Objective To predict the lymph node metastasis status of patients with invasive pulmonary adenocarcinoma by constructing machine learning models based on primary tumor radiomics, peritumoral radiomics, and habitat radiomics, and to evaluate the predictive performance and generalization ability of different imaging features. Methods A retrospective analysis was performed on the clinical data of 1 263 patients with invasive pulmonary adenocarcinoma who underwent surgery at the Department of Thoracic Surgery, Jiangsu Province Hospital, from 2016 to 2019. Habitat regions were delineated by applying K-means clustering (average cluster number of 2) to the grayscale values of CT images. The peritumoral region was defined as a uniformly expanded area of 3 mm around the primary tumor. The primary tumor region was automatically segmented using V-net combined with manual correction and annotation. Subsequently, radiomics features were extracted based on these regions, and stacked machine learning models were constructed. Model performance was evaluated on the training, testing, and internal validation sets using the area under the receiver operating characteristic curve (AUC), F1 score, recall, and precision. Results After excluding patients who did not meet the screening criteria, a total of 651 patients were included. The training set consisted of 468 patients (181 males, 287 females) with an average age of (58.39±11.23) years, ranging from 29 to 78 years, the testing set included 140 patients (56 males, 84 females) with an average age of (58.81±10.70) years, ranging from 34 to 82 years, and the internal validation set comprised 43 patients (14 males, 29 females) with an average age of (60.16±10.68) years, ranging from 29 to 78 years. Although the habitat radiomics model did not show the optimal performance in the training set, it exhibited superior performance in the internal validation set, with an AUC of 0.952 [95%CI (0.87, 1.00)], an F1 score of 84.62%, and a precision-recall AUC of 0.892, outperforming the models based on the primary tumor and peritumoral regions. Conclusion The model constructed based on habitat radiomics demonstrated superior performance in the internal validation set, suggesting its potential for better generalization ability and clinical application in predicting lymph node metastasis status in pulmonary adenocarcinoma.

Objective: To investigate the current status and influencing factors for cognitive frailty among the elderly in community, so as to provide the evidence for early identification and prevention of cognitive frailty among the elderly. Methods: Residents aged 60 years and above with local household registration from 11 counties (cities, districts) in Zhejiang Province from 2021 to 2023 were selected as study participants using a multistage random sampling method. Demographic information, lifestyle, and health status were collected through questionnaire surveys. Depressive symptoms were assessed using the Patient Health Questionnaire. Cognitive frailty was evaluated using the FRAIL Scale and the Mini-Mental State Examination. Factors affecting cognitive frailty among the elderly in community were identified using a multivariable logistic regression model. Results: A total of 16 613 individuals were surveyed, including 7 465 males (44.93%) and 9 148 females (55.07%). The average age was (70.97±7.29) years. A total of 784 individuals were detected with depressive symptoms, with a detection rate of 4.72%. A total of 724 individuals were detected with cognitive frailty, with a detection rate of 4.36%. Multivariable logistic regression analysis showed that females (OR=1.419, 95%CI: 1.179-1.708), aged ≥70 years (70-<80 years old, OR=1.869, 95%CI: 1.490-2.345; ≥80 years old, OR=5.017, 95%CI: 3.935-6.398), without a spouse (OR=1.495, 95%CI: 1.234-1.810), sedentary (OR=2.420, 95%CI: 1.829-3.202), chronic diseases (1 type, OR=1.456, 95%CI: 1.175-1.804; ≥2 types, OR=1.639, 95%CI: 1.314-2.045), and depressive symptoms (OR=4.191, 95%CI: 3.361-5.225) were associated with a higher risk of cognitive frailty among the elderly in community. Conversely, a lower risk of cognitive frailty was seen among the elderly in community who had primary school or above (primary school, OR=0.512, 95%CI: 0.389-0.676; junior high school or above, OR=0.464, 95%CI: 0.354-0.608), engaged in physical exercise (OR=0.396, 95%CI: 0.291-0.539), and were reported average or good self-rated health status (average, OR=0.641, 95%CI: 0.475-0.866; good, OR=0.150, 95%CI: 0.109-0.208). Conclusions The detection rate of cognitive frailty among the elderly in community is relatively low and is influenced by demographic factors such as gender, age, education level, as well as lifestyle like sedentary and physical exercise, and health status. It is recommended to reduce the risk of cognitive frailty among the elderly through multidimensional interventions, including health education, promotion of healthy lifestyles, and enhanced mental health support.

Objective: To establish a nomogram prediction model for Alzheimer's disease (AD) among the elderly in community, so as to provide the evidence for early screening and prevention of AD. Methods: Based on the Zhejiang Healthy Aging Cohort Study, the elderly aged 60-90 years who completed the baseline survey were selected as the study subjects. Follow-up surveys were conducted from 2015 to 2016 and from 2019 to 2021. Sociodemographic characteristics, lifestyle factors, medical history, and waist circumference were collected through questionnaire surveys and physical examinations. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), and a diagnosis of AD was made based on the Alzheimer's Disease Assessment Scale-Cognitive Subscale and medical history. The participants were randomly divided into training and validation sets at 8∶2 ratio. LASSO regression was used to screen for predictive factors. Multivariable logistic regression model was used to analyze predictive factors and construct a nomogram. The model was analyzed and evaluated using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results: A total of 6 988 elderly were included at baseline, with a mean age of (68.19±6.63) years. There were 3 438 males (49.20%), and 3 550 females (50.80%). The median follow-up duration was 4.90 (interquartile range, 3.80) years, with 817 new cases of AD were identified, yielding an incidence of 11.69%. LASSO regression and multivariable logistic regression showed that age (OR=1.017, 95%CI: 1.005-1.030), gender (female, OR=1.820, 95%CI: 1.533-2.165), educational level (primary school, OR=0.813, 95%CI: 0.673-0.980), physical exercise (not active, OR=1.572, 95%CI: 1.260-1.980), dining companions (spouse and children, OR=0.771, 95%CI: 0.598-0.995), baseline MMSE score (OR=0.843, 95%CI: 0.821-0.866), and waist circumference (OR=0.981, 95%CI: 0.973-0.989) were risk predictors for AD among the elderly in community. The prediction model demonstrated an area under the ROC curve of 0.740 (95%CI: 0.698-0.783) in the validation set, with a sensitivity of 0.731 and a specificity of 0.667. DCA indicated that when the probability threshold was 0.060 to 0.325, the clinical net benefit was relatively high. Conclusion The AD risk prediction model constructed in this study has good discrimination and clinical practicability, can be used for early screening of AD among the elderly in the community.

Objective:To explore the effects of genistein-3'-sodium sulfonate (GSS) on on motor function and brain autophagy levels in Parkinson disease (PD) model mice.Methods:Forty C57BL/6J mice were randomly divided into control group, model group, low-dose GSS group (0.15 mg/kg), medium-dose GSS group (0.50 mg/kg) and high-dose GSS group (1.50 mg/kg), with 8 mice in each group.Mice in the model group and the high, medium, and low-dose GSS groups were injected intraperitoneally with 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine to establish the PD mouse model, then mice in high, medium and low-close GSS group were intraperitoneally injected with corresponding doses of GSS (once a day for 21 days). The mice in model group were injected with equal volume 0.9% sodium chloride solution(once a day for 21 days), while the control group mice were fed normally.After 21 days, the motor and cognitive abilities of mice were evaluated by gait analysis, open field test, rotarod test, and modified Y maze test.Western blot was used to detect the expression levels of LC3-Ⅱ and Beclin-1 proteins in the cerebral cortex and striatum tissues of mice.SPSS 26.0 software was used for data analysis.One-way ANOVA was used for normal distribution data comparison among multiple groups, and LSD test was used for further pairwise comparisons, while Kruskal-Wails H test was used for non normal distribution data comparison. Results:(1) Gait analysis showed that there were statistically significant differences in the stride length of left forelimb, left hindlimb, right hindlimb( F=5.93, 6.21, 3.78, all P<0.01) and regularity index( H=14.409, P<0.01). The regularity index of the model group mice was lower than that of the control group ( P<0.05), and the regularity indexes of the low, medium, and high-dose GSS groups were all higher than that of the model group (all P<0.05). (2)In the open field test, there were statistically significant differences in the total distance and speed of movement among the 5 groups ( F=5.49, 5.49, both P<0.01). The total distance and speed of movement in the model group were both lower than those in the control group (both P<0.05). The total distance and speed of movement in the medium-dose GSS group( (2 395.57±319.35) cm, (7.98±1.06) cm/s) and high-dose GSS group ((2 386.51±396.00) cm, (7.95±1.32) cm/s) were higher than those of the model group ((1 863.31±278.96) cm, (6.21±0.93) cm/s) and the low-dose GSS group ((1 956.90±297.15) cm, (6.52±0.99) cm/s) (all P<0.05). (3) In the rotarod test and modified Y maze test, there were significant differences in latency to fall and residence time among the 5 groups ( F=58.41, 9.90, both P<0.01). The latency to fall and residence time of model group were lower than those of control group (both P<0.05), while those in the medium-dose and high-dose GSS groups were higher than those in the model group and low-dose GSS group (all P<0.05). (4) Western blot results showed that there were significant differences in the expression levels of LC3-Ⅱ/LC3-Ⅰ ratio ( F=8.17, 15.47, both P<0.01)and Beclin-1 protein( F=29.07, 20.54, both P<0.01) in cerebral cortex and striatum among the five groups.The LC3-Ⅱ/LC3-Ⅰ ratio and Beclin-1 protein levels in the cerebral cortex ((0.51±0.14), (0.46±0.06)) and striatum ((0.58±0.09), (0.55±0.10)) of the model group were lower than those in the control group (cerebral cortex: (1.00±0.10), (1.00±0.05), striatumm: (1.00±0.06), (1.00±0.25), all P<0.01). The LC3-Ⅱ/LC3-Ⅰratio and Beclin-1 protein in the medium-dose GSS group were higher than those in the model group, low-dose and high-dose GSS groups in both cerebral cortex and striatum (all P<0.05). The level of Beclin-1 of cerebral cortex in model group was lower than those in various doses of GSS group(all P<0.05). There were no statistically significant differences of Beclin-1 protein levels between the model group mice and various doses of GSS groups in striatum (all P>0.05). Conclusion:GSS can improve the motor and cognitive functions of PD model mice, and the mechanism may be related to the upregulation of autophagic activity in the cerebral cortex and striatum of mice.

Objective: To investigate the trend of hepatitis B incidence among children under 10 years in Zhejiang Province from 2004 to 2020 with age, period and birth cohort, so as to provide the basis for evaluating the implementation of hepatitis B prevention and control measures for children in Zhejiang Province. Methods: Data of hepatitis B incidence among children under 10 years in Zhejiang Province from 2004 to 2020 were collected through the Infectious Disease Reporting Information System of Chinese Disease Prevention and Control Information System. The trend in hepatitis B incidence was analyzed using an age-period-cohort model. Results: The incidence of hepatitis B among children under 10 years in Zhejiang Province decreased from 12.91/105 in 2004 to 0.61/105 in 2020, with a reduction of 95.24%. The incidence showed an decreasing trend with the increase of age. Compared with 2012, the risk of hepatitis B incidence among children under 10 years appeared a tendency towards a decline with time, with the period rate ratio decreased from 4.546 (95%CI: 3.322-6.220) in 2004 to 0.277 (95%CI: 0.161-0.478) in 2020. Compared with the 2008 cohort, the risk of hepatitis B incidence appeared a tendency towards a decline with cohort, with the cohort rate ratio decreased from 25.535 (95%CI: 15.105-43.166) in 1995 to 0.135 (95%CI: 0.038-0.475) in 2020. Conclusions The incidence of hepatitis B among children aged under 10 years in Zhejiang Province from 2004 to 2020 showed a downward trend. The risk of hepatitis B incidence decreased with increasing age and advancing birth cohort.

A high performance liquid chromatography (HPLC) method utilizing correction factors was established for the quantitative detection of related substances in flumazenil. Separation was achieved using an Agilent Pursuit XRs C18 column (250 mm × 4.6 mm, 5 μm) with an isocratic elution of dilute phosphoric acid, methanol, and tetrahydrofuran as the mobile phases. Correction factors calculated from a standard curve method were applied to determine the impurity content. The quantification of impurities in flumazenil was conducted using both external standard and correction factor methods, followed by validation and comparison of the two. For the identification of degradation products, a forced degradation approach was employed to prepare a flumazenil degradation solution, and the resulting impurities were confirmed by LC-MS analysis. The separation of flumazenil and its impurities was found to be efficient. The limits of quantification for impurities A, B, D, and E were established at 0.169 9, 0.314 7, 0.143 9, and 0.270 8 ng, respectively, with the limits of detection at 0.055 8, 0.096 9, 0.048 8, and 0.089 0 ng. These impurities demonstrated a strong linear relationship across the concentration ranges of 0.034 9-7.847 0, 0.038 7-8.710 7, 0.034 6-7.794 1, and 0.032 4-7.292 8 µg·mL^-1, respectively (n = 7). The method achieved average recoveries between 98.25% and 99.42%, with an RSD of less than 2.0% (n = 9), indicating high accuracy. The external standard and correction factor methods were used to determine the related substances in flumazenil, and the results of the two methods were consistent. The established HPLC method is characterized by its high accuracy, sensitivity, and repeatability, and is suitable for determining related substances in flumazenil.

Discipline construction is the main focus of the high-quality development of public hospitals. The authors elaborated on the practice of Zhongshan Hospital(Xiamen), Fudan University, based on the " double-center" homogenization management, implementing the 123456 strategy of " integrated management and homogeneous development" in discipline construction. The hospital has promoted discipline construction from six aspects: building discipline cluster, promoting talent cultivation, building science and technology innovation platform, precise personnel classification, medical and education collaborative education, and information sharing and support. It has achieved new development goals of filling weak discipline gaps, transforming talent transfusion into hematopoietic, and integrating medical, educational, research and management innovation. However, it also encountered difficulties such as homogenization barrier of discipline construction, shortage of excellent talents, and limited brand influence of superior disciplines. The authors put forward suggestions from three dimensions: deepening homogeneous management, building talent echelon, and increasing publicity, in order to provide experience for the high-quality development of other hospitals.

ObjectiveTo evaluate the efficacy and safety of Qingyusan capsules in the long-term treatment of mild to moderate active ulcerative colitis （UC） with the syndrome of large intestine dampness-heat. MethodA randomized， controlled design was adopted， and 88 patients with mild to moderate UC and syndrome of large intestine dampness-heat were randomized into a Qingyusan （Qingyusan capsules， 0.8 g·d^-1） group and a control （mesalazine， 0.4 g·d^-1） group， with 44 patients in each group. Three and one patients dropped out in the control and Qingyusan groups， respectively， during the 32 weeks of treatment. The clinical remission rate， mucosal healing rate， and modified Mayo score， TCM symptom score， and short inflammatory bowel disease questionnaire （SIBDQ） score before and after treatment were compared between the two groups. The colonoscopic and pathological changes were observed， and the clinical safety was compared between the two groups. ResultAfter treatment， the clinical remission rate and mucosal healing rate in the Qingyusan group were 72.1% （31/43） and 74.4% （32/43）， respectively， which were higher than those ［26.8% （11/41） and 41.5% （17/41）， respectively］ in the control group （χ²=17.200， χ²=10.843， respectively， both P<0.01）. The treatment in both groups decreased the modified Mayo score， partial Mayo score， and TCM symptom score （P<0.05）， and the decreases in the Qingyusan group were higher than those in the control group （P<0.01）. After treatment， the SIBDQ scores in both groups increased （P<0.05）， and the increase was more pronounced in the Qingyusan group than in the control group （P<0.01）. There was no difference in the incidence of adverse events between the two groups. ConclusionThe clinical efficacy of Qingyusan capsules is remarkable in the long-term treatment of UC with the syndrome of large intestine dampness-heat. Particularly， Qingyusan capsules demonstrates advantages in inducing and maintaining clinical remission， promoting mucosal healing， alleviating TCM symptoms， and enhancing the survival quality of patients， with high safety.

ObjectiveTo reveal the correlation of Rehmannia glutinosa-soil feedback process with the formation of its continuous cropping obstacles through the identification of the root exudates of R. glutinosa and analysis of the specific rhizomicrobes recruited by the root exudate. MethodThe root exudates of R. glutinosa seedlings germinated under sterilized condition and those enriched in the rhizosphere of R. glutinosa cultivated in the field were collected and analyzed using the ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry（UPLC-Q-TOF-MS）. The highly abundant compounds identified in the root exudates were added into blank soil， and the soil microbial community was profiled using Illumina Miseq sequencing. The bacterial and fungal functions were predicted by PICRUSt and FUNGuild， respectively. ResultThe identification results showed that seven phenylethanoid glycosides were found in R. glutinosa root exudates， and acteoside possessed the highest abundance. In the soil enriched with acteoside， the bacterial genera such as Agromyces， Pseudomonas， Lysobacter， Sphingobium， Pseudoxanthomonas and Sphingomonas were enriched. For the fungi， the genera Neocosmospora， Plectosphaerella and Dactylonectria， and the species such as Neocosmospora rubicola， Plectosphaerella cucumerina， Dactylonectria alcacerensis and Fusarium solani showed higher abundance. The functional analysis indicated the above-mentioned bacterial genera may realize rapid proliferation by utilizing， biodegrading and transforming phenylethanoid glycosides， and some potential fungal pathogens were colonized. ConclusionThe R. glutinsoa-soil feedbacks were likely generated by the phenylethanoid glycosides in the root exudates together with the specific rhizomicrobes. The investigations of R. glutinsoa-soil feedbacks under continuous cropping system are critical to the further understanding of the underlying mechanisms related to its continuous cropping obstacles.

Aim To explore the mechanism of action of Ruanmai decoction in treating atherosclerosis through network pharmacology. Methods The chemical components and targets of Ruanmai decoction were queried using TCMSP. Relevant targets for atherosclerosis were retrieved from DrugBank, GeneCards, OMIM, and TTD databases. The " Drug-Active Ingredient-Target" PPI network was constructed using Cyto-scape software. GO and KEGG enrichment analysis were performed using the David database. Molecular docking verification of key components with core targets was conducted using the Seesar software. Atherosclerosis mouse models were established by feeding ApoE mice with a high-fat diet, and Ruanmai decoction granules were administered orally. Aortic pathological sections were stained, blood lipids were measured, and immunofluorescence was used to detect Mac2 and YWHAZ protein expression. Western blot was used to detect p-p38MAPK and C-CASP3 protein expression. Results Ruanmai decoction screened a total of 72 active drug components corresponding to 168 target genes for the treatment of atherosclerosis. The targets were primarily enriched in biological processes related to lip-id metabolism, inflammation and immunity, oxidative stress, vascular endothelial function, cell proliferation and apoptosis, glycolysis, and ubiquitination. Signaling pathways such as МАРК, TNF, PDK-Akt, and IL-17 were also involved. Animal experiments verified that RMJ could regulate the p38MAPK signaling pathway by down-regulating key targets YWHAZ, p-p38MAPK, and C-CASP3, thereby reducing AS inflammation and inflammation-induced apoptosis. Conclusions Ruanmai decoction can inhibit the expression of YWHAZ and activate the p38MAPK signaling pathway, potentially improving vascular inflammation, lipid metabolism, oxidative stress, and other pathological processes by regulating the МАРК, TNF, PDK-Akt, and IL-17 signaling pathways, thus preventing and treating atherosclerosis.