Fungal infections of the digestive tract in children can be caused by a variety of fungi, the most common of which are Candida and Aspergillus.Occurrence of invasive fungal infections is dependent on numerous factors including geographic location and routes of exposure, and host factors, such as predisposing conditions, high-risk medications, or underlying medical comorbidities that modulate overall immune function.However, advances in DNA and ribosomal RNA sequencing and serologic testing have led to shifts in how gut fungal microbiota are identified and in diagnosing opportunistic infections.This article will briefly expound the common pathogens, risk factors, clinical manifestations, diagnosis, and treatment of gastrointestinal fungal infections in children.

Objective:To explore the talent cultivation model of nursing professional group under the 1+X certificate system, to build a talent cultivation system for nursing professional groups with "three progressions, four integrations, and five cocultivation"Methods:From 1 July 2021 to 31 December 2023, built a professional group course system of "mutual sharing of foundations, mutual generation of majors, mutual selection of positions, and progressive improvement of abilities". Aligned course content with X certificate content. Deepen the reform of the three education systems, create a "dual teacher" teaching team that combines full-time and part-time work, and build teaching resources that connect the cloud and the ground. The application effect of this model was evaluated in 2021 nursing majors in Cangzhou Medical College by cluster sampling.Results:There were 748 students majoring in nursing in class of 2021, 150 boys aged 19-22(20.00 ± 1.23), 598 girls, aged 19-21(19.00 ± 2.57). There were 118 students majoring in midwifery in class of 2021, all of them were girls, aged 18-20(18.00 ± 2.11). There were 128 students majoring in rehabilitation therapy technology in class of 2021, 66 boys aged 19-21(19.00 ± 2.11), 62 girls aged 19-21(19.00 ± 2.54). Nursing professional group completed the "Basic Nursing Technology Training Guidance", "Elderly Care" and other 5 self-compiled textbooks, 730 students had participated in the X certificate assessment, 729 students e passed the assessment, the passing rate was 99.9%.Conclusions:The talent cultivation model of "three progressions, four integrations, and five co cultivation" in the nursing professional group can cultivate students′ professional abilities, and cultivate a composite technical and skilled talent with multiple abilities and interconnections in one job.

Purpose/Significance To solve the problem that regional clinical research data are difficult to integrate efficiently,and to promote"Chinese evidence"and"Chinese protocol"in the global clinical research community.Method/Process Based on the standard-ization theory,the data standardization system is proposed,and the construction and application methods of the regional clinical research data platform are explored with the integration of multi-center clinical research data as the starting point.Result/Conclusion The theo-retical framework of the regional clinical research data platform has been preliminarily established,and the clinical research capabilities of tertiary hospitals in Shanghai have been significantly improved.

Objective:To explore the value of different radiomics models based on machine learning in predicting the risk of distant recurrence and metastasis of triple-negative breast cancer after neoadjuvant therapy.Methods:The clinical and imaging data of 150 patients with triple-negative breast cancer (TNBC) confirmed by histopathology were retrospectively analyzed. All patients underwent neoadjuvant chemotherapy and surgical resection from August 2011 to May 2017 in Fudan University Shanghai Cancer Center and Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. One hundred and nine patients from Shanghai Fudan University Shanghai Cancer Center were used as the training group, and 41 patients from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were used as the validation group. The features were extracted from dynamic contrast-enhanced MRI (DCE-MRI) before treatment and were added with time domain features innovatively. Least absolute shrinkage and selection operator cross validation and recursive feature elimination were applied to select features. Six different supervised machine learning algorithms (logistic regression, linear discriminant analysis, k-nearest neighbor, naive bayesian, decision tree, support vector machine) were used to predict the prognosis. ROC curve, accuracy and F1 measure were used to evaluate the performance of the six algorithms, and also verified by the validation group.Results:The support vector machine algorithm had the best predictive effect in the recurrence and metastasis model based on 15 features, with the highest area under curve (training group was 0.917, validation group was 0.859), and the highest accuracy rate (training group was 87.5%, validation group was 82.9%) and the highest F1 measure (training group was 0.800, validation group was 0.741). In addition, of the 15 imaging features, 12 were the time domain features and 3 were spatial features.Conclusion:With the help of the time domain features and machine learning algorithms, radiomics signatures based on preoperative DCE-MRI can help predict the distant prognosis for TNBC after neoadjuvant chemotherapy and provide support for clinical decision making and follow-up management.

Objective:To explore a new training mode for nursing professionals suitable for the 1+X certificate system, and realize the training goal of "one specialty and multi-ability" compound technical nursing talents.Methods:To take the "1+ X" certificate standard as the basis for the construction of nursing specialty, to reconstruct the talent training program of integration of graduation certificate and certificate. To take the content of "1+X" certificate as the basis for the construction of professional courses, construct the core curriculum system of integration of curriculum and certificate. To build a "new double-qualified" teaching staff and constructing of new double-qualified teachers and accelerate the development of quality resources.Results:The talent training mode of integration of graduation certificate and certificate under the 1+X certificate system was constructed. The curriculum structure has been optimized. The teachers′ability of teaching, training and examination was improved.Conclusions:The new mode of training nursing professionals under the 1+X certificate system meets 1 degree education and X vocational training of nursing students and achieve a "1" and "X" seamless convergence. It provides innovative ideas for the promotion and implementation of 1+X certificate system pilot work in the field of nursing education nationwide.

Objective:To investigate the knowledge of the disease and demands of medical intervention in high-risk individuals of arteriosclerotic cardiovascular diseases (ASCVD).Methods:The 10-year ASCVD incidence risk prediction model was used to screen ASCVD high-risk individuals from Luohu district of Shenzhen city. From October 2018 to April 2019,a semi-structured in-depth interview was conducted among ASCVD high-risk individuals selected by stratified sampling method according to age, gender and educational level. The original data were analyzed with Colaizzi′s seven-step analysis method.Results:Total 37 interviewees were enrolled with an average age of (65.2±8.9) years and with an average ASCVD risk value of (14.2±3.2). Three themes were extracted from the interview, including: (1) Majority interviewees had better Knowledge about the hazards and risk factors of ASCVD; (2) Most of the interviewees had lower medical demands; (3) The interviewees were more likely to focus on symptomatic diseases or diseases disturbing them.Conclusions:The asymptomatic high-risk ASCVD individuals generally have better awareness of ASCVD and less demands for intervention. The result indicates that for health education, not only the knowledge, but also the attitude and behavior should be enhanced.

Objective: To explore the mental health status and influencing factors of medical staff after blood-borne occupational exposure, and to provide scientific basis for effective psychological intervention. Methods: From January 2017 to December 2018, 178 medical staff with blood-borne occupational exposure in three hospitals of Shandong Province were collected as the contact group, and 100 routine medical staff as the control group during the same period. Questionnaires were conducted among medical staff in the two groups, including general information questionnaire, symptom checklist 90 (SCL-90) , post-traumatic stress disorder self-rating scale (PCL-C) , coping style scale (CPS) , social support scale (SSRS) . The basic situation and mental health level of medical staff in the two groups, as well as the coping and social support status of medical staff exposed to hematogenous occupational exposure were analyzed. Relevant influencing factors. Results: The total score of SCL-90 was 1.66+0.33, 45 (38.14%) were positive, and 21 (21.00%) were positive in the control group. The difference was statistically significant (χ²=7.529, P<0.05) . Compared with the control group, the scores of SCL-90 somatization, obsessive-compulsive symptoms, depression, anxiety, hostility, paranoia and total scores of medical staff in the exposure group increased significantly (P<0.05) . The total PCL-C score of exposure group was 36.84+9.50, PTSD positive 47 (39.83%) and control group 13 (13.00%) . The difference was statistically significant (χ²=19.534, P<0.05) . Compared with the control group, PCL-C re-experience, avoidance, vigilance factor scores and total scores of medical staff in the contact group increased significantly (P<0.05) . The problem solving, help seeking and subjective support of the medical staff in the positive mental health group with blood-borne occupational exposure were significantly lower than those in the negative group, while self-blame, fantasy and withdrawal were significantly higher than those in the negative group (P<0.05) . The mental health level of medical staff with occupational exposure was negatively correlated with problem solving, help seeking and subjective support, and positively correlated with self-blame, fantasy and withdrawal (P<0.05) . Problem solving, help seeking and subjective support were protective factors of mental health (OR=2.121, 1.616, 1.371) , and self-blame and withdrawal were risk factors of mental health (OR=0.160, 0.484) . Conclusion Medical personnel exposed to blood-borne occupational exposure are prone to psychological problems and PTSD. Solving problems, seeking help and subjective support are protective factors for mental health, while self-blame and withdrawal are risk factors for mental health.

Objective To study the effect of predictive nursing combined with 317 nursing-nurse's education assistant on the bowel preparation of elderly patients.Methods The elderly patients who was hospitalized or physically examined between March and December 2017 were divided into two groups with their wills:60 cases in the observation group and 58 cases in the control group.In the former group, the education with the predictive nursing and the 317 nursing-nurse's education assistant by primary nurses was conducted and in the latter,the traditional oral and paper method was used for the bowel preparation. Results The quality of bowel preparation in the observation group was significantly higher than that in the control group. The complication rate in the observation group was significantly lower than that in the control group (P<0.05). Conclusion The predictive nursing combined with the 317 nursing-nurse's education assistant can improve the bowel preparation quality and reduce the complication rate in the elderly patients.

Objective To investigate the physical constitution and living habits of 800 hypertensive patients by using the current investigation method, and to further explore the relationship.Methods The TCM constitution types and living habits of 800 hypertensive patients who met the diagnostic criteria of hypertension in outpatient and inpatient department of Shaanxi University of Traditional Chinese Medicine from 2014 to 2015 were studied.Results Hypertension patients showed the highest frequency of mediocre, and partial physical constitutionincluded yin deficiency, yang deficiency, phlegm and dampness, qi stagnation, dampness and heat, special temperament and blood stasis. It showed significant difference among the TCM constitution in the fields of age, gender (χ2 values were 40.273, 56.457, 31.719,P<0.01); the coronary heart disease, cerebrovascular disease and blood pressure control were consistent with the distribution of physical types of population, and the difference was significant (χ2 values were 48.975, 8.321, 6.514,P<0.01). In terms of lifestyle, the differences in physical constitution between different tastes were statistically significant (χ2= 480.403,P<0.05); exercise time and sleep (P<0.05), and the difference was significant (P<0.001) the relationship between yin deficiency and exercise time (P<0.001); phlegm-dampness and exercise time and sleep time (P=0.009,P<0.001,P=0.001); qi stagnation and dietary hobby and sleep time (P<0.001); special temperament and diet and sleep time (P values were 0.001, 0.008, respectively).Conclusions The constitution type of TCM in hypertensive patients is related to sex, age, educational level and previous diseases, and is affected by diet, exercise time and sleep habits

Objective: To compare aortic annular diameter measured by transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and multislice computed tomography (MSCT) in patients with severe aortic stenosis, and to evaluate the impact on selection of prosthetic valve type in transcatheter aortic valve implantation (TAVI). Methods: Clinical data of 138 patients with severe aortic stenosis referred for TAVI between January 2014 and June 2016 in our hospital were retrospectively analyzed.The difference of aortic annular diameter measured by TTE, TEE, and MSCT were compared.TTE was performed after TAVI to evaluate the accuracy of measurement before TAVI. Results: (1) Aortic annular diameter was (23.37±2.22) mm by TTE and (23.52±1.70) mm by TEE (P=0.12). Pearson correlation analysis showed that aortic annular diameter measured by TTE was correlated to that measured by TEE (r=0.87, P<0.05). (2)The long-axis diameter and the short-axis diameter measured by MSCT multiplanar reconstruction were significantly different ((27.86±2.87) mm vs. (21.91±2.53) mm, P<0.05). There was no significant difference between the mean of the long- and short-axis diameters and the diameter derived from cross-sectional area by MSCT ((24.92±2.38) mm vs. (24.84±2.25) mm, P=0.08). However, the diameter derived from the circumference ((25.35±2.34) mm) was significantly larger than the mean of the long- and short-axis diameters and the diameter derived from cross-sectional area by MSCT, and the difference were (0.43±0.62) mm and (0.51±0.62) mm respectively(both P<0.05). (3) Measurements of the aortic annulus diameter by MSCT including the mean of the long- and short-axis diameters, diameter derived from cross-sectional area, and diameter derived from the circumference were larger than the measurement by TTE and TTE (all P<0.05). (4) Implantation was successful in all patients.Moderate to severe paravalvular leakage was detected in 3 patients at 7 days post TAVI, and 1 patient developed severe prosthetic valve restenosis at 6 months post TAVI and received valve-in-valve implantation. Conclusions In severe aortic stenosis patients referred for TAVI, the aortic annular diameter derived from TTE and TEE measurements are smaller than that from MSCT.In the absence of a gold standard, selection of prosthetic valve type in TAVI procedure should rely on comprehensive considerations, which is of importance to get good clinical results for severe aortic stenosis patients underwent TAVI.