In vivo confocal microscopy of the cornea is a non-invasive, rapid, and comprehensive technique for real-time, dynamic observation of all layers of the cornea. Confocal microscopy allows the examination of the morphology and cell density in the different layers of the cornea through direct visualization. With the increasing prevalence of diabetes, ocular complications have become common and have garnered more interest and in-depth research from clinical and scientific communities. This paper provides a comprehensive review of research progress made using in vivo confocal microscopy to observe various layers of cornea tissue in diabetic patients.

Objective:To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China.Methods:A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test.Results:A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region ( χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference ( χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) ( χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant ( χ2=0.51, P=0.476). Conclusions:There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.

Objective:To analyze the clinical characteristics of three patients with Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome.Methods:Three patients with IPEX syndrome diagnosed at the Children′s Hospital of Fudan University from January 24, 2013 to July 29, 2019 were selected as the study subjects. Their clinical features, laboratory investigations and results of genetic testing were summarized. Treatment and prognosis were also explored.Results:All of the three children had developed the disorder during infancy. One child had initial features including diabetes and diabetic ketoacidosis, whilst the other two had initiated by diarrhea. All patients had gastrointestinal involvement, and one was diagnosed as very early onset inflammatory bowel disease by colonoscopy and biopsy. Two children also had endocrine glands involvement. One child had manifested type 1 diabetes and positivity for thyroglobulin and thyroid peroxidase antibodies, though his thyroid function had remained normal. Another one had hypothyroidism and was treated by levothyroxine. Genetic testing revealed that all children had harbored missense variants of the FOXP3 gene, including c. 1222G>A (p.V408M), c. 767T>C (p.M256T) and c. 1021A>G (p.T341A). The clinical symptoms of one patient were alleviated following allogeneic hematopoietic stem cell transplantation. One patient was stable after treatment with infliximab plus insulin, and one child had died of refractory septic shock and multiple organ dysfunction syndrome at 3 months old. Conclusion:FOXP3 gene variant-associated IPEX syndrome may have very early onset and diverse clinical manifestations. For male patients with infantile onset chronic diarrhea, multiple endocrine or multiple system involvement, genetic testing is recommended, which may facilitate early diagnosis, treatment and genetic counseling.

Objective: To explore the intervention effect of sedentary interval on body composition and blood lipid metabolism of obese female college students, so as to provide reference for health promotion among obese students. Methods: Eighty obese female college students from first and second grades were randomly assigned into three groups, the control group ( n =28), experimental group A ( n =26), and experimental group B ( n =26), between September and November 2022. The participants received appropriate dietary guidance, a 90-minute optional physical education course was offered to control group once a week, on the basis of the control group, experimental group A performed 5-minute-intermittent brisk walking (6 km/h) during each break. Experimental group B performed 5-minute-intermittent brisk walking (6 km/h) during each break for the first 4 weeks, then changed to 4-minute-brisk walking (6 km/h) and 1-minute-rope skipping (60 skips/min) during each break for weeks 5-8, and changed to 4-minute-brisk walking (6 km/h) and 1-minute-rope skipping (80 skips/min) during each break for 9-12 weeks. The intervention was performed 10 times per day, with the interruption time and frequency on weekends remaining the same. Body mass index (BMI), body fat rate (BFR), waist hip ratio (WHR), visceral fat index (VFI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured before and after the experiment. Results: After 12 weeks intervention, there were no significant differences in body composition and blood lipids in control group ( P >0.05), BMI, BFR, VFI and TG in Group A were lower than those before intervention ( t=3.20, 2.80, 8.19, 2.21, P <0.05), BMI, BFR, WHR, VFI, TG, TC, LDL-C were lower and HDL-C in group B were higher than those before intervention ( t=6.27, 5.85, 10.82 , 19.91, 3.86, 3.29, 7.20, -4.93, P <0.01). There were significant differences in BMI, BFR, WHR, VFI and HDL-C among the three groups ( F=24.01, 23.77, 10.00, 15.28, 6.72, P <0.01), and the intervention effects of BMI, BFR and HDL-C in group B were better than those in group A and control group ( P <0.01). Conclusion The intervention of brisk walking and rope skipping had a good effect on improving body composition and blood lipid metabolism of obese female college students. Schools should make good use of the time between classes and adopt short-time and high-intensity exercise intervention to improve the body composition and blood lipid metabolism of obese students.

Objective:To optimize the clinical nursing pathway, service program and evaluation parameters of percutaneous coronary intervention(PCI), for references for the cost accounting and compensation mechanism of nursing program in public hospitals.Methods:After literature analysis and group discussion, the initial templates were constructed for the PCI clinical nursing pathway, nursing service projects, and their evaluation parameters. 15 experts were consulted by two rounds of Delphi method to optimize PCI nursing path, nursing service items and their evaluation parameters (basic labor consumption, basic time consumption, technical difficulty and risk degree).Results:Two rounds of Delphi method finally determined the PCI clinical nursing path and 27 nursing service items, and adjusted the evaluation parameters of 10 nursing service items. The new projects for PCI clinical nursing services included adjustment and review of dual antiplatelet therapy plans, postoperative rehabilitation nursing, and key project verification. The three nursing service projects with the highest level of technical difficulty and risk were intravenous blood transfusion, gastric catheterization, and gastrointestinal decompression. The two items with the highest importance assigned were high pump assisted arterial/venous infusion (blood) and invasive continuous arterial blood pressure monitoring.Conclusions:The PCI clinical nursing pathway and nursing service project constructed in this study could closely integrate with clinical practice, highlight the integrated nursing service model, and reflect the labor value of nurses.

OBJECTIVE: To assess the practical and health economical values of non-invasive prenatal test (NIPT) in Changsha Municipal Public Welfare Program. METHODS: A retrospective analysis was carried out on 149 165 women undergoing NIPT test from April 9, 2018 to December 31, 2019. For pregnant women with high risks, invasive prenatal diagnosis and follow-up of pregnancy outcome were conducted. The cost-benefit of NIPT for Down syndrome was analyzed. RESULTS: NIPT was carried out for 149 165 pregnant women and succeeded in 148 749 cases (99.72%), for which outcome were available in 148 538 (99.86%). 90% of pregnant women from the region accepted the screening with NIPT. 415 (0.27%) were diagnosed as high risk. Among these, 381 (91.81%) accepted amniocentesis, which led to the diagnosis of 212 cases of trisomy 21 (PPV=85.14%), 41 cases with trisomy 18 (PPV=48.81%) and 10 cases with trisomy 13 (PPV=20.83%). The sensitivity and specificity of NIPT for trisomy 21, trisomy 18 and trisomy 13 were (97.70%, 99.98%), (97.62%, 9.97%) and (100%, 99.97%), respectively. In addition, 213 and 30 cases were diagnosed with sex chromosomal aneuploidies (PPV=46.2%) and other autosomal anomalies (PPV=16.57%), respectively. For Down syndrome screening, the cost and benefit of the project was 120.79 million yuan and 1,056.95 million yuan, respectively. The cost-benefit ratio was 1: 8.75, and safety index was 0.0035. CONCLUSION NIPT is a highly accurate screening test for trisomy 21, which was followed by trisomy 18 and sex chromosomal aneuploidies, while it was less accurate for other autosomal aneuploidies. The application of NIPT screening has a high health economical value.
Aneuploidy ; Cost-Benefit Analysis ; Female ; Humans ; Noninvasive Prenatal Testing ; Pregnancy ; Retrospective Studies ; Trisomy 18 Syndrome/genetics*

Objective:To identify the classification characteristics and quality of life (QOL) of breast cancer (BC) patients during chemotherapy, so as to provide basis for improving the sleep and QOL of this group.Methods:A cross-sectional investigation was completed among 421 BC patients in 5 tertiary hospitals in Shanghai, Wuhan, Tangshan and Nanning in 1-12 months of 2016 using validated instruments including self-made general information questionnaire, Pittsburgh Sleep Quality Index (PSQI) and Functional Assessment of Cancer Therapy-Breast (FACT-B).Results:Four latent class of patients were identified through latent profile analysis (LPA), named by badly worse sleep quality(SQ) (C1, n=23), medium-SQ with difficulty to fall asleep (C2, n=127), medium-SQ with worse sleeping process (C3, n=30), none sleep disorders (C4, n=241). Total points of SQ among C1-C4 had significant difference ( χ2 value was 309.28, P<0.05). Age, BMI, job status, whether had surgery and course of chemotherapy between classes had statistically significant differences ( χ2 values were 9.57-25.28, all P<0.05). It had significant difference between C2 and C3, C2 and C4, C3 and C1, C3 and C4 on QOL ( χ2 values were 5.96-52.73, all P<0.05). Conclusion:SQ of BC patients during chemotherapy has heterogeneity among population. Different features of SQ of BC patients have different performance on QOL. Health professionals should keep an eye on patients with features of older age, high BMI, in job status, already received surgery and during early-stage chemotherapy, provide personal nursing intervention to improve SQ and QOL.

Objective: Exploring the relation between lifestyle, negative emotions and obesity of female college students,and to provide references for controlling obesity improving life style and promoting physical and mental health. Methods: A random sample survey of 2 044 female college students in Henan Province was conducted using height and weight tester, body composition analyzer, the Depression-Anxiety-Stress Scale and College Students’ Healthy Lifestyle Scale. SPSS 17.0 and AMOS 20.0 were used for statistical analysis. Results: The detection rates of recessive obesity, overweight and dominant obesity among female college students were 28.6%, 6.5% and 4.2% respectively. Exercise behavior, dietary nutrition behavior and stress management behavior of female college students’ lifestyle could predict the degree of obesity positively, and negative emotions could predict the degree of obesity positively( r =-0.23, -0.22, -0.21, 0.26, P <0.01). The proportion of negative emotions explained in the associations between exercise, dietary behavior and stress management with obesity was 22.1%, 25.9% and 42.5%, respectively, between the negative emotions of exercise behavior and obesity, dietary nutrition behavior and obesity, stress management behavior and obesity. Conclusion Negative emotions played an intermediary role between exercise behavior and obesity, dietary nutrition behavior and obesity, stress management behavior and obesity.

Objective To evaluate the value of lung ultrasound score (LUS) on assessing the severity and extubation opportunity in postoperative patients of general surgery, and to investigate the correlation between LUS and oxygenation index (PaO2/FiO2), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA), stay length in ICU and stay length in hospital. Methods A prospective double- blind cohort study was conducted. Eighty- nine postoperative patients of general surgery with successful extubation were selected, and the patients were divided into 2 groups:group A ( admission ICU to extubation time less than 48 h, 52 cases) and group B(admission ICU to extubation time more than 48 h, 37 cases). Before extubation, the PaO2/FiO2 was recorded according the blood gas analysis, and APACHE Ⅱ, SOFA and LUS were examined, and the staying time in ICU and staying time in hospital were recorded. The correlation was analyzed. Results The LUS, APACHE Ⅱ, SOFA, staying time in ICU and staying time in hospital in group A were significantly lower than those in group B: (3.98 ± 2.31) scores vs. (13.41 ± 2.82) scores, (7.52 ± 1.96) scores vs. (14.92 ± 3.07) scores, (4.50 ± 2.24) scores vs. (9.70 ± 3.64) scores, (1.77 ± 1.41) d vs. (8.49 ± 4.35) d and (8.49 ± 2.28) d vs. (15.63 ± 6.10) d, and the PaO2/FiO2 was significantly higher than that in group B:(441.57 ± 45.31) mmHg (1 mmHg=0.133 kPa) vs. (305.78 ± 90.72) mmHg, and there were statistical differences (P<0.01). The LUS had negative correlation with the PaO2/FiO2 (r=-0.882, P<0.01), and it had positive correlation with APACHEⅡ, SOFA, staying time in ICU and staying time in hospital (r=0.711, 0.590, 0.930 and 0.709;P<0.01). Conclusions The LUS is simple and easily available. It can evaluate the changes of pulmonary ventilation, and also evaluate its degree of severity and prognosis. It is helpful in the prediction of the extubation time, staying time in ICU and staying time in hospital in patients with general surgery.

Objective To evaluate the effect of the single energy metal artifact reduction (SEMAR) algorithm with a 320 multi-slice computed tomography (MSCT) volume scanner in patients with knee tumor prostheses.Methods From November 2015 to March 2016,23 consecutive patients with knee tumor prostheses who underwent a 320-MSCT scan were collected.And the raw data were reconstructed using two different methods:conventional iterative reconstruction (IR) alone and IR associated with SEMAR.The ROI were objectively and subjectively assessed at osteotomy level and articular level,and the Wilcoxon signed rank test was used for them.Results Compared with IR,objectively,artifact index (AI) values of the osteotomy level decreased 44.8％ to 74.1％ and that of the articular level decreased 73.2％ to 93.2％;subjectively,the scores of image quality of two levels were increased 0.5 to 2.0 scores and 1.0 to 4.0 scores by SEMAR respectively.The objective and subject image quality of periprosthetic structures were all significantly improved by the SEMAR algorithm (P＜0.05).Conclusion The SEMAR algorithm significantly reduced the metal artifact of knee tumor prostheses,improved the image quality of periprosthetic structures and may increase diagnostic confidence of prosthetic complications in patients with modular knee tumor prostheses,especially at the osteotomy level.