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.

ObjectiveTo develop a full-process data platform of renal rehabilitation, diagnosis and quality control information. MethodsA hierarchical architectural design was proposed, adhering to clinical pathway models and standardized data protocols. The platform comprehensively covered assessment, intervention, follow-up and quality control for maintenance hemodialysis (MHD) patients. By integrating multidisciplinary resources and standardizing rehabilitation workflows, it delivered standardized and intelligent rehabilitation services. ResultsThe platform achieved standardized and intelligent management of rehabilitation services, effectively improved the physiological function, psychological state and quality of life convenience for MHD patients, while significantly reduced the economic and care burden on patients' families and society. ConclusionThe rehabilitation service model based on a full-process data platform may provide scientific and systematic support for MHD patients.

Exportin 1 (XPO1) is aberrantly overexpressed in various malignant tumors and can lead to the loss of anti-tumor effects of important tumor suppressor proteins such as p53, RB1, and FOXO by mediating their nuclear export. Although XPO1 inhibitor Selinexor has entered clinical application, its single-agent anti-tumor activity remains suboptimal, which is closely related to the compensatory activation of multiple signaling pathways in response to XPO1 inhibition. Focusing on the core regulatory role of XPO1 in tumor cells, this article systematically summarizes the current landscape of combination therapies involving XPO1 inhibitors and various targeted agents, including inhibitors of CDK4/6, FLT3, BET, ATR, and BCL2/MDM2, aiming to provide some reference for the development of XPO1-centered combination therapy strategies.

Ocular myasthenia gravis(OMG)is the subtype of myasthenia gravis with the miklest symptoms The current detection methods for OMG have limited sensitivity or specificity.Oral pyridostigmine and glucocorticoids,as conventional treatments,have limited effects in simple OMG cases and are prone to cause a series of side effects.This article introduces the positive manifestations and advantages of Repetitive Ocular Vestibular Evoked Myogenic Potentials,the potential of Video-oculography and detection of AChR-Ab in tear fluid for auxiliary diagnosis,and the exploration of ocular injection of hormones in the treatment of OMG.It was demonstrated that female gender and AChR-Ab are risk factors for the progression of OMG to generalized myasthenia gravis.Immunosuppressive therapy reduces the possibility of OMG progression,and the elevation of microRNA has extremely high sensitivity in predicting disease progression.Furthermore,attention should be paid to the fact that multiple biological agents can include OMG-like symptoms.

Purpose To investigate the clinicopathological features and diagnosis of breast epithelial-myoepithelial tumors.Methods Collect 10 cases of breast epithelial-myoepithelial tumors.Clinical features,histopathologic fea-tures,immunophenotype,and molecular characteristics were analyzed.Results All patients were female,aged 27-49 years,and the maximum diameter of the mass was 1.5 to 6.0 cm.Among them,8 cases were diagnosed as adeno-myoepithelioma(AME)of the breast,1 case as atypical AME,and 1 case as malignant adenomyoepithelioma(AME-M).All ten patients were alive with no evidence of disease or metastasis,with follow-up periods ranging from 4 to 64 months.All epithelial-myoepithelial tumors consisted of proliferative epithelial and myoepithelial cells,with myoepithe-lial hyperplasia being the predominant component.In the atypical AME case,myoepithelial cells exhibited mild to moderate atypia,with mitotic figures observed occasionally(3/10 HPF).AME-M was composed of solid and cystic ar-eas.In the solid area,myoepithelial cells exhibited moderate to severe atypia with a high mitotic rate(6-8/10 HPF).Additionally,necrosis and areas of squamous cell carcinoma were present,leading to a diagnosis of epithelial-myoepithelial carcinoma.Papillary squamous cell carcinoma was found in cystic area and it involved the adjacent lob-ules.The peripheral breast tissue contained focal ductal carcinoma in situ.The luminal epithelial cells showed expres-sion of CK8/18 and CK7.The myoepithelial cells showed expression of p63,CD10,and SMA.The Ki67 index was less than 10％in AME,40％in atypical AME.In the AME-M,it was 80％in the epithelial-myoepithelial carcinoma component,and 70％in the papillary squamous cell carcinoma component.Sanger sequencing of 6 cases AME and 1 case atypical AME revealed no hotspot mutations in HRAS or PIK3CA.In one case of AME-M,pyrosequencing indica-ted no hotspot mutations of AKT1,KRAS,HRAS,and PIK3 CA in the components of epithelial-myoepithelial carcino-ma and papillary squamous cell carcinoma while one KRAS(c.183A＞C/T,p.Q61H)mutation was present in the peripheral ductal carcinoma in situ.Molecular genetic analysis on 22 short tandem repeat loci showed an identical pat-tern including LOH at D19S433 in both components of AME-M and squamous cell carcinoma.Conclusion AME is an rare tumor with a heterogeneous morphology.The biphasic proliferation of epithelial and myoepithelial components is the key to correct diagnosis.Molecular genetic analysis suggested AME-M and squamous cell carcinoma were clonally independent from the peripheral ductal carcinoma in situ.

Purpose To investigate the clinicopathological features and diagnosis of breast epithelial-myoepithelial tumors.Methods Collect 10 cases of breast epithelial-myoepithelial tumors.Clinical features,histopathologic fea-tures,immunophenotype,and molecular characteristics were analyzed.Results All patients were female,aged 27-49 years,and the maximum diameter of the mass was 1.5 to 6.0 cm.Among them,8 cases were diagnosed as adeno-myoepithelioma(AME)of the breast,1 case as atypical AME,and 1 case as malignant adenomyoepithelioma(AME-M).All ten patients were alive with no evidence of disease or metastasis,with follow-up periods ranging from 4 to 64 months.All epithelial-myoepithelial tumors consisted of proliferative epithelial and myoepithelial cells,with myoepithe-lial hyperplasia being the predominant component.In the atypical AME case,myoepithelial cells exhibited mild to moderate atypia,with mitotic figures observed occasionally(3/10 HPF).AME-M was composed of solid and cystic ar-eas.In the solid area,myoepithelial cells exhibited moderate to severe atypia with a high mitotic rate(6-8/10 HPF).Additionally,necrosis and areas of squamous cell carcinoma were present,leading to a diagnosis of epithelial-myoepithelial carcinoma.Papillary squamous cell carcinoma was found in cystic area and it involved the adjacent lob-ules.The peripheral breast tissue contained focal ductal carcinoma in situ.The luminal epithelial cells showed expres-sion of CK8/18 and CK7.The myoepithelial cells showed expression of p63,CD10,and SMA.The Ki67 index was less than 10％in AME,40％in atypical AME.In the AME-M,it was 80％in the epithelial-myoepithelial carcinoma component,and 70％in the papillary squamous cell carcinoma component.Sanger sequencing of 6 cases AME and 1 case atypical AME revealed no hotspot mutations in HRAS or PIK3CA.In one case of AME-M,pyrosequencing indica-ted no hotspot mutations of AKT1,KRAS,HRAS,and PIK3 CA in the components of epithelial-myoepithelial carcino-ma and papillary squamous cell carcinoma while one KRAS(c.183A＞C/T,p.Q61H)mutation was present in the peripheral ductal carcinoma in situ.Molecular genetic analysis on 22 short tandem repeat loci showed an identical pat-tern including LOH at D19S433 in both components of AME-M and squamous cell carcinoma.Conclusion AME is an rare tumor with a heterogeneous morphology.The biphasic proliferation of epithelial and myoepithelial components is the key to correct diagnosis.Molecular genetic analysis suggested AME-M and squamous cell carcinoma were clonally independent from the peripheral ductal carcinoma in situ.

Objective To explore the characteristics of gastric emptying in the whole process of drinking water for colonoscopy in the elderly,and to develop an elderly-friendly drinking water program,thereby improving the comfort and the quality of bowel preparation.Methods From April to September 2024,gastric ultrasound was used to monitor gastric emptying indicators in the whole process of drinking water for colonoscopy in the elderly,summa-rizing its physiological features.On this basis,in October 2024,through literature review and expert argumentation,a bowel preparation drinking water program that meets the characteristics of gastric emptying in the elderly was de-veloped.A convenience sample of 90 elderly patients scheduled for colonoscopy at 2 tertiary hospitals in Beijing was enrolled from November 2024 to January 2025.A non-concurrent controlled trial was conducted:an experimen-tal group from December 2024 to January 2025 received the new elderly-friendly drinking water program,while a control group in November 2024 followed the conventional program.Outcomes included drinking comfort assessed via Visual Analogue Scale(VAS),adverse events,total fluid intake volume and bowel preparation quality via Boston Bowel Preparation Scale(BBPS).Results The experimental group demonstrated superior VAS score(P＜0.05),bowel preparation quality(P＜0.05),total fluid intake(P＜0.05),and higher compliance with optimal stool consistency(P＜0.05),compared to the control group.The experimental group also exhibited a lower incidence of adverse events(P＜0.05).No significant difference was observed in total bowel preparation duration between 2 groups(P＞0.05).Conclusion The bowel preparation drinking water program based on the characteristics of gastric emptying in the elderly improved solution intake tolerance and bowel preparation quality,with practical implications for clinical implementation.

Purpose To explore the relationship between the proportion of HER2 low expression and clinicopatho-logical characteristics of gastric adenocarcinoma patients.Methods Clinical data from 3 779 gastric adenocarcinoma patients who underwent radical resection were collected.HER2 expression was categorized using immunohistochemistry combined with FISH,and the clinicopathological characteristics and prognosis of HER2 low expression gastric adeno-carcinoma patients were analyzed.Results Among the 3 779 gastric adenocarcinoma cases,1 251 cases(33.10％)showed HER2 low expression.Compared with HER2 negative expression,HER2 low expression patients were more likely to be older males,present with well-differentiated Lauren's intestinal-type adenocarcinoma,and have less nerve invasion.Furthermore,compared to HER2 negative expression,they showed higher Ki67 proliferation index and more advanced clinical stage.Meanwhile,compared with patients with HER2 over expression,those with low HER2 expres-sion were more likely to be younger females,present with well-differentiated Lauren's diffuse-type adenocarcinoma,and have more nerve invasion.Furthermore,compared to HER2 over expression,they showed lower Ki67 proliferation index and more advanced clinical stage.There was no significant difference in prognosis between HER2 low expression,HER2 negative,and HER2 over expression groups.Conclusion HER2 low expression have a relatively large propor-tion in gastric adenocarcinoma patients,and HER2-targeted antibody-drug conjugates may provide an effective treatment option for these patients with HER2 low expression.

Objective To explore the similarities and differences in clinical efficacy and mRNA transcriptomics characteristics between acupuncture and shallow needling at non-acupoints and to provide a basis for determining whether shallow needling at non-acupoints is suitable as a sham acupuncture control in acupuncture clinical trials.Methods Eighty patients with chronic spontaneous urticaria(CSU)who visited the Dermatology Department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine between July 8,2018 and to July 29,2019,were included.The patients were randomly divided into the acupuncture group(n=41)and the sham acupuncture group(n=39)using a computerized complete random design.Additionally,12 healthy individuals were included as the healthy control group.For patients in the acupuncture group,"Baihui(GV20),""Shenting(GV24),""Zhongwan(CV12),"and bilateral"Quchi(LI11),""Tianshu(ST25),""Xuehai(SP10),""Zusanli(ST36),"and"Sanyinjiao(SP6)"were selected for regular acupuncture.The sham acupuncture group received non-acupoint shallow needling at eight non-acupoints on the head,upper limbs,lower limbs,and abdomen.Both groups underwent daily treatment,with five consecutive days constituting one treatment course followed by a two-day interval.A total of two courses were administered.The urticaria activity score(UAS)was used to evaluate wheals and pruritus,whereas the visual analog scale(VAS)score was used to evaluate the degree of pruritus.Blinding effectiveness was also evaluated.Based on clinical evaluation and sample quality,serum samples from six patients in each treatment group before and after the intervention,along with those from six healthy individuals,were selected for RNA sequencing using the BGISEQ-500 sequencer.Differentially expressed mRNAs were identified using the"DEGseq"software package,and the similarities and differences in mRNA expression between the two groups were analyzed.Results UAS and VAS scores decreased in both groups at 1,2,3,and 4 weeks of treatment compared with before treatment(P＜0.01).The decrease in UAS and VAS scores in both groups was time-dependent(P＜0.01)but not related to the grouping or the interaction between grouping and time(P＞0.05).By the end of the second week of treatment,the number of patients in both groups who believed they had received true acupuncture was similar between the two groups,with no significant difference.mRNA transcriptomic sequencing revealed that,before and after treatment,the enrichment types and degrees of differentially expressed mRNA were similar between the acupuncture and sham acupuncture groups at the biological process,cellular component,and molecular function levels.In terms of biological processes,both groups were commonly enriched in coagulation,hematoma,oxygen transport,and gas transport.In terms of cellular components,both groups exhibited enrichment in hemoglobin complexes,platelet alpha granules,extracellular exosomes,extracellular organelles,and extracellular vesicles.At the molecular function level,both groups were commonly enriched in actin filament-binding substances,haptoglobin,peroxidase activity,and oxygen blood binding.In the Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis,both groups showed common enrichment in multiple entries such as cytokine-cytokine receptor interaction,ECM-receptor interaction,microRNAs in cancer,proteoglycans in cancer,bladder cancer,and malaria.Conclusion Acupuncture and sham acupuncture exhibited similar clinical treatment effects and mRNA transcriptomics profiles.In the design of acupuncture clinical trials,disease specificity should be carefully considered.Sham acupuncture control using non-acupoint shallow needling may not be suitable for skin diseases such as urticaria.

Ocular myasthenia gravis(OMG)is the subtype of myasthenia gravis with the miklest symptoms The current detection methods for OMG have limited sensitivity or specificity.Oral pyridostigmine and glucocorticoids,as conventional treatments,have limited effects in simple OMG cases and are prone to cause a series of side effects.This article introduces the positive manifestations and advantages of Repetitive Ocular Vestibular Evoked Myogenic Potentials,the potential of Video-oculography and detection of AChR-Ab in tear fluid for auxiliary diagnosis,and the exploration of ocular injection of hormones in the treatment of OMG.It was demonstrated that female gender and AChR-Ab are risk factors for the progression of OMG to generalized myasthenia gravis.Immunosuppressive therapy reduces the possibility of OMG progression,and the elevation of microRNA has extremely high sensitivity in predicting disease progression.Furthermore,attention should be paid to the fact that multiple biological agents can include OMG-like symptoms.