ObjectiveTo systematically assess the public health governance capacity in Zhejiang Province, to conduct an in-depth analysis of its strengths and weaknesses, so as to provide scientific basis and strategic recommendations for further enhancement. MethodsA systematic collection of policy documents, public information reports, and research literature related to public health governance capacity in Zhejiang Province from 2002 to 2023 was conducted (encompassing a total of 1 263 policy documents, 138 pieces of information reports and 631 research articles). Based on the evaluation criteria suitable for public health systems previously developed by the research team, the basic status and magnitude of change in public health governance capacity in Zhejiang Province was evaluated. Additionally, normative gap analyses were employed to identify the strengths and weaknesses. ResultsZhejiang Province ranked 4th nationwide in terms of public health governance capacity with a score of 733.4 points (1 000.0-point maximum). The province has effectively implemented the principle of health first (scoring 698.5 points in the assessment of health-first strategy implementation) and attached sufficient importance to health-related goals (scoring 658.2 points in the scientific rationality of goal setting). However, the implementation of inter-departmental coordination and incentive mechanisms only scored 178.7 points, the feasibility of management and monitoring mechanisms scored even lower at only 144.0 points, and the coverage of incentive mechanisms scored 286.0 points. ConclusionZhejiang Province has effectively implemented its health first strategy and attached great importance to health targets, but still needs to strengthen cross-departmental coordination mechanisms and health-oriented incentives.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

ObjectiveTo systematically evaluate the public health governance capacity of 40 cities in Jiangsu, Zhejiang, and Anhui Provinces, providing a scientific evaluation basis for building a "Healthy Yangtze River Delta". MethodsA comprehensive collection of policy documents, public information reports, and research literature related to public health governance capacity in Jiangsu, Zhejiang, and Anhui Provinces was conducted, totaling 6 920 policy documents, 1 720 information reports, and 1 200 literature pieces. Based on the evaluation standards for an appropriate public health system established by the research team, the basic status of public health governance capacity was assessed to identify the strengths and weaknesses of the 40 cities. ResultsIn 2022, the public health governance capacity score for the 40 cities in Jiangsu, Zhejiang, and Anhui Provinces was (562.5±38.0) points. In terms of specific areas, the emergency response field received the highest score of (791.4±49.7) points, while the chronic disease prevention and control field received the lowest score of (368.2±29.6) points. The Jiangsu-Zhejiang-Anhui region has largely achieved the strategic priority of health, gradually improved public health legal regulations, and established a basic organizational framework with a solid foundation for information and data infrastructure. However, challenges still need to be addressed, such as unstable government funding for public health, unclear departmental responsibilities, and barriers to information interoperability. ConclusionThe public health governance capacity of the 40 cities in Jiangsu, Zhejiang, and Anhui Province has been at a moderate level, but disparities have still existed across regions and fields. In the future, while continuing to deepen existing advantages, it is essential to accurately identify the causes of problems, establish a long-term and stable investment mechanism, enhance information connectivity mechanisms, further clarify departmental responsibilities, and promote the achievement of the "Healthy Yangtze River Delta" goal.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

Objective:To explore the regional equity status and dynamic evolution patterns of primary healthcare resource allocation in China from 2009 to 2023.Methods:Based on statistical data of China's primary healthcare resources,the Dagum Gini coefficient decomposition method was used to analyze regional equity differences in primary healthcare resource allocation in China from 2009 to 2023,and Kernel density estimation was employed to investigate the spatial distribution and dynamic evolution process of resource allocation.Results:From 2009 to 2023,the total volume of primary healthcare resources in China continued to grow,with institutions,beds,and personnel increasing by 15.20%,65.53%,and 101.83%respectively,but significant regional disparities persist.Different types of resource allocation showed divergent equity trends:the Gini coefficient for personnel allocation decreased from 0.14 to 0.07,while the Gini coefficient for bed allocation increased from 0.15 to 0.22,and institutional allocation remained relatively stable.Kernel density estimation revealed that personnel allocation transformed from a bimodal distribution to a concentrated unimodal distribution,while bed allocation became more dispersed.Conclusion:China's primary healthcare resource allocation exhibits a divergent phenomenon with concurrent improvement in personnel allocation equity and deterioration in bed allocation equity.It is necessary to establish a differentiated allocation system with targeted policies,implement regional coordinated development strategies,improve monitoring and evaluation mechanisms,and strengthen technological support.

Objective:To explore the regional equity status and dynamic evolution patterns of primary healthcare resource allocation in China from 2009 to 2023.Methods:Based on statistical data of China's primary healthcare resources,the Dagum Gini coefficient decomposition method was used to analyze regional equity differences in primary healthcare resource allocation in China from 2009 to 2023,and Kernel density estimation was employed to investigate the spatial distribution and dynamic evolution process of resource allocation.Results:From 2009 to 2023,the total volume of primary healthcare resources in China continued to grow,with institutions,beds,and personnel increasing by 15.20%,65.53%,and 101.83%respectively,but significant regional disparities persist.Different types of resource allocation showed divergent equity trends:the Gini coefficient for personnel allocation decreased from 0.14 to 0.07,while the Gini coefficient for bed allocation increased from 0.15 to 0.22,and institutional allocation remained relatively stable.Kernel density estimation revealed that personnel allocation transformed from a bimodal distribution to a concentrated unimodal distribution,while bed allocation became more dispersed.Conclusion:China's primary healthcare resource allocation exhibits a divergent phenomenon with concurrent improvement in personnel allocation equity and deterioration in bed allocation equity.It is necessary to establish a differentiated allocation system with targeted policies,implement regional coordinated development strategies,improve monitoring and evaluation mechanisms,and strengthen technological support.

Objective:To investigate the clinical value of left ventricular shape index (SI) and eccentricity index (EI) in evaluating left ventricular remodeling.Methods:A retrospective analysis was performed on 324 patients (264 males, 60 females, age (62.5±11.8) years) diagnosed with myocardial infarction (MI) and 113 healthy controls (HC; 47 males, 66 females, age (57.8±10.7) years) who received gated myocardial perfusion imaging (GMPI) in First Hospital of Shanxi Medical University from January 2016 to September 2020. SI (end-diastolic SI (EDSI), end-systolic SI (ESSI)), EI and left ventricular function parameters (end-diastolic volume (EDV), end-systolic volume (ESV), left ventricular ejection fraction (LVEF), summed motion score (SMS), summed thickening score (STS), peak ejection rate (PER) and peak filling rate (PFR)) were obtained by quantitative gated SPECT (QGS) software. Propensity score (PS) inverse probability of treatment weighting (IPTW) was used to balance the intergroup covariates. The differences and correlations of EDSI, ESSI, EI and left ventricular function parameters between patients in MI group and HC group were analyzed. ROC curve analysis was used to evaluate the values of EDV, EDSI, ESSI and EI alone and in combination in the assessment of left ventricular systolic function impairment. Data were analyzed by independent-sample t test, Pearson correlation and Spearman rank correlation analyses, and Delong test. Results:After IPTW, EDSI and ESSI in MI group ( n=319) were higher than those in HC group ( n=133; EDSI: 0.66±0.09 vs 0.60±0.06; ESSI: 0.59±0.11 vs 0.47±0.07; t values: 8.05, 14.67, both P<0.001), and EI was lower than that in HC group (0.81±0.06 vs 0.85±0.03; t=-8.93, P<0.001). In both groups, there were significant correlations between EDSI and ESSI ( r values: 0.928, 0.873), between EDSI, ESSI and EI ( r values: from -0.831 to -0.641), between EDSI, ESSI and LVEF ( r values: from -0.627 to -0.201), between ESSI and EDV, ESV and SMS ( rs values: 0.336-0.584), between ESSI and -PER, PFR ( rs values: from -0.406 to -0.402, r values: from -0.352 to -0.325) (all P<0.01). ROC curve analysis showed that EDV (AUC: 0.895) and ESSI (AUC: 0.839) had the highest efficacy in evaluating left ventricular systolic function impairment in MI group and HC group, respectively. EDV-EDSI-ESSI-(1-EI) had higher efficacy in the assessment of impaired left ventricular systolic function in MI group (AUC: 0.956), which was higher than that of EDV or EDV-EDSI or EDV-ESSI or EDV-(1-EI) ( z values: from -2.64 to -2.18, P values: 0.008-0.029); EDV-EDSI-ESSI-(1-EI) also had high efficacy in HC group (AUC: 0.911), which was higher than that of EDV or EDV-EDSI or EDV-(1-EI) ( z values: from -2.60 to -2.43, P values: 0.009-0.015). Conclusions:In MI patients, the increase of SI and the decrease of EI indicate the increase of left ventricular sphericity and the aggravation of left ventricular remodeling. SI and EI have certain clinical application values in evaluating left ventricular morphology, predicting left ventricular remodeling and left ventricular systolic function impairment.

Objective To examine the relationship between the expressions of mismatch repair proteins,MutS homolog 2(MSH2)and MutS homolog 6(MSH6),and villin and the pathological features in patients with colon cancer.Methods A total of 310 cases of colon cancer patients who were treated at our hospital between January 2017 and September 2021 were selected.The diagnosis of colon cancer of all patients was verified by pathological evaluation.Immunohistochemistry was used to determine the protein expressions of MSH2,MSH6,and villin.The correlation between the expressions of MSH2,MSH6,and villin and the clinicopathological parameters in patients with colon cancer was analyzed accordingly.Multivariate logistic regression was used to analyze the correlation between the expressions of MSH2,MSH6,and villin and the clinicopathological parameters of colon cancer.Kaplan-Meier survival curve was used to compare the 2-year survival rates of colon cancer patients with different expression levels of the proteins.Results Among the 310 patients with colon cancer,the negative expression rates of MSH2,MSH6,and villin proteins in cancer tissues were 8.71％(27/310),9.35％(29/310),and 46.13％(143/310),respectively.The negative expression rates of the three proteins in tissues adjacent to cancer were 3.23％(10/310),4.19％(13/310),and 9.68％(30/310),respectively.The negative expression rates of the three proteins in cancer tissues were all higher than those in adjacent tissues(P＜0.05).Regression analysis showed that the expression of MSH2 and MSH6 in cancer tissues was correlated with the age,the location of tumor lesions,tumor differentiation degree,and lymph node metastasis in colon cancer patients(P＜0.05).The expression of villin in the cancer tissue is correlated with the depth of tumor infiltration,lymph node metastasis,distant metastasis,and clinical staging status in colon cancer patients(P＜0.05).The 2-year survival rates of patients with negative expressions of MSH2 and MSH6 were 51.85％and 44.83％,respectively,which were lower than those of patients with positive expression of MSH2 and MSH6(79.51％and 80.43％,P＜0.05).Thirteen patients(4.1％)had negative expression of MSH2,MSH6,and villin(referred to as"triple negative expressions")in the cancer tissues,and their 2-year survival rate was 30.77％,which was lower than that of colon cancer patients who did not meet the criteria for triple negative expressions(79.12％[235/297],P＜0.05).Conclusion The expressions of MSH2,MSH6,and villin are closely correlated with the pathological features of colon cancer patients.Evaluating the expression of the three proteins may assist in the clinical diagnosis,treatment,and prognosis evaluation of colon cancer.

Objective To predict the potential distribution areas of three kinds of Stemonae Radix in China;To provide reference for the cultivation site selection of three kinds of Stemonae Radix;To reduce the confusion of Stemonae Radix medicinal materials in the selection of planting areas.Methods Totally 130 pieces of geographical distribution information of Stemona tuberosa Lour.,52 pieces of geographical distribution information of Stemona japonica(Bl.)Miq.,and 52 pieces of geographical distribution information of Stemona sessilifolia(Miq.)Miq.were combined with 91 environmental variables and 3 topographic factors.The maximum entropy(MaxEnt)model and geographic information system software ArcGIS 10.2 were used to predict the potential distribution areas of the three kinds of Stemonae Radix.Results Stemona tuberosa Lour.is mainly distributed in the southern provinces,including eastern Sichuan,western Chongqing,eastern Guangdong,southwestern Fujian,Taiwan,Hainan,southern Yunnan and the junction of Guizhou,Guangxi and Yunnan provinces.The high suitable area is about 293 983 km2,and the medium suitable area is about 519 667 km2.Stemona japonica(Bl.)Miq.is mainly distributed in the plain area of the middle and lower reaches of the Yangtze River,including northwestern and eastern Zhejiang,northern Jiangxi,eastern Hubei,southern Anhui,southern Jiangsu and northern Fujian.The high suitable area is about 140 320 km2,and the medium suitable area is about 188 752 km2.Stemona sessilifolia(Miq.)Miq.is mainly distributed in the North China Plain,including northeastern Hubei,southern Henan,central Anhui,western Jiangsu and central Shandong.The high suitable area is about 198 568 km2,and the medium suitable area is about 198 626 km2.Conclusion The results have important guiding significance for the standardized cultivation of three kinds of Stemonae Radix,and also provide reference for the cultivation of Stemonae Radix.

Microorganisms are one of the important factors which maintain the homeostasis of human health. Despite recent advances, the relationship between microorganisms and head and neck squamous cell carcinoma （HNSCC） is still unclear, and the impact of microorganisms on the incidence and prognosis of HNSCC cannot be neglected. Therefore, this article provides a systematic and comprehensive review summarizing the epidemiological evidence of microbial dysbiosis related to HNSCC and discusses the associations between them.
Humans ; Carcinoma, Squamous Cell/pathology* ; Epithelial Cells ; Head and Neck Neoplasms ; Microbiota ; Prognosis ; Squamous Cell Carcinoma of Head and Neck