Objective: To explore the correlation among picky eating levels in preschool children, parental self-efficacy and parenting stress. Methods: A convenience sampling method was employed to conduct an electronic questionnaire survey among 459 children aged 3-6 years and their parents from five kindergartens in Urumqi in November 2023. The survey included a general information questionnaire, the Children s Eating Behavior Questionnaire (CEBQ), the Parenting Sense of Competence Scale (PSOC), and the Parenting Stress Index-Short Form (PSI-SF). The Mann-Whitney U-test was used for twogroup comparisons, and the Kruskal-Wallis H-test was applied for multi-group comparisons. Spearman correlation analysis was conducted to examine the relationships between children s picky eating levels and parenting selfefficacy as well as parenting stress. Results: The picky eating score of preschool children was 10.00 (4.00), and the parenting self-efficacy score was 58.00 (12.00), both indicating a moderate level. The parenting stress score was 75.00 (16.00), reflecting a moderately low level. Spearman correlation analysis showed that children s picky eating levels were negatively correlated with the total score of parenting self-efficacy ( r =-0.28) and positively correlated with the total score of parenting stress( r =0.25)( P <0.01). Conclusions Picky eating levels of preschool children are closely associated with parenting self-efficacy and parenting stress. Picky eating behaviors in children can be reduced by implementing various effective measures to enhance parenting self-efficacy and alleviate parenting stress.

Objective To investigate the status and influencing factors of overweight and obesity among primary and secondary school students in Pudong New Area of Shanghai, and to provide reference for formulating obesity-related intervention strategies for school-age children. Methods Stratified cluster random sampling method was used to conduct a questionnaire survey among primary and secondary school students in Pudong New Area. The overweight and obesity rate was calculated according to the Chinese health industry standard, and the risk factors of overweight and obesity in children and adolescents of different school age groups were analyzed by logistic regression. Results The overweight and obesity rate (25.3%) of primary and secondary school students in Pudong New Area exceeded the national average level. In primary school group, male, sleep time ≥ 8h per day, water intake ≥ 1200 mL per day, and the presence of mobile food stalls around the school were the risk factors for overweight and obesity. Daily extracurricular exercise time of 30 minutes to 2 hours was a protective factor. In junior high school group, male and electronic product use time of ≥ 2h per day were the risk factors for overweight and obesity. The daily extracurricular exercise time of 1 to 2 hours was a protective factor. In high school group, drinking water ≥1200mL per day was a risk factor for overweight and obesity. Eating breakfast every day for the past week was a protective factor. Conclusion Group intervention targeting overweight and obese school-age children, while changing corresponding unhealthy habits according to different school age groups, is crucial for weight loss in school-age children.

Objective:To construct a bundled therapy management and practice program for sepsis and explore its clinical application effect.Methods:① Construction of sepsis bundled therapy management and practice program: a project team was established to conduct literature review, select experts, compile and distribute questionnaires, organize, analyze expert opinions, and ensure quality control throughout the research process. From October to November 2022, expert letter consultation was carried out, and questionnaires were distributed and collected by on-site filling and WeChat. The Likert 5-point scale was used to rate each item. ② Clinical application of the protocol: ninety patients with sepsis admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Xinjiang Medical University from January to July 2022 were retrospectively selected as the control group, and routine bundle treatment and nursing strategy for sepsis were adopted. Ninety patients with sepsis admitted from January to July 2023 were prospectively selected as the intervention group. Based on the treatment and nursing strategy of the control group, sepsis bundled therapy management and practice program constructed using the Delphi inquiry method was implemented. The completion rate of 1-hour, 3-hour and 6-hour bundle, the levels of inflammatory indicators at 1, 3, 7 days of treatment, and prognostic indicators were compared between the two groups.Results:① Construction of sepsis bundled therapy management and practice program: the final plan consists of 4 primary indicators, 15 secondary indicators and 34 tertiary indicators. The response rates for both rounds of inquiry questionnaires were 100%. The coefficients of expert authority value were 0.948 and 0.940, respectively. The coefficient of variation for each item was 0-0.287 and 0-0.187, respectively. Kendall's W coefficients were 0.242 and 0.249, respectively, with statistical significances (all P < 0.05). ② Clinical application of the protocol: there were no statistically significant differences in baseline data such as age, gender, infection site, pathogen species, duration of mechanical ventilation, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) between the two groups. The completion rate of 1-hour, 3-hour and 6-hour bundle in the intervention group were higher than those in the control group (1-hour bundle completion rate: 53.30% vs. 21.10%, 3-hour bundle completion rate: 92.20% vs. 80.00%, 6-hour bundle completion rate: 88.89% vs. 65.56%, all P < 0.05). The levels of C-reactive protein (CRP), white blood cell count (WBC), procalcitonin (PCT), and interleukin-6 (IL-6) in two groups of patients showed statistically significant differences at different time points, between groups, and in interaction effects. Compared with the control group, the length of ICU stay in the intervention group was significantly shortened [days: 7.00 (4.00, 14.00) vs. 8.00 (7.00, 20.00), P < 0.01], and the hospitalization cost of ICU was significantly reduced [ten thousand yuan: 4.63 (3.36, 6.19) vs. 6.46 (3.32, 11.34), P < 0.05]. The 28-day mortality in the intervention group was lower than that in the control group (33.33% vs. 46.67%), but the difference was not statistically significant ( P > 0.05). Conclusions:The constructed bundled therapy management and practice program for sepsis can improve the completion rate of bundle treatment, shorten the length of ICU stay of sepsis patients, reduce the hospitalization cost in ICU, and have a tendency to reduce the 28-day mortality.

Objective To retrieve,evaluate and summarize the best evidence on the management of ocular complications in intensive care patients ventilated in prone position,and to provide references for clinical practice.Methods Evidence on management of ocular complications in intensive care patients ventilated in prone position was systemically retrieved in the guideline websites,professional association websites and databases,such as the BMJ Best Practice,UpToDate,Cochrane Library,Joanna Briggs Institute,PubMed,Web of Science,Science Direct,Embase,CNKI,Wanfang and other databases,including guidelines,clinical decisions,evidence summaries,expert consensuses,group standards,systematic reviews and scoping reviews,published from January 2013 to June 2023.The guidelines were individually evaluated by 4 researchers,and the remaining literature was individually evaluated by 2 researchers.The literature that met the criteria was extracted and graded.Results A total of 15 articles were involved,including 6 guidelines,2 clinical decisions,2 evidence summaries,3 systematic reviews,1 scoping review and 1 group standard.Finally,6 evidence topics and 16 pieces of best evidence were formed,including organization and training,risk identification,eye assessment,eye protection,position management and regular observation.Conclusion This study summarized the best evidence on the management of ocular complications in intensive care patients ventilated in prone position.In the application,the best evidence should be selected according to the clinical situation,so as to reduce the incidence of ocular complications and improve the quality of life of patients.

Objective To investigate knowledge,attitude and practice towards the fertility preservation of female cancer patients among clinical nurses in a cancer hospital,and to analyze influencing factors,so as to provide references for clinical implementation of related nursing services.Methods A self-designed questionnaire was delivered to 336 nurses working at a tertiary oncology hospital in Tianjin.Univariate analysis and multiple linear regression were used to analyze the factors influencing the knowledge,attitude,and practice level of female fertility preservation among nurses in a cancer hospital.Results In October 2022,a total of 291 nurses completed the questionnaires.The score of the knowledge,attitude and practice were(46.13±8.66),31.00(29.00,33.00),12.00(8.00,14.00),respectively,and the total score was(88.08±12.78).Multiple logistic regression analysis showed that education level,position,department types and whether or not getting the knowledge about fertility preservation of female cancer patients were the influencing factors for the total scores of knowledge,attitude and practice(P＜0.05).Conclusion Nurses who work at the cancer hospital have a positive attitude towards fertility preservation for female cancer patients,while their knowledge and practice level need be improved.Nursing administrators should attach importance to improving the knowledge level and practical ability of nurses in cancer hospitals to protect the fertility of female cancer patients,so as to promote the development of onco-fertility nursing in the future.

Objective To understand the experience of oncology nurses participating in fertility preservation services,and to provide a reference for oncology nurses to formulate targeted training courses and management measure.Methods From September to November 2023,phenomenological research methods were used to select 14 oncology nurses in a tertiary A cancer hospital in Tianjin for semi-structured interviews.Colaizzi 7-step analysis method was used to analyze the interview data and summarize the themes.Results 3 themes and 10 sub-themes were extracted:①The driving forces for participating in fertility preservation services(long-term benefits of fertility preservation,individual conditions of cancer patients,self-conscious cognition of role responsibilities,and internal drivers of empathy);②Oncology nurses are hampered by the lack of professional quality(knowledge system has not been built,ideological deviation needs to be corrected,communication skills need to be strengthened);③ The practical difficulties of oncology nurses participating in fertility preservation services(lack of targeted education and training,lack of multidisciplinary team contact channels,and lack of normative institutional guarantee).Conclusion Oncology nurses play an indispensable role in fertility preservation services.Hospitals need to pay attention to the unique role of oncology nurses and develop targeted training courses to improve their professional quality,so as to promote the implementation of fertility preservation services in China.

We retrieved the data on sexual-health internet hospitals from the Baidu Search Engine and Apple and Android APP Stores between August 2018 and September 2022.With the specialized Sexual-Health Internet Hospital affiliated to SPPH as an exam-ple,we analyzed its framework and system.It fully displays the closed-loop of medical service system of"doctor-patient-medicine-insurance-delivery",provides the protection of patients'privacy,offers comprehensive services,and manifests the values of socializa-tion,instrumentalization and commercialization.The booming of the internet medical industry in China is driven by national policies,and the rapid-rising of specialized internet hospitals largely stems from the clearer requirements of the state for regulation compliance and operation supervision.Against the background of the global spread of COVID-19,which has been demonstrated with a significant correlation to sexual health,only further rational and standardized management can ensure safe and efficient development of sexual-health internet hospitals to satisfy various health needs.

Objective:To analyze the effectiveness and interobserver agreement of the Parer five-tier, the National Institute of Child Health and Human Development (NICHD) three-tier, and the International Federation of Gynecology and Obstetrics (FIGO) three-tier electronic fetal monitoring (EFM) systems in identification of neonatal acidosis during labor.Methods:This retrospective study was conducted on full-term singleton cephalic deliveries with neonatal acidosis (umbilical artery blood gas pH≤7.1) and normal newborns (umbilical artery blood gas pH≥7.2) in the Nanjing Drum Tower Hospital, Nanjing University Medical School from January to December 2020. EFM tracings during the last 30-60 min before delivery were collected. Four obstetricians independently described the features of randomly sorted and coded EFM tracings. Another obstetrician categorized these tracings using the NICHD three-tier, FIGO three-tier, and Parer five-tier evaluation systems based on the features. All researchers were masked to the clinical characteristics and maternal and neonatal outcomes. The sensitivity and specificity for identifying neonatal acidosis, as well as the interobserver agreement, were analyzed for all three systems. Independent sample t-test, Chi-square (or Fisher's exact test) and Mann-Whitney U tests were used for statistical analysis. Inter-group comparisons of sensitivity and specificity between the three evaluation systems were assessed using McNemar's test. The Kappa statistic was used to analyze interobserver agreement. Results:This study included a total of 3 558 cases. After propensity score matching, there were 44 cases of neonatal acidosis and 78 control cases. There were no significant differences in parity, gestational weeks, modes of delivery, placental abruption, or analgesia rates between the two groups. The rates of instrumental vaginal delivery and neonatal intensive care unit (NICU) admission in the acidosis group were significantly higher than those in the control group [15.8% (7/44) vs. 2.6% (2/78), χ2=8.45, P=0.003; 31.8% (14/44) vs. 12.8% (10/78), χ2=8.45, P=0.004], while the umbilical artery blood pH and mean base excess were lower in the acidosis group than in the control group [7.04±0.07 vs. 7.30±0.05, t=4.98; (－12.40±3.32) vs. (－5.64±1.95) mmol/L, t=13.61; both P<0.001]. (2) Using the NICHD three-tier system, 95.5% (42/44) of the acidosis cases and 89.7% (70/78) of the control cases were classified as having category Ⅱ EFM tracings, indicating potential fetal acid-base imbalance; category Ⅲ EFM tracings were only observed in 4.5% (2/44) of the cases in the acidosis group. With the FIGO three-tier system, 81.8% (36/44) of the acidosis cases were categorized as having "pathological" tracings, and with the Parer five-tier system, 86.4% (38/44) of the acidosis cases were correctly classified into the "orange or red" risk zones that indicated acid-base imbalance. Among the control cases, there were 28.2% (22/78) with EFM tracings of "normal patterns" categorized by the FIGO three-tier system, and 41.0% (32/78) classified into the "green or blue" risk zones by the Parer five-tier system, which indicated good fetal conditions. None of the acidosis cases were misdiagnosed as being normal by the Parer five-tier system. (3) Compared with the NICHD three-tier system, both the FIGO three-tier and the Parer five-tier systems showed increased diagnostic sensitivity [4.5% (1.2%- 14.5%) vs. 81.8% (66.8%-89.4%) and 86.4% (71.8%-92.4%)], but decreased specificity [100.0% (95.3%- 100.0%) vs. 87.2% (78.0%-92.9%) and 84.6% (75.0%-91.0%)]. There was no statistically significant difference in the sensitivity or specificity between the FIGO three-tier and Parer five-tier systems for identifying neonatal acidosis ( P=0.727 and 0.791). (4) When reading the tracings of control cases, the total agreement rate for the NICHD three-tier system by different observers was as high as 94.2%, while the total agreement rates for the FIGO three-tier and Parer five-tier systems were 69.7% and 67.7%, respectively. In the interpretation of EFHR tracings for acidosis cases, the interobserver agreement for the Parer five-tier system was excellent [Kappa (95% CI): 0.87 (0.79-0.95)], while both the NICHD three-tier and FIGO three-tier systems showed good agreement [Kappa (95% CI): 0.77 (0.66-0.88) and 0.72 (0.60-0.84)]. Conclusions:The Parer five-tier and the FIGO three-tier systems have higher sensitivity in identifying neonatal acidosis than the NICHD three-tier system, and the Parer five-tier system achieves a higher negative predictive value and a greater agreement in the interpretation of pathological EFM patterns.

Objective:To investigate the factors that influence the prolongation of gestation following emergency cervical cerclage.Methods:This retrospective study included 88 singleton pregnant women who were diagnosed with cervical incompetence and underwent emergency cervical cerclage at 12-26 weeks of gestation in the Jiaxing Maternity and Child Health Care Hospital from January 1, 2019 to September 1, 2022. The participants who delivered after 28 gestational weeks were assigned to the success group ( n=77), while those who delivered or miscarried before 28 gestational weeks were assigned to the failure group ( n=11). Two independent sample t-test or Mann-Whitney U test was used for comparison between groups. The factors affecting the prolongation of gestation after the procedure were selected by univariate analysis and multiple regression equations. Results:The success rate (delivery rate≥28 weeks) was 87.5% (77/88). There were six women delivered at 28-31 +6 weeks of gestation (6/77, 7.8%), two at 32-33 +6 weeks of gestation (2/77, 2.6%), 16 at 34-36 +6 weeks of gestation (16/77, 20.8%), and 53 at 37 weeks of gestation or later (53/77, 68.8%). Multiple regression analysis indicated that three times of early pregnancy miscarriage ( β=－5.1, 95% CI: -9.5 to -0.7), five times of early pregnancy miscarriage ( β=－11.8, 95% CI: -22.1 to -1.6), had two live births ( β=－6.9, 95% CI: -12.9 to -0.9), gestational age at cerclage ( β=－0.6, 95% CI: -1.0 to -0.3), external cervical os dilation<15 mm ( β=－12.1, 95% CI: -22.5 to -1.8) and ≥15 mm before cerclage ( β=－11.0, 95% CI: -21.4 to -0.71) were factors affecting the prolongation of gestation after cerclage. After adjusting for maternal age and weight before emergency cervical cerclage, five times of early pregnancy miscarriage ( β=－18.1, 95% CI: -28.3 to -7.8), gestational age at cerclage ( β=－0.6, 95% CI: -1.0 to -0.3), and external cervical os dilation≥15 mm before cerclage ( β=－11.4, 95% CI:－21.2 to -1.6) remained the significant influencing factors (all P<0.05). Conclusion:The number of early pregnancy miscarriages, gestational age at cerclage, and the width of external cervical os dilation before cerclage≥15 mm are the factors that influence the prolongation of gestation after the emergency cervical cerclage procedure.

A retrospective analysis was conducted on data of 13 patients with rectal or anal canal lesions involving the dentate line who underwent endoscopic submucosal dissection (ESD) at the Digestive Endoscopy Center of Jiangsu Province Hospital of Chinese Medicine from January 2022 to July 2023. The efficacy and safety of ESD were evaluated. ESD was performed on 14 lesions in 13 patients. The lesions had a length of 1.4 to 12.5 cm and 5.4 cm in average, which were removed entirely in a single session, with an R0 resection rate of 92.31% (12/13). The ESD procedure duration ranged from 35 to 225 minutes, with an average of 88.3 minutes. Anal canal stenosis occurred in 1 case after ESD, which was improved after treatment with anal dilatation. No delayed bleeding, perforation, or other complications occurred. Pathological examination after ESD revealed 6 tubulovillous adenoma, 2 tubular adenoma, 3 tubular adenocarcinoma, and 2 squamous epithelial intraepithelial neoplasia (both 2 lesions were combined with human papillomavirus infection). In one case of tubular adenocarcinoma, the local resection margin showed focal tubulovillous adenoma, while the other cases were negative on lateral margins around and basal margins. The median follow-up period was 7.0 months (range 2 to 13 months), with no local residue, recurrence or metastasis observed. ESD is safe and effective for early rectal or anal canal lesions involving the dentate line, and is worthy of clinical promotion and application.