Objective To investigate the Meta-analysis of microRNA(miRNA)in distinguishing active tu-berculosis and latent tuberculosis.Methods CNKI,Wanfang Data,VIP,PubMed,Cochrane Library,Web of Science and Embase databases were searched to select the literature on miRNA in discriminating active tuber-culosis and latent tuberculosis from the establishment of the database to April 2023,and screened strictly ac-cording to the inclusion and exclusion criteria.The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2,and data extraction and summary analysis were carried out with Stata16.0 software.Heterogeneity among studies was evaluated by calculating I2,and the sources of heteroge-neity were further explored by Meta-regression and subgroup analysis.Publication bias was assessed using Deeks funnel plot.Results The Meta-analysis encompassed 9 articles,comprising 13 studies.The combined sensitivity of miRNA in differentiating active tuberculosis and latent tuberculosis was found to be 0.79(95％CI:0.69-0.86,I2=86.24％),with a specificity of 0.73(95％CI:0.64-0.81,I2=81.80％).The positive likelihood ratio was 2.96(95％CI:2.22-3.95,12=63.84％),while the negative likelihood ratio was 0.29(95％CI:0.20-0.41,I2=84.04％).Furthermore,the diagnostic odds ratio was 10.33(95％CI:6.43-16.61,I2=99.90％),and the area under the receiver operating characteristic curve was 0.83(95％CI:0.79-0.86).The results of Meta-regression and subgroup analysis showed that sample size may be the source of sensitivity heterogeneity,and dysregulation of miRNA may be the source of specificity heterogeneity.Deeks funnel plot showed no publication bias among included studies.Conclusion miRNA shows good diagnostic a-bility in distinguishing active tuberculosis and latent tuberculosis,which has important significance for impro-ving the development of diagnostic strategies for tuberculosis management.

To compare the performance of self-inflating bag (SIB) with T-piece resuscitator (TPR) in neonatal resuscitation.Methods:This study involved the trainees participating in a Neonatal Resuscitation Simulation Camp (NRSC) organized by Shanghai First Maternity and Infant Hospital in December 2019. They were trained to provide positive pressure ventilation with the two devices on artificial lungs. Ventilation parameters including peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), PIP in pulmonary alveoli (PIP alv), mean airway pressure (MAP), frequency, inspiratory time (Ti), tidal volume and minute ventilation volume were recorded and analyzed by independent sample t-test or rank sum test. Results:The PIP alv, PIP, oxygen flow rate, tidal volume and minute ventilation volume delivered by TPR were significantly lower than those by SIB [(17.18±1.61) vs (24.05±4.29) cmH 2O (1 cmH 2O=0.098 kPa), t=－6.87; (17.91±1.35) vs (29.97±4.50) cmH 2O, t=－14.06; (3.65±0.25) vs (6.88±1.59) L/min, t=－11.33; (15.90±1.81) vs (24.02±4.29) ml/min, t=－10.99; (664.71±88.94) vs (1 069.49±205.68) ml/min, t=－9.89; all P<0.001]. However, compared with SIB, the PEEP in pulmonary alveoli, Ti, duration of ventilation, inspiratory to expiratory ratio were increased when using TPR [(4.76(4.69-5.57) vs 0.19(0.12-4.10) cmH 2O, T=1 190.00; (0.59±0.15) vs (0.43±0.09) s, t=5.01; (1.46±0.23) vs (1.36±0.11) s, t=2.15; 0.71±0.22 vs 0.47±0.13, t=5.14; all P<0.05]. Conclusion:TPR could deliver more stable and safer PIP, PEEP and tidal volume than SIB and keeping MAP at a stable level during positive pressure ventilation on artificial lungs.

This study applied both qualitative and quantitative research methods to describe Norwegian health care reform, covering such performance indicators as key reform process, healthcare reform trends in number of beds per thousand, health care resource utilization, hospital management system, general practitioners, and public health management system. Moreover, the paper put forward suggestions for the reform in China, namely health governance mechanism, the transformation from scale expansion to quality and performance-based development, reforming family physician system.

Objective: To investigate the strong expression (S+) of P53 and BCL2 proteins in MYC/BCL2 double-expression DLBCL (DEL) and whether they can be used for the prognostic evaluation and stratified diagnosis of DELs. Methods: Tissue microarray were made by filed FFPE blocks of 174 DLBCL cases. The translocation of MYC, BCL2 and BCL6 genes were detected by FISH, and the proteins were detected by IHC. Data of clinicopathologic features and follow up of patients were collected and OS (overall survival) and PFS (progression free survival) were analyzed by statistics. Results: Eight double-hit lymphomas (DHLs) were identified in all cases, and 45 DELs were selected from 166 remaining cases, which have no significant difference in OS and PFS compared with non-DEL cases (P=0.668 and P=0.790) . Of 42 DEL-cases with follow up data, 24 cases with P53+ or/and BCL2 (S+) are significantly shorter OS and PFS than others (P=0.003 and P=0.000) , in which the cases with P53+/BCL2 (S+) co-expression were the worst prognosis, and P53/BCL2 co-weaker positive DEL cases even have superior OS and PFS than those non-DELs. Although statistics showed that the cases of P53+ or/and BCL2 (S+) have a lower OS and PFS in total cases (P=0.063 and P=0.024) , it is not the case when the DEL-cases take out from total cases, that is the cases with P53+ or/and BCL2 (S+) are as similar OS and PFS as others in non-DEL group (P=0.590 and P=0.550) . Conclusion The strong expression of P53 and BCL2 proteins can be used as indicators of stratified diagnosis and poor prognosis of DEL.

This paper summarized health care delivery system in remote areas of Japan including criteria for underserved areas, regular adjustment to the list, comprehensive national plans, integrated provision system, governmental responsibilities, establishment of Jichi Medical University, participation of social organizations.We raise such suggestions as leading role of the government, precision listing underserved areas,implementing special plan, financing and payment policy, human resources for health, and regional co-ordination of medical resource.

Based on an analysis of the compensation policy and its problems of the primary medical and health institutions, this paper put forward the corresponding reform framework in Zhejiang province. It proposed to change the compensation policy of " predefining revenue and expenditure, subsidizing its gap after performance appraisal" into " a mixed system of special subsidy and pay for performance". Related policies were also described including governmental functions, special subsidies for input-based payments, classified payments for output services, precautions against financial risks, etc. This paper also suggested that we focus on dealing with the six pairs of balance, such as that between subsidy for the supply and demand sides, and that between internal market and external market.

Objective To explore the correlation of the timing of enteral nutrition (EN) and the prognosis of the patients with septic shock.Methods From December 2016 to August 2017,fifty-five patients with septic shock who received treatment in the ICU of Tongji University School of Medicine were selected in the study and randomly divided into two groups,28 cases in the early enteral nutrition (EEN) group and 27 cases in the delayed enteral nutrition (DEN) group.All the patients was treated with EN before and after 48 h at admission respectively.After 1 week of treatment,the nutrition indicators,clinical efficacy,complications and prognosis of the two groups were compared.Results The levels of ALB,PA and HB in EEN group after treatment were significantly increased,compared with those before treatment,and were superior to those in DEN group ((38.4±4.5) g/L vs.(34.6±3.8) g/L,(207.8±41.4) mg/Lvs.(180.6±47.6) mg/L,(119.2 ±18.3) g/Lvs.(110.7±14.2) g/L;t =3.39,2.26,1.99,P＜0.05).Compared with DEN group,the length of ICU stay,CRRT time,mechanical ventilation time of EEN group were significantly shortened ((6.4± 1.7) d vs.(9.8±2.4)d,(4.7±1.2) d vs.(7.9±2.5)d,(3.6±1.2)d vs.(6.4±1.8) d;t=6.16,6.32,7.09,P＜0.05).After treatment,the SOFA score,APACHE Ⅱ score and qSOFA score were significantly improved in both groups,and the improvement in EEN group was significantly better than that in DEN group((3.8±0.9)points vs.(5.1 ± 1.2) points,(12.2 ± 2.4) points vs.(15.1 ± 3.7) points,(87.4 ± 14.7) points vs.(77.4 ± 13.2) points),(t=4.53,3.46,4.31,P＜0.05).Conclusion The implementation of EEN in patients with septic shock can improve the nutritional status of the patients,alleviate the severity of the disease,reduce the incidence of complications and improve the prognosis.

Diffuse large B-cell lymphoma(DLBCL)is a highly invasive malignant lymphoma,and the molecular mechanism of its patho-genesis is not fully understood.Next generation sequencing(NGS)is an increasingly mature gene assay technology,which has been widely applied in recent years to study the genetics of DLBCL.Targeted therapy development has progressed significantly on the basis of these studies,which has made genetic mutations in DLBCL become the new research hotspot.This review summarizes the progress in research on progress-related gene mutations in DLBCL.

The control handles( including financing, provider payment, organization, regulation and behavior) proposed by World Bank in health policy research as the basic framework,and the nature and positioning of family doctors′ contract-based service as the precondition, we recommended the system framework of such a mechanism, comprising one contract, three regulations, five control handles and seven supporting policies. Such a framework can serve as the cornerstone for family doctors′ contract-based service experiment in Zhejiang province for the sake of hierarchical medical system.

Objective To develop a microsphere-based suspension array for simultaneous detec-tion and identification of Salmonella H antigens by using Luminex xTAG technology and to evaluate its capa-bility in serotyping Salmonella strains. Methods The fliC and fljB genes, encoding the H antigen of Salmo-nella, were selected as the target genes. Universal upstream primers were designed based on the highly con-served regions of fliC and fljB genes, and the corresponding specific reverse primers were designed based on the variable regions. While synthesizing, the 5′end of each upstream primer was labeled with biotin and the 5′end of each specific reverse primer was modified with its certain TAG sequence. After amplified and la-beled with biotin and TAG sequence, the PCR products of specimens were hybridized with the mixture of va-rious MagPlex-xTAGTM microspheres. Each set of microspheres contained its unique anti-TAG sequences. The results of hybridization were analyzed by using Luminex MagPix reader system and the median fluores-cence intensity ( MFI) was reported. The H antigens of 145 Salmonella strains were identified with this de-veloped xTAG suspension array, and the results were compared with those obtained by using traditional ser-um agglutination test. Results The PCR products of different H antigens ranged from 94 bp to 245 bp and could be identified by hybridizing with MagPlex-xTAGTM microspheres. There was no cross-reaction between different H antigens or with DNAs derived from Escherichia coli, Vibrio cholerae, Vibrio parahaemolyticus and Shigella flexneri. Compared with the traditional serum agglutination test, the sensitivity and specificity of the xTAG suspension array in the identification of H antigens of 145 Salmonella strains were 95. 1% and 100%, respectively. Conclusion The developed xTAG suspension array was a specific, accurate and effective method for simultaneous detection and identification of 31 H antigens of common Salmonella serovars strains. It could be used for determining the H antigens of more than 90 Salmonella strains within 5 hours.