Objective To observe the clinical effect of the preventive device for foot stress injury in bedridden patients with stroke.Methods A total of 166 patients with stroke who were hospitalized in the department of intensive care unit(ICU)of Hangzhou First People's Hospital from March 2021 to March 2022 were selected as the study subjects.The experimental design of the quantitative study was adopted,and the patients were divided into the control group(ICU 4th floor patients)and the observation group(ICU 5th floor patients)according to the different ward of ICU,with 83 cases in each group.Nurses were also grouped according to this method(41 in observation group,43 in control group).Both groups received conventional treatment and nursing care to prevent pressure injury.The control group was depressurized by sponge ring or existing pillow,and the foot sagging was prevented by T-shoe lined towel.The observation group used the self-designed and developed foot pressure injury prevention device for bedridden patients.The incidence of foot stress injury and foot drop,as well as the satisfaction of patients with using the preventive device for foot stress and the satisfaction of nurses with operating the preventive device for foot stress were observed.Results The incidence of foot pressure injury and foot drop in the observation group was significantly lower than that in the control group[incidence of foot pressure injury:3.61%(3/83)vs.8.43%(7/83),the incidence of foot drop:9.64%(8/83)vs.16.87%(14/83),both P<0.05].The satisfaction of patients in the observation group was significantly higher than that in the control group[91.6%(76/83)vs.79.5%(66/83),P<0.05],and nurse satisfaction in the observation group was higher than that in the control group[95.1%(39/41)vs.86.0%(37/43)],but there was no significant difference between the two groups(P>0.05).Conclusion The foot stress injury prevention device is suitable for patients with severe stroke in bed,which can effectively reduce the incidence of stress injury and foot drop,improve the satisfaction of patients and operators,and is worthy of clinical promotion.

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.

To summarize the reform measures of nursing vertical management in our hospital under the background of diagnosis related groups,including refined performance management,cancellation of nursing main pharmacy classes,implementation of attending nursing working group,establishment of DRGs nursing quality control coder position,head nurse responsible for bed allocation,deepening nursing quality management and other measures,so as to provide references for other hospitals to carry out the reform of nursing vertical management under the background of DRGs.

Objective:To evaluate the health risk of fluoride in rural drinking water in drinking-water-borne endemic fluorosis(referred to as drinking-water-borne fluorosis) areas of Shaanxi Province, and to provide scientific basis for the formulation of water improvement and fluoride reduction measures.Methods:The fluoride monitoring results of rural drinking water in Guanzhong Plain and Loess Plateau of Northern Shaanxi in drinking-water-borne fluorosis areas of Shaanxi Province in 2020 were collected from the "National Drinking Water Quality and Sanitation Monitoring Information System". Using the health risk assessment method recommended by the United States Environmental Protection Agency (USEPA), the level of fluoride exposure of adults in fluorosis areas through drinking water was evaluated, and the health risk value was calculated.Results:A total of 4 342 rural drinking water samples from drinking-water-borne fluorosis areas were monitored. The overall compliance rate of fluoride in water quality was 95.39% (4 142/4 342), and the fluoride content median was 0.470 mg/L; the health risk value was 0.368, and the non-carcinogenic risk was low. A total of 200 water samples with fluoride exceeding the standard were detected, and the fluoride content median was 1.450 mg/L; the health risk value of the fluoride excess water samples was 1.135, indicating a high non-carcinogenic risk. There were significant differences in fluoride content in rural drinking water between different regions, water sources and treatment methods ( H = - 7.73, - 7.60, 34.40, P < 0.05). Conclusions:The non-carcinogenic risk of fluoride exposure of adults in drinking-water-borne fluorosis areas through drinking water in Shaanxi Province is relatively low, and the non-carcinogenic risk caused by water samples with excessive fluoride is relatively high. In the future, it is necessary to continue to promote the comprehensive prevention and control measures focusing on improving water and reducing fluoride.

Acute kidney injury(AKI)is a very common critical disease worldwide, especially in pediatric intensive care unit(PICU). There are many pathogenic factors for AKI, among which sepsis is essential to the development of AKI.Sepsis-associated acute kidney injury(SA-AKI) often have sudden onset and poor prognosis.Because there is still a lack of powerful diagnostic tools, resulting in clinical intervention in SA-AKI often lags behind.Therefore, awareness of SA-AKI risk and early identification of injury severity, as well as timely initiation of supportive treatment, remain the main contents of current research.There are hundreds of new biological markers and diagnostic tools for early identification and prognosis of AKI.This review introduced the progress on diagnosis of SA-AKI.The aim is to improve clinicians′ understanding of SA-AKI.

Angiopoietin-like proteins (ANGPTLs) are a family of secretory glycoproteins recently found to be constitutionally homologous with angiogenin and play a role in the regulation of angiogenesis. In recent years, more and more studies have shown that ANGPTLs play an important role in glucose and lipid metabolism, inflammation, and tumor. As we all know, nonalcoholic fatty liver disease and its disease spectrum are closely associated with metabolism, inflammation, and tumor. This article reviews the role of ANGPTLs in various diseases associated with nonalcoholic fatty liver disease, in order to provide new ideas for the prevention and treatment of nonalcoholic fatty liver disease in clinical practice.

Objective To understand the status and dynamic changes in the treatment of rural garbage and sewage in Shaanxi Province and provide the basis for relevant departments to formulate policies and measures. Methods Every year from 2016 to 2018, 600 administrative villages in 30 agricultural counties were randomly selected as monitoring points, and 3 000 households were selected as monitoring households. Monitoring data was obtained through data reading, interviews, and on-site observations. Results The three-year rural population coverage rate of the garbage treatment plant was 28.31%, 36.10%, 39.36%, respectively, and the sewage treatment plant coverage rate was 12.27%, 20.39%, 15.02%, respectively. The annual differences were statistically significant（χ²=23.24、22.42，P=0.00）. The proportion of monitoring points for the three-year unified collection of domestic garbage was 30.50%, 43.67%, 51.00%, respectively, and the percentage of monitoring points for incineration garbage was 16.67%, 15.00%, 8.33%, respectively, and the annual differences were statistically significant（χ²=53.25、20.19，P=0.00）. The proportion of domestic sewage discharge monitoring points through pipelines was 12.67%, 11.17%, 31.17%, respectively, and the proportion of monitoring points discharged into treatment plants was 4.33%, 6.00%, 15.17%, respectively, and the annual differences were both statistically significant（χ²=99.45、52.50，P=0.00）. Conclusion In recent years, the rural garbage and sewage treatment situation in Shaanxi Province had improved, but there was still much room for improvement. It is recommended to increase environmental protection publicity and government investment, strengthen daily supervision, pay equal attention to construction and management, control the random stacking and discharging of garbage and sewage, and enhance the disposal rate of garbage and sewage.

Objective: To understand the status and trend of heavy metal indicators of drinking water in rural schools in different regions of Shaanxi Province, so as to provide scientific basis for safety of drinking water in rural schools. Methods: In 2017-2019, 697 rural school water supply projects in Shaanxi Province were tested for heavy metal indicators in the peripheral water. According to the sanitary standard for drinking water (GB 5749—2006), five heavy metal indicators, including arsenic, cadmium, hexavalent chromium, lead and mercury, were analyzed and evaluated in different years and regions. Results: A total of 2 298 valid water samples were collected and analyzed in 3 years. Except that lead and mercury are all up to standard, the standard rates of other heavy metals such as arsenic, cadmium and hexavalent chromium were 98.83%, 99.91% and 96.95% respectively. Compared with the Northern Shaanxi plateau and Qinba mountain area, the standard rate of water arsenic in Guanzhong Plain was lower (χ2=5.67, 13.59,P<0.01). The standard rate of hexavalent chromium was the highest in Qinba mountain area, followed by Guanzhong Plain, and the lowest in Northern Shaanxi plateau (χ2=20.48, 17.05, 48.32, P<0.01). Two samples of cadmium exceeding standard were from the Northern Shaanxi plateau. Conclusion The heavy metal index of drinking water in rural schools in Shaanxi Province exceeds the standard, which has obvious regional characteristics. We should focus on the harm of arsenic, hexavalent chromium and other heavy metals to the health of students in the Northern Shaanxi plateau and Guanzhong Plain. Cadmium and mercury in drinking water in local areas should be paid continued attention. Safety of drinking water in schools should be ensured from the aspects of water source selection and water treatment technology.

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.

Objective: To understand the disinfection status and microbial pollution of water supply project in rural schools in Shaanxi Province in 2018, and to provide basis for improving drinking water quality in rural schools. Methods: Data of water quality of water supply project in rural schools of Shaanxi Province in 2018 was collected, and the disinfectant surplus and microbial index compliance rate were analyzed according to "Sanitary Standard for Drinking Water" (GB 5749-2006). Results: The overall compliance rate of microbial indicators of water supply projects in rural schools in Shaanxi Province was 68.09%, and that of groundwater microbial indicators(71.97%) was higher than that of surface water(61.42%)(χ2=15.68, P<0.01); The overall compliance rate of microbial indicators in flood season(71.85%) was higher than that in dry season(64.34%)(χ2=7.44, P<0.01); The rate of reaching the standard of disinfectant residue was 77.27%. The rate of reaching the standard of microbial index of water samples with disinfection measures was higher than that of water samples without disinfection measures (χ2=31.88, P<0.01), The rate of reaching the standard of microbial index of water samples with disinfectant residue(88.89%) was higher than that of water samples with disinfectant residue(44.44%)(χ2=12.28, P<0. 01). Conclusion The main cause of microbial contamination of drinking water in rural schools in Shaanxi Province is inadequate equipment of disinfection equipment in water supply projects or not being used as required. It is suggested that schools, education and health departments should take measures to strengthen supervision and management of water plants to ensure the normal use of disinfection equipment.