Objective To study the diagnostic value of miR-571 for liver fibrosis by detecting miR-571 expression in the peripheral blood of patients with liver fibrosis.Methods From December 2022 to September 2023,40 patients with liver fibrosis,40 patients with chronic hepatitis,and 40 healthy controls were chosen as research subjects.The expression level of miR-571 in peripheral blood was detected using a real-time quantitative polymerase chain reaction,and the relative expression of miR-571 in each group was evaluated.The Spearman correlation method was utilized to examine the relationship between miR-571 and clinical detection indices.To assess the capacity of miR-571 and the multivariate diagnostic model to identify liver fibrosis,binary logistic regression was used to create a multivariate diagnostic model,and ROC curves were generated.Results The expression of miR-571 was significantly higher in the liver fibrosis group than in the healthy control and hepatitis groups,and the difference was statistically significant(P<0.001).The expression level of miR-571 was positively connected with ALT,APRI score,and FIB-4 index(r = 0.23,0.30,0.22,P<0.05)and negatively correlated with PLT(r =-0.19,P<0.05)according to Spearman correlation analysis.Logistic regression research revealed that miR-571 and the FIB-4 index were independent risk factors for liver fibrosis.The AUC for miR-571 to diagnose fibrosis was 0.91(95%CI:0.85～0.96),while the AUC for miR-571 paired with the FIB-4 index was 0.94(95%CI:0.90～0.98).Conclusion MiR-571 expression was shown to be considerably higher in the peripheral blood of hepatic fibrosis patients,and the combined FIB-4 index offers some clinical diagnostic value for hepatic fibrosis.

Objective To make the cost-effectiveness analysis of pembrolizumab and platinum chemotherapy as the first-line treatment for advanced non-small cell lung cancer(NSCLC)in the population with tumor proportion score(TPS)≥1%of PD-L1,and provide some reference for the clinical use and future price negotiation of pembrolizumab.Methods Based on Pubmed database,the published RCT literatures of pembrolizumab were analyzed,and the survival data were extracted,combined with the treatment plan of a tertiary hospital,the Markov model were established to simulate the cost and health effectiveness of patients for twenty years,and the stability of the model was tested by one-way sensitivity analysis and probability sensitivity analysis.Results Twenty years later,the cost-effectiveness ratio of pembrolizumab group and chemotherapy group was ￥58 517.60/quality adjusted life month(QALM)and ￥41 213.08/QALM.Compared with the chemotherapy group,the incremental cost effective ratio(ICER)was ￥104 485.36/QALM.Conclusion When the willingness to pay(WTP)value was ￥30 902/QALM,the pembrolizumab therapy was not more cost-effective advantages than platinum chemotherapy,and the sensitivity analysis showed that the results of the model were relatively stable.

Objective:To analyze the application effect of progressive resistance training (PRT) in breast cancer patients.Methods:PubMed, Web of Science, Embase, Medline, Cochrane Library, CNKI, Wanfang Data Knowledge Service platform, VIP and SinoMed databases were searched for randomized controlled trial (RCT) of PRT in breast cancer patients. The retrieval period was from the establishment of databases to November 30, 2020. Meta-analysis was performed using Revman 5.3 and Stata 16.1.Results:A total of 22 RCT were included. Meta-analysis showed that PRT could improve muscle strength [grip strength ( MD=1.43, 95% CI 0.57-2.30, P=0.001) , supine lifting force ( MD=13.0, 95% CI 9.39-16.61, P<0.000 01) , leg lifting force ( MD=43.88, 95% CI 27.85-59.91, P<0.000 01) ], shoulder flexion ( MD=9.62, 95% CI 5.16-14.09, P<0.000 1) , lean body weight ( MD=1.03, 95% CI 0.71-1.35, P<0.000 01) , quality of life ( SMD=0.51, 95% CI 0.25-0.78, P=0.000 1) . PRT could reduce the number of symptoms of upper limb lymphedema in breast cancer patients ( SMD=-0.23, 95% CI -0.42--0.04, P=0.020) , severity of symptoms ( SMD=-0.26, 95% CI -0.44--0.07, P=0.006) , body fat percentage ( MD=-1.49, 95% CI -1.94--1.04, P<0.000 01) , fat content ( MD=-0.87, 95% CI -1.48--0.26, P=0.005) , but there were no statistically significant differences in shoulder joint abduction, extension, body weight and body mass index ( P>0.05) . Descriptive analysis showed that PRT could reduce the incidence of upper limb lymphedema to a certain extent. Conclusions:The existing evidence shows that compared with the control group, PRT can improve the muscle strength, shoulder anterior flexion, lean body weight content and quality of life of patients with breast cancer and reduce the number and severity of upper extremity lymphedema symptoms, body fat percentage and fat mass.

Objective:To investigate the predictive value of abnormal heart rate circadian rhythm for all-cause mortality in stage 5 chronic kidney disease (CKD 5) patients.Methods:The retrospective study was performed in CKD 5 patients enrolled from the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) and the Affiliated BenQ Hospital of Nanjing Medical University from February, 2011 to December, 2019. A total of 159 healthy volunteers were enrolled as the healthy control group during the same period. The circadian rhythm of heart rate was monitored by 24-hour Holter. Related indices (including 24-hour, daytime and nighttime mean heart rate, night/day heart rate ratio, 24-hour maximum heart rate, 24-hour minimum heart rate and difference between maximum and minimum of 24-hour heart rate) were calculated. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Cox regression model was used to analyze the risk factors of all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve and Log-rank test were used to compare the differences of cumulative mortality between high ratio group (night/day heart rate ratio>0.91) and low ratio group (night/day heart rate ratio≤0.91). The nonlinear relationship between night/day heart rate ratio and all-cause mortality was analyzed by restricted cubic spline plot. Time-dependent receiver operating characteristic (ROC) curve was used to analyze the predictive value of night/day heart rate ratio for all-cause mortality in CKD 5 patients.Results:A total of 159 healthy volunteers and 221 CKD 5 patients were included in this study. There were 123 males (55.66%) and the age was (52.72±13.13) years old in CKD 5 patients. The total median follow-up time was 50.0 months. Compared with controls, 24-hour, nighttime mean heart rate, 24-hour minimum heart rate in CKD 5 patients were increased (all P<0.05), furthermore, the night/day heart rate ratio was higher [(0.91±0.09) vs (0.81±0.08), P<0.001], showing "non-dipping heart rate". However, the 24-hour maximum heart rate and the difference between maximum and minimum of 24-hour heart rate in CKD 5 patients were lower than controls (both P<0.05). Multivariate Cox regression analysis showed that the increased night/day heart rate ratio (per 0.1 increase, HR=1.557, 95% CI 1.073-2.258, P=0.020) was an independent influencing factor for all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve analysis showed that the cumulative mortality of the high ratio group was significantly increased than that of the low ratio group (Log-rank test χ 2=7.232, P=0.007). From the restricted cubic spline plot, there was a linear effect between night/day heart rate ratio and all-cause mortality ( P=0.141), and when night/day heart rate ratio was above 0.91, the risk of all-cause mortality was significantly increased in CKD 5 patients. According to time-dependent ROC curve, the accuracy of night/day heart rate ratio in predicting all-cause mortality was 70.90% even when the survival time was up to 70.0 months. Conclusions:The circadian rhythm of heart rate in CKD 5 patients displays "non-dipping" state. High night/day heart rate ratio is an independent influencing factor for all-cause mortality in CKD 5 patients.

Objective:To observe heart rate circadian rhythm in patients with chronic kidney disease (CKD) stage 5 and to analyze the effects of parathyroidectomy (PTX) on heart rate circadian rhythm in severe secondary hyperparathyroidism (SHPT) patients.Methods:A cross-sectional observation was performed in 213 patients with CKD stage 5 and 96 controls, and the patients were divided into those with severe SHPT (PTX group, n=70) and without severe SHPT (non-PTX group, n=143). Forty-six PTX patients were followed up prospectively. The baseline data were compared among these groups. Holter electrocardiogram was performed for each participant. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Multiple linear regression analysis was used to analyze the related factors of heart rate circadian rhythm in patients with CKD stage 5. Results:The 24-hour, daytime and nighttime mean heart rate in patients with CKD stage 5 were all higher than those in controls, especially in PTX group (all P<0.05). The night/day heart rate ratios of controls and CKD stage 5 patients were (0.81±0.08) and (0.91±0.08) respectively ( P<0.01). Correlation analysis showed 24-hour and daytime or nighttime mean heart rate in patients with CKD stage 5 were positively correlated with serum levels of phosphorus and ln(alkaline phosphatase), while nighttime mean heart rate and night/day heart rate ratio were positively related with serum intact parathyroid hormone level. After adjusting with postoperative follow-up period (median time: 10.9 months), 24-hour and nighttime mean heart rate, and night/day heart rate ratio in PTX patients all decreased significantly (all P<0.01). Conclusions:Heart rate is increased and circadian rhythm is abnormal in patients with CKD stage 5, which are related with mineral and bone disorder. PTX significantly decreases 24-hour and nighttime mean heart rate in severe SHPT patients, and improves the heart rate circadian rhythm.

Objective:To summarize the different teaching models and their effects in evidence-based medicine at home and abroad by qualitative method and systematic review.Methods:We searched the following databases (from inception to 13 May, 2019): PubMed, Embase, Proquest, Cochrane, Web of Science database and the Chinese databases (CNKI, Wanfang, SinoMed and VIP). To assess data strength and validity, risk of bias assessments were undertaken.Results:A total of 52 literatures were included in this study, including 21 Chinese-language literature and 31 English-language literature. PBL teaching model, mixed teaching model and workshop teaching model were the three teaching models with the largest number of studies in 20 teaching models.Conclusion:The evidence-based medicine teaching effect was closely related to the teaching models, so it is necessary to explore more suitable teaching models for the evidence-based medicine to improve the teaching effects.

Objective To investigate the relationship between 24-hour urinary protein quantification and maternal and neonatal complications in severe preeclampsia. Methods Totally 2305 cases of pregnant women which were diagnosed as severe preeclampsia more than 28 weeks of single pregnancy in 37 hospitals in mainland China were selected from January 1 to December 31, 2011. According to the results of the highest 24 hours urine protein quantitative after admission, the subjects were divided into 3 groups. The group Ⅰ included 590 cases whose 24h urinary protein were 0-2g. There were 843 cases in group Ⅱ whose 24h urinary protein were 2-5g, 872 cases were in group Ⅲ whose 24h urinary protein were more than 5g. The complications of the maternal and neonatal outcome were analyzed among the three groups. Results The incidence of hypoalbuminemia was 14. 8％, the rate of chest /ascites /pulmonary edema / heart failure was 1. 6％, the incidence of renal dysfuction was 0. 6％ and the incidence of placental abruption and HELLP syndrome was 2. 7％ and 3. 0％. There was significant difference in the incidence of hypoalbuminemia among the three groups of which the incidence of groupⅠwas significantly lower than that of group Ⅱ and group Ⅲ (P ＜ 0. 017). The rate of fetal growth restriction, fetal distress and neonatal asphyxia was 3. 3％, 9. 5％, and 1. 1％. The incidence of neonatal body weight, fetal growth restriction and neonatal asphyxia among the three groups were significantly different (P ＜ 0. 05). The body weight of neonatal group was significantly higher than that of group Ⅱ and group Ⅲ (P ＜ 0. 017). The incidence of FGR in group Ⅱ was significantly higher than that in group Ⅲ (P ＜ 0. 017). The rate of neonatal asphyxia in group Ⅰ was significantly lower than that in group Ⅲ (P ＜ 0. 017). There are no significant difference in the incidence of heart failure /pulmonary edema, placental abruption, HELLP syndrome and cesarean section among the three groups. Conclusion 24-hour urinary protein may increase the risk of hypoalbuminemia in pregnant women with severe preeclampsia, but do not increase the risk of heart failure /pulmonary edema, placental abruption and HELLP syndrome. 24-hour urinary protein was associated with severe preeclampsia neonatal body weight, fetal growth restriction, and neonatal asphyxia.

Objective To explore the feasibility and safety of emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation in the treatment of pelvic fracture combined with hemorrhagic shock.Methods A retrospective analysis of 21 patients with pelvic fractures and hemorrhagic shock who were treated with emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation was performed.The percutaneous minimally invasive screw fixation was performed immediately after embolization.Results There were 18 of 21 cases with obvious arterial bleeding confirmed by femoral artery angiography.And the corresponding interventional embolization was performed.No obvious arterial hemorrhage was found in the other 3 cases who received suspicious hemorrhagic internal iliac arterial prophylactic embolization.The time-consuming of percutaneous minimally invasive screw fixation was no more than 90 min for each patient.There was no servious complication associated with arterial embolization after intervention.Totall 18 cases were improved after discharge.Another 3 cases died,including 2 cases died for postoperative multiple organ failure or disseminated intravascular coagulation,1 case died for hemorrhagic shock caused by still continue bleeding after surgery.The postoperative follow-up was performed during 3-18 months with the average of (10.81 ± 2.62) months.The fractures in all the surviving cases achieved bone healing with good function.Conclusion The emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation is a safe,fast and effective method for the treatment of pelvic fractures and hemorrhagic shock with less complications.

Objective: To conduct a preliminary evaluation for the usability of Carelink remote monitoring system by clinical physician. Methods: A total of 215 patients received cardiovascular implantable electronic devices (CIED) with Carelink remote monitoring function from 12 hospitals in China between 2012-01 and 2013-10 were prospectively enrolled. The patient's mean age was (62.3±14.3) years including 108 male and 107 female. There were 54 physicians completed questionnaire survey. Based on the type of CIED, the patients were divided into3 groups: PM (pace maker) group,n=110, ICD (implantable cardioverter defibrillator) group,n=54 and CRT (cardiac resynchronization therapy) group,n=51. The patients received routine hospital visit at 3 months of CIED implantation and meanwhile, they performed device data transmission at 3 and 6 months of Carelink remote monitoring. The time physician spent to evaluate data was collected at 3 months and the questionnaire survey was completed by physician at 6 months after CIED implantation. Results: All 54 physicians felt that Carelink remote monitoring system was simple to operate and easy to use. There were 147 patients ifnished hospital visit at 3 months after CIED implantation, the mean time for physician to evaluate data was (14.8±8.4) min; 150 patients ifnished Carelink remote monitor at 3 months after CIED implantation, the mean time for physician to evaluate data was (8.2 ±4.6) min,P<0.0001.Conclusion: Carelink remote monitoring system was easy to use, it may save time in follow-up study which with high satisfaction in clinical practice.

Objective Based on the medical records and follow-up records of hospitalized patients who received anti-tuberculosis therapy in the Third People' s Hospital of Zhenjiang in Jiangsu province from 2006 to 2012,we investigated the incidence and outcome of anti-tuberculosis drug induced hepatotoxicity (ATDH) and provided evidence for the prevention of ATDH.Methods According to tuberculosis patients' medical information and liver function test records,ATDH patients were diagnosed according to the criteria of International Consensus Meeting and American Thoracic Society respectively,then the related factors and outcomes were analyzed.Results A total of 1 967 hospitalized tuberculosis patients were reviewed retrospectively,in which 1 403 (71.3％) were men,1 790 (91.0％) were pulmonary tuberculosis patients,1 528 (77.8％) were patients receiving initiative treatment,979 (49.8％) were sputum smear-positive patients,and 1 297 (65.9％) had other complicated diseases.According to the criterion of International Consensus Meeting,the incidence of ATDH was 16.5％,the median time of onset was 25 days.According to the criterion of American Thoracic Society,the incidence of ATDH was 8.3％,the median time of onset was 23 days.The incidence of ATDH was significantly higher in males and HRZE therapy group (P＜0.05).Under the two liver criteria,69.5％ and 70.1％ of the patients changed primary therapy respectively after ATDH occurred.89.8％ and 88.4％ patients' liver function returned to normal range after changing or stopping therapy.Conclusion According to two liver injury criteria,the incidences of ATDH were 16.5％ and 8.3％ in hospitalized tuberculosis patients respectively,and ATDH mainly occurred in the furst month of anti-tuberculosis treatment.The monitoring of liver function should be strengthened in males and HRZE therapy group to reduce the incidence of ATDH.