Objective·To explore the effect of continuous nursing based on EMS[environment management(E),medicine direction(M)and self monitoring(S)]management mode on the preschool children with asthmatic diseases.Methods·A total of 67 children aged 0 to 6 years with asthmatic diseases admitted to the Department of Respiratory Medicine,Shanghai Children's Hospital,Shanghai Jiao Tong University School of Medicine from December 2019 to November 2020 were selected and divided into observation group(33 cases)and control group(34 cases)according to the random number table method,with 3 cases lost,and finally 32 cases in each group.The observation group received continuous nursing care based on EMS management mode,while the control group received routine care and discharge follow-up through the telephone.The children in the two groups were followed up at 1,3,and 6 months after discharge to evaluate the results of Test for Respiratory and Asthma Control in Kids(TRACK)and wheezing recurrence;Medication Adherence Report Scale for Asthma(MARS-A)and Nursing Job Satisfaction Questionnaire were used to evaluate medication adherence and nursing job satisfaction 6 months after discharge.Results·There was no significant difference in demographic characteristics and clinical baseline characteristics between the two groups.Repeated measures analysis of variance showed that effects of time,groups and the interaction of groups×time on the total score of TRACK were statistically significant.The total scores of TRACK in the observation group were significantly higher than those in the control group at 1,3,and 6 months after discharge(P=0.000).The total scores of TRACK in the two groups gradually increased with time(P=0.000).The recurrence rates of wheezing in the observation group were 25.0%,18.7%,and 9.4%at 1,3,and 6 months after discharge,which were significantly lower than those in the control group(50.0%,43.7%,and 31.3%,respectively,P<0.05).Generalized estimating equation analysis showed that there was a statistically significant difference between the two groups(P=0.013),and the intervention effect of the observation group was better than that of the control group(OR=0.292).The MARS-A score of the observation group was 4.519±0.395 at 6 months after discharge,which was significantly higher than that of the control group(3.994±0.739,P=0.001).The nursing job satisfaction of the observation group was significantly higher than that of the control group(P=0.000).There was a moderate positive correlation between the MARS-A score and the nursing job satisfaction(r=0.389,P=0.001).Conclusion·Continuous nursing based on EMS management mode can significantly improve the medication compliance and wheezing control level of the preschool children with asthmatic diseases,significantly reduce the recurrence rate of wheezing,and improve the nursing satisfaction.

Objective: To investigate the implementation of sex education and its influencing factors among preschool teachers in Luzhou City, Sichuan Province, so as to provide insights into promoting the development of sex education, physical and mental health for preschool children. Methods: In January 2022, preschool teachers were sampled in 24 kindergartens in Longmatan District, Naxi District and Hejiang County of Luzhou City using the stratified random cluster sampling method. Demographic information, knowledge, attitudes, implementation of sex education, as well as difficulties, support, and needs in implementing sex education among preschool teachers were collected through questionnaire surveys. Factors affecting practice of sex education by preschool teachers were analyzed using a multivariable logistic regression model. Results: A total of 461 preschool teachers were included, including 456 females (98.92%), and had a median age of 28.00 (interquartile range, 9.50) years. The proportions of preschool teachers with good and pass of knowledge about sex education for preschool children were 10.20% and 57.48%, respectively. The proportions of preschool teachers with positive and general attitudes towards sex education were 28.20% and 36.44%, respectively. A total of 343 preschool teachers had implemented sex education (74.40%). A lack of a relaxed social environment was the main difficulty in carrying out sex education for preschool children (76.14%), while support from parents of preschool children was the primary need for conducting sex education activities (75.27%). Multivariable logistic regression analysis showed that age (>30 years, OR=2.218, 95%CI: 1.256-3.917), kindergarten type (public, OR=2.101, 95%CI: 1.253-3.524), attitude towards sex education (positive, OR=2.083, 95%CI: 1.036-4.187), participation in activities related to sex education (OR=6.355, 95%CI: 3.362-12.015), and communication with parents about sex education (OR=5.399, 95%CI: 3.152-9.248) were influencing factors for practice of sex education by preschool teachers. Conclusions The main difficulty in the practice of sex education for preschool children by preschool teachers in Luzhou City is a lack of a relaxed social environment, and there is a high demand for support from parents. Age, kindergarten type, attitude towards sex education, participation in activities related to sex education, and communication with parents about sex education are associated factors.

Objective: To understand the needs of parents of kindergarten children in urban areas for online training on sexuality education, so as to provide a basis for the development of parent training courses. Methods: In May 2023, a multistage cluster random sampling method was used to select 3 516 parents of young children from 12 kindergartens in urban areas of Changshou District, Chongqing. A self designed questionnaire on Knowledge, Attitude and Practice of Early Childhood Sexuality Education (Parents) was used for the survey, and χ 2 test and multi factor Logistic regression model were used for data analysis. Results: The online training demand rate of urban parents for early childhood sexuality education was 57.05%. The results of the multi factor Logistic regression analysis showed that age, education level, occupation, whether or not they were the main caregivers, total score level of the scale, awareness of their own responsibility, communication with family and friends about early childhood sexuality education and young children s participation in kindergarten sexuality education activities were the influencing factors of parents online training demand on sexuality education ( OR =1.18, 1.44, 1.42, 0.83, 1.19, 0.51, 0.75, 0.75, P <0.05). Conclusion Urban parents have a high demand for online training on early childhood sexuality education, and training courses should be developed according to the specific needs and characteristics of parents of young children.

Objective:To develop a U-Net-based quadruple numerical neural network (QU-Net) model for retinal vessel segmentation and to verify its precision and efficiency in extracting and segmenting retinal vessels from fundus images.Methods:This study used the concept of hypercomplex numbers, the three channels of color images, and a quaternion matrix representing all the information data of the images, which was then used as input for quaternion convolution and quaternion fully connected layers based on the U-Net architecture to form a QU-Net model.The QU-Net model was first tested on the DRIVE, STARE, and CHASE_DB1 datasets and compared with the traditional real-valued U-Net, M-Net, and SU-Net models in terms of accuracy, sensitivity, specificity, precision, F1 score, and Matthews correlation coefficient.Finally, the model was further optimized and the optimized QU-Net model was compared side-by-side with the well-known advanced models to comprehensively evaluate and analyze the efficiency and accuracy of the model in extracting and segmenting retinal blood vessels from fundus images.Results:The results showed that the QU-Net model achieved the following vessel segmentation results: accuracy 0.956 6, sensitivity 0.700 8, specificity 0.987 9, precision 0.595 4 on the DRIVE dataset, accuracy 0.975 5, sensitivity 0.890 7, specificity 0.984 2, precision 0.662 5 on the STARE dataset, and accuracy 0.979 4, sensitivity 0.747 0, specificity 0.990 6, precision 0.596 9 on the CHASE_DB1 dataset.Its specificity was better than U-Net, M-Net and SU-Net models, and its accuracy, sensitivity and precision were not inferior to the three models.After optimization, the sensitivity, precision and F1 value of the QU-Net model were effectively improved on the three datasets while maintaining its original accuracy and specificity.When compared with the performance indicators of other models on the three datasets, it was found that the optimized QU-Net model had good performance in accuracy, specificity, sensitivity, precision, and F1 score, indicating that its vessel segmentation ability was not inferior to the advanced models.Among all the models compared, the optimized QU-Net model had the best F1 score and Matthews correlation coefficient.Conclusions:The QU-Net model proposed in this study expands the data dimension space from the traditional real number space to the complex number space and greatly reduces the loss of data information.The optimized QU-Net model has good efficiency and accuracy in extracting retinal vessel segmentation from fundus images, and has certain advantages in detecting fine vessels.

The occurrence and development of malignant tumors are closely related to immune checkpoint receptors, and tumor cells can evade immune surveillance by activating the immune checkpoint pathway. T cell immunoglobulin and ITIM domain(TIGIT) is an inhibitory receptor expressed on lymphocytes, which can inhibit the function of natural killer cells(NK) and T cells through a variety of mechanisms, making tumor cells escape from the surveillance of the immune system. This article made a systematic review on the research progress of the immunosuppressive mechanism of TIGIT, and reviewed the research progress of the immunosuppressive mechanism of TIGIT.

Abstract OBJECTIVE To determine the index weight, optimize the extraction process of gastropathy oral thick paste 1. METHODS Taking the amount of water added, extraction time and extraction times as factors, depend on the single factor experiment, L9(34) orthogonal table was selected to design the experiment. The content of chlorogenic acid was determined by HPLC and the content of total flavonoids content was determined by ultraviolet spectrophotometry. With the above two contents plus the yield of dry extractum as the evaluation index, the weights were assigned based on the analytic hierarchy process, entropy weight method and independence weight method, and the extraction process was optimized by orthogonal experimental design. RESULTS Multi-index scoring was more scientific and reasonable, and the final optimal extraction conditions for gastropathy oral thick paste 1 were as follows: add 8 times the amount of water, extract twice and 0.5 h for each time. CONCLUSION The optimized extraction process using analytic hierarchy process, entropy weight method and independence weight method is reasonable, feasible, stable, and reproducible, which is suitable for the preparation of gastropathy oral thick paste 1, providing reference for subsequent research and development.

Objective: To evaluate the effect of sexuality education for parents of preschoolers, to provide a basis for sexuality educational programs in rural settings. Methods: This community intervention trial chose four kindergartens in Jiangyang District of Luzhou City as the intervention group and other four kindergartens in Jiangyou City of Mianyang City of Sichuan Province as the control group. Sexuality education for parents was carried out in the intervention group, and the control group received routine arrangement. The baseline survey was conducted from March to May 2019, and the final survey was conducted in December 2019. The investigators conducted a face to face or self filled questionnaires among each parent who agreed to participate in the survey by using the self designed questionnaire "Research on Current Situation and Countermeasures of Early Childhood Sexuality Education in Rural Areas (Parent)". Results: Before the intervention, there was no significant difference in the basic information of parents and their children, and the situation of early childhood sexuality education between the intervention group and the control group( P > 0.05 ). After intervention, parents of the intervention group and the control group showed differences in correct rate of the knowledge regarding early childhood sexuality education (41.5%，32.1%), proportion of recognition of parental responsibility (90.7%， 81.3 %), sexuality education in the family (55.7%，45.9%), sexuality education in schools (70.2%，39.1%) and attitude behavior consistency (28.9%，16.3%) ( χ 2=4.05，8.05，4.17，42.48，9.59， P <0.05). Conclusion Sexuality education towards parents is effective through improving knowledge, responsibility, the implementation of sexuality education in the family, and attitude behavior consistency among parents.

Objective:To understand the mental health status of pregnant women in the third trimester of pregnancy, and explore the influencing factors.Methods:The general demographic information and pregnancy information of 575 pregnant women in the Chinese Pregnant Women Cohort Study were collected. The mental health status of pregnant women in the third trimester was investigated by using Edinburgh Postpartum Depression Scale, Self-Rating Anxiety Scale and University of California at Los Angeles. Multivariate unconditional logistic regression was used to analyze the influencing factors for mental health of pregnant women.Results:In the third trimester of pregnancy, the incidence of depression was 16.52%, the incidence of anxiety was 11.13%, and the incidence of feeling loneliness was 26.26%. Logistic regression analysis showed that compared with those with education level of junior high school below, those with education level of college or bachelor's degree ( OR=0.418, 95% CI: 0.184-0.950) and master's degree or above ( OR=0.116, 95% CI: 0.027-0.503) were less likely to feel loneliness. Pregnant women with higher annual family income (10 000 RMB yuan) were less likely to suffer from depression (≥20 vs. <10: OR=0.527, 95% CI: 0.279-0.998), anxiety (10-20 vs. <10: OR=0.363, 95% CI: 0.180-0.731; ≥20 vs. <10: OR=0.271, 95% CI: 0.132-0.554) and feeling loneliness (≥20 vs. <10: OR=0.477, 95% CI: 0.276-0.826). Conclusions:The education level and family income have impacts on the mental health status of pregnant women in the third trimester. Medical staff should give targeted psychological advice to pregnant women to improve their mental health status.

Objective To understand the status of economic burden of maternal health care of pregnant women in China, and to discuss the equity and accessibility of maternal health care during pregnancy among different regions and populations. Methods A total of 9 193 women during early pregnancy were recruited from the Chinese Pregnant Women Cohort Study between July 25, 2017 and November 26, 2018. Information on general condition and economic burden of maternal health care was surveyed. SPSS 25.0 software was used for statistical analysis. Results The median direct medical cost of maternity check-ups for pregnant women was 400 CNY per visit, and the median cost of lost work was 360 CNY per visit. The analysis of the results showed that the median medical expense was highest in pre-pregnant women with BMI <18.5kg/m² (P=0.008). The median medical expense was higher in urban residents than rural residents (P<0.001). Families with fewer members had higher direct medical expenses (P<0.001, P_trend=0.003). The higher the socioeconomic status was, the higher the direct medical expense was (P<0.001, P_trend=0.003). The cost of lost work was lower in pregnant women with higher socioeconomic status (P=0.025, P_trend=0.017). In addition, the medical expense was highest in women living in the eastern part of China (P<0.001). The direct medical expenses (P=0.002) and lost-time expenses of pregnant women in the North were higher than those in the South (P=0.013). Conclusion The problem of equity and accessibility of maternal health care still existed. It is recommended that relevant departments further improve maternal health care services and build a diversified healthcare service system to ensure maternal and child health and promote eugenics.

Objective To analyze the prevalence of depression in early pregnancy, explore its possible influencing factors, and provide reference for mental health care during pregnancy. Methods A baseline survey of 9 193 early pregnant women recruited by the Chinese Pregnant Women Cohort Study (CPWCS) program was conducted. Edinburgh Postnatal Depression Scale was used to assess the depression symptoms in early pregnancy. The χ² test and multivariable logistic regression were used to analyze the influencing factors. Results The rate of depression in early pregnant women in CPWCS was 46.50%. Multivariate analysis showed that unplanned pregnancy (OR=1.23, 95%CI: 1.12~1.35, P<0.001), passive smoking (OR=1.28, 95%CI: 1.18~1.39, P<0.001), drinking (OR=1.35, 95%CI: 1.12~1.63, P=0.002) and consumption of carbonated or sugary beverages （OR=0.80, 95%CI: 0.73~0.88, P<0.001） were risk factors for depression during early pregnancy, while enough sleep (OR=0.71, 95%CI: 0.57~0.88, P=0.002), moderate-high level of physical activity (OR=0.87, 95%CI: 0.78~0.98, P=0.023), healthy intake of vegetables and fruits（OR=0.60, 95%CI: 0.51~0.70, P<0.001), animal foods（OR=0.82, 95%CI: 0.74~0.91, P<0.001） and milk and dairy products（OR=0.81, 95%CI: 0.72~0.90, P<0.001）were protective factors. Conclusion The rate of depression was high and it was affected by many factors. It is necessary to pay more attention to depression symptoms during early pregnancy and carry out targeted psychological health care during pregnancy.