Background:Slight mucosal lesions in the early stage of gastric cancer(GC)are difficult to recognize,and the miss rate of early GC by conventional endoscopy is high.Artificial intelligence(AI)systems can assist in the identification of gastric neoplastic lesions and reduce miss rate,but it is not clear whether AI-assisted endoscopic screening is cost-effective.Aims:The subjects of this study were to evaluate the cost-effectiveness of a population-based endoscopy screening program for GC in high-incidence countries(China,Japan and South Korea),and to explore the applicability of domestic AI--Intelligent and real-time endoscopy analytical device(IREAD)-assisted endoscopy for GC screening in these three countries.Methods:Based on the natural history of GC,a Markov model with cycle year of 1 year was constructed to compare cost-effectiveness of two strategies for GC screening in recommended age group:no screening(the control strategy),conventional endoscopy screening and IREAD-assisted endoscopy screening.Data such as transition probabilities of different states and treatment costs were obtained from previously published studies.The cost-effectiveness analysis was conducted from the perspective of society by calculating cost,Quality adjusted life years(QALY),Incremental cost effectiveness ratio(ICER).Results:The cohort results showed that 15.87%and 24.52%of GC-related deaths could be respectively avoid by conventional endoscopy screening and IREAD-assisted endoscopy screening in China,which the screening effects were similar to Japan;In South Korea,Conventional endoscopic screening and IREAD-assisted endoscopic screening averted 41.34%and 53.15%of GC-related deaths,respectively.Between the two strategies,IREAD-assisted endoscopic screening is more economic,with ICER of $34 827.61/QALY,$87 978.71/QALY and $10 574.30/QALY in China,Japan and South Korea,respectively,which were lower than the willingness-to-pay(WTP)threshold.Conclusions:When the threshold of WTP is 3 times Gross domestic product per capita,the application of AI-assisted endoscopy for GC screening in age-specific population in high-incidence countries may be more cost-effective.Meanwhile,this study provides important evidence for the promotion of domestic IRAED-assisted endoscopy in GC screening in China,Japan and South Korea.

Objective:To evaluate the effect of intestinal carbapenem-resistant Enterobacteriaceae (CRE) active screening combined with enhanced intervention in the prevention and control of nosocomial infection in patients admitted to the hematological ward.Methods:Patients who were admitted to the Department of Hematology in a tertiary-care general hospital from March 1, 2017 to December 31, 2019 and underwent chemotherapy or immunosuppressive therapy comprised the intervention group. They were screened for intestinal CRE at least thrice. From December 1, 2016 to February 28, 2017, patients who underwent chemotherapy or immunosuppressive therapy without active intestinal CRE screening in the Department of Hematology formed the control group. Both the patient groups were monitored for CRE infection in real time. The χ2 test was used to compare the changes in the CRE infection rate and mortality in high-risk patients before and after the active screening. Results:During the intervention period, the CRE colonization rate of patients was 16.46% (66/401) ; in terms of disease distribution, the colonization rate of acute leukemia was the highest 23.03% (26/113) . Of the 66 colonized patients, 27 (40.9%) patients were identified as positive for CRE at the first screening, 15 (22.7%) were identified at the time of the second screening, and the remaining 24 (36.4%) were identified at the third or subsequent screening; Carbapenem-resistant Klebsiella pneumoniae (CRPK) strains were dominant among the pathogens, accounting for 54.55% (36/66) . During the active screening period, the CRE infection rate (2.49%) and mortality rate (50.00%) of high-risk patients were significantly lower than those of the controls (11.30% and 69.23%, respectively) . The pathogens of 10 CRE infection patients during the intervention period were exactly the same as the previous active screening pathogens, and the coincidence rate was 100%.Conclusion:The CRE colonization rate was the highest in patients with acute leukemia who were admitted in the hematology wards. CRPK is the main pathogen of CRE colonization, infection, and death. Increasing the frequency of screening can significantly raise the positive rate of screening, Active screening can effectively reduce the incidence and subsequent mortality of CRE in high-risk patients admitted in the hematological wards. High coincidence rate between CRE screening positive pathogens and subsequent CRE infection pathogens. Intestinal CRE screening can serve as an indicator of CRE bloodstream infection in patients with hematological diseases as well as provide information for antibiotics therapy.

Objective To explore the relationship between serum soluble human matrix lysine 2 (sST2) with chronic heart failure(CHF) and its clinical value for diagnosis and prognosis of CHF .Methods 60 cases of CHF and 60 cases of non-CHF were selected as the CHF group and control group respectively ,and the CHF group was divided into sST2 low level group and sST2 high level group according to the diagnostic threshold .The ELISA method was used to detect the serum sST 2 level of each group .The CHF group were followed up for 6 months .Then the influence of sST2 on CHF prognosis survival rate was observed .Results There was no statistical difference in age ,gender ,body mass index ,basic disease history ,basic medication situation and blood lipid indexes between the CHF group and control group(P＞0 .05);serum brain natriuretic peptide(BNP) level in the CHF group was obviously higher than that in the control group(P＜0 .01);serum sST2 levels in the CHF group and control group were (55 .08 ± 3 .98)ng/mL and (10 .46 ± 0 .72)ng/mL ,the difference was statistically significant (P＜0 .01) .Serum sST2 was positively correlated with BNP(r=0 .4606 ,P＜0 .01) ,moreover 95% CI was 0 .3066-0 .5911 .When the critical value was 0 .5303 ,the area under curve ,95% CI ,sensitivity ,specificity and likelihood ratio of sST 2 combined BNP detection were 0 .9362 ,0 .8853 -0 .9877 , 85 .00% (73 .43% -92 .90% ) ,98 .33% (91 .06% -99 .96% ) and 50 .00 respectively .The survival curve had statistical difference between the sST2 low level group and sST2 high level group(P=0 .0149) .Conclusion Serum sST2 can be used as a new biomarker for the diagnosis and prognosis of CHF ,and its combined with BNP may have better diagnostic value.

Objective To analyze and discuss the status of fighter pilots' centrifuge training,to investigate the pilots' G tolerance and to provide reference for training program improvement.Methods One thousand and one hundred ninety-nine fighter pilots' human centrifuge training data were collected and analyzed by cross-sectional study.Pilots were classified by the training purposes that were for aeromedical qualification and competitive assessment.The up-to-standard rates were compared upon the analysis of pilots' training performance.Results In 877 pilots for aeromedical qualification,594 completed the runs of 8 G for 10 s,106 completed 9 G for 10 s.The qualification rate was 79.1％.In 180 high performance fighter pilots selected for competitive assessment,141 completed the runs of 9 G for 10 s.The qualification rate was 78.3％.In 142 second generation fighter pilots selected for competitive assessment,140 completed the runs of 7 G for 10 s.The qualification rate was 98.6％ which was significantly greater than that of the pilots for aeromedical qualification (x 2 =31.141,P ＜ 0.01) and high performance fighter pilots selected for competitive assessment (x 2 =29.318,P＜0.01).There was no difference on qualification rate between the latter two groups (x2 =0.058,P ＞0.05).The incidence of G-LOC and A-LOC was 5.0％ and 2.7％ respectively.The incidences of G-LOC (x2 =4.983,P＜0.05) and A-LOC (x2 =7.528,P＜0.05) of the pilots selected for competitive assessment were significantly greater than those of the pilots for aeromedical qualification.In 1 199 pilots,only 2 pilots (0.17％) had severe acute lumbar sprain.Conclusions Advanced anti-G methods have been adopted in our centrifuge training.The incidences of G-LOC and spinal injury induced by centrifuge training are low.The training program still needs further development and the training effectiveness should be improved.

Objective To analyze and discuss the status of fighter pilots' centrifuge training,to investigate the pilots' G tolerance and to provide reference for training program improvement.Methods One thousand and one hundred ninety-nine fighter pilots' human centrifuge training data were collected and analyzed by cross-sectional study.Pilots were classified by the training purposes that were for aeromedical qualification and competitive assessment.The up-to-standard rates were compared upon the analysis of pilots' training performance.Results In 877 pilots for aeromedical qualification,594 completed the runs of 8 G for 10 s,106 completed 9 G for 10 s.The qualification rate was 79.1％.In 180 high performance fighter pilots selected for competitive assessment,141 completed the runs of 9 G for 10 s.The qualification rate was 78.3％.In 142 second generation fighter pilots selected for competitive assessment,140 completed the runs of 7 G for 10 s.The qualification rate was 98.6％ which was significantly greater than that of the pilots for aeromedical qualification (x 2 =31.141,P ＜ 0.01) and high performance fighter pilots selected for competitive assessment (x 2 =29.318,P＜0.01).There was no difference on qualification rate between the latter two groups (x2 =0.058,P ＞0.05).The incidence of G-LOC and A-LOC was 5.0％ and 2.7％ respectively.The incidences of G-LOC (x2 =4.983,P＜0.05) and A-LOC (x2 =7.528,P＜0.05) of the pilots selected for competitive assessment were significantly greater than those of the pilots for aeromedical qualification.In 1 199 pilots,only 2 pilots (0.17％) had severe acute lumbar sprain.Conclusions Advanced anti-G methods have been adopted in our centrifuge training.The incidences of G-LOC and spinal injury induced by centrifuge training are low.The training program still needs further development and the training effectiveness should be improved.

Objective To explore the application value of Thyroid Imaging Reporting and Data System ( TI?RADS) stratification in diagnosing thyroid nodules in respect of the effect of age and gender. Methods A total of 684 patients with thyroid nodules, including 118 males and 566 females, were stratified into subgroups according to their age and gender, and the results of TI?RADS evaluation were compared with their pathological diagnosis. Results The sensitivity, specificity, and AUC of TI?RADS grading for malignant thyroid nodules in the males was 84.7%, 66.7%, and 0.803 (95% CI 0.709?0.897), respectively. In the females, the sensitivity and specificity were 80. 8% and 65. 0%, respectively, with an AUC of 0.812 (95% CI 0.758?0.849). There was no statistically significant difference between genders when using TI?RADS to determine the nature of thyroid nodules ( P>0.05) . In the patients aged 26?35 years, the sensitivity, specificity and AUC of TI?RADS classification for malignant thyroid nodules were 85.4%, 90.0%, and 0.915 (95% CI 0.818?0.987), respectively. In the patients aged 36?45 years, the sensitivity and specificity of TI?RADS classification for malignant thyroid nodules were 84. 4% and 78. 1%, respectively, with an AUC of 0. 898 ( 95% CI 0. 842?0. 953 ) . In the patients aged 46?55 years, the corresponding parameters were 79.7%, 71.4% and AUC 0.822 (95% CI 0.789?0.925), respectivey, while in those aged 56?65 years, the corresponding data were 75.6%, 60.0%, and AUC 0.729 (95% CI 0.576?0.785), respectively. The ROC curve of patients aged 56?65 years was statistically significantly different from those of patients aged 26?35, 36?45 and 46?55 years ( P<0.05 for all) . Conclusions Patient gender has no significant effect on the results of TI?RADS classification, but age of the patients does. The age factor should be considered during ultrasound diagnosis of thyroid nodules using TI?RADS classification.

Objective To explore the application value of Thyroid Imaging Reporting and Data System ( TI?RADS) stratification in diagnosing thyroid nodules in respect of the effect of age and gender. Methods A total of 684 patients with thyroid nodules, including 118 males and 566 females, were stratified into subgroups according to their age and gender, and the results of TI?RADS evaluation were compared with their pathological diagnosis. Results The sensitivity, specificity, and AUC of TI?RADS grading for malignant thyroid nodules in the males was 84.7%, 66.7%, and 0.803 (95% CI 0.709?0.897), respectively. In the females, the sensitivity and specificity were 80. 8% and 65. 0%, respectively, with an AUC of 0.812 (95% CI 0.758?0.849). There was no statistically significant difference between genders when using TI?RADS to determine the nature of thyroid nodules ( P>0.05) . In the patients aged 26?35 years, the sensitivity, specificity and AUC of TI?RADS classification for malignant thyroid nodules were 85.4%, 90.0%, and 0.915 (95% CI 0.818?0.987), respectively. In the patients aged 36?45 years, the sensitivity and specificity of TI?RADS classification for malignant thyroid nodules were 84. 4% and 78. 1%, respectively, with an AUC of 0. 898 ( 95% CI 0. 842?0. 953 ) . In the patients aged 46?55 years, the corresponding parameters were 79.7%, 71.4% and AUC 0.822 (95% CI 0.789?0.925), respectivey, while in those aged 56?65 years, the corresponding data were 75.6%, 60.0%, and AUC 0.729 (95% CI 0.576?0.785), respectively. The ROC curve of patients aged 56?65 years was statistically significantly different from those of patients aged 26?35, 36?45 and 46?55 years ( P<0.05 for all) . Conclusions Patient gender has no significant effect on the results of TI?RADS classification, but age of the patients does. The age factor should be considered during ultrasound diagnosis of thyroid nodules using TI?RADS classification.

BACKGROUND:Currently, hematopoietic stem celltransplantation mainly depends on unrelated donors. Mental state of the unrelated donors is very important to ensure the successful celltransplantation. OBJECTIVE:To compare mental and physical health status of relative and unrelated donors during the hematopoietic stem cellcol ection. METHODS:We compared the mental (Symptom Checklist-90) and physical (temperature, breath, pulse, and blood pressure) health status of relative and unrelated donors at admission, 1 day before cellcol ection, and 1-2 days after cellcol ection.RESULTS AND CONCLUSION:At admission, there was no difference in the mental health status of relative and unrelated donors (P>0.05), while the scores on Symptom Checklist-90 were significantly higher in the unrelated donors than the relative donors, including total score, forced, depression, anxiety, hostility, and fear (P<0.05). The physical signs were steady in the unrelated and relative donors, but the difference in breath and systolic blood pressure was of great significance before and after cellcol ection in the two groups. These findings indicate that during cellcol ection, the unrelated donors exhibit heavier mental load than the relative donors, and psychological counseling and health guidance are necessary.

Objective To investigate maternal risk factors for fetal congenital heart diseases (CHD). Methods A case-control study was conducted on 16 645 pregnant women who underwent cardiovascular malformation screening for fetal cardiovascular system,whose pregnancy outcomes were recorded,and whose newborns were scanned by an echocardiography in Peking University People's Hospital,Haidian,Changping,Mentougou and Daxing Maternal and Child Health Hospital from Nov.2006 to Oct.2009.One hundred and twelve pregnant women whose babies were found to be CHD (40 severe CHD and 72 simple CHD) before or after delivery were taken as study group.Women in control group (n =304) were randomly selected from those pregnant women who had infants without CHD.Logistic regression analysis and x2 test were used to analyze the maternal risk factors for fetal CHD. Results (1) The average age of women whose infants had severe CHD was 28.3 years (21-40 years),and it was 29.9 years (22-39 years) for women whose infants had simple CHD.There were no significant differences between the control group (29.5 years,20-44 years) and the above two groups (t=1.511 and -0.826,P=0.138 and 0.410 respectively).(2) Single factor analysis:during first trimester,the rate of upper respiratory infection (18/39,46.2 ％) and exposure to certain chemicals (13/40,32.5％) of severe CHD group were higher than those of control group [(14.9％ (45/303) and 2.0％ (6/304)] (x2 =22.399 and 62.678,OR=4.895 and 23.753,95％CI:2.419-9.905 and 8.358-67.506,P =0.000 respectively).Compared with control group (0.0％,0/304),the rate of pregnant women with CHD family history in simple CHD group was significantly higher (4.2％,3/72)(Fisher exact test,P=0.007).(3) Logistic regression analysis:maternal upper respiratory infections (OR =5.120,95％CI:2.340-11.206,P =0.000) and exposure to certain chemicals (f)R=23.030,95％CI:7.506-70.665,P=0.000) during first trimester were risk factors for fetal severe CHD. Conclusions Upper respiratory infection and exposure to certain chemicals during first trimester might play important roles in the occurrence of fetal severe CHD.Maternal family history of CHD might associate with fetal simple CHD.

Objective To investigate the mechanism of the increased permeability of the blood-brain barrier during transcranial ultrasound contrast imaging. Methods Sprague-Dawhy (SD) rats were performed transcranial ultrasound contrast imaging, the lanthanum nitrate and the evans-blue were used as tracers,the distribution of the tracers were observed and the transports mechanism were also investigated. Results The opening of the tight junction and increased permeability of the cellular membrane were observed after the transcranial ultrasound contrast imaging. Conclusions The main mechanism of the increased permeability of the blood-brain barrier was the opening of the tight junction and increased permeability of the cellular membrane.