Objective:Based on the cost-effectiveness,it aimed to assess the health benefits amd economic value of screening,di-agnosis,treatment,and optimal delicacy management of liver disease in hepatocellular carcinoma(HCC)patients.Methods:A Deci-sion tree-Markov model was developed to compare the cost-effectiveness of HCC screening and long-term surveillance versus no screening in population at risk from the health care system perspective.Results:It is found that HCC screening was a cost-effective approach compared to no screening(Incremental Cost-Effectiveness Ratio[ICER]:17 790 yuan/QALY).Scenario analyses suggested that initiating HCC screening at the age of 40,as recommended by clinical guidelines,and implementing long-term surveillance based on risk stratification were more cost-effective.Conclusions:For the implementation of HCC screening programs,attention should be paid to improving participation and compliance among the population at risk,incorporating advanced screening methods,improving management efficiency with digital tools,and introducing innovative payment methods to reduce economic burden.

Objective:To explore the effects of conflicting stimuli generated by different chromatic lights on visual display terminal (VDT) on accommodative response and microfluctuation of myopes and emmetropes, and to investigate the possible relationship between chromatic light, accommodation and the development and progression of myopia.Methods:A non-randomized controlled trial was conducted.Forty-one subjects aged 22 to 30 years old were enrolled, including 19 emmetropes in emmetropic group and 22 myopes in myopic group.The subjects had the normal color vision and no ocular organic diseases.The interventions were screens of different colors.There were 7 chromatic light conditions, including 3 monochromatic lights (red, green, blue), 3 bichromatic lights (red+ green, red+ blue, green+ blue) and 1 polychromatic light (white=red+ green+ blue). Subjects were asked to look at a black E target on a VDT at a distance of 33 cm for more than 20 seconds.The background color of the VDT was changed randomly in the 7 chromatic light conditions.The accommodative responses were recorded with the Grand Seiko WAM-5500 automatic infrared refractor every 0.2 seconds and the accommodative microfluctuation was calculated as the standard deviation of the accommodative response.Accommodative response and accommodative microfluctuation under different chromatic light conditions were compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (No.2019-1564). Written informed consent was obtained from each subject.Results:No statistically significant difference was found in the accommodative response between the two groups ( Fgroup=2.626, P=0.113). There was a statistically significant difference under different chromatic light conditions between the two groups ( Flight=39.070, P<0.01). There were similar trends in the effects of various color lights in both groups, with the largest accommodative response under monochromatic red light, followed by the bichromatic light containing red light, and then the smallest accommodative response under monochromatic blue light, and the differences were statistically significant (all at P<0.05). The accommodative microfluctuations under red, green, blue, red+ blue, red+ green, blue+ green and white light conditions were (0.142±0.033), (0.128±0.038), (0.131±0.043), (0.139±0.039), (0.127±0.034), (0.131±0.043) and (0.139±0.042)D in emmetropic group, and (0.178±0.043), (0.164±0.043), (0.159±0.039), (0.174±0.042), (0.166±0.036), (0.159±0.031) and (0.174±0.035)D in myopic group, respectively, showing statistically significant differences between them ( Fgroup=12.146, P<0.01; Flight=2.782, P<0.05). The accommodative microfluctuations under the 7 light conditions were higher in myopic group than in emmetropic group, and the differences were statistically significant (all at P<0.05). In myopes, the accommodative microfluctuation was the largest under red light, which was significantly larger than that under blue light, and was the smallest under blue+ green light (all at P<0.05). There was no significant difference in the accommodative microfluctuation between bichromatic light and its two monochromatic lights, or between the polychromatic light (white light) and its three monochromatic lights (all at P>0.05). There was no significant effect of various chromatic lights on the accommodative microfluctuation in emmetropic group (all at P>0.05). Conclusions:The accommodative microfluctuation is greater in myopes than in emmetropes.The stimuli produced by long-wavelength light cause larger accommodative microfluctuation, while conflicting stimuli generated by different chromatic lights do not increase accommodative microfluctuation.

Objective    To evaluate the early and mid-term results of robot-assisted coronary artery bypass grafting (RACAB) in the treatment of multi-vessel coronary artery disease (MV-CAD). Methods     Patients with MV-CAD who underwent RACAB from April 2018 to December 2021 in our hospital were included. Patients who underwent hybrid coronary revascularization (HCR) which combined RACAB with percutaneous coronary intervention were allocated to a HCR-RACAB group, and patients who underwent multi-vessel RACAB were allocated to a MV-RACAB group. Perioperative and follow-up data were collected and compared between the two groups. Results     A total of 102 patients were included, including 81 males and 21 females with a mean age of 61.7±10.8 years. Two (2.0%) patients were transferred to conventional CABG due to sudden ventricular fibrillation and pleura adhesion. In the remaining 100 patients who underwent RACAB, 100 left internal mammary arteries (LIMA) and 46 right internal mammary arteries (RIMA) were harvested with a 100.0% success rate. Besides, all patients undergoing RACAB achieved LIMA/RIMA-left anterior descending branch reconstruction, with an average number of 2.5±0.6 target vessels revascularized by stent or graft. One patient had perioperative myocardial infarction with an outcome of death. The incidence of major perioperative adverse events was 1.0%. There was no perioperative stroke or re-sternotomy for hemostasis. The mean follow-up time was 28.2 months, with a follow-up rate of 99.0% and an overall major adverse cardiac and cerebrovascular event (MACCE) rate of 7.0%, including 3 all-cause deaths (3.0%), 2 strokes (2.0%) and 3 re-revascularizations (3.0%). The HCR-RACAB group had fewer red blood cell transfusion (P=0.030) and intraoperative blood loss (P=0.037) compared with the MV-RACAB group, and there was no statistical difference in the incidence of major perioperative adverse events or MACCE between the two groups during the follow-up period (P>0.05). Conclusion    RACAB can be safely applied in the treatment of MV-CAD with good early and mid-term outcomes. High-quality harvesting of LIMA/RIMA and aortic no-touch technique are crucial to achieve these results.

Objective:To systematically review the teaching effect of problem-based learning (PBL) combined with evidence-based medicine (EBM) teaching mode on the standardized residency training.Methods:CNKI, Wanfang database, VIP database, SinoMed, Embase, PubMed and Web of SCI databases were searched, and the randomized controlled trial (RCT) studies of the application of EBM combined with PBL teaching in standardized residency training were collected. The retrieval time was from the establishment to 1st July, 2018. Two investigators independently extracted data and assessed the quality of the studies. After assessing the risk of bias of included studies, Meta-analysis was performed on RevMan 5.3.Results:In total, 4 studies were included in the review. Narrative assessment was adopted, because outcome indicators of these study were varied and the quality of the literatures could not meet the requirement of Meta-analysis. Our study suggested that the residents who were in PBL combined with EBM teaching mode group got higher scores in the standardized residency training, compared with those in the lecture-based learning (LBL) teaching mode group, especially in case analysis score, total score of examination, improvement of clinical thinking ability, communication and expression ability, organization and cooperation ability, etc.Conclusion:The current evidence suggests that the application of EBM combined with PBL teaching mode has a positive effect on the standardized residency training. Compared with the traditional LBL teaching, EBM can improve students' ability. However, limited by the quantity and quality of included studies, the above conclusions still need to be verified by more studies with larger samples and higher quality.

Objective    To investigate the feasibility and safety of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD). Methods    A total of 50 patients with MVCAD who underwent HCR technique in our heart center from May 2016 to April 2019 were included in this study (a HCR group), including 38 patients who underwent two-stage HCR and 12 patients one-stop HCR. There were 39 males and 11 females, with an average age of 62.4 (46-82) years. Another 482 patients who underwent conventional median incision under off-pump coronary artery bypass grafting (OPCAB) at the same period were selected as control (an OPCAB group), including 392 males and 90 females, with an average age of 64.2 (48-84) years. The safety and feasibility of HCR were evaluated and compared with conventional OPCAB technique. Results    There was no perioperative death in both groups. Compared with the OPCAB, HCR was associated with shorter operation time, less chest tube drainage, lower requirement of blood transfusion, shorter mechanical ventilation time and shorter postoperative intensive care unit (ICU) stay (P<0.05). There was no statistical difference in the incidence of major adverse cardiac or cerebrovascular events during the follow-up of 6 to 36 months between the two groups. Conclusion    HCR provides favorable short and mid-term outcomes for selected patients with MVCAD compared with conventional OPCAB.

Invasive neural electrodes promote human understanding of neuroscience to the micrometer and millisecond scale. Due to the large mechanical mismatch between traditional rigid electrodes and soft brain tissues, flexible electrodes have become the new trend of neural electrodes. The flexibility of the neural electrode reduces the immune response while losing the implantation stiffness. The implantation mechanism of the neural electrode was reviewed and current researches on the implantation strategies of the flexible electrodes were summarized, so as to help solve the loss of implantation ability of flexible electrode and acute implantation injury. Based on the characteristics of various implantation strategies, the prospect of flexible electrode implantation strategies was proposed.

Objective:To explore the performance of the commonly used whole blood C-reactive protein (CRP) detection systems and give related recommendation on the performance requirements of detection systems.Methods:A total of 7 540 venous blood samples from 26 maternal, child and children′s hospitals were collected to conduct this multi-center study on the analytical performance of 5 commonly used whole blood CRP detection systems from March to April in 2019. The blank check, carryover, repeatability, intermediate precision, linearity, sample stability, influence of hematocrit/triglyceride/bilirubin, comparison with SIEMENS specific protein analyzer and trueness were evaluated. The 5 systems included BC-5390CRP autohematology analyzer, AstepPLUS specific protein analyzer, Ottoman-1000 Automated Specific Protein POCT Workstation, i-CHROMA Immunofluorometer equipment Reader and Orion QuikRead go detecting instrument. The 5 systems were labeled as a, b, c, d and e randomly.Results:Within the 5 systems, all values of blank check were less than 1.00 mg/L, the carryovers were lower than 1.00%. The repeatability of different ranges of CRP concentrations including 3.00-10.00, 10.00-30.00 and>30.00 mg/L were less than 10.00%, 6.00% and 5.00%, respectively, and the intermediate precision was less than 10.00%. The linearity correlation coefficients of the 5 systems were all above 0.975, while the slope was within 0.950-1.050. Whole blood samples were stable within 72 hours both at room temperature (18-25 ℃) and refrigerated temperature (2-8 ℃). The CRP results were rarely influenced by high triglyceride or bilirubin, except for the immmunoturbidimetric test based on microparticles coated with anti-human CRP F(ab) 2 fragments. When triglyceride was less than 15.46 mmol/L, the deviation of CRP was less than 10.00%. When bilirubin was less than 345.47 μmol/L, the deviation of CRP was less than 10.00%. CRP was more susceptible to Hct on the systems without Hct correction. The deviation of CRP between different Hct dilution concentration and 40% dilution concentration can reach as high as 67.48%. The correlation coefficients ( r) of 5 systems were all more than 0.975 in the range of 0-300.00 mg/L compared with Siemens specific protein analyzer. All systems passed the trueness verification using the samples with specified values of 12.89 and 30.60 mg/L. Conclusion:The performance of 5 systems can basically meet the clinical needs, but it is suggested that the whole blood CRP detection system without automatic Hct correction should be modified manually.

The present study was aimed to evaluate resting-state functional connectivity and topological properties of brain networks in narcolepsy patients compared with healthy controls. Resting-state fMRI was performed in 26 adult narcolepsy patients and 30 matched healthy controls. MRI data were first analyzed by group independent component analysis, then a graph theoretical method was applied to evaluate the topological properties in the whole brain. Small-world network parameters and nodal topological properties were measured. Altered topological properties in brain areas between groups were selected as region-of-interest seeds, then the functional connectivity among these seeds was compared between groups. Partial correlation analysis was performed to evaluate the relationship between the severity of sleepiness and functional connectivity or topological properties in the narcolepsy patients. Twenty-one independent components out of 48 were obtained. Compared with healthy controls, the narcolepsy patients exhibited significantly decreased functional connectivity within the executive and salience networks, along with increased functional connectivity in the bilateral frontal lobes within the executive network. There were no differences in small-world network properties between patients and controls. The altered brain areas in nodal topological properties between groups were mainly in the inferior frontal cortex, basal ganglia, anterior cingulate, sensory cortex, supplementary motor cortex, and visual cortex. In the partial correlation analysis, nodal topological properties in the putamen, anterior cingulate, and sensory cortex as well as functional connectivity between these regions were correlated with the severity of sleepiness (sleep latency, REM sleep latency, and Epworth sleepiness score) among narcolepsy patients. Altered connectivity within the executive and salience networks was found in narcolepsy patients. Functional connection changes between the left frontal cortex and left caudate nucleus may be one of the parameters describing the severity of narcolepsy. Changes in the nodal topological properties in the left putamen and left posterior cingulate, changes in functional connectivity between the left supplementary motor area and right occipital as well as in functional connectivity between the left anterior cingulate gyrus and bilateral postcentral gyrus can be considered as a specific indicator for evaluating the severity of narcolepsy.

Objective: To assess the effectiveness in optimizing resources and shortening critical children′s waiting time in pediatric emergency department (PED) with five-level pediatric emergency triage system (PETS). Methods: This retrospective study was conducted in the First Affiliated Hospital of Xiamen University after PETS was applied. The data of patients who visited the pediatric emergency department from January 2015 to December 2017 were collected and analyzed, including age, sex, diseases, visiting time, triage rate and destination. Results: A total of 375 985 patients were included, among whom males were 225 308 (59.9%) and females were 150 677 (40.1%), all younger than 14 years of age. The number of critical cases (level Ⅰ, level Ⅱ and level Ⅲ) was increased from 4 719 (3.7%) in 2015, 12 209 (10.2%) in 2016 to 16 188 (12.7%) in 2017. The number of non-critical patients (level Ⅴ) decreased year by year, as from 98 213 (76.8%) in 2015 to 75 210 (62.6%) in 2016 and 78 857 (61.7%) in 2017. The patients who classified as level Ⅰ or levelⅡaccording to the PETS were seen immediately by physician (n=1855, 0.5%). Overall, 119 738 patients (98.3%) who were classified as level Ⅲ or level Ⅳ could be seen by physician in a timely manner according to triage guidelines, while 2 112 patients (1.7%) could not. The mean waiting time was 9.09 min in level Ⅲ, 17.7 min in level Ⅳ, and 55.76 min in level Ⅴ patients, respectively. The critical cases admitted to the intensive care units were 175 (36.2%) in 2015, 350 (62.8%) in 2016 and 374 (66.2%) in 2017. The etiologies were respiratory diseases (73.3%), gastrointestinal diseases (15.8%) and infectious diseases (3.1%). Conclusion The application of PETS could optimize emergency resources and shorten the waiting time of critically ill children.

course of Internal Medicine and Surgery Nursing. Methods From September 2014 to July 2016, the Grade 2013 nursing students at the Sino American cooperative nursing class in the Nursing College of Wenzhou Medical University were selected as the experimental group by convenient sampling method, with a total of 59 people. The Grade 2012 nursing students in the Sino American cooperative nursing class were selected as the control group, with a total of 60 people. The nursing students in the control group received traditional teaching methods and the nursing students in the experimental group received the self participating teaching method. We compared students' self-learning ability, theoretical knowledge and comprehensive practical ability between the two groups. Results The total score of self-learning ability and the scores of all dimensions of experimental group were higher than those in the control group after class, and the differences were statistically significant (P< 0.05). The scores of theoretical knowledge and comprehensive practice ability of the experimental group were higher than those of the control group, and the differences were statistically significant (P< 0.05). Conclusions Self participation teaching method is a teaching method that helps teachers play a leading role in giving play to students' main body status. It helps to promote the development of nursing students' independent learning ability, and improve their theoretical level and nursing practice ability.