Objective To investigate the application value of clinical-radiomics nomogram in predicting the expression of liver kinase B1(LKB1)in non-small cell lung cancer(NSCLC)before surgery.Methods A total of 140 NSCLC patients were randomized into training group(n=106)and validation group(n=34)according to the ratio of 7∶3.The training group was used as the study cohort to screen the clinically independent predictors and radiomics characteristics related to LKB1 expression,and the clinical model,radiomics model and clinical-radiomics nomogram model were constructed,respectively.The predictive performance of the three models was analyzed using the receiver operating characteristic(ROC)curve in the training group,and validated in the validation group.The calibration curve was used to assess the consistency between the predicted results of nomogram model and the actual observations,and the decision curve was used to evaluate the clinical benefit of the nomogram model.Results The clinical model consisted of pathological type and hilal/mediastinal lymphadenopathy,the radiomics model consisted of Radiomics score(Radscore),and the nomogram model consisted of Radscore,pathological type and hilal/mediastinal lymphadenopathy.In the training group,the area under the curve(AUC)of the nomogram model,radiomics model and clinical model was 0.884,0.843 and 0.788,respectively.In the validation group,the AUC of the three models were 0.976,0.851,and 0.912,respectively.The calibration curve analysis showed good consis-tency between the predicted results of nomogram model and the actual observations,and the decision curve showed that the model had good clinical benefit.Conclusion Radiomics combined with clinical risk factors can effectively predict the expression of LKB1 in NSCLC patients before surgery,so as to contribute to the formulation of therapeutic strategies in clinical practice.

Objective To investigate the application value of clinical-radiomics nomogram in predicting the expression of liver kinase B1(LKB1)in non-small cell lung cancer(NSCLC)before surgery.Methods A total of 140 NSCLC patients were randomized into training group(n=106)and validation group(n=34)according to the ratio of 7∶3.The training group was used as the study cohort to screen the clinically independent predictors and radiomics characteristics related to LKB1 expression,and the clinical model,radiomics model and clinical-radiomics nomogram model were constructed,respectively.The predictive performance of the three models was analyzed using the receiver operating characteristic(ROC)curve in the training group,and validated in the validation group.The calibration curve was used to assess the consistency between the predicted results of nomogram model and the actual observations,and the decision curve was used to evaluate the clinical benefit of the nomogram model.Results The clinical model consisted of pathological type and hilal/mediastinal lymphadenopathy,the radiomics model consisted of Radiomics score(Radscore),and the nomogram model consisted of Radscore,pathological type and hilal/mediastinal lymphadenopathy.In the training group,the area under the curve(AUC)of the nomogram model,radiomics model and clinical model was 0.884,0.843 and 0.788,respectively.In the validation group,the AUC of the three models were 0.976,0.851,and 0.912,respectively.The calibration curve analysis showed good consis-tency between the predicted results of nomogram model and the actual observations,and the decision curve showed that the model had good clinical benefit.Conclusion Radiomics combined with clinical risk factors can effectively predict the expression of LKB1 in NSCLC patients before surgery,so as to contribute to the formulation of therapeutic strategies in clinical practice.

ObjectiveTo analyze the hemagglutinin variation and the genetic evolution of A(H1N1)pdm09 influenza virus in Huzhou City, 2023. MethodsRespiratory tract specimens from two influenza monitoring hospitals were collected for the isolation of A(H1N1)pdm09 influenza virus and HA genome sequencing. MEGA 7.0 and BioAider were utilized to analyze genetic similarity, genetic evolution, antigen mutation sites, receptor binding sites, pathogenicity, and potential glycosylation sites of the influenza virus sequencing results. ResultsThe nucleotide and amino acid similarities between the 25 A(H1N1)pdm09 strains and the vaccine strain A/Wisconsin/67/2022 were 98.41% to 99.22% and 98.41% to 99.36%, respectively. These strains belonged to the 6B.1A.5a.2a evolutionary lineage. Notably, there were 19 amino acid variations in the HA protein, including substitutions of S137P and R142K in the epitope Ca2 cluster. Additionally, seven potential glycosylation sites were found in the HA protein, and no new or missing sites were observed in the 25 A(H1N1)pdm09 influenza virus isolates compared to the vaccine strains. Furthermore, no multiple continuous alkaline amino acids were detected in the HA cleavage site of the 25 isolates. ConclusionTheA(H1N1)pdm09 pandemic strain in 2023 closely matches the vaccine strain, indicating good protection against the currently circulatingA(H1N1)pdm09 influenza virus. The circulating A(H1N1)pdm09 strain in Huzhou is characterized as a low-pathogenic influenza virus.

ObjectiveTo investigate the mutation and genetic evolution of drug resistance gene of A（H1N1） pdm09 influenza pandemic strain in 2023 in Huzhou City， Zhejiang Province. MethodsRespiratory tract specimens from 2 influenza monitoring hospitals were collected forA（H1N1） pdm09 influenza virus nucleic acid detection. Positive specimens were inoculated with MDCK cells for influenza virus isolation and sequencing. DNA Star 7.1 software and Mega 4.0 software were used to analyze the neuraminidase （NA） enzyme active site and the amino acid sites related to drug resistance in M2 protein. ResultsNucleotide homology and amino acid homology of NA between the isolated and the vaccine strains were 98.87%‒99.22% and 98.94%‒99.36%， respectively. The nucleotide homology range of M gene was 99.07% to 99.85%， and the amino acid homology range was 99.02%‒99.94%. The isolates and vaccine strains belong to the evolutionary clades of 6B.1A.5a.2a. The amino acids at the key sites of the enzyme activity center of NA were still highly conserved， and the 9 key amino acid sites related to NA inhibitor resistance did not change， but some mutations occurred at the non-enzyme active sites in some popular strains. The 5 amino acid sites related to drug resistance of M2 protein were not replaced， but the 31st amino acid sites changed from serine to asparagine. ConclusionThe A（H1N1） pdm09 pandemic strain in Huzhou in 2023 has high homology with the 2023‒2024 vaccine strain recommended by WHO. All endemic strains are resistant to amantadines.

Objective:To observe the effects of repetitive transcranial magnetic stimulation (rTMS) at different frequencies on learning and memory abilities in rats during the early recovery phase of middle cerebral artery occlusion (MCAO) and to explore the underlying mechanisms.Method:Successfully modelled MCAO rats were randomly divided into the model group,low-frequency group,high-frequency group,and sham-operated group was set up at the same time,with 12 rats in each group. The low-frequency group and high-frequency group were stimulated with a CCY-I transcranial magnetic stimulator 2 times/day for 14d;the low-frequency group was treated with 1Hz at the left prefrontal lobe of the rat's skull,and the high-frequency group was treated with 10Hz at the right prefrontal lobe. The model group and the sham-operated group were not treated but were subjected to the same conditions of handling and re-straint before returning to their cages. Neurobehavioral scores were recorded on the 1st and 14th day after the operation;the Morris water maze test was conducted on day 3—7 after the operation;TTC staining,PCR and Western blot to detect the mRNA and protein expression of key genes (Notch1,Hes1,Hes5) were performed at the end of the intervention on the 14th postoperative day. Result:①Neurological deficit scores:After 14 days of intervention,both the high-frequency and low-frequency groups showed a reduction in neurofunctional compared to the model group (P<0.05),with no significant dif-ference between the model group and high-frequency group (P>0.05). ②Morris water maze experiment:The av-erage escape latency during the directional navigation experiment was significantly reduced day by day in the low frequency group,high frequency group and sham operation group (P<0.05). The escape latency was short-er in the high-frequency group compared to the model group,and shorter in the low-frequency group com-pared to the high-frequency group (P<0.05). The number of platform crossings in the spatial exploration experi-ment showed no significant difference between low frequency group and sham operation group,high frequency group and model group (P>0.05). The high-frequency group and the model group had fewer crossing than the sham operation group,and the low-frequency group had more than the model group and high-frequency group (P<0.05). ③TTC staining:The infarct size in the low-frequency group and high-frequency group was signifi-cantly smaller than in the model group. ④PCR and Western blot:Compared to the model group,the high fre-quency group and the low frequency group had significantly increased mRNA and protein expression of Notch1,Hes1 and Hes5 (P<0.05). There was no significant difference in the mRNA and protein expression of Notch1,Hes1 and Hes5 between the low frequency group and high frequency group (P>0.05).Conclusion:Both high and low frequency rTMS can improve the learning and memory abilities in MCAO rats,potentially by activating and increasing the expression of the Notch1 pathway in hippocampal tissues,which improves the synaptic plasticity of hippocampus.

Objective:To observe the effects of repetitive transcranial magnetic stimulation (rTMS) at different frequencies on learning and memory abilities in rats during the early recovery phase of middle cerebral artery occlusion (MCAO) and to explore the underlying mechanisms.Method:Successfully modelled MCAO rats were randomly divided into the model group,low-frequency group,high-frequency group,and sham-operated group was set up at the same time,with 12 rats in each group. The low-frequency group and high-frequency group were stimulated with a CCY-I transcranial magnetic stimulator 2 times/day for 14d;the low-frequency group was treated with 1Hz at the left prefrontal lobe of the rat's skull,and the high-frequency group was treated with 10Hz at the right prefrontal lobe. The model group and the sham-operated group were not treated but were subjected to the same conditions of handling and re-straint before returning to their cages. Neurobehavioral scores were recorded on the 1st and 14th day after the operation;the Morris water maze test was conducted on day 3—7 after the operation;TTC staining,PCR and Western blot to detect the mRNA and protein expression of key genes (Notch1,Hes1,Hes5) were performed at the end of the intervention on the 14th postoperative day. Result:①Neurological deficit scores:After 14 days of intervention,both the high-frequency and low-frequency groups showed a reduction in neurofunctional compared to the model group (P<0.05),with no significant dif-ference between the model group and high-frequency group (P>0.05). ②Morris water maze experiment:The av-erage escape latency during the directional navigation experiment was significantly reduced day by day in the low frequency group,high frequency group and sham operation group (P<0.05). The escape latency was short-er in the high-frequency group compared to the model group,and shorter in the low-frequency group com-pared to the high-frequency group (P<0.05). The number of platform crossings in the spatial exploration experi-ment showed no significant difference between low frequency group and sham operation group,high frequency group and model group (P>0.05). The high-frequency group and the model group had fewer crossing than the sham operation group,and the low-frequency group had more than the model group and high-frequency group (P<0.05). ③TTC staining:The infarct size in the low-frequency group and high-frequency group was signifi-cantly smaller than in the model group. ④PCR and Western blot:Compared to the model group,the high fre-quency group and the low frequency group had significantly increased mRNA and protein expression of Notch1,Hes1 and Hes5 (P<0.05). There was no significant difference in the mRNA and protein expression of Notch1,Hes1 and Hes5 between the low frequency group and high frequency group (P>0.05).Conclusion:Both high and low frequency rTMS can improve the learning and memory abilities in MCAO rats,potentially by activating and increasing the expression of the Notch1 pathway in hippocampal tissues,which improves the synaptic plasticity of hippocampus.

Objective:To explore the significance of exposing the circummammary ligament under endoscopy and the effect of membrane anatomy in breast reconstruction.Methods:The case data of 49 breast cancer patients who underwent endoscopic nipple-sparing mastectomy combined with one-stage breast reconstruction with prosthesis implantation in Beijing Friendship Hospital, Capital Medical University from February 2014 to December 2021 were retrospectively analyzed, there were 44 cases of posterior pectoralis prosthesis implantation, 5 cases of anterior pectoralis prosthesis implantation. The anatomical structure of the circummammary ligament was observed under endoscopy during operation, and the annular mammary ligament was used as an anatomical marker to complete subcutaneous glandectomy and prosthesis implantation for breast reconstruction, the BREAST-Q scales were used to evaluate the postoperative effect.Results:The medial sternal ligament, sub clavicular ligament, lateral confluence ligament and triangular ligament condensation could be clearly exposed in all 49 cases. Breast reconstruction module of BREAST-Q were used to evaluate the surgery effect after breast cancer surgery, the scores of postoperative breast satisfaction, chest wall status, psychosocial status and sexual health status were 81.43±12.57, 88.39±10.61, 88.04±13.70, 74.82±15.93.Conclusion:The endoscopic technique is beneficial to expose the circummammary ligament during operation, and surgical resection and reconstruction can better restore the appearance of the breast and improve postoperative satisfaction according to the principle of membrane anatomy.

Objective: To learn the epidemiological characteristics of coronavirus disease 2019（COVID-19）in Huzhou,so as to provide reference for prevention and control of COVID-19. Methods: All the confirmed cases of COVID-19 in Huzhou,diagnosed according to the COVID-19 Diagnosis and Treatment Plan（Sixth Version Trial）and reported from January 25 to February 7,2020,were recruited. The process of diagnosis and treatment,clinical manifestation,exposure history and close contacts were collected to analyze the epidemiological characteristics. Results: On January 25,the first confirmed cases of COVID-19 in Huzhou was reported. By February 7,totally 10 confirmed cases were reported and no asymptomatic infection was found. They were all imported,including three Wuhan residents,two with a trip to Wuhan,three with a trip to Suizhou,one with a trip to Hangzhou and one with a trip to Thailand（two Wuhan passengers on the same flight）. The ratio of male to female cases was 1∶1. The median age was 32 years old. Seven cases were found when they went to a doctor by themselves,and three cases were found during the quarantine. The main clinical manifestations were fever,dry cough and fatigue. The median time from onset to diagnosis was 3 days. By March 3,all the cases were discharged,with median course of 24 days. There were 312 close contacts,and all of them were released after 14 days of quarantine. Conclusions To prevent imported cases from outside and stop spread inside taken by Huzhou government was proved to be effective. All the COVID-19 cases in Huzhou were imported,mostly from Wuhan. No local cases were reported.

Objective To analyze the genetic characteristics of norovirus (NoV) outbreaks in Huzhou city in 2018.Methods Totally 73 stool samples were collected from NoV outbreaks and tested by real-time RT-PCR.The polymerase and capsid protein regions were amplified from the norovirus nucleic acid positive samples in each cluster epidemic.The amplified products were further analyzed by gene sequencing and genotyping.Results A total of 57 specimens from 8 outbreaks were positive for GII type NoV nucleic acid and 5 samples were positive for both genogroup Ⅰ and genogroup [I.The alignment of polymerase and capsid protein nucleic acid sequences showed that 5 cases were GII.P16/GII.2 type,1 case was GII.P17/ GII.17 type,1 case was GII.P12/GII.3 type,and 1 case was mixed infection with GI.P4/GI.5 type and GII.P17/GII.17 type.Conclusions NoV is the main pathogen causing the epidemic of acute gastroenteritis and diarrhea in Huzhou city.The virus was mainly GII type,with multiple genotypes and recombinant strains.

Objective To investigate the imaging characteristics of nontraumatic spontaneous intramural hematoma of small bowel secondary to warfarin therapy.Methods The retrospective and descriptive study was conducted.The clinical data of 12 patients with nontraumatic spontaneous intramural hematoma of small bowel secondary to warfarin therapy who were admitted to the First People's Hospital of Wenling (11 patients) and Taizhou Hospital of Zhejiang Province (1 patient) between January 2010 and December 2016 were collected.Patients received plain and enhanced scans of computed tomography (CT).Patients stopped warfarin therapy,received intramuscular injection of vitamin K1 and fresh-frozen plasma transfusion.Observation indicators:(1) primary signs of CT:① small bowel wall thickening;② increased density of small bowel wall;(2) secondary signs of CT:intestine lumen stenosis,intestinal pneumatosis,perienteric changes and other concomitant signs;(3) treatment situations.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Results Twelve patients received total abdomen plain scans of CT,and 7 received total abdomen enhanced scans of CT.(1) Primary signs of CT:① Small bowel wall thickening.CT of 12 patients showed solitary,homogeneously symmetric,consecutive and diffuse thickening of small bowel wall,including ileal involvement in 7 patients and jejunum involvement in 5 patients.Ascending part of duodenum of 3 patients involved the 2nd and 3rd groups small bowel.The average length of involved small bowel was 30.7 cm (range,11.0-58.0 cm).There was no multifocal thickening or colonic involvement.Of 12 patients,10 and 2 showed moderate thickening (thickness was 1.0-2.0 cm) and severe thickening (thickness ＞ 2.0 cm),and the thickest small bowel wall was 2.5 cm.② Increased density of small bowel wall.Twelve patients showed varying degrees of increased density of small bowel wall,with an average value of 49.7 HU (range,36.0-63.4 HU).Of 12 patients,homogeneously increased whole layer density of small bowel wall were detected in 4 patients,higher submucous layer density of small bowel compared with serosal layer density in 4 patients,and all of the above characteristics in 4 patients.Enhanced scans of CT in 7 patients showed enhancement in small bowel mucosal layer and serosal layer,no obvious enhancement in the submucous layer of small bowel wall,clear layers,and a target sign when small bowel lumen was perpendicular to scan slice,including 5 patients with obvious enhancement in small bowel mucosal layer,spring-like change,and clear imaging in portal vein phase.(2) Secondary signs of CT:① Intestine lumen stenosis:12 patients had varying degrees of intestine lumen stenosis.Five patients were complicated with small bowel obstruction,showing a gas-liquid level.② Intestinal pneumatosis:2 of 12 patients showed patchy and mottled gas shadow.③ Perienteric changes and other concomitant signs:12 patients showed obviously increased fat density in surrounding area of involved small bowel and corresponding mesenteric area,and indistinct outside small bowel,including 8 with lots of lath-like high density shadow in surrounding area of small bowel and mesenteric area.The varying degrees of hemoperitoneum were seen in 12 patients.(3) Treatment situations:of 12 patients,9 underwent correct treatments,8 of them were improved,and 1 of them with persistently severe abdominal pain underwent urgent explorative laparotomy,showing hemorrhage and necrosis,and then underwent surgery;3 didn't undergo correct treatment,without improved or severe symptoms.Conclusion Patients undergoing anticoagulant therapy show acute abdominal pain with abnormal coagulation function,small bowel wall thickening and increased density by CT scans,hemoperitoneum complicated with intestine lumen stenosis,small bowel obstruction and hematocele in surrounding area of small bowel and mesenteric area,these are highly indicative of nontraumatic spontaneous intramural hematoma of small bowel secondary to warfarin therapy.