Objective To evaluate the efficacy of confocal laser endomicroscopy(CLE)for the assessment of the grading of gastric intestinal metaplasia(GIM)in vivo.Methods Patients with known GIM underwent CLE(Pentax EC-3870K).The presence of GIM was indentified immediately by the endoscopist during the procedure.The updated Sydney Classifycation System as reference,GIM was subdivided as mild,moderate and severe according to the area of intestinal metaplasia glands and the number of goblet cells.The histological evaluation remained the gold standard for the final diagnosis of GIM.The presence of the dysplasia and the expression of the Ki67 were examined.Results A total of 151 GIM positive areas were found in 58 patients with mild in 92,moderate in 34.and severe in 25 by CLE. One hundred and forty-six GIM areas were examined histopathologically with positive rate of 96.7%(mild in 82,moderate in 36 and severe in 28).The sensitivity and specificity of CLE were 90.2%and 73.9%in diagnosis of mild GIM,69.4 oA and 92.2%in moderate GIM,71.4% and 95.9%in severe GIM.The kappa coefficient of CLE criteria and the histopathological grading for mild,moderate and severe GIM were 0.65,0.63 and 0.70,respectively.The more severe the GIM,the higher the ratio of incomplete GIM,the ratio of dysplasia and the stronger expression of Ki67.Conclusions CLE may offer an instant and reliable diagnosis for GIM with high accuracy.It is helpful in grading of GIM.

Neonatal persistent pulmonary hypertension refers to the continuous increase of pulmonary artery pressure, right heart pressure, right-to-left shunt at foramen ovale and ductus arteriosus level, severe hypoxemia and even respiratory failure after birth.At present, the drug treatments of neonatal persistent pulmonary hypertension include inhaling nitric oxide, sildenafil, milrinone, endothelin receptor antagonists bosentan, prostaglandins and their analogs.This review briefly summarized the progress on the treatment of neonatal persistent pulmonary hypertension.

Objective ToinvestigatetheimpactofCTimagequalityforfilteringbackprojection(FBP),conventionalmodel-based iterativereconstruction(MBIRC)andnewgeneration model-basediterativereconstruction (MBIRN)onchest.Methods Thirtypatientswith chestCTscanwerecollected.FBP,MBIRCandMBIRN wereusedtoreconstructtheimage.Objectivequality[standarddeviation(SD) valueoftheROI,SNR],thenoisereductionrateandSNRimprovementrateofMBIRCand MBIRN withrespecttoFBP werecom-paredacrossthethreeimages.Atthesametime,tworadiologistsusedtheblind methodtoevaluatetheintrapulmonarystructurein thelungalgorithm FBP,MBIRC,MBIRN,andthemediastinalstructure (5-pointsystem)inthestandardalgorithmsFBP,MBIRC, MBIRN.Results ComparedwithFBP,theimagemusclenoisesofMBIRCand MBIRN were76.71% and86.06%lowerthanFBP,respectively, andthefatnoiseswere66.91% and78.18%lowerthanFBP,respectively.Thedifferencewasstatisticallysignificant(P<0.05).The imageSNRofMBIRCandMBIRN were74.12% and84.97% higherthanthatoftheFBPgroup,respectively.ThefatSNRwere65.63% and 76.02% higherthanthatoftheFBPgroup (P<0.05).Thethreealgorithmsshowedstatisticallysignificantdifferencesinsubjective noise,intrapulmonaryvascular,bronchialresolution,mediastinalbloodvessels,andlymphnodes.MBIRN hadthelowestsubjective noise,andthehighestSNR,mediastinalstructure,andintrapulmonaryvesselsandbronchi.Conclusion Comparedwith MBIRC and FBPwithnormaldosechestCTscan,MBIRN cansignificantlyreducethenoiseofchestCTscanimages,improveSNR,and more clearlyshowthedetailsofthescanrangeandlesionedgefeatures.

Objective:To study the prevalence and epidemiological characteristics of adult thyroid nodules in Wuhan City, and to analyze the influencing factors of thyroid nodules, so as to provide basis for prevention and treatment of adult thyroid nodules in Wuhan City.Methods:From 2019 to 2021, two communities or towns were selected from each of the 13 districts in Wuhan City using multi-stage cluster random sampling method. One hundred permanent residents over the age of 16 were selected from each community or town according to the inclusion and exclusion criteria (age and sex ratio balanced), for questionnaire survey, physical examination, urinary iodine test and thyroid ultrasound examination. The influencing factors of thyroid nodules was analyzed using logistic regession and Spearman correlation.Results:A total of 2 578 adults were investigated, including 1 168 men and 1 410 women. The age was (41.79 ± 13.01) years. The prevalence of thyroid nodules was 35.49% (915/2 578). The prevalence of single nodules was 19.16% (494/2 578), which was higher than that of multiple nodules [16.33% (421/2 578), χ 2 = 2 577.00, P < 0.001]. Multivariate logistic regression analysis showed that female ( OR = 2.033, 95% CI: 1.631 - 2.535), older ( OR = 1.404, 95% CI: 1.290 - 1.528), history of thyroid disease ( OR = 1.351, 95% CI: 1.211 - 1.506) and diabetes ( OR = 1.449, 95% CI: 1.083 - 1.938) were independent risk factors for adult thyroid nodules ( P < 0.05). The median urinary iodine of residents in Wuhan City was 185.32 μg/L, at an appropriate level of iodine nutrition, there was no correlation between urinary iodine and thyroid nodules ( r = 0.02, P = 0.391). Conclusions:The prevalence of thyroid nodules of adults in Wuhan City is high. Women, older, a history of thyroid diseases and diabetes are all risk factors for thyroid nodules. No correlation is found between urinary iodine level and thyroid nodules.

Objective: To understand the distribution of tobacco retailer within 100 meters outside middle schools in Wuhan City and its impact on smoking behavior of middle school students, so as to provide basis and feasible suggestions for the development of tobacco control policy for adolescents. Methods: From February to May 2023, a multi stage stratified cluster random sampling method was used to select 20 middle schools from 4 districts in Wuhan City. To investigate the distribution of tobacco retailer within 100 metres outside the school and the sale of tobacco to minors. A total of 4 882 students were surveyed using the core questions of the 2021 Chinese Adolescent Tobacco Prevalence Questionnaire. Fisher exact probability test, Chi square test and Chi square trend test were used for statistical analysis. Results: Nearly 70.00% of middle schools had tobacco retailer within 100 metres, with an average of (1.10±0.97) per middle school. The awareness rate (100.00%) and labeling rate (87.50%) of licensed tobacco retailer were higher than those of non licensed tobacco retailer (33.33%, 16.67%) ( P <0.05). The rates of tried smoking, current smoking and buying cigarettes within 30 days were 7.13%, 1.99% and 2.54%, respectively. The rates of students who tried smoking ( 8.58 %), current smoking (2.29%) and buying cigarettes within 30 days (2.85%) in schools with tobacco retailer within 100 metres were higher than those in schools without tobacco retailer (3.79%, 1.28%, 1.83%)( χ 2=35.80, 5.37, 4.37 , P <0.05). And as the grade increased, the rates of tried smoking, current smoking and buying cigarettes among middle school students all showed an upward trend ( χ 2 trend =66.20, 36.10, 16.17, P <0.05). Conclusions Middle school students in Wuhan City have high tobacco availability. The findings suggest that school ban should be extended from 50 meters to 100 meters, and the regulatory authorities must strictly prohibit selling tobacco products to minors at tobacco retailer.

Objective To explore the characteristics of white matter lesions(WMLs)causing cognitive function change in the patients with asymptomatic middle cerebral artery(MCA)stenosis,and to analyze the diagnostic efficiency of related indexes.Methods Thirty-nine patients diagnosed with asymptomatic MCA ste-nosis and presenting with WMLs in the department of neurology of the hospital from 2021 to 2022 were in-cluded as the observation group,and 34 healthy people were included as the control group.The two groups conducted the behavioral assessment of cognitive function,such as the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Test of Connectivity Type A(TMT),Digit Symbol Test(SDMT),Digit Breadth Test(DST),Drawing the Clock Test(CDT),and Verbal Fluency Test(VFT).The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of related indica-tors.Results In the single cognitive function assessment scales,the scores of TMT in the observation group were significantly higher than those in the control group(P＜0.01),the scores of SDMT,DST,CDT and VFT in the observation group were significantly lower than those in the control group and the differences were sta-tistically significant(P＜0.01).In the comprehensive cognitive function assessment scales,the total scores of MMSE and MoCA in the observation group were significantly lower than those in the control group(P＜0.01).In the scores of each factor of the MMSE scale,the verbal ability in the observation group was signifi-cantly lower than that in the control group(P＜0.01),but the scores of orientation,memory,attention,calcu-lation and recall were had no statistically significant differences between the two groups(P＞0.05).In the scores of each factor of MoCA,the visuospatial and executive ability,delayed memory,attention and abstrac-tion ability in the observation group were significantly lower than those in the control group(P＜0.01),but the scores of naming ability,attention ability and orientation ability had no statistically difference(P＞0.05).The area under the ROC curve(AUC),sensitivity and specificity of MoCA and MMSE were 0.80,0.73,0.52,0.71,0.92 and 0.74 respectively.The efficiency of MoCA for diagnosing cognitive function disorders caused by asymptomatic MCA stenosis was higher.Conclusion Compared with single cognitive function assessment scale,the comprehensive cognitive function assessment scales could more comprehensively and accurately screen the cognitive function disorders caused by WMLs in the patients with asymptomatic MCA stenosis,in which the diagnostic efficiency of MoCA is the highest.

Bronchopulmonary dysplasia(BPD)is the most common chronic respiratory disease in premature and low birth weight infants, characterized by alveolar and pulmonary vascular dysplasia.This article reviews the factors related to the pathogenesis of BPD, with the aim of providing new ideas for the research of pathogenesis of BPD and its prevention and treatment.Among them, immature lung development, acute lung injury, and abnormal repair after injury are the key links of BPD.Other influencing factors include oxygen poisoning, barotrauma, infection, lack of nutritional support, patent ductus arteriosus, blood transfusion, gastroesophageal reflux, pulmonary interstitial edema, abnormal coagulation function, cholestasis and so on.

Objective To investigate and analysis the epidemiological characteristics of a cluster epidemic of COIVD-19 in a collective workplace in Tianjin, evduate the prevention and control measures based on limited evidence and experience in early period of COVID-19 epidemic. Methods Descriptive research method was used to describe the distribution and other epidemiological characteristics of the cluster cases of COVID-19. Results Since the onset of the first index case on January 15, ten confirmed COVID-19 cases had occurred in the workplace, and the epidemic had spread from the workplace to 4 families, infecting 7 family members. The median age of 17 cases was 55 (19-79) years. All the 10 employee cases were males, and in 7 family cases, 3 were males and 4 were females. Of the employee cases, 8 worked in CW workshop and 2 worked in administrative office building. The median exposure-onset interval of all the cases was 4 (0-12) days, and the median exposure-onset interval was 4.5 days in the employee cases and 4 days in the family cases. The median onset-medical care seeking interval was 4 days in the non-isolated cases, 2.5 days in the cases with home isolation after onset, and 0.5 day in the cases with home isolation before onset. Conclusion The clustering of COVID-19 cases was observed in this workplace in Tianjin, which affected 4 families. In the early stage of the epidemic, accurate and rapid blocking and control measures can completely prevent the large-scale spread of COVID-19.