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Objective To apply electrical impedance tomography (EIT) technology to assess the lung regional ventilation distribution in patients admitted to the intensive care unit (ICU) after a cardiac surgery, and to analyze its value of predicting patients’ short-term prognosis. Methods Data from 46 patients admitted to ICU after a cardiac surgery from January to November 2023 were retrospectively collected. Using EIT, we assessed the lung regional ventilation of four regions of interest (ROI) and analyze its influence on patients’ length of stay in ICU, mechanical ventilation duration and tracheal intubation duration. Results Patients who received a cardiac surgery equal to or over 5 hours had worse ventilation in the dorsal region (ROI 4) (P = 0.022). Patients with worse dorsal region ventilation (ROI4 < 9%) had lower oxygenation index (P = 0.025), longer mechanical ventilation duration (P = 0.004), longer tracheal intubation duration (P = 0.010), and longer ICU stay (P = 0.018). A larger ROI 4 percent is a protective factor for patients’ prognosis (OR = 0.743, 95%CI: 0.587~0.941, P = 0.014) after controlling for the impact of age, gender, length of surgery and acute physiology and chronic health evaluation (APACHE) score at the admission. Using a cutoff value of 9.5%, ROI 4 has 85.7% sensitivity and 56.2% specificity to predict worse patients’ prognosis. The area under the curve (AUC) is 0.752 (95% CI: 0.599~0.905, P = 0.007). Conclusion The length of a cardiac surgery influences patients’ lung ventilation, which further impacts patients’ prognosis. EIT can be used as a bedside tool to assess patients’ lung ventilation and to inform corresponding clinical interventions to improve patients’ prognosis.
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Pain is one of the most common symptoms in cancer patients. Apart from causing patients to suffer from unpleasant feelings and emotional experiences, uncontrolled pain may also influence patients' function and quality of life, and may be associated with poorer prognosis. Difficulties in management of chronic cancer-related pain may be related to its complicated mechanisms, limitations of current clinical treatment and insufficient cognition of clinicians and patients. This review summarizes the definitions, classifications, evaluation and treatment principles of chronic cancer-related pain,, aiming to provide clinicians with the overall idea of pain management in adult cancer patients, emphasizing the importance of multidisciplinary management and patient education in cancer pain management.
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Objective To explore the incidence and related factors of subacute and chronic pain in patients returning to the ICU after surgery, provide diagnostic and therapeutic insights for the evaluation and management of such patients, and improve the prognosis of this population. Methods Patients who underwent surgical treatment and returned to the ICU from November 29, 2021 to December 31, 2021 at Peking Union Medical College Hospital were prospectively recruited. Subacute and chronic pain incidence and characteristics were assessed by telephone at 1 and 3 months after surgery and the influencing factors were further explored. Results A total of 117 patients were enrolled, with an average age of 60.85 ± 16.03 years. The incidence of subacute postoperative pain in patients returning to the ICU after surgery was 45.7%(53/116), and the incidence of chronic postoperative pain in patients returning to the ICU after surgery was 32.7% (36/110) . The mean NRS for moderate to severe subacute pain and chronic pain after surgery were (4.9±1.2) and (5.2±1.1), respectively. Multivariable logistic regression analysis showed that coronary artery disease (OR=5.263 , 95%CI : 1.436~19.292) was risk factor for chronic postoperative pain in patients returning to the ICU after surgery. Conclusions Cardiac surgery and coronary artery disease were the risk factors for postoperative chronic pain in patients returning to the ICU, a relatively common surgical complication. Perioperative multimodal pain management can be used to improve the pain experience of patients during ICU hospitalization and the shortterm and long-term prognosis of patients.
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Objective    To investigate the risk factors for early relapse after curative resection of Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) and to construct a visual predictive model.     Methods    A retrospective analysis was conducted on the clinicopathological data of patients diagnosed with Siewert type II/III AEG who underwent curative resection at the Second Hospital of Lanzhou University from January 2016 to March 2021. The samples were randomly divided into a training group and a validation group in a 7:3 ratio. The LASSO-logistic regression method was used to select variables predictive of early recurrence of Siewert type II/III AEG and to construct a predictive model for early recurrence. The model was validated through 1000 bootstrap resampling. Receiver operating characteristic (ROC) curves, area under the curve (AUC), calibration curves, and decision curve analysis (DCA) were used to evaluate the model's stability.     Results    According to the inclusion and exclusion criteria of this study, a total of 320 Siewert type II/III AEG patients were included, with 122 experiencing recurrence within two years and 198 without recurrence within the same timeframe. Lasso-logistic regression analysis revealed AJCC staging, degree of differentiation, CA199, CEA, NLR, and tumor maximum diameter as independent predictive factors for early recurrence of Siewert type II/III AEG. A predictive model was constructed with these factors and depicted as a nomogram. The AUC of the ROC curve for the training group was 0.836, 95%CI (0.785–0.887), with a sensitivity of 81.4% and a specificity of 85.6%; for the validation group, the AUC was 0.812, 95%CI (0.711–0.912), with a sensitivity of 80.6% and a specificity of 87.7%. Calibration curves for both the training and validation groups displayed curves close to the reference line, indicating high model stability. The DCA curve showed the model provided a good net benefit with threshold probabilities between 0.05 and 0.75.     Conclusions    A multivariate model to predict early relapse in patients with Siewert type II/III AEG was developed using LASSO-logistic regression, which may be instrumental in assessing patient prognoses and in guiding postoperative surveillance and management for patients with Siewert type II/III AEG.

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Objective To investigate the expression and clinical significance of GATA-3 and H3K27me3 in Tibet with bladder urothelial carcinoma (BUC). Methods BUC and normal bladder tissues were collected retrospectively from January 2016 to December 2021 in the People's Hospital of Tibet Autonomous Region. The expression of GATA-3 and H3K27me3 in both tissues was detected by immunohistochemical method, and the clinical and pathological characteristics were statistically analyzed. Results A total of 70 patients with BUC were selected, including 51 males and 19 females, with an average age of (60.5± 12.0) years. At the same time, 20 normal bladder tissue samples were collected during the same period. All cases were Tibetan patients. Immunohistochemistry results showed that the high expression rate of GATA-3 in BUC and normal bladder tissue was 70% (49/70) and 100% (20/20), respectively. High expression of GATA-3 was associated with male, low pathological grade, and non invasive tissue (P<0.05). The high expression rate of H3K27me3 in BUC and normal bladder tissue was 45.7% (32/70) and 20% (4/20), respectively. High expression of H3K27me3 was only associated with male (P<0.05). Conclusions The expression of GATA-3 is down regulated in patients with BUC in Tibet, and significantly down regulated with the increase of tumor grade, suggesting that GATA-3 may be involved in the occurrence and development of BUC and related to its malignancy, providing a reference for clinical diagnosis and treatment and judging disease prognosis. The expression of H3K27me3 in BUC in Tibet is higher than that in normal bladder tissue, suggesting that H3K27me3 may be a new immune marker for diagnosis of bladder urothelial carcinoma.
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Carcinoembryonic antigen-related cell adhesion molecule 1(CEACAM1) is a transmembrane protein of the immunoglobulin superfamily,which is involved in mediating cell adhesion,tissue metastasis,control of immune response,and metabolic homeostasis.Studies have shown that CEACAM1 plays a protective role in the liver by promoting insulin clearance and preventing fat deposition.The down-regulation of the CEACAM1 expression level leads to a vicious cycle of insulin resistance and aggravates metabolic disorders.Because CEACAM1 is critical in controlling metabolic dysfunction-associated steatotic liver disease (MASLD),stimulating its pathway or regulating its expression level is expected to be a new therapeutic approach for MASLD.In this paper,we summarize the research progress of CEACAM1 in MASLD.
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Antisense oligonucleotides (ASOs) are a novel class of small molecule gene-targeted drugs that can bind to target mRNA. Through complementary base pairing with the target sequence, antisense oligonucleotides achieve targeted regulation of genes. With the continuous development of gene sequencing technology and molecular synthesis techniques, research and applications of ASOs in the musculoskeletal system are further advancing. This article reviews the mechanisms of ASOs in gene silencing and expression regulation, as well as their prospects in gene therapy. In addition, we evaluate the research progress and applications of ASOs in musculoskeletal diseases, while analyzing the urgent issues currently faced by this class of drugs. This comprehensive study aims to deepen our understanding of ASOs and provide valuable references for their widespread application in biomedical research and clinical settings.
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Purpose To develop and connotation and framework of Clinical Teaching Management (CTM)positions competency, and to conduct preliminary application of competency framework. Methods Key groups of clinical teaching coordinators, clinical trainees, teaching administrators and educational reform practice and research group at Peking Union Medical College Hospital(PUMCH) were selected as the research samples. The Nominal Group Technique (NGT) was used to generate, integrate, form framework and provide descriptions of CTM competencies, and rankings of competency importance were collected. Further, the competency framework was used to conduct a self-assessment of CTM using questionnaire survey. The self-assessment was scored with the Likert method (with a maximum of 5 points and a minimum of 1 point), and the self-assessment results were analyzed. Results Through the first round of NGT discussions of key groups, consensus was achieved on the primary framework of CTM competency, including professionalism, coordinating ability, teaching ability, and teaching innovation. However, different opinions were held regarding the connotations and importance rankings of each dimension. Based on the second round of NGT discussion conducted by educational reform practice and research group, a self-assessment was conducted using the CTM framework of competency. Through the second round of NGT discussions, educational reform practice and research group has developed a competency framework for clinical teaching management positions covering seven dimensions (medical knowledge and skills, learner centeredness, communication and cooperation, professionalism and role modelling, reflection and improvement, teaching theory and methods, teaching coordination and management) based on the results of the first round of discussions. The self-assessment results show that except for the two dimensions of "teaching coordination and management" and "teaching theory and methods", the scores of the other five dimensions are above 4 points. Conclusion A preliminary competency framework of CTM has been developed and applied, specific items require further validation and improvement in practice.
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Objective To explore the effect of esketamine on working memory impairment in neuropathic mice and its underlying mechanism. Methods Fifty clean grade male C57BL/6J mice (2 months) were divided into 5 groups by random number table method: sham + saline (SN group), CCI + saline (CN group), CCI+(S)-ketamine(CE group), CCI + ANA-12 (CA group), CCI + ANA-12+(S)-ketamine (CAE group), with 10 mice in each group. Chronic constriction injury (CCI) was employed to establish a neuropathic pain model. On the 16th day after modeling, CE group and CAE group were administered ketamine (10 mg/kg), CAE group received ANA-12 (0.5 mg/kg) half an hour before ketamine injection, CA group was only given ANA-12, and SN group and CN group received an equivalent volume of saline. The administration was done through intraperitoneal injection for 5 consecutive days. The open-field test (OFT), paw withdrawal threshold (PWT), paw withdrawal latency (PWL) and Y-maze test were performed from day 21 after surgery. Bromo-2- deoxyUridine (BrdU) was dissolved in saline and intraperitoneally injected into the mice on days 21 to 23 after the surgery. Western blot was performed to determine the expression of Brain-derived neurotrophic factor(BDNF) in hippocampus, the immunofluorescence was performed to determine the number of bromodeoxyuridine nucleoside (BrdU) and doublecortxin (DCX) positive cells in the dentate gyrus (DG) area of hippocampal. Results Compared with SN group, the other four groups showed significant reductions in both PWT and PWL on day 21 after surgery (all P<0.05); There was no significant difference in the total distance travelled by the 5 groups of mice (P=0.142) ; In the Y maze test, compared to SN group, the accurate percentage of spontaneous alternation in CN group showed significant reductions (P<0.001), which was reversed by esketamine administration (P<0.001); compared with CE group, there was a significant reduction of the accurate percentage of spontaneous alternation in CAE group (P=0.004). The expression of BDNF protein in CN group was lower than that in SN group(P=0.021) and CE group (P=0.03), and compared with CE group, the expression of BDNF was significant decreased in CEA group (P=0.043). The number of BrdU positive and DCX positive cells significantly reduced in the DG area of the hippocampus in CN group compared to SN group(P=0.025) and CE group (P=0.003). The number of BrdU positive and DCX positive cells in CAE group significantly reduced in the DG region of the hippocampus compared to CE group(P=0.014). Conclusion Esketamine improves working memory impairment in neuropathic mice and the neurogenesis in dentate gyrus area of hippocampal through the BDNF-TrkB pathway.
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Objective To investigate the expression and significance of cell surface receptor signaling lymphocyte activation molecule receptor 7 (SLAMF7) in normal intestinal tissues and intestinal inflammatory tissues of mice. Methods Five C57BL/6J wild-type male mice aged 8-10 weeks were taken and fed normally. Lamina propria lymphocytes (LPLs) and intestinal epithelial cells (IECs) were extracted, and total cell RNA was extracted by Trizol reagent. The mRNA expression of SLAMF7 in cells was detected by reverse transcription polymerase chain reaction (RT-PCR) and real-time fluorescent quantitative polymerase chain reaction (RT-qPCR). Ten C57BL/6J wild-type male mice aged 8-10 weeks were randomly divided into control group (n=5) and model group (n=5). The control group was fed with normal drinking water for 5 days, the model group was fed with 2.5% dextran sodium sulfate (DSS) drinking water for 5 days to establish a model of ulcerative colitis(UC), and the mice in both groups were killed on the 5th day. Flow cytometry was used to detect the expression of SLAMF7 in immune cell subpopulations in the control group and the model group. Results Compared with colonic IECs, the expression of SLAMF7 was higher in colonic LPLs (P=0.017). After DSS induced enteritis, the expression of SLAMF7 was up-regulated in neutrophils (P=0.001), but had no significant changes in CD4+T cells, CD8+T cells, B cells, macrophages and conventional dendritic cell (all P>0.05). Conclusion SLAMF7 may play a certain role in the occurrence and development of UC through neutrophilrelated pathways.
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Adaptive design, with advantages such as dynamically adjusting trial plans, reducing resource waste, and improving trial efficiency, has broken through the competitive situation of new drug development and gradually met the needs of clinical research. In recent years, the use of adaptive design in platform trials as an innovative research model has added impetus to new drug development. This article briefly outlines the research progress , content and characteristics, common design types, statistical analysis, and case interpretation of adaptive design, introduces the concept, types, and applications of adaptive platform trials, in the hope to provide scientific references for further exploration of clinical trials and new drug development.
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Missing data commonly occur in clinical trials due to various reasons. The occurrence of missing data will cause information loss of the original data, and reduce the robustness and validity of the research results. Therefore, how to adequately deal with missing data should be considered with caution in clinical trials. This article introduces the causes and types of missing data, as well as several common methodological approaches to addressing missing data, aiming to promote researchers’ understanding and improve the quality of handling missing data in trials. Nevertheless, the best way to deal with missing data is to prevent or reduce the occurrence of data being missing in clinical trials, rather than relying on post hoc statistical analyses.

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Systematic reviews are the basis of evidence-based medical research, and high-quality systematic reviews represent the highest level of evidence for evaluating treatment effects. Traditional systematic reviews are mainly done manually, especially the reading and screening of massive literature requires a lot of energy and time for clinicians, and the efficiency is low, which cannot meet the needs of rapid decision-making. This article systematically sorts out existing automated tools for systematic review literature screening, and analyzes their respective performance, characteristics, and usage to understand the current development status of this field and provide reference for related research and applications.
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Objective To explore the clinical effect, safety and effectiveness of ultrasound-guided rhomboid intercostal and subserratus plane (RISS) block for postoperative analgesia after minimally invasive McKeown esophagectomy (MIE-McKeown), and provide new ideas for the selection of postoperative analgesia programs for minimally invasive esophageal cancer surgery patients. Methods: A prospective randomized controlled study design was used to collect 96 patients undergoing MIE-McKeown in the Department of cardiothoracic surgery of Fuling Hospital of Chongqing University from March 2022 to June 2023 were prospectively collected as research objects, They were divided into three groups by random number table method: Group A: continuous RISS plane block+patient controlled intravenous analgesia (PCIA), Group B: single RISS plane block+PCIA, Group C: control group, simple PCIA, with 32 cases in each group. The outcome indicators of each group were recorded and compared: ①Analgesic effect [visual analogue scale (VAS) pain score for rest and cough at 2, 6, 12, 24, and 48 hours after surgery], ②Postoperative use of analgesics [the amount of sufentanil used within 24 hours after surgery, the number of effective presses of the analgesia pump and the number of additional rescue analgesia], ③Adverse reactions during postoperative analgesia [dizziness, lethargy, postoperative nausea and vomiting(PONV), hypotension, respiratory depression, urinary retention, etc.], ④Intraoperative hemodynamic indicators [mean arterial pressure (MAP) and heart rate (HR) at different time points], ⑤Analgesia satisfaction. ①②③ were the primary outcome indicator, and ④⑤were the secondary outcome indicator. Results: Group A patients had lower resting and cough VAS scores at 2, 6, 12, 24, and 48 hours after surgery compared to Group C. Group A had lower resting VAS scores at 2, 24 hours after surgery and lower cough VAS scores at 12, 24 hours after surgery compared to Group B. Group B patients had lower resting VAS scores at 2, 6, 12 hours after surgery and lower cough VAS scores at 2, 6, 12, 24, and 48 hours after surgery compared to Group C, with statistically significant differences (P<0.05). The dosage of sufentanil, the number of effective compressions of the analgesic pump, and the additional number of remedial analgesia gradually increased between groups A, B, and C within 24 hours after surgery, with statistical differences (P<0.05). The incidence of dizziness and PONV in Group C was higher than that in Groups A and B, respectively (P<0.05). There were no statistically significant differences in MAP and HR among the three groups of patients before anesthesia induction (T0), immediately after skin incision (T1), 5 minutes after skin incision (T2), and 5 minutes after extubation (T3) (P>0.05). The satisfaction with pain relief in Group A, Group B, and Group C decreased sequentially. Conclusion: Ultrasound guided RISS block can provide good postoperative analgesia for MIE-McKeown surgery. As an active exploration of multimodal analgesia, continuous RISS has better analgesic effects, is safe and effective, and is worthy of further clinical promotion and use.
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Objective This study aims to analyze the research trends and cutting-edge hot spots in the field of multimorbidity in older adults from 2000 to 2023. Methods We conducted a search in the Web of Science Core Collection database, specifically looking for articles or reviews in English literature on multimorbidity in older adults published between January 1, 2000, and October 24, 2023. VOSviewer 1.6.18 software was used to extract the content in the literature and to draw the cooperative network diagram of countries(regions) and institutions and the timeline diagram of keyword co-occurrence relationship. CiteSpace 6.1.R6 software was used to co-occur and cluster analyse the information of authors, research institutions and countries(regions). The "bibliometrix" package in R was used to analyse the evolution of keywords in the literature. Results A total of 2590 documents were obtained, consisting of 2230 Articles and 360 Reviews. The worldwide publication count has significantly increased since 2000. Among the countries(regions), the United States has the highest number of publications (907 articles, accounting for 35.02% of the total) and total citations (31,343 times) in this field. In terms of institutions, the University of Toronto stands out with 67 articles (2.59%) as the top contributor. McMaster University's author, Jenny Ploeg is recognized as the most prolific authors, having published 32 articles (1.24%). When it comes to journals, BMC Geriatrics has the highest amount of literature related to multimorbidity (99 articles). The key areas of research in this field include multimorbidity, older adults, frailty, aging, and polypharmacy. Notably, there is growing interest in studying the relationship between multimorbidity and aging in older adults, as well as the impact of frailty and polypharmacy on multimorbidities. Conclusions In recent years, research on multimorbidities in the elderly has primarily centered around examining the correlation between comorbidities and aging, as well as exploring the impact of frailty and polypharmacy on individuals with multimorbidities. Future research could potentially delve into the significance of primary health care and comprehensive geriatric assessment in effectively managing comorbidities among older adults, while also emphasizing the importance of maintaining their overall quality of life.
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Objective To analyze the methodological and reporting quality of systematic reviews of prediction models published in Chinese journals, with the aim of providing references for enhancing the quality of Chinese systematic reviews of prediction models. Methods Chinese systematic reviews of prediction models were electronically searched in CNKI, WanFang Data, CBM, and VIP databases from inception to July 20, 2023. Two independent reviewers screened literature, extracted data, and used the AMSTAR and PRISMA 2020 tools to assess methodological and reporting quality of the included reviews. Results A total of 55 systematic reviews published between 2015 and 2023 were included, with 12 of them being meta-analyses. These reviews encompassed a range of topics, with a primary focus on cardiovascular diseases, stroke, and diabetes. The identified systematic reviews exhibited obvious deficiencies in some areas, including items 1, 4, 5, 6, and 10 of AMSTAR, as well as items 7, 10a, 12, 13a-f, 14, 15, 16a-b, 17, 20b-d, 21, 22, 23d, 24a-c, 25 and 26 of PRISMA 2020. Furthermore, a moderate positive correlation (r = 0.58, P < 0.001) was observed between the methodological and reporting quality. Multiple linear regression analyses revealed: greater number of pages, more recent publications, and funding support were associated with higher methodological quality (P < 0.05). Similarly, greater number of pages, more recent publications, qualitative systematic reviews, and funding support were associated with higher reporting quality, but the number of authors showed a negative association (P < 0.05). Conclusions The current systematic reviews of prediction models published in Chinese journals require enhancement in both methodological and reporting quality.
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Artificial intelligence(AI) empowers the development of the medical industry, providing precise and intelligent assistance for clinical diagnosis, treatment, and rehabilitation.AI has the potential to facilitate shared decision making (SDM). AI interventions used for SDM are currently in their infancy, with new challenges and opportunities. Therefore, this paper describes the application of AI in SDM, explores the problems and challenges of AI-based decision aid used for SDM, and proposes possible solutions, aiming to provide a guide for the development and implementation of AI-based decision aid.
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Objective This study explores the essential factors during the consensus process in guideline development, aiming to improve the quality of the consensus process by providing methodological suggestions for enhancing standardization. Methods Semi-structured qualitative interviews were used to interview guideline leaders, working groups and consensus groups to explore the relevant factors affecting the credibility of the consensus and their views on the composition and process of the consensus method. Results The researchers interviewed 26 individuals. After summarization, 212 codes were deepened into five areas:establishment of a consensus group, patient participation, meeting moderator, preparation of consensus and the influencing factors of consensus. Summarized the three basic steps of constructing a consensus group and the 17 basic principles of the application of the consensus method. Conclusion In the future guideline development, it is recommended to increase the methodological training before the consensus process and the full participation of methodologists, encourage experts to treat differences reasonably, pay attention to the methodology and evidence materials. The process should involve openly disclosing the selection of consensus group members, increasing patient participation, and managing and reporting conflicts of interest to reduce bias and enhance transparency, reliability, and scientific rigor of consensus outcomes.
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The development of clinical practice guidelines involves a series of evidencebased decision-making processes, of which the formation of recommendations being a particularly challenging aspect. It demands decision-makers to have a thorough and precise understanding of the evidence, weigh the potential benefits and risks of interventions, and make value judgments and clinical choices. Compared to traditional approaches of presenting evidence information, the use of visualization tools can facilitate the communication and analysis of evidence, simplify information interpretation, and improve the efficiency of decision-making. Based on previous studies, this paper proposes a visualization tool, Vitruvian plot, for summarizing evidence and provides illustrative examples to demonstrate its usage and application effects, aiming to offer valuable guidance for researchers.