Objective: To develop and validate a health literacy assessment scale for junior high school students, providing an effective tool for evaluating and monitoring health literacy among Chinese adolescents. Methods: Based on school health education policy documents, a health literacy assessment framework was constructed, comprising five horizontal and four vertical dimensions. From May to June and August to September in 2024, the framework was refined through Delphi expert consultations and focus group discussions, leading to the development of the Health Literacy Assessment Scale for Junior High School Students. In September 2024, a convenience sample of 625 students from three junior high schools in Beijing and Tianjin completed the questionnaire. Item analysis, reliability, and validity tests were conducted to evaluate the scale. Results: The recovery rate for two rounds of expert consultation questionnaires was 100%. The expert authority coefficients ( Cr ) were 0.86 and 0.87 respectively (both >0.70), with Kendall W values of 0.34 and 0.27 ( P <0.05). The focus group discussions followed a rigorous structure, and after multiple rounds of item screening and revision, the version 3.0 of the junior high school students health literacy assessment scale was developed, comprising 57 items. Three items that failed to meet the comprehensive screening criteria were preliminarily removed, and the final scale contained 54 items. The scale demonstrated excellent reliability, with an overall Cronbach s α coefficient of 0.92 and split half reliability of 0.93. Confirmatory factor analysis [ χ 2/df =2.094, root mean square error of approximation ( RMSEA )=0.042, comparative fit index ( CFI )=0.911, Tucker Lewis index ( TLI )=0.907] indicated good model fit indices. Conclusions The preliminary development of the health literacy assessment scale for junior high school students follows a rigorous item screening process with well designed dimensions, demonstrating good reliability and validity, thus serving as an appropriate evaluation tool for adolescent health literacy.

Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation(EA)in patients undergoing laparoscopic hernia repair.Methods Seventy-two male patients who treated with lapa-roscopic hernia repair under general anesthesia were randomly divided into AS group(subanesthetic esketamine)and control group.In the AS group,0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended,while the control group was given an equal volume of normal saline.Upon surgery completion,patients were transferred to PACU with endotracheal tube retained,and the time to extubation was recorded.Hemo-dynamic parameters were measured immediately after extubation and at 10 min,30 min,1 h,and 4 h thereafter.Patients' pain and sedation levels were assessed at the above time points using RASS and VAS,respectively.The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR-40 and adverse events were recorded.Results Compared to those in the control group,patients in the AS group had higher HR and MAP at 10 min post-extubation,and the changes in HR and MAP over time were more stable(P<0.05).The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points(P<0.05),both groups showed temporal changes in RASS and VAS scores(P<0.05),but the change process in the AS group was more stable(P<0.05).Postoperative extubation time,PACU observation duration,and adverse event rates(delirium,respiratory depression,nausea and vomiting)did not differ significantly between the two groups(P>0.05),while recovery quality was markedly better in the AS group(P<0.05).Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA,supports hemodynamic stability during PACU stay,and enhances recovery quality in patients undergoing laparo-scopic hernia repair,demonstrating clinical value.

Objective: To develop a health literacy evaluation scale for Chinese high school students, providing a tool for dynamic monitoring of health literacy among high school students and evaluating the effectiveness of health school construction. Methods: Through theoretical research, an evaluation index system for health literacy of Chinese high school students was constructed. Two rounds of Delphi expert consultations were conducted to quantitatively screen the items, and the item pool was revised based on expert opinions to compile the health literacy evaluation scale for Chinese students. Two focus group interviews were held to collect suggestions from health educators, high school teachers, and high school students regarding optimized scale length, question types, difficulty and wording of the scale. The scale was revised accordingly. A pilot survey was conducted in Beijing and Tianjin in November 2024, and the reliability and validity of the scale were evaluated based on the pilot survey data. Results: The response rate in both rounds of Delphi expert consultations was over 80%, and the expert authority coefficient was over 0.70. The expert opinions were highly concentrated, and the dispersion was small. The revised item pool based on expert opinions contained 39 items. The revised scale based on the suggestions and opinions collected from the focus group interviews had a moderate number of questions and difficulty level. The pilot survey obtained 800 valid responses, with the response rate of 89.39%. The Cronbach α coefficient of the scale was 0.911, χ 2/df =3.321, the root mean square error of approximation was 0.054, the adjusted goodness-of-fit index was 0.991 , and the factor loadings of some items were less than 0.40. Conclusion The health literacy evaluation scale for Chinese high school students demonstrates scientific rigor and practical applicability, with good internal consistency and structural validity.

Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation(EA)in patients undergoing laparoscopic hernia repair.Methods Seventy-two male patients who treated with lapa-roscopic hernia repair under general anesthesia were randomly divided into AS group(subanesthetic esketamine)and control group.In the AS group,0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended,while the control group was given an equal volume of normal saline.Upon surgery completion,patients were transferred to PACU with endotracheal tube retained,and the time to extubation was recorded.Hemo-dynamic parameters were measured immediately after extubation and at 10 min,30 min,1 h,and 4 h thereafter.Patients' pain and sedation levels were assessed at the above time points using RASS and VAS,respectively.The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR-40 and adverse events were recorded.Results Compared to those in the control group,patients in the AS group had higher HR and MAP at 10 min post-extubation,and the changes in HR and MAP over time were more stable(P<0.05).The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points(P<0.05),both groups showed temporal changes in RASS and VAS scores(P<0.05),but the change process in the AS group was more stable(P<0.05).Postoperative extubation time,PACU observation duration,and adverse event rates(delirium,respiratory depression,nausea and vomiting)did not differ significantly between the two groups(P>0.05),while recovery quality was markedly better in the AS group(P<0.05).Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA,supports hemodynamic stability during PACU stay,and enhances recovery quality in patients undergoing laparo-scopic hernia repair,demonstrating clinical value.

Objective To explore the application value of iterative model reconstruction(IMR)technique in low-dose lumbar CT scanning.Methods A total of 48 patients who underwent lumbar CT plain scan were selected and divided into regular-dose group(group A)and ultra-low dose group(group B).The group A underwent imaging with 120 kV tube voltage,automatic tube current modulation technology,and iDose 4 reconstruction.The group B was scanned with a tube voltage of 100 kV and a tube current of 80 mAs,and the images of B1 and B2 groups were reconstructed by iDose 4 and IMR,respectively.The standard deviation(SD)value(the SD value represents the noise of the measured tissue),signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR)of cancellous bone,intervertebral disc,dural sac,and psoas muscle were measured and calculated at the L3-L4 vertebral body level.Two diagnosticians rated the image quality.Sample t-test and ANOVA were used to compare the measurement results and subjective scores.Results The comparison of SD for intervertebral disc,dural sac,and psoas muscle showed group B2＜group A＜group B1,while the subjective score comparison indicated group A＞group B2＞group B1.The SNR for intervertebral disc and psoas muscle demonstrated group B2＞group A＞group B1.There was no significant difference in bone quality score between group A and group B1(P＞0.05),but there was a significantly different between the bone quality scores of group B2 and those obtained with iDose 4 reconstruction(group A and group B1)(P＜0.05).The effective dose(ED)of group B was reduced by approximately 70.28％compared with group A.Conclusion IMR can significantly reduce SD,improves SNR and CNR,resulting in high-quality images.Compared to iDose 4 technique,IMR has more advantages in soft tissue display,while iDose 4 technique is superior in observing fine bone structures.The combined application of iDose 4 and IMR technique ensures high-quality images for diagnosis,while significantly reducing the radiation dose to patients.

Background::An evidence gap still exists regarding the efficacy and safety of tegoprazan in patients with erosive esophagitis (EE) in China. This study aimed to verify the efficacy and safety of tegoprazan vs. esomeprazole in patients with EE in China. Methods::This study was a multicenter, randomized, double-blind, parallel, active-controlled, non-inferiority phase III trial of patients with EE randomized 1:1 to tegoprazan 50 mg/day vs. esomeprazole 40 mg/day. This study was conducted in 32 sites between October 24, 2018 and October 18, 2019. The primary endpoint was the cumulative endoscopic healing rate at week 8. The secondary endpoint included endoscopic healing rate at week 4, changes in the reflux disease questionnaire (RDQ) and gastroesophageal reflux disease health-related quality of life (GERD-HRQL) scores, and symptom improvement. Results::A total of 261 patients were randomized: 132 to the tegoprazan group and 129 to the esomeprazole group. The cumulative endoscopic healing rate at 8 weeks in the tegoprazan group was non-inferior to that of the esomeprazole group (91.1% vs. 92.8%, difference: -1.7%, 95% confidence interval [CI]: -8.5%, 5.0%, P = 0.008). There were no statistically significant differences in the changes in RDQ (total, severity, and frequency) and GERD-HRQL scores between the two groups (all P >0.05). The percentages of days without symptoms, including daytime and nighttime symptoms based on patients' diaries, were similar between the two groups (all P >0.05). In the tegoprazan and esomeprazole groups, 71.5% (93/130) and 61.7% (79/128) of the participants reported adverse events (AEs), 2.3% and 0 experienced serious AEs, while 70.0% and 60.2% had treatment-emergent AEs, respectively. Conclusion::Tegoprazan 50 mg/day demonstrated non-inferior efficacy in healing EE, symptom improvement, and quality of life, and it has similar tolerability compared with esomeprazole 40 mg/day.

Objective To evaluate the safety and efficacy of enteroscopy in the treatment of rare small intestinal diseases,including Peutz-Jeghers syndrome(PJS),blue rubber bleb nevus syndrome(BRBNS),and cryptogenic multifocal ulcerative stenosing enteritis(CMUSE),thereby providing a reference for clinical diagnosis and treatment.Methods Patients with rare small intestinal diseases diagnosed and treated in the De-partment of Gastroenterology,Shanghai Changhai Hospital,from January 2020 to December 2024 were included.Detailed records of patients' general information,clinical manifestations,auxiliary examinations,and endoscopic treatment data were collected and systematically analyzed.Results A total of 30 PJS patients un-derwent 88 small intestinalpolypectomies under enteroscopy,including 62 procedures via the oral approach(mean operative time:92.8±30.1 min;largest polyp diameter:2.9±1.2 cm)and 26 via the anal approach(95.0±29.4 min;1.9±1.3 cm).Six adverse events occurred in the oral approach group.Ten BRBNS patients received 26 endoscopic treatments(25 sclerosing agent injection under enteroscopy and 1 sclerosing agent injec-tion combined with ligation session),with a mean operative time of 68.1±17.4 min.Eleven intestinal venous aneurysms were ligated,and 4 adverse events were reported.Five CMUSE patients underwent 6 endoscopic treatments(5 samll intestinal stenosis balloon dilations and 1 samll intestinal stenosis incision),with no ad-verse events observed.Conclusions Small intestinal endoscopy is feasible,safe,and effective for treating rare small intestinal diseases such as PJS,BRBNS,and CMUSE.For PJS patients,the oral approach should be pri-oritized.Sclerosing agent injection under enteroscopy for intestinal venous aneurysms in BRBNS via small bowel endoscopy is safe and effective,though the safety of ligation of venous aneurysms under enteroscopy requires further investigation.Stenosis balloon dilation and incision under enteroscopy are both feasible options for CMUSE,and these two approaches can complement each other.

Objective To evaluate the safety and efficacy of enteroscopy in the treatment of rare small intestinal diseases,including Peutz-Jeghers syndrome(PJS),blue rubber bleb nevus syndrome(BRBNS),and cryptogenic multifocal ulcerative stenosing enteritis(CMUSE),thereby providing a reference for clinical diagnosis and treatment.Methods Patients with rare small intestinal diseases diagnosed and treated in the De-partment of Gastroenterology,Shanghai Changhai Hospital,from January 2020 to December 2024 were included.Detailed records of patients' general information,clinical manifestations,auxiliary examinations,and endoscopic treatment data were collected and systematically analyzed.Results A total of 30 PJS patients un-derwent 88 small intestinalpolypectomies under enteroscopy,including 62 procedures via the oral approach(mean operative time:92.8±30.1 min;largest polyp diameter:2.9±1.2 cm)and 26 via the anal approach(95.0±29.4 min;1.9±1.3 cm).Six adverse events occurred in the oral approach group.Ten BRBNS patients received 26 endoscopic treatments(25 sclerosing agent injection under enteroscopy and 1 sclerosing agent injec-tion combined with ligation session),with a mean operative time of 68.1±17.4 min.Eleven intestinal venous aneurysms were ligated,and 4 adverse events were reported.Five CMUSE patients underwent 6 endoscopic treatments(5 samll intestinal stenosis balloon dilations and 1 samll intestinal stenosis incision),with no ad-verse events observed.Conclusions Small intestinal endoscopy is feasible,safe,and effective for treating rare small intestinal diseases such as PJS,BRBNS,and CMUSE.For PJS patients,the oral approach should be pri-oritized.Sclerosing agent injection under enteroscopy for intestinal venous aneurysms in BRBNS via small bowel endoscopy is safe and effective,though the safety of ligation of venous aneurysms under enteroscopy requires further investigation.Stenosis balloon dilation and incision under enteroscopy are both feasible options for CMUSE,and these two approaches can complement each other.

Objective To explore the application value of iterative model reconstruction(IMR)technique in low-dose lumbar CT scanning.Methods A total of 48 patients who underwent lumbar CT plain scan were selected and divided into regular-dose group(group A)and ultra-low dose group(group B).The group A underwent imaging with 120 kV tube voltage,automatic tube current modulation technology,and iDose 4 reconstruction.The group B was scanned with a tube voltage of 100 kV and a tube current of 80 mAs,and the images of B1 and B2 groups were reconstructed by iDose 4 and IMR,respectively.The standard deviation(SD)value(the SD value represents the noise of the measured tissue),signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR)of cancellous bone,intervertebral disc,dural sac,and psoas muscle were measured and calculated at the L3-L4 vertebral body level.Two diagnosticians rated the image quality.Sample t-test and ANOVA were used to compare the measurement results and subjective scores.Results The comparison of SD for intervertebral disc,dural sac,and psoas muscle showed group B2＜group A＜group B1,while the subjective score comparison indicated group A＞group B2＞group B1.The SNR for intervertebral disc and psoas muscle demonstrated group B2＞group A＞group B1.There was no significant difference in bone quality score between group A and group B1(P＞0.05),but there was a significantly different between the bone quality scores of group B2 and those obtained with iDose 4 reconstruction(group A and group B1)(P＜0.05).The effective dose(ED)of group B was reduced by approximately 70.28％compared with group A.Conclusion IMR can significantly reduce SD,improves SNR and CNR,resulting in high-quality images.Compared to iDose 4 technique,IMR has more advantages in soft tissue display,while iDose 4 technique is superior in observing fine bone structures.The combined application of iDose 4 and IMR technique ensures high-quality images for diagnosis,while significantly reducing the radiation dose to patients.

Background::An evidence gap still exists regarding the efficacy and safety of tegoprazan in patients with erosive esophagitis (EE) in China. This study aimed to verify the efficacy and safety of tegoprazan vs. esomeprazole in patients with EE in China. Methods::This study was a multicenter, randomized, double-blind, parallel, active-controlled, non-inferiority phase III trial of patients with EE randomized 1:1 to tegoprazan 50 mg/day vs. esomeprazole 40 mg/day. This study was conducted in 32 sites between October 24, 2018 and October 18, 2019. The primary endpoint was the cumulative endoscopic healing rate at week 8. The secondary endpoint included endoscopic healing rate at week 4, changes in the reflux disease questionnaire (RDQ) and gastroesophageal reflux disease health-related quality of life (GERD-HRQL) scores, and symptom improvement. Results::A total of 261 patients were randomized: 132 to the tegoprazan group and 129 to the esomeprazole group. The cumulative endoscopic healing rate at 8 weeks in the tegoprazan group was non-inferior to that of the esomeprazole group (91.1% vs. 92.8%, difference: -1.7%, 95% confidence interval [CI]: -8.5%, 5.0%, P = 0.008). There were no statistically significant differences in the changes in RDQ (total, severity, and frequency) and GERD-HRQL scores between the two groups (all P >0.05). The percentages of days without symptoms, including daytime and nighttime symptoms based on patients' diaries, were similar between the two groups (all P >0.05). In the tegoprazan and esomeprazole groups, 71.5% (93/130) and 61.7% (79/128) of the participants reported adverse events (AEs), 2.3% and 0 experienced serious AEs, while 70.0% and 60.2% had treatment-emergent AEs, respectively. Conclusion::Tegoprazan 50 mg/day demonstrated non-inferior efficacy in healing EE, symptom improvement, and quality of life, and it has similar tolerability compared with esomeprazole 40 mg/day.