At present, four operating modes have been explored for physical-medical integration in China: hospital health guidance center, sports club health guidance, community health monitoring center and industry-university-research cooperation on the integration of physical and medical services. However, physical-medical integration is still in its infancy, the cultivation of physical-medical integration talents has been a key to the deep development of "physical-medical integration". The researches show that the current training mode of integrative talents mainly focuses on on-the-job training, which is faced with many problems such as serious shortage of specialized talents, imperfect certification system and single talent training mode. It is suggested that the training system, the curriculum system, the public opinion system and the professional standards should be improved so as to realize the scientific and sustainable development of physical-medical talents.

Objective:Based on the microarray data mining method, the function and pathway of differential genes were analyzed after the differential genes were screened. At the same time, the core genes that determine the prognosis of pediatric hepatoblastoma were screened by coexpression network, and their predictive ability was evaluated.Methods:The microarray expression profile of pediatric hepatoblastoma used in this study was from the European Institute of bioinformatics (http: //www.ebi.ac.uk/embl/). The deadline for data collection was December 31, 2018. Firstly, the differentially expressed genes (gene expression level increased to 2 times or decreased to 1/2 of the original) were screened by SAM method, then the core genes were screened by coexpression network model based on dimension reduction principle, and the gene regulation evaluation score was calculated by MCODE algorithm to evaluate its regulation ability in the whole network model.Results:According to the enrichment results of 213 differentially expressed genes, the highest enrichment degree of signal pathway was metabolic pathways (2 122.529). The misjudgment rate of signal pathway enrichment results was less than 0.001, and the misjudgment rate was statistically significant by SAM method ( P<0.001). A total of 213 differentially expressed genes in different prognosis groups were used as the basis for the construction of the coexpression network. A total of 12 differentially expressed genes were included in the coexpression network. Using the poor prognosis group as the experimental group, and the better prognosis group as the control group, the MCODE algorithm was used to calculate the gene regulatory ability score. The results showed that the highest gene for determining the prognosis control ability of children hepatblastoma was ADH1A gene with a score of 19. In addition, the regulatory ability scores of HAO1, ADH1B, ALDOB and DPYS genes were higher than or close to 5, so they could be considered as the core genes in the coexpression network module. Conclusions:According to the results of coexpression network model, ADH1A gene is closely related to the occurrence and development of hepatoblastoma in children, and its molecular biological evidence needs to be further explored to guide the clinical development of tumor targeted intervention therapy.

Objective:To understand the characteristics and differences of diarrhea-related symptoms caused by different pathogens, and the clinical features of various pathogens causing diarrhea.Methods:Etiology surveillance program was conducted among 20 provinces of China from 2010 to 2016. The acute diarrhea outpatients were collected from clinics or hospitals. A questionnaire was used to survey demographics and clinical features. VFeces samples were taken for laboratory detection of 22 common diarrhea pathogens, to detect and analyze the clinical symptom pattern characteristics of the patient’s.Results:A total of 38 950 outpatients were enrolled from 20 provinces of China. The positive rates of Rotavirus and Norovirus were the highest among the five diarrhea-causing viruses (Rotavirus: 18.29%, Norovirus: 13.06%). In the isolation and culture of 17 diarrhea-causing bacterial, Escherichia coli showed the highest positive rates (6.25%). The clinical features of bacterial diarrhea and viral diarrhea were mainly reflected in the results of fecal traits and routine examination, but pathogenic Vibrio infection was similar to viral diarrhea. Conclusion:Infectious diarrhea presents different characteristics due to various symptoms which can provide a basis for clinical diagnosis.

Objective? To explore the current situation of health empowerment of elderly fragility fracture patients and to analyze its influencing factors. Methods? We selected four Class Ⅲ Grade A hospitals randomly in Hengyang. From October 2017 to February 2018, a total of 176 elderly fragility fracture inpatients were investigated with the self-designed general information questionnaire, Elderly Frailty Assessment Scale, Osteoporosis Self-Efficacy Scale (OSES), Health Empowerment Scale for Elderly Patients with Chronic Disease. Multiple linear regression analysis was used to explore the influencing factors of health empowerment of patients. Results? The score of health empowerment of elderly fragility fracture patients was (89.00±14.31) and responsibility belief dimension was with the highest score (3.74±0.88). Patients' health empowerment had a negative correlation with the frailty (r=-0.576, P＜0.01) and had a positive correlation with the self-efficacy (r=0.496, P＜ 0.01). Multiple linear regression analysis showed that the main influencing factors of health empowerment of patients included ages, education levels, medical payment methods, frailty and self-efficacy (P＜0.05). Conclusions? Nurses should pay attention to patients' health empowerment ability and provide the individualized nursing to strengthen the health empowerment ability of elderly fragility fracture patients.

OBJECTIVE:To screen the method for extracting total flavonoids in persimmon leaves and optimize extraction tech-nology. METHODS:Using extract quality and flavonoids content as indexes,the effects of extracting total flavonoids in persim-mon leaves by ethanol refluxing method,enzyme method(cellulase,β-glucanase and complex enzyme mixed by equal amounts of both),semi-bionic method and semi-bionic-enzyme method (the same enzymes) were compared. Using flavonoids content as in-dex,solid-liquid radio,reflux temperature,reflux time as factors,orthogonal test was designed to optimize the extraction technolo-gy conditions of flavonoids in persimmon leaves by semi-bionic-enzyme method,and the verification test was conducted. RE-SULTS:The extract quantity and flavonoids content by semi-bionic-enzyme method was the highest among the 4 extraction meth-ods,and the complex enzyme was the most suitable;the optimized extracting condition of semi-bionic-enzyme method were as fol-lows as solid-liquid radio of 1:14,reflux temperature of 50 ℃,reflux time of 2.0 h;extraction rates of flavonoids in 3 verification tests were 5.9%,5.8%,5.9%(RSD=0.98%,n=3). CONCLUSIONS:The optimized semi-bionic-enzyme method is efficient and stable in extracting flavonoids in persimmon leaves.

Objective To understand the status of knowledge awareness rates and influencing factors of clonorchiasis among the residents in 4 counties(cities)of Hunan Province,so as to provide the references for formulating the prevention and control strategy of clonorchiasis in the province. Methods A total of 1224 subjects were selected by the multi-stage cluster sampling method and investigated with questionnaires and face-to-face interviews. Results The clonorchiasis knowledge awareness rates of the residents were 15.67% in Yongzhou City,9.94% in Yueyang City,13.25% in Wangcheng County,and 21.96% in Tongd-ao County,respectively. In the whole province,the clonorchiasis knowledge awareness rates of the residents were 44.67%, 56.43%,60.95%,and 42.46% in the etiology,clinical manifestations,epidemiological characteristics and daily prevention,re-spectively. The logistic regression showed that the influencing factors of clonorchiasis knowledge awareness rates were the daily dining place,whether or not having the medical personnel in the family,the degree of attention to the relevant news reports, and the history of parasitic diseases. Conclusions The level of clonorchiasis than that in other areas,but the overall level of clonorchiasis knowledge awareness of the residents in Hunan Province is not high. Therefore,the relevant authority should strengthen the health education in clonorchiasis prevention knowledge including personal daily food hygienic knowledge. knowl-edge awareness rate of the residents in the west-southern areas of Hunan Province is higher

Objective To analyze the epidemiological characteristics of mumps in China from 2004 to 2013. Methods Data of mump cases occurring between 2004 and 2013 were gathered from the national notifiable disease reporting system in China (excluding Hong Kong, Macao, and Taiwan);only cases classified as“final card”, laboratory confirmed, or clinical diagnosis were included. Descriptive epidemiology techniques were used to analyze features of sex, age, trends over time, and geography. Results Average incidence of mumps between 2004 to 2013 was 24.20/100 000. Peaks were in 2011 and 2012, with incidence 33.9/100 000 (454 385/1.340 million) and 35.6/100 000 (479 518/1.347 million). Two seasonal peaks occurred regularly in years, one from April to July in the first year, and the other from November to January in the next year. During the study period, provinces with the highest incidence were Ningxia, Tibet, Xinjiang, and Guangxi; incidences were 72.1/100 000 (4 425/6.13 million), 48.5/100 000 (1 396/3 million), 51.7/100 000 (10 887/21.04 million), and 40.8/100 000 (19 179/46.99 million), respectively. Guangdong (28 078), Sichuan (21 924), Guangxi (21 616), and Zhejiang (20 000) provinces reported the highest number of mumps cases. Beijing, Tianjin, and Shanghai showed a consistently low incidence. Mumps cases occurred primarily among children aged 5-9 years, with incidence ranging from 118.2/100 000 to 281.4/100 000. In 2004-2008, the peak age was 6-8 years (174.1/100 000) and in 2009-2013, peak age was 5-7 years (234.5/100 000). Conclusion The highest incidences of mumps in China were reported in 2011 and 2012, with children of school age constituting the majority of cases.

Objective To analyze the epidemiological characteristics of mumps in China from 2004 to 2013. Methods Data of mump cases occurring between 2004 and 2013 were gathered from the national notifiable disease reporting system in China (excluding Hong Kong, Macao, and Taiwan);only cases classified as“final card”, laboratory confirmed, or clinical diagnosis were included. Descriptive epidemiology techniques were used to analyze features of sex, age, trends over time, and geography. Results Average incidence of mumps between 2004 to 2013 was 24.20/100 000. Peaks were in 2011 and 2012, with incidence 33.9/100 000 (454 385/1.340 million) and 35.6/100 000 (479 518/1.347 million). Two seasonal peaks occurred regularly in years, one from April to July in the first year, and the other from November to January in the next year. During the study period, provinces with the highest incidence were Ningxia, Tibet, Xinjiang, and Guangxi; incidences were 72.1/100 000 (4 425/6.13 million), 48.5/100 000 (1 396/3 million), 51.7/100 000 (10 887/21.04 million), and 40.8/100 000 (19 179/46.99 million), respectively. Guangdong (28 078), Sichuan (21 924), Guangxi (21 616), and Zhejiang (20 000) provinces reported the highest number of mumps cases. Beijing, Tianjin, and Shanghai showed a consistently low incidence. Mumps cases occurred primarily among children aged 5-9 years, with incidence ranging from 118.2/100 000 to 281.4/100 000. In 2004-2008, the peak age was 6-8 years (174.1/100 000) and in 2009-2013, peak age was 5-7 years (234.5/100 000). Conclusion The highest incidences of mumps in China were reported in 2011 and 2012, with children of school age constituting the majority of cases.

Objective To evaluate the value of dual energy CT with Lung Vessels application in diagnosing pulmonary embolism (PE) of children.Methods Forty-seven patients with nephrotic syndrome and aged ≤ 18 years old (32 male,15 female,mean age 15 years) underwent dual-energy CT pulmonary angiography (CTPA).Two radiologists recorded the presence or absence of emboli and counted the clots on a per-patient and per-lobe basis with Lung Vessels,respectively.With conventional CTPA as reference standard,sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) of Lung Vessels application to detect PE were computed for two readers.Inter-reader agreement was also calculated.Results Conventional CTPA detected 51 clots in 35 lung lobes in 13 patients,giving PE incidence was 27.6％ (13/47) for this cohort.On a per-patient basis,readers 1 and 2 detected 25 and 21 patients with PE with Lung Vessels,corresponding to sensitivities,specificities,PPVs,and NPVs of 100.0％ (13/13),58.6％ (17/29),43.3％ (13/30),100.0％ (17/17) and 100.0％ (13/13),76.5％ (21/29),50.0％ (13/26),100.0％ (21/21),respectively.On a per-lung lobe basis,readers 1 and 2 detected 74 and 63 clots with Lung Vessels,respectively,corresponding to sensitivities,specificities,PPVs,and NPVs of 94.3％ (33/35),79.5％ (159/200),44.6％ (33/74),98.7％ (159/161) and 97.1％ (34/36),85.5％ (171/200),54.0％ (34/63),98.8％ (171/173),respectively.On a per-clot basis,134 and 105 clots were detected with Lung Vessels application,corresponding to sensitivities,specificities,PPVs,and NPVs for DECT of 96.1％ (49/51),64.9％ (159/245),36.3％ (49/135),98.7％ (159/161) and94.1％ (48/51),75.0％ (171/228),45.7％ (48/105),98.3％ (171/174)for readers 1 and 2,respectively.Excellent or good inter-reader agreement was observed on a per-patient,per-lobe and per-clot basis (Kappa =0.828,0.859,0.695 ; all P ＜ 0.01).Conclusions Dual-energyCT with Lung Vessels application has a high sensitivity and negative predictive value for PE detection in children.More clots are detected with Lung Vessels application than conventional CTPA,which deserve further investigation.

Objective To study the clinicopathological and immunohistochemical features of squamous cell carcinoma (SCC) of breast.Methods Three cases with breast SCC were studied by analyzing their clinical data,histomorphology and immunophenotype.The related literature was reviewed.Results The patients were all females.Their ages ranged from 37 to 50 years,with 43 years as the medium.The tumor diameter was 2-9 cm,with 4.3 cm as the medium.Metastasis of axillary lymph node was found in one case,accounting for 33％ of the total.Two cases had painless lumps in their left breasts.One case had a lump with local inflammation,pain and ulcer in her left breast.Histopathological examination showed the polygonal and spindle-shaped cells with eosinophilic cytoplasm were found in cancer nest,as well as the prominent intercellular bridges and keratin pearls were found to be rich in three cases.Interstitial fibrosis with hyalinization and lymphocytic infiltrate around the tumor was also found.Immunohistochemistry showed ER,PR,HER-2,CK18 and SMA were negative while CK,CK14,CK5/6,p63,S-100 and vimentin were positive.Conclusions SCC is a rare subtype of breast carcinoma with distinct histopathological and morphological features.SCC is a typical basal-like breast carcinoma,and the majority of breast SCC appear a basal-like immunophenotype with poor prognosis.