serum FSH,LH,INHB levels and testicular volume has important clinical value for predicting testicular spermatogenie function in azoospermia patients,and can be used to guide clinical testicular sperm aspiration.

Objective To up-regulate the expression of Glil gene in periodontal ligament stem cells ( PDLSCs) and to explore the effect of Glil gene on PDLSCs proliferation and osteogenesis differentiation by establishing Glil gene adenovirus vectors. Methods Subcloned Glil to viral backbone vector Adtrack-CMV and transfered the established vector to 293T cells, which was to acquire the virus particles. Trans-fected aim cells,namely PDLSCs,with these virus. Detected its effect on PDLSCs proliferation with CCK-8 assay, and detected the expression of Glil and the bone-related markers ALP and Runx2 through Western blot. Results An adenovirus vector, which were over expressed Glil gene, was successfully constructed and transfected to PDLSCs. Compared with the empty vector group and normal group, the over expressed one had a much slower proliferation rate in CCK-8 assay (P=0. 003). Western blot showed that ALP and Runx2 can be overexpressing os-teogenic differentiated after PDLSCs successfully transfected with the Glil gene. Conclusion Over expressing Glil gene would lead to a much slower proliferation rate in the PDLSCs and an increase of the bone-related markers. It is concluded that Glil can enhance the osteogenic dif-ferentiation capacity in PDLSCs.

Objective To evalute the effects of subcutaneous transfection of human beta-nerve growth factor (Ad-hNGFβ) gene on the function of sensory nerve in a rat model of diabetic neuropathic pain (DNP).Methods Healthy male Sprague-Dawley rats,weighing 180-220 g,were used in this study.Ten rats were randomly collected as normal control without DNP (group C).DNP model was established by intraperitoneal injection of streptozocin (STZ) 75 mg/kg.Seventy-five rats with DNP were randomly divided into 3 groups (n =25 each):DNP group; Ad-hNGF group and Ad-LacZ group.Groups Ad-NGF and Ad-LacZ received subcutaneous transfection of 1.12 × 1011 PFU Ad-hNGFβ 10 ul and 1.12 × 1011 PFU Ad-LacZ 10 ul respectively after pain thresholds were measured on 21 days after STZ injection.The mechanical and thermal pain thresholds were measured before STZ injection (baseline) and at 21,35 and 49 days after STZ injection.The conduction velocity and latency of the sensory nerve and the expression of substance P (SP) in dorsal root ganglion (by immmuno-histpchemistry) were determined after measurement of pain threshold on 49 days after STZ injection.Results Compared with group C,the mechanical and thermal pain thresholds were significantly increased at each time point after STZ injection in groups DNP,Ad-NGF and Ad-Lacz,the conduction velocity of the sensory nerve was significantly decreased,the latency of the sensory nerve was prolonged,and the expression of SP in dorsal root ganglion was down-regulated in groups DNP and Ad-LacZ,the conduction velocity of the sensory nerve was significantly decreased (P ＜ 0.05),and no significant change was found in the latency of the sensory nerve and expression of SP in dorsal root ganglion in group Ad-NGF (P ＞ 0.05).Compared with group DNP,the thermal pain threshold was significantly increased at 49 days after STZ injection,the conduction velocity of the sensory nerve was decreased,the latency of the sensory nerve was shortened,and the expression of SP in dorsal root ganglion was down-regulated (P ＜ 0.05 or 0.01),while no significant change was found in the mechanical pain threshold in group Ad-NGF,and no significant change was found in the parameters mentioned above in group Ad-LacZ (P ＞ 0.05).Conclusion Subcutaneous transfection of Ad-hNGFβ can improve the function of sensory nerve in a rat model of DNP through up-regulat-ing of the SP expression in dorsal root ganglion.