Objective The digital transformation of healthcare has made data-driven approaches critical for improving the quality and efficiency of medical services.This study aims to improve the quality of critical value management by a data-driv-en intervention.Methods This study built an advanced digital platform to precisely record the time-stamp of each step,from de-tection to solution.This platform also delivered real-time notifications of patient critical value information to doctors' mobile de-vices,thereby optimizing the critical value management.Data were collected via this platform.A cohort study was designed:March 2024 data(pre-go-live)served as the control group and May 2024 data(post-go-live)as the intervention group.Comple-tion rate,processing time,and the proportion of in-patient critical values which were entered into the electronic progress were compared.Results The critical-value completion rate rose from 97.1％to 100.0％,and the proportion of values processed within 30 min increased from 80.91％to 83.42％.Among alerts that required ≥30 min,median(IQR)processing time fell from 100.27(230.09)min in March 2024 to 91.07(169.73)min in May 2024.Median processing time shortened for both e-mergency and out-patient alerts,with the out-patient reduction being statistically significant(median-45 min,P=0.042).Conclusion The data-driven platform not only improved the critical-value management,but also enhanced the transparency and traceability,providing clinical decision support and enhancing patient safety.

Objective The digital transformation of healthcare has made data-driven approaches critical for improving the quality and efficiency of medical services.This study aims to improve the quality of critical value management by a data-driv-en intervention.Methods This study built an advanced digital platform to precisely record the time-stamp of each step,from de-tection to solution.This platform also delivered real-time notifications of patient critical value information to doctors' mobile de-vices,thereby optimizing the critical value management.Data were collected via this platform.A cohort study was designed:March 2024 data(pre-go-live)served as the control group and May 2024 data(post-go-live)as the intervention group.Comple-tion rate,processing time,and the proportion of in-patient critical values which were entered into the electronic progress were compared.Results The critical-value completion rate rose from 97.1％to 100.0％,and the proportion of values processed within 30 min increased from 80.91％to 83.42％.Among alerts that required ≥30 min,median(IQR)processing time fell from 100.27(230.09)min in March 2024 to 91.07(169.73)min in May 2024.Median processing time shortened for both e-mergency and out-patient alerts,with the out-patient reduction being statistically significant(median-45 min,P=0.042).Conclusion The data-driven platform not only improved the critical-value management,but also enhanced the transparency and traceability,providing clinical decision support and enhancing patient safety.

Objective:To investigate the clinical performance of fecal syndecan 2(SDC2)/tissue factor pathway inhibitor 2(TFPI2)gene methylation assay in prospective colorectal cancer screening.Methods:The individuals who underwent routine physical examina-tion were enrolled as subjects,and their fecal samples were collected and tested with fecal SDC2/TFPI2 gene methylation assay.In addition,enteroscopy was recommended for the subjects with positive results.Results:A total of 1215 subjects received fecal SDC2/TFPI2 gene methylation assay,among whom there were 708 male subjects and 507 female subjects,with a mean age of(44.7±13.9)years.Among all subjects,28 had positive test results,resulting in a positive rate of 2.30%,and among these 28 subjects,27(96.43%)underwent enteroscopy,among whom 16(59.26%)had abnormal findings.With enteroscopy and/or pathological examination as diag-nostic criteria,fecal SDC2/TFPI2 gene methylation assay had a positive predictive value of 7.41%for colorectal cancer,22.22%for progressive precancerous lesion,and 7.41%for non-progressive precancerous lesion.Conclusion:Fecal SDC2/TFPI2 gene methyla-tion assay shows good clinical performance in prospective colorectal cancer screening and thus provides a noninvasive method for the screening and auxiliary diagnosis of colorectal cancer.

The chemical constituents such as polysaccharides, flavonoids and polyphenols in Sanghuangporus have anti-tumor, anti-inflammatory, anti-oxidation and immune regulation effects. Sanghuangporus and its chemical constituents have shown anti-tumor activity against lung cancer, gastric cancer, liver cancer, colorectal cancer, breast cancer, melanoma, glioma and other malignant tumor cells. The mechanism mainly includes blocking cell cycle, inducing apoptosis and autophagy, inhibiting cell metastasis, immune regulation, etc., and can cooperate with radiotherapy and chemotherapy, targeted therapy, by inducing tumor cell apoptosis, blocking cell cycle, inhibiting inflammatory response, alleviating oxidative stress, etc., in order to play a role in reducing toxicity and increasing efficiency. In the future, small molecules and monomers with anti-tumor activity in Sanghuangporus can be screened. The varieties, producing areas and cultivation methods of Sanghuang would be standardized, and the bioavailability is improved by the development of new dosage forms. Through modern molecular biology and multi-omics techniques, the specific mechanism and target of its anti-tumor effect would be comprehensively explored. Pharmacodynamic toxicology research and large-scale clinical trials would be combined to verify its safety, so as to provide more evidence for its clinical application.

Background::Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China.Methods::Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran’s I analysis. Results::The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603) of total cases and cirrhosis cases accounted for 11.23% (180/1603). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (Moran’s I <0) and percentage of urban population (Moran’s I <0), and positively correlated with the number of pediatric beds per million population (Moran’s I >0). Conclusion::The number of severe hepatitis B cases is low in areas with high gross domestic product levels and high urban population ratios, and health care costs have been declining over the years.

Background::Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China.Methods::Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran’s I analysis. Results::The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603) of total cases and cirrhosis cases accounted for 11.23% (180/1603). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (Moran’s I <0) and percentage of urban population (Moran’s I <0), and positively correlated with the number of pediatric beds per million population (Moran’s I >0). Conclusion::The number of severe hepatitis B cases is low in areas with high gross domestic product levels and high urban population ratios, and health care costs have been declining over the years.

OBJECTIVE:Percutaneous sacroiliac screw internal fixation has become the main surgical procedure for the treatment of posterior pelvic ring fractures;however,the unassisted closure operation requires high operator experience and repeated fluoroscopy increases the radiation hazard for patients and medical personnel.This article compares the clinical efficacy of robot-assisted versus unassisted percutaneous sacroiliac screw placement for posterior pelvic ring fractures by meta-analysis. METHODS:Computer searches of CNKI,WanFang,VIP,CBM,PubMed,Embase,Cochrane Library and ClinicalTrials.gov were conducted from the time of database inception to December 2022.The literature on the clinical efficacy of robot-assisted versus freehand percutaneous sacroiliac screw placement in the treatment of posterior pelvic ring fractures was collected in and outside China.The data were independently screened and extracted by two investigators according to the inclusion and exclusion criteria,respectively.The quality of randomized controlled trials was evaluated using Cochrane risk assessment criteria.The quality of included cohort studies was assessed using the Newcastle-Ottawa Scale.Meta-analysis was performed using RevMan 5.4 software for inclusion metrics.Outcome metrics included operative time,intraoperative bleeding,fluoroscopy time,fluoroscopy frequency,number of holes drilled,Majeed postoperative function score,the excellent and good rates of Matta fracture reduction,the excellent and good rates of Gras screw position,fracture healing time and complications. RESULTS:(1)A total of 13 publications were included,2 were randomized controlled trials both referring to randomized methods,11 non-randomized controlled studies were evaluated for quality of literature according to the Newcastle-Ottawa Scale,1 scored 8,9 scored 7;and 1 scored 6;the quality of literature was good.A total of 748 patients were included,including 430 in the robot-assisted group and 318 in the freehand group.(2)The results of the meta-analysis showed that the operative time(MD=-28.30,95%CI:-40.20 to-16.40),intraoperative bleeding(MD=-6.36,95%CI:-10.06 to-2.66),intraoperative fluoroscopy time(MD=-12.13,95%CI:-19.54 to-4.72),intraoperative fluoroscopy frequency(MD=-17.39,95%CI:-29.00 to-5.78),number of intraoperative needle drillings(SMD=-9.50,95%CI:-14.27 to-4.73)and the excellent and good rates of Gras screw position(OR=8.65,95%Cl:3.26-22.92)in the robot-assisted group were significantly better than those in the freehand group(P<0.05).(3)In the robot-assisted group,the overall postoperative complication rate was significantly reduced(OR=0.10,95%Cl:0.02-0.48,P<0.05).(4)No significant difference was detected in fracture healing time(MD=-0.08,95%CI:-0.21,0.06),the excellent and good rates of Matta fracture repositioning rate(OR=2.06,95%Cl:0.97-4.39),and Majeed functional score(MD=0.91,95%CI:-0.31-2.13)between both groups(P>0.05). CONCLUSION:Compared with freehand sacroiliac joint nailing,robotic assistance shortens the operative time,reduces intraoperative bleeding,decreases radiation damage to patients and medical staff,improves the excellent and good rate of screw position,and reduces the overall incidence of postoperative complications in patients,but there was no significant improvement in fracture reduction quality,fracture healing time,and postoperative function.In the future,more large-sample,multicenter,and high-quality randomized controlled trials are still needed to verify.

Objective To discuss the clinical application value of super selective renal artery embolization-assisted(SRAE-assisted)laparoscopic partial nephrectomy(LPN).Methods A retrospective analysis of the clinical data of patients with stage T1 renal carcinoma,who received LPN,was conducted.The patients were divided into SRAE group(performing LPN without adopting renal hilum vascular clamping)and VC group(performing LPN with adopting renal hilum vascular clamping).The time spent for operation,amount of intraoperative blood loss,and preoperative and postoperative renal functions were compared between the two groups.According to the warm ischemia time(WIT),the patients of the VC group were subdivided into WIT＜25 min subgroup and WIT≥25 min subgroup,and the preoperative and postoperative renal functions were compared between the two subgroups.Results A total of 59 patients with renal carcinoma were enrolled in this study,including 12 patients in SRAE group and 47 patients in VC group.In VC group,WIT＜25 min subgroup had 33 patients and WIT≥25 min subgroup had 14 patients.In both SRAE group and VC group,no patient was referred to open surgery or total nephrectomy.No patient in SRAE group was referred to traditional LPN.The time spent for operation in SRAE group and VC group was 100.50(73.75,132.50)min and 120.00(90.00,145.00)min respectively,the difference between the two groups was not statistically significant(P＞0.05).The postoperative estimated glomerular filtration rate(eGFR)in SRAE group was 100.56(82.85,106.81),which was remarkably higher than 84.66(70.84,94.85)in VC group(P＜0.05).The postoperative serum creatinine level in VC group was 90.50(77.10,104.90)μmol/L,which was strikingly higher than 72.24(65.97,80.27)μmol/L in SRAE group(P＜0.05).The amount of intraoperative blood loss in SRAE group was 50(50,50)mL,which was lower than 50(50,100)mL in VC group(P＜0.05).In VC group,the postoperative eGFR in WIT≥25 min subgroup was 66.13(47.08,82.50),which was lower than 90.80(77.18,98.78)in WIT＜25 min subgroup(P＜0.05).During the postoperative one-year follow-up,no recurrence was observed in both groups.Conclusion Compared with traditional LPN,SRAE-assisted LPN doesn't need to obstruct the renal hilus during surgery,which can avoid the ischemic impairment of the residual renal function and reduce the amount of intraoperative blood loss,moreover,it doesn't increase the operation time,doesn't increase the incidence of complications such as postoperative bleeding,etc.and doesn't affect the curative efficacy and patient's prognosis.

Objective:To explore the application of a scenario-based onsite first-aid skills station in objective structured clinical examination (OSCE).Methods:Based on common scenarios and cases in medical practice, an evaluation framework of the OSCE onsite first-aid skills station—containing assessment indicators, exam room setting, examiner training, and assessment process—was designed to evaluate the onsite first-aid competencies of medical graduates of the five-year program for three consecutive years. SPSS 24.0 was used to perform the Kruskal-Wallis test and Pearson correlation analysis to calculate the correlation between course examination scores and OSCE onsite first-aid skills station assessment scores. Excel was used to calculate the difficulty index and discrimination index of test items.Results:The graduates' OSCE onsite first-aid skills station assessment scores were improved year by year, with a mean score of about 80 points. The station assessment items showed a moderate difficulty level (0.7-0.8), a good discrimination level (>0.4), and good internal consistency (Cronbach's α>0.7). The examiners and examinees had a high recognition of the design and effectiveness of this station assessment method. There was a positive correlation between the OSCE scores and corresponding course scores (2016, r=0.245, P=0.001; 2017, r=0.108, P=0.026; 2018, r=0.198, P=0.006). Conclusions:Through scientific scoring and strict examination management, the OSCE scenario-based onsite first-aid skills station can effectively evaluate examinees' injury treatment competencies in different situations, which can provide a reference for course teaching.

Objective The aim of this study was to investigate the mechanism of circ_0008043 regulating glycolysis of hepa-tocellular carcinoma(HCC)cells.Methods The expression of circ_0008043,miR-198 and SLC2A1 in clinical samples and HCC cell lines was detected by qPCR,and the targeted binding of circ_0008043 to miR-198 and miR-198 to SLC2A1 was verified by dual luciferase reporting assay.HCC cells were transfected with sh-circ_0008043/sh-NC,miR-198 inhibitor/miR-198 inhibitor-NC,miR-198 mimic/mimic NC,or pcDNA3.1-SLC2A1/pcDNA3.1-NC to detected the effects of circ_0008043,miR-198 and SLC2A1 on the glycolysis of HCC cells.The effect of circ_0008043 on tumor growth in HCC was verified by HCC cell xenografts through a nude mouse model.Results circ_0008043 was highly expressed in both HCC tissues and cell lines(P<0.01).Silencing circ_0008043 could inhibit the glycolysis of HCC cells.The expression of miR-198 was decreased in HCC tissues and cell lines(P<0.001)and neg-atively correlated with the expression of circ_0008043(r=-0.550,P<0.001).The inhibition of glycolysis caused by silencing circ_0008043 was partially restored by inhibiting miR-198 expression.SLC2A1 was highly expressed in HCC tissues and cell lines(P<0.001),and overexpression of SLC2A1 reversed the inhibitory effect of miR-198 on glycolysis in HCC cells.The nude mouse experi-ment showed that silencing circ_0008043 could inhibit the growth of HCC cell xenografts(P<0.001).Conclusion circ_0008043 promotes HCC cell glycolysis and growth through the miR-198/SLC2A1 axis.